Resisted exercises for lower limb
- 2. DEFINITION Resisted exercise is any form of active exercise in which dynamic or static muscle contraction is resisted by an outside force applied manually or mechanically.
- 3. MUSCLE PERFORMANCE & RESISTANCE EXERCISES Muscle performance refers to the capacity of a muscle to do work (force x distance). 3 elements of muscle performance – strength, power & endurance – can be enhanced by some form of resistance exercises.
- 4. STRENGTH Ability of a contractile tissue to produce tension & resultant force based on demands placed on the muscles. Strength training –controlling heavy loads (resistance) for a relatively lower number of repetitions or a short period of time.
- 5. POWER Muscle power is related to strength & speed of movement & is defined as work produced by muscle per unit time (force × distance/time). Power training – By increasing work of muscle for specific time or reducing time for specific work of muscle.
- 6. ENDURANCE Muscle endurance is the ability to contract repeatedly against a load, generate & sustain tension & resist fatigue over an extended period of time. Endurance training – low intensity muscle contraction, large number of repetitions for prolonged time period.
- 7. Types of muscle work Isometric Isotonic Isokinetic Concentric Eccentric
- 8. PRINCIPLES 1. Overload principle 2. SAID principle 3. Reversibility principle
- 10. EXAMINATION & EVALUATION Determine the baselines: a. General physical examination b. Strength: MMT, RM c. ROM: Goniometry d. Functional performance Decide if strengthening is needed and appropriate at this point Periodic reassesment
- 11. APPLICATION Warm up Placement of resistance Stabilization Intensity of exs / amount of resistance Volume / no of reps & sets & rest intervals Verbal / written instructions Monitoring the patient Cool down
- 12. PRECAUTIONS Overtraining Overwork Exercise induced muscle soreness – Acute muscle soreness – During or directly after strenuous exercise Delayed onset muscle soreness (DOMS) – DOMS begins to develop 12-24hrs after the cessation of strenuous activity; intensifies & peaks 24-48hrs later Can be prevented by gradual progression of intensity & volume of resistance; warm up & cool down; slow stretches before & after exercise
- 13. CONTRAINDICATIONS 1. Pain 2. Inflammation 3. Severe cardiopulmonary disease. 4. Loss of joint integrity
- 14. TYPES OF RESISTANCE EXERCISES Manual and mechanical Static and dynamic Open and closed chain Isokinetic exercise
- 15. MANUAL AND MECHANICAL RESISTANCE EXERCISES Manual resistance: Resistance is provided by hand. Can be provided by a therapist or self resisted. Can not quantify resistance Useful for weak muscles in the early stages of rehab or conditions which needs careful control. Mechanical resistance: Resistance is applied through the use of equipment or mechanical apparatus. Amount of resistance can be measured and can be increased progressively. Useful when strong exercises needed.
- 17. HIP FLEXION
- 18. HIP EXTENSION
- 23. KNEE FLEXION
- 24. KNEE EXTENSION
- 27. ANKLE INVERSION
- 28. ANKLE EVERSION
- 30. TYPES OF MECHANICAL RESISTANCE Weights: Sandbags, metal weights, medicine balls, weight cuffs, dumbbells etc. Weight and pulley circuit Elastic resistive devices: Spring, theraband, theratubes Malleable resistance: Putty, clay, wax, plasticines etc. Water: Hyrotherapy unit
- 42. ISOMETRIC EXERCISES (STATIC) Sources of resistance – Holding against force applied manually Holding weight in particular position Maintaining position against resistance of body weight Pushing or pulling immovable objects Prevent or minimize muscle atrophy due to external immobilization Develop postural or joint stability Improve muscle strength when dynamic activity is not permissible
- 43. DYNAMIC EXS – CONCENTRIC & ECCENTRIC Resistance can be applied by – Constant resistance (body wt/simple wt/ wt pulley) Weight machine (variable resistance) Isokinetic device (controls velocity) Acts as a source of shock absorption during high impact activities. Essential component of rehabilitation & conditioning program to reduce risk of muscle injury or re-injury.
