Chapter 5 Impaired Muscle Performance

Chapter 5
Impaired Muscle
Performance
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Definitions
Strength – The
maximum force that a
muscle can develop
during a single muscle
contraction, and is the
result of complex
interactions of
neurologic, muscular,
biomechanical, and
cognitive systems.

Definitions (cont.)
Force – Agent that produces or tends to produce a

change in the state of rest or motion of an object.
Kinetics – Study of forces applied to the body.
Torque – The ability of a force to produce rotation.

Moment Arm
Perpendicular distance from the line of action of the

force to the axis of rotation.
Axis
Moment arm
Vector of force

Torque can be altered by
1. Changing the force magnitude

2. Changing the moment arm
length
3. Changing the angle b/t the
direction of force and
momentum

Power and Work
Power – Rate of performing work.

Work – Magnitude of force acting on an
object multiplied by the distance through
which the force acts.

Endurance
The ability of a muscle to sustain forces

repeatedly or to generate forces over a certain
period.
Evaluate using:
 Isometric contractions
 Repeated dynamic contractions
 Repeated contractions using isokinetic
dynamometer

Muscle Actions
 Isometric – contraction w/o motion about
an axis (force is product)
 Dynamic (NOT isotonic) – Concentric

(shortening contraction), eccentric
(lengthening contraction)
 Isokinetic – Concentric or eccentric w/

constant velocity

Factors Affecting Muscle Performance
1. Fiber type
2. Fiber diameter
3. Muscle size
4. Force – velocity relationship:
Active force continually adjusts to the speed at
which the contractile system moves.

Muscle Fibers
I SO S
Tonic Slow Oxidative Slow
II A FO FR
Fast Oxidative Fast Fatigue
Resistant
II AB FOG FI
Fast Oxidative Fast Intermediate
plus Glycolytic Fatigueability
II B FG FF
Fast Glycolytic Fast Fatigueability
Strength is related to fiber diameter, not type. Type I fibers typically have smaller
diameter than type II fibers.
Length–Tension Relationship
Capacity to produce force depends on

the length at which muscle is held
with maximum force delivered near
the muscle’s normal resting length.
Emphasis of therapeutic exercise intervention

should be on restoring normal length and tension
development at appropriate point in the range,
rather than just strengthening the muscle.

Changes in Numbers of Sarcomeres

Positional Strength

Muscle Architecture
1. The force the muscle can produce is directly

proportional to the cross-sectional area (more
sarcomeres in parallel).
2. The velocity and working excursion of the muscle

are proportional to the length of the muscle (more
sarcomeres in series).
Muscles w/ shorter fibers and a larger cross sectional area –
designed to produce force
Muscles w/ long fibers – designed to produce excursion and
velocity.

Clinical Considerations
Many factors impact effectiveness of exercise program:
 Medications
 Physical health
 Age
 Program design
All can impact ability to participate and physical response
to training stimulus.

Morphology and Physiology of Muscle
Performance
Improving muscle
performance often
translates into
improvements in
functioning by the
patient.

Dosage
Can be Altered in a Variety of Ways:
 Increasing intensity/load
 Changing relationship to gravity
 Increasing lever arm length
 Increasing sets/repetitions
 Decreasing rest interval
 Increasing frequency
Intensity, duration, frequency are related and considered

“training volume”. All must be considered when designing a
program.
Resistive exercise must progress functional activity to transition
intervention at impairment level to a functional situation

Sequence
 Generally – Multijoint exercises for strength and power gains.
 For patient’s – First – Specific isolated training for impaired
muscle performance.
 Isometric to multijoint, slow to fast speeds,
For General Strength:

 Large muscle groups before small
 Multijoint before single-joint “activities”
 When training individual muscle groups, perform higher
intensity exercises before lower intensity exercises

More Factors Affecting Muscle
Performance
 Program Design – looking at the overall training session.

 Training Specificity – Muscle responds to the specific
ROM, posture, type in which it’s trained.
 Neurologic Adaptation – Initial increase in strength is
neural adaptation (2–4 weeks).
 Muscle Fatigue – Dosage of resistive exercise is limited
to “form fatigue” (sacrifice of technique).
 Muscle Soreness – Some activity is still advised!

Lifespan Considerations
Prepuberty
 ~20% of child’s body mass is muscle.
 Benefits of exercise – improved muscle, motor
performance, body composition, sense of well-being.
 Moderate resistance training is acceptable.
 Heavy resistance should be avoided.
 Focus on neurologic aspects of training.

Puberty
 Body composition changes to 27–40% of body mass

(Boys).
 Onset of puberty, strength of boys and girls diverges
remarkably.
 General strength training is recommended.
 Avoid heavy loads (epiphyses remain vulnerable to
injury).

Early Adulthood
 Biologic structures are in a state of excellent

adaptability.
 Emphasis should be based on balanced fitness

program for cardiopulmonary fitness, muscle
performance, and flexibility.

