Resistance Exercise

For Impaired
Muscle
Performance
Chapter No 6
Part 6
DR.IQRA ASHRAF
DPT,MS-MSK
PRECAUTIONS------------
FOR RESISTANCE EXERCISE

 Regardless of the goals of a resistance exercise program and

the types of exercises prescribed and implemented the
exercises must not only be effective but safe
0
Valsalva Maneuver
 The Valsalva maneuver (phenomenon), which is defined as an
expiratory effort against a closed glottis, must be avoided
during resistance exercise
 The Valsalva maneuver is characterized by the following
sequence:
“A deep inspiration is followed by closure of the glottis and
contraction of the abdominal muscles”.
 This increases intra-abdominal and intrathoracic pressures,
which in turn forces blood from the heart, causing an abrupt,
temporary increase in arterial blood pressure.
 Occurs with high intensity isometric and dynamic muscle
contraction.
At-Risk Patients
 The risk of complications rise in BP:
 coronary artery disease
 myocardial infarction
 cerebrovascular disorders
 hypertension
 Neurosurgery
 eye surgery
 intervertebral disc pathology.
 Prevention During Resistance
Exercise
 Caution the patient about breath-holding.
 Ask the patient to breathe rhythmically, count, or talk
during exercise.
 Have the patient exhale with each resisted effort.
 Be certain that high-risk patients avoid high-intensity
resistance exercises.
 Substitute Motions
 Iftoo much resistance is applied to a contracting muscle
during exercise, substitute motions can occur.
 When muscles are weak because of fatigue, paralysis, or pain.
A patient may attempt to carry out the desired movements that
the weak muscles normally perform by any means possible.
 Example
If the deltoid or supraspinatus muscles are weak or
abduction of the arm is painful, a patient elevates the scapula
(shrugs the shoulder) and laterally flexes the trunk to the
opposite side to elevate the arm. It may appear that the patient is
abducting the arm, but in fact that is not the case
 To avoid substitute motions during exercise, an appropriate
amount of resistance must be applied, and correct stabilization
must be used with manual contacts, equipment, or by means of
muscular (internal) stabilization by the patient
 Overtraining and Overwork
 These terms refer to deterioration in muscle
performance and physical capabilities (either
temporary or permanent) that can occur in healthy
individuals or in patients with certain neuromuscular
disorders.
 Overtraining
a decline in physical performance in healthy individuals
participating in high-intensity, high-volume strength and
endurance training programs
 The terms chronic fatigue, staleness, and burnout are
also used to describe this phenomenon
 When overtraining occurs, the individual progressively
fatigues more quickly and requires more time to recover
from strenuous exercise because of physiological and
psychological factors
Overtraining-Contributing Factors
Overtraining is brought on by
 Inadequate rest intervals between exercise sessions
 Too rapid progression of exercises
 And inadequate diet and fluid intake
 Overtraining - Prevention
 Fortunately, in healthy individuals, overtraining is a
preventable, reversible phenomenon that can be resolved
by tapering the training program for a period of time by
periodically decreasing the volume and frequency of
exercise (periodization)
Overwork
 The term overwork, sometimes called overwork weakness, refers to progressive
deterioration of strength in muscles already weakened by non-progressive
neuromuscular disease
Example
Guillain-Barre syndrome & Post polio syndrome is also thought to be
related to long-term overuse of weak muscles
 Overwork - Prevention
 Patientsin resistance exercise programs who have impaired
neuromuscular function or a systemic, metabolic, or
inflammatory disease that increases susceptibility to muscle
fatigue must be monitored closely, progressed slowly and
cautiously, and re-evaluated frequently to determine their
response to resistance training.
 These patients should not exercise to exhaustion and should
be given longer and more frequent rest intervals during and
between exercise sessions
 Exercise-Induced Muscle Soreness
Exercise-induced muscle soreness falls into two categories:
 Acute onset.
 Delayed onset.
 Acute Muscle Soreness
 Acute muscle soreness develops during or directly after
strenuous exercise performed to the point of muscle
exhaustion
 This response occurs as a muscle becomes fatigued during
acute exercise because of the lack of adequate blood flow and
oxygen (ischemia) and a temporary buildup of metabolites,
such as lactic acid and potassium, in the exercised muscle
 Symptoms

The sensation is characterized as a feeling of

burning or aching in the muscle.
 Patho-physiology

It is thought that the noxious metabolic

waste products may stimulate free nerve endings and cause
pain
 Recovery
 The muscle pain experienced during intense exercise is
transient and subsides quickly after exercise when adequate
blood flow and oxygen are restored to the muscle.

