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Welcome
Exercise Prescription for Sports and Massage Therapists
With:
Richard Gregory - Msc (hons) Physiotherapy; Bsc (hons)
Sport Science)
Katie Emmett - Bsc (hons) Sports Therapy
* 2
@Physiocouk #manchesterphysio facebook.com/physiocouk
Who are we?
Katies LinkedIn: www.linkedin.com/katieemmett
Twitter: @KatiePhysiocouk
Richs LinkedIn: www.linkedin.com/in/richard-gregory-60712887

Twitter: @RichPhysiocouk
3
Lets connect
Website: www.physio.co.uk
Twitter: @physiocouk
Facebook: www.facebook.com/physiocouk
4
Itinerary
10.00 - 10.30 - Induction / Arrival
10.30 - 11.30 - Theory: exercise prescription
11.30 -11.45 Break
11.45 - 12.30 - Practical: Lower Limb exercise prescription
12.30 13.00 Lunch
13.00 -13.45 - Practical: Upper Limb exercise prescription
13.45- 15.00 - Case Studies: upper and lower limb
5
Aims of today
To discuss the physiological and neurological effects of
detraining
To understand specific exercise prescription in terms of

volume, load, rest, training days per week
End-stage rehab
Returning to previous level of activity or becoming specifically

conditioned for an activity

Muscle Fibre Types
Three pure fibre types can be identified based on their contractile/metabolic
characteristic.
TYPE I
TYPE IIA
TYPE IIB
Further intermediate hybrid fibres result in continuum ranging from slowest to fastest (Fry
2004).
I IC IIC IIAC IIA IIAB IIB

(SLOWEST) (FASTEST)

Muscle Fibre Types
COSTILL ET AL (1976)
1. Untrained individuals: 50/50 ratio between slow-
twitch/fast-twitch
2. Long/middle distance runners: 60-70% slow-twitch

3. Sprinters: 80% fast-twitch

What happens to injured
individuals?

The Exercise Detraining
Effect
2 WEEKS
Decrease in VO2 max (up to 7%; Coyle, 1984)
No reductions in strength
No muscle atrophy

Effect
2-3 WEEKS
Further decrease in VO2 max (9%)
Decrease in capillary density (Blomquist et al
1983)
Muscle atrophy (6.4% in CSA; Bangsbo &
Mizuno, 1987)
58% elevation in HGH (Houston et al 1979)
19.2% elevation in testosterone (Houston et al
1979)
No reduction in strength (uninjured population)

Effect
4-8 WEEKS
Decrease in eccentric strength (Hortobagyi et al

1993)
6% reduction in 1RM (Hakkinen et al 2000)
Fibre type switching: Slow twitch to fast twitch

(5% FTB to 19% FTB after 56 days detraining in
cyclists; Hakkinen et al 2000). Implications to
antigravity/postural muscles.

Effect
8-12 WEEKS
Almost complete loss of increased VO2 max
among those training at lower intensities
7-12% loss in strength (Hakkinen et al,

2001)
Maximal neural innervation activity

reduced (Hakkinen et al, 1985)

Specific Exercise
Prescription

Training Principles
.GETTING THE BASICS RIGHT:
S.
P.
O .
R .
T .
F .
I .
T .
T .

Variables to Consider
Intensity of effort
Load
Repetitions
Rest intervals
Volume
Range of motion
Contraction types

Force Velocity Curve

Pain Management
Some of our tools.
R.I.CE
Manual Therapy (Grade II/III)
R.O.M (synovial sweep)
Therapeutic Massage
DTFM
Specific exercise prescription to reduce pain
Tendons love Isometrics
Naugle et al (2012): Isometric exercise exerts a generalized pain inhibitory response.
Cook and Purdam (2013): 40-60 second holds, 4-5 times, several times a day. In highly irritable
tendons, a bilateral exercise, shorter holding time and fewer repetitions per day may be indicated.

Training for Strength
How does
White Goodman
do it?