- 44. DYNAMIC EXS – CONSTANT & VARIBLE RESISTANCE Dynamic constant external resistance exs (DCER)– free weights like weight cuffs, Pulley system, torque arm units. Contracting muscle is challenged maximally at only one point of ROM Variable resistance exercise – Specially designed resistance equipments imposes varying levels of resistance to contracting muscle to load the muscle more effectively at multiple points in ROM. Eg with elastic tubes or bands or lever arm system. Performed against manual resistance, a skilled therapist can vary the force applied to the contracting muscle throughout the ROM.
- 45. DYNAMIC CONSTANT EXTERNAL RESISTANCE EXS (DCER)– N-K EXC. UNIT
- 46. VARIABLE RESISTANCE EXERCISE- CYBEX/EAGLE FITNESS SYSTEM
- 47. OPEN CHAIN & CLOSED CHAIN EXERCISES Functional activities & exc.’s are commonly categorized as having weight bearing or non weight bearing characteristics. Also called as “open or closed kinetic chain” Open kinetic chain refers to completely unrestricted movement in space of a peripheral segment of the body. (waving the hand, swinging the leg) Closed kinetic chain movements – peripheral segment meets with the considerable external resistance. One joint motion is always accompanied by adjacent joint motions.
- 49. ISOKINETIC EXERCISES Its a form of dynamic exs in which velocity of muscle shortening or lengthening is predetermined & held constant by a rate limiting device known as isokinetic dynamometer. Characteristics – Constant velocity Range & selection of training velocity Specificity of training(speed specific) Compressive forces on joints Accommodation to fatigue Accommodation of painful arc
- 53. PROGRESSIVE RESISTANCE EXERCISE PRE is a system of dynamic resistance training with constant external load to contracting muscle by some mechanical means & incrementally increased. RM (repetition maximum) – basis for determining & progressing the resistance. Beneficial in variety of pathological conditions (muscle injuries, osteoarthritis, osteoporosis, hypertension, diabetes, COPD, etc) Various regimens are:- Delorme Oxford Macqueen DAPRE
- 54. DELORME REGIMEN
- 55. SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 50% of 10 RM 2 10 75% of 10 RM 3 10 100% of 10 RM 30 lifts 4 times weekly Progress 10 RM once weekly
- 56. OXFORD REGIMEN
- 57. SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 10 RM 2 10 10 RM minus 1 lb (453g) 3 10 10 RM minus 2 lbs 4 10 10 RM minus 3 lbs 5 10 10 RM minus 4 lbs 6 10 10 RM minus 5 lbs 7 10 10 RM minus 6 lbs 8 10 10 RM minus 7 lbs 9 10 10 RM minus 8 lbs 10 10 10 RM minus 9 lbs 100 lifts 5 times weekly Progress 10 RM daily
- 58. MAC QUEEN REGIMEN SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 100% of 10 RM 2 10 100% of 10 RM 3 10 100% of 10 RM 4 10 100% of 10 RM 40 lifts 3 times weekly Progress 10 RM every 1-2 weeks
- 59. DAPRE REGIMEN Daily adjustable progressive resisted exercises More systematic & takes into account the different rates at which individuals progress during rehabilitation or conditioning program. Based on 6RM working weight SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 50% 6RM 2 6 75% 6RM 3 Max possible 100% 6RM 4 Max possible 100% of adjusted working weight
- 60. CRITERIA TO FIND ADJUSTED WORKING WEIGHT REPETITIONS IN SET 3 SET 4 NEXT EXC. SESSION - 3 0 – 2 Dec. 5 – 10 lbs Dec. 5 – 10 lbs 3 – 4 Dec. 0 – 5 lbs Same weight 5 – 6 Keep same weight Inc. 5 – 10 lbs 7 – 10 Inc. 5 – 10 lbs Inc. 5 – 15 lbs 11 or more Inc. 10 - 15 lbs Inc. 10 - 15 lbs
- 64. “Plyometric training” / “stretch shortening drill” / “stretch strengthening drill” is a system of high velocity training characterized by rapid eccentric contraction during which the muscle elongate immediately followed by rapid reversal of movement with a resisted shortening contraction of same muscle. Integrated into advanced phases of rehabilitation to train neuromuscular system to react quickly. Source of resistance –body weight/equipment. Eg. Catching & throwing ball, dribbling the ball, jumping forward or sideways, etc.
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