 An appropriate cool-down period of low-intensity exercise

(active recovery) can facilitate this process.
 Delayed-Onset Muscle Soreness
 After vigorous and unaccustomed resistance training or
any form of muscular overexertion, delayed-onset muscle
soreness (DOMS), which is noticeable in the muscle belly
or at the myotendinous junction, begins to develop
approximately 12 to 24 hours after the cessation of
exercise.
 Contributing Factor: High-intensity eccentric muscle
contractions consistently cause the most severe DOMS
symptom
 Etiology of DOMS

current research seems to suggest that DOMS is linked to some

form of contraction-induced, mechanical disruption
(microtrauma) of muscle fibers and/or connective tissue in
and around muscle that results in degeneration of the tissue.
 Evidence of tissue damage such as elevated blood serum
levels of creatine kinase, is present
for several days after exercise and is accompanied by
inflammation and edema.
 Prevention and treatment of DOMS
 Itis a commonly held opinion in clinical and fitness settings
that the initial onset of DOMS can be prevented or at least
kept to a minimum by progressing the intensity and volume
of exercise gradually by performing low-intensity warm-up
and cool-down activities or by gently stretching the
exercised muscles before and after strenuous exercise.
 Prevention and treatment of DOMS
 There is some evidence to suggest that the use of
repetitive concentric exercise prior to DOMS-inducing
eccentric exercise does not entirely prevent but reduces the
severity of muscle soreness and other markers of muscle
damage.
 The best prevention of DOMS appears to be a regular
routine of exercise, particularly eccentric exercise, after
an initial episode of DOMS has developed and remitted
 Topical salicylate creams, which provide an analgesic effect,
may also reduce the severity of and hasten the recovery from
DOMS-related symptoms.
 Pathological Fracture
When a patient with known (or at high risk for) osteoporosis
or osteopenia participates in a resistance exercise program,
the risk of pathological fracture must be addressed
 Osteoporosis is a systemic skeletal disease characterized
by reduced mineralized bone mass that is associated with
an imbalance between bone resorption and bone formation,
leading to fragility of bones
 The changes in bone associated with osteoporosis make the
bone less able to withstand physical stress. Consequently,
bones become highly susceptible to pathological fracture.
 A pathological fracture (fragility fracture) is a fracture of
bone already weakened by disease that occurs as the result
of minor stress to the skeletal system
 Pathological fractures most commonly occur in the
vertebrae, hips, wrists, and ribs
 Todesign and implement a safe exercise program, a
therapist needs to know if a patient has a history of
osteoporosis and, as such, an increased risk of pathological
fracture.
 Prevention of Pathological Fracture
 Avoid high-intensity (high-load), high-volume weight
training. Depending on the severity of osteoporosis,
begin weight training at low intensities; initially, perform
only one set of several exercises and keep the intensity
low for the first 6 to 8 weeks.
• Progress intensity and volume (repetitions) gradually;
eventually work up to three or four sets of each exercise
at moderate levels of intensity, if appropriate.
 Prevention of Pathological
Fracture(Cond)
 Avoid high-impact activities such as jumping or hopping.
Perform most strengthening exercises in weight-bearing
postures that involve low impact to no impact, such as
lunges or step-ups/step-downs against additional resistance
(hand-held weights, a weighted vest, or elastic resistance).
• Avoid high-velocity movements of the spine or
extremities
 Prevention of Pathological
Fracture(Cond)
 Avoid trunk flexion with rotation and end-range resisted
flexion of the spine that could place excessive loading on
the anterior portion of the vertebrae, potentially resulting in
anterior compression fracture, wedging of the vertebral
body, and loss of height.
• Avoid lower extremity weight-bearing activities that involve
torsional movements of the hips, particularly if there is
evidence of osteoporosis of the proximal femur.