Conceptual Basis For
Strength Gains
PERIPHERAL FACTORS
The peripheral factors that might affect strength gains include:

Hypertrophy
Hyperplasia
Muscle fibre type shifts

Strength Gains
MUSCLE HYPERTROPHY AND
HYPERPLASIA
1. Acute: Sarcoplasmic Hypertrophy
(Fluid content)
2. Chronic: Myofibrilar hypertrophy

(increased myofibrils)
3. Hyperplasia: Increase in the number
of muscle fibres

Strength Gains
CENTRAL FACTORS
The central factors that might affect strength gains include:
Inter-muscular co-ordination
Motor unit recruitment
Motor unit firing frequency

Training For Strength-
Intensity

Load and Volume
KEY FOR STRENGTH = HIGH LOAD, HIGH VOLUME
LOAD:
Novice: 60-70% 1RM
Advanced: 80-100% 1RM
VOLUME:
Novice: 1-3 sets, 8-12 repetitions
Advanced: 2-6 sets, 1-8 repetitions
ACSM (2013)

Training For Strength- Rest
Intervals
ACSM (2013):
2-3 minutes for intense exercises with heavy load
ROBINSON ET AL (1995):
3 minutes more beneficial than 1 minute for improving squat 1RM
WILLARDSON AND BURKETT (2008)
Benefits in strength with 2 minute rest. No further improvement with 4 minute
rest

Frequency

Frequency
ACSM (2013):
Novices: 2-3 times per week working entire body

Advanced: 4-6 workouts a week, still only working each muscle group 2-3 times a week.
Rozier (1981): No difference between training 3 or 5 times a week (trend to improving

more with 3 times)
Farinatti (2013): Compared training muscle groups 1, 2, or 3 times a week.
Result:
Bench press and calf raise 10RM = no difference between groups

Knee extension 10RM = favoured 3 times a week

Training For Muscular
Endurance
THE ABILITY OF A MUSCLE TO EXERT SUBMAXIMAL FORCE REPEATEDLY OVER TIME.

Endurance
LOAD
Less than 70% of 1RM (ACSM 2013)
VOLUME
2-4 Sets
10-25 Repetitions (ACSM 2013)
20-28 Repetitions (CAMPOS 2002)

Endurance
REST PERIODS
ACSM (2013)
30 Seconds to 1 minute between sets
ISSA (2010)
1:1 Ration (Exercise:Rest)
WHY?
Creates high lactate levels in exercising muscles, causing body to improve ability
to buffer accumulating lactate (improves lactate threshold)

Endurance
ADAPTATIONS:
Fibre shifting: decrease in type 2B fibres; increase in type 2AB fibres (Campos
2002)
Hypertrophy (Fisher 2013)

Angiogenesis (Katch 2011)
Arteriogenesis (Yang et al 2008)
Mitochondrial Biogenesis

Training For Motor Control

Training For Motor Control
LOAD
30-50% 1RM
VOLUME
20-25 Repetitions
3-5 Sets per muscle group
FREQUENCY
5-7 Days per week (SHUMWAY-COOK, 2007)

Training For Power

Training For Power
LOAD
30-60% 1RM
VOLUME
1-3 Sets
3-6 Repetitions
REPETITION DURATION
Short/explosive ACSM (2013)

Training For Power
REST PERIODS
2-3 Minutes for high intensity exercises using heavy loads

1-2 Minutes for low intensity exercises using light loads
FREQUENCY
Novices: 2-3 times per week working entire body
Advanced: 4-6 workouts a week, still only working each muscle group 2-3 times
a week.

Coffee Break

Practical
Exercise Prescription: Lower Limb

Hamstring Exercises

Exercise Selection - Hamstrings

Glute Max/Glute Med
Exercises

Exercise Selection Gluteus Maximus

Exercise Selection Gluteus Medius

Exercise Selection Gluteals

Hip adductors

Exercise Selection Adductors

Lunch

Practical
Exercise Prescription: Upper Limb

Rotator Cuff Exercises

Exercise Selection Rotator Cuff

Exercise Selection RC : Infraspinatus

Serratus Anterior Exercises

Exercise Selection Serratus Anterior

Upper/Lower Trap Exercises

Exercise Selection Upper/ Lower Trapezuis

Return to Sport

Return to Sport
ADVANTAGE DISADVANTAGE
Joint compression
Exercise in non-WB
Joint translation
position
OPEN CHAIN
Functionality
Exercise through ROM
Able to isolate muscle
Joint forces
Joint compression
Joint translation
Not able to work through
CLOSED CHAIN Functionality ROM
Improved muscle activity Not able to isolate muscles

