STRENGTH TRAINING IN REHABILITATION
Designing Strength based rehabilitation
When starting to design your strength program from a rehabilitation point of view -post injury, surgery and/or deconditioning for any reason – you have to observe – above all – the safety and the good technique. What happens when you fatigue, and form goes out the window? Or, on the flip side, what if an exercise has become too easy? We understand that no one wants to put themselves in harm’s way by doing an exercise incorrectly or waste their time on an exercise program that won’t achieve their goals. You may be faced with altering the strength training initially!
These adaptations are exactly what our highly trained and experienced instructors/ physios at Pilates Power and Physiotherapy Cronulla are trained to do - straight from their exercise toolbox!!
Regression = an approach to decrease the demand of an exercise or movement.
Progression = an approach to increase the demand of an exercise or movement.
1. Intensity / Load
5. Body Position
BUT: while you adjust the variable you MUST always maintain the exercise stimulus (overload) that suits your strength level: specific training leads to specific outcomes!! Read the Principles of Strength Training!
- Joint swelling
- Range limitations
- Surgical restrictions
- Limb immobilisation
You may also require changing the mode of muscle activation:
- Isometric work
Isometric training has shown to improve strength in other joint ranges as well as concentric strength (increased 12-15%) but only at long muscle lengths, f e quadriceps isometric near knee flexion 90 degrees is more beneficial that at 60 or 30 degrees of flexion.
Power and speed of contraction understandably did not increase with isometric work.
Noorkõiv M et al. J Sports Sci. 2015;33(18):1952-61. 7
- Eccentric work
Meta-analyses: eccentric training performed at higher intensities vs concentric:
Total strength and eccentric strength increased significantly more! Eccentric work develops higher forces due to a specialised neural pattern and there is increased stimulus to build additional sarcomeres (muscle tissue)
Roig,et al. (2009). Br J Sp Med. 43, 556-558
Compound vs Isolation exercises:
Compound exercises recruit >1 muscle groups, are more functional as they ask for more coordination and can also share the load – result in a higher challenge
Isolation exercises are very focussed and less technical, thereby safer. Here it is generally easier to manipulate the range of motion – are less functional
Common isolation exercises: calf raises, biceps curls, quadriceps knee extension exercise
Common compound exercises: leg press, dead lift, squat and lunge.
PLANNING AND PROGRAMMIMG
Hierarchies of importance & determining rehabilitation focus:
Example Knee OA - Week 1-3
WHAT DO YOU WANT TO ACHIEVE? Strength, Power, Control, Endurance?
PLAN & DESIGN: Principles of Training: Specificity, Overload, Progression.
DELIVER: Clinical consideration/limitation, Patient characteristics, time & equipment.
CONSULT YOUR PROFESSIONAL TEAM AT PILATES POWER AND PHYSIOTHERAPY
If you have any further questions, please do not hesitate to ask!
A Pain in the Butt…well Hip!
Following on from my blog from last week, here is some more information on a common tendon issue …remember the tendon is the part that attaches the muscle to the bone and is very sensitive to sudden overuse or repetitive lifestyle habits. This one can be a real pain in the butt, literally!
Your buttock or gluteal muscles are actually made up of multiple layers of muscle all with different roles. Some are designed for big powerful movements like stepping up, jumping or squats. However, there are many which play an important stabilising force around this hip and pelvis like the gluteus minimus and medius.
It is these two muscles, and their respective tendons, that can give you a real pain in the butt or, more specifically, the side of the hip. Pain when lying on the side of your hip at night, climbing stairs, or after sitting in a low chair. Depending on the stage of tendon aggravation your symptoms will vary, for some you may just feel sore on the outside of the hip initially on starting exercise or the next day after doing exercise. These are just some of the symptoms.
Habitual patterns of standing, like hanging off one hip, crossing your legs when sitting can also contribute to the problem. Remember, I mentioned how tendons don’t like compression…that’s what happens when you hold the body in the above static positions, the tendons can get stretched across the bone where they attach. This can also then compress the bursa (or cushion) that sits between the tendons and the bone.
This tendon issue can creep in with a sudden fitness regime of long walks if we are not strong enough in some of the deep stabilising muscles around the hip and pelvis and don’t build up slowly. A common mistake is that people try to stretch the gluteal muscles with exercises that pull the leg across the body or stretch the ITB over the outside of the hip, which further aggravates the problem.
Remember the rule of thumb – increase by no more than 10% each week and to start with, consider a day off in between long walks, especially, if they involve a lot of stairs or hill climbing. Also, a strengthening program that focuses on the core and deeper gluteal muscles will prepare you well and hopefully prevent a pain in the butt later when increasing or starting a walking or running.
Nikki Scott, Physiotherapist
Tendon Injuries, Running and Starting a new Exercise Program during Lockdown
While lockdown has meant more of us can work from home, some of us have also found we have more time or more motivation to exercise.
Remember, it is important to build up slowly. Some parts of our body need longer to adjust to a new exercise regime or changes in routine.
Tendons are the part of our body that connect our muscles to our bones and can be sensitive to sudden changes in load or demand.
For example, the Achilles tendon is located at the back of the heel. If someone suddenly decides they are going to run every day during lockdown with no build up, this may lead to what we call Achilles tendinopathy.
This is where the tendon becomes aggravated due to overload. There are other causes as well of course, such as poor running shoes or running style but, in many cases, it develops due to a sudden change in training load without enough recovery time. Tendons are also very sensitive to compression load but I will go more into that in the next blog!
To ensure you build in enough recovery time, try to add variety into your routine and try to give yourself a day off in between the same exercise. That rest day could be an opportunity to do some pilates or yoga or a different activity such as swimming or cycling.
In general, progress slowly, increasing you weight session or running sessions by no more than 10% each week.
If you’ve never run before, there are some good apps that will build you up slowly and split your running into walking and running intervals until you are running continuously. For example, ‘5K’ Couch to 5K – Run Training.
Running is great, as you require no equipment (other than a good pair of running shoes) and you can literally open the door and go. However, if you have suddenly decided to give running a go, make sure you build up slowly and have a day off in between running sessions.
If this is you already, there are some specific exercises you can learn to assist. The first step is to get it properly diagnosed. Next, learn what exercises and lifestyle changes you can make to decrease your pain and to build healthy tendons.
I’ll be writing some more blogs about common tendon injuries over the next few weeks, such as those affecting the shoulder hip and foot…stay tuned….
Nikki Scott, Physiotherapist