through co-activation

Sport-specific Explosive
Power

Plyometrics
Exercises designed to reach maximal force in shortest time possible
Aims to increase power of subsequent movements by using elastic
properties of muscle and tendon and stretch reflex
When used correctly, plyometric training has consistently been shown to
improve production of muscle force and power (Hewett et al, 1996; Lachance
1995)

Stretch-shortening Cycle

Plyometrics - Prescription
REST INTERVALS
5-10 seconds between repetitions
2-3 minutes between sets (ACSM 2013)
FREQUENCY
1-3 sessions per week (Baechle and Earle, 2008)
RECOVERY TIME
48-72 hours between training sessions (CHU, 1998)

Plyometrics Upper Limb

Plyometrics Lower limb

Return to Sport Guidelines
Pain free
No effusion
Full (optimal) AROM
Between 90% - 100% strength
Can perform sport specific functional tests

In-Line / Off-Line Rehab
Consider the specific
demands of the sport
Most sports (particularly

invasion sports) do not only
work in a frontal plane
Need to return to off-line

movements before the are
match ready

Sherry and Best (2004)
Hamstring rehab protocol:
1 minute side steps

1 minute karaoke
1 minute fast-feet
3 sets, 2 min rest between sets
Resulted in significant reduction in hamstring re-injury rates when

compared to control

Case Studies

Upper Limb
Tennis player - rotator cuff impingement
Stage 1
Ax:
1/52 post injury
7/10 VAS
Pain arc
Pain on resisted abduction/ER.
+ve HK
Stage 2
Ax:
8/52 post injury
Pain free ROM
-ve HK
-ve pain on ER
5/5 strength

Lower Limb
Rugby player: Back (winger). Grade 2 Hamstring injury
Stage 1:
Ax:
3/52 post injury
Full pain-free range of motion.
No pain on resisted testing
Mild tenderness on palpation of bicep femoris MTJ
4/5 oxford scale strength in knee flexors
4+/5 oxford scale strength in gluteals, knee extensors
Stage 2:
Ax:
6/52 post injury
5/5 oxford scale
No tenderness on palpation

In Summary

Thanks for coming!
Dont forget to follow us on Twitter: @physiocouk
@Physiocouk #manchesterphysio 72 facebook.com/physiocouk

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Katie Emmett - Bsc (hons) Sports Therapy

Richs LinkedIn: www.linkedin.com/in/richard-gregory-60712887

To understand specific exercise prescription in terms of

Returning to previous level of activity or becoming specifically

@Physiocouk #manchesterphysio facebook.com/physiocouk

I IC IIC IIAC IIA IIAB IIB

@Physiocouk #manchesterphysio facebook.com/physiocouk

2. Long/middle distance runners: 60-70% slow-twitch

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Decrease in eccentric strength (Hortobagyi et al

6% reduction in 1RM (Hakkinen et al 2000)

Fibre type switching: Slow twitch to fast twitch

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7-12% loss in strength (Hakkinen et al,

Maximal neural innervation activity

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Specific exercise prescription to reduce pain

Tendons love Isometrics

Naugle et al (2012): Isometric exercise exerts a generalized pain inhibitory response.

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The peripheral factors that might affect strength gains include:

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2. Chronic: Myofibrilar hypertrophy

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The central factors that might affect strength gains include:

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Novices: 2-3 times per week working entire body

Rozier (1981): No difference between training 3 or 5 times a week (trend to improving

Farinatti (2013): Compared training muscle groups 1, 2, or 3 times a week.

Bench press and calf raise 10RM = no difference between groups

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Hypertrophy (Fisher 2013)

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2-3 Minutes for high intensity exercises using heavy loads

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