Middle Age
 Decrement of strength must be differentiated.
 Training for as little as 2 hours per week can positively
influence strength.
 Small amount of training increases the difference b/t
active and inactive persons.
 Leisure time activities account more for existing
strength than professional demands

Advanced Age
 Possible to reverse muscular weakness in old

age.
 Resistive exercise should be directed toward
muscles susceptible to atrophic changes. (e.g.
deep neck flexors, scapular stabilizers,
abdominal muscles, pelvic floor muscles, gluteal
muscles, and quadriceps)
 Training considerations should include power and
strength.

More Factors Affecting Muscle
Performance
 Cognitive aspects of performance
(e.g.visualization)
 Effects of alcohol
 Effects of corticosteroids

Causes of Decreased Muscle Performance
 Neurologic pathology
 Muscle strain
 Disuse and conditioning
 Length-associated changes

Physiologic Adaptations to Resistive
Training
 Improvement in muscle
performance
 Positive effects on cardiovascular
system, connective tissue, and
bone

Possible Physiologic Adaptations to
Resistive Exercise
 Muscle – in fiber size and mitochondrial density
 Connective tissue – ligament and tendon strength and
collagen content may
 Bone – density may
 Cardiovascular system – HR, systolic and diastolic
BP, cardiac output and VO2 max, cholesterol

Endurance
Muscle’s response to endurance training different from its strength or
power training.
Muscles trained for endurance:
 Demonstrate cells with increased mitochondrial size, number,

and enzymatic activity
 Delays onset of muscular fatigue.
 Demonstrate increased local fuel storage (up to 2-fold).
 Increase fatty acid use and decreases use of glycogen as fuel.
 Allows more exercise before fatigue.
 Improves oxygen delivery system by increasing the local capillary
network, producing more capillaries per muscle

Examination and Evaluation of Muscle
Performance
Tests include an analysis of functional muscle
strength
 Manual muscle testing (consider imbalances, length–
tension relationships, and positional weakness when
choosing positions)
 Handheld dynamometers
 Isokinetic dynamometers
 Dynamic strength test

Activities to Increase Muscle
Performance
 Isometric Exercise (strength base for dynamic

exercise)
 Dynamic Exercise (weight machine exercise,
free-weight exercise, plyometric exercise)
 Isokinetic Exercise (provides maximum
resistance throughout entire ROM)

Methods of Resistance Training
Method of Indication Considerations Precaution/limitation
Resistance
Manual When manual contact is necessary to Readily available. Patients with hypertension/CVD.
Resistance ensure proper muscle activation Easily modified. Labor intensive.
Not practical for home.
Precise measurement difficult.
Pulley System Any time resistive exercise Applies constant load. Use after baseline strength is established.
through a range of motion is Muscle maximally loaded only in weakest
necessary. portion of range.
Variable Where stability and safety is of Provides less resistance at Fixed increments. Little proprioception,
Resistance concern. beginning/end balance, or coordination is learned.
Machine ROM, more midrange.
Elastics Any time strengthening by Inexpensive. Material fatigues quickly-decreases force.
external resistance is required. Force increases with stretch. Full ROM requires close attention to
resistance angle and length of elastic
Free Weights For discrete measureable overload. Can be used in many Little external stabilization
different ways that meet the needs of
individual patients.
Isokinetic Devices Muscle performance Fully activate more muscle fibers for Expensive/bulky. Most training is done in a
testing and training. longer periods. Testing/training at single plane, with a fixed
variety of speeds. axis at a constant velocity in an open kinetic
chain.

Dosage – Intensity, Duration,
Frequency, Sequence
 Intensity – Perform exercise to substitution of form
fatigue.
 Duration – Vary rest intervals dependent upon volume
(total repetitions) and rest intervals.
 Frequency – Depends on rehab goals.
 Sequence – Affects the development of strength.
Rehab generally specific isolation training and
graduate to multi-joint exercises, small-large
movements.

Dosage Varies
 Strength Training – 60–70% of 1RM, 8–12 reps.
 Power Training – 1–3 sets 30–60% of 1RM.
 Endurance Training – 10–15 reps, 10–25 reps

(advanced). Shorter rest periods.

Precautions and Contraindications
 Avoid use of valsalva maneuver.
 Use isometrics with caution (persons at risk – high
BP).
 Overtraining/overwork (may lead to mood
disturbances).
 Caution should be used with prepubertal, pubertal
children and adolescents (minimize stress to
epiphyseal sites).
 Acute or chronic myopathy (exercise is
contraindicated).

Therapeutic Exercise Intervention for
Impaired Muscle Performance
Program Initiation
 What muscle or muscle group(s) need training?
 What type of training is required at this stage?
 Should muscle be isolated or worked as a synergist?
 What activity will best accomplish this goal?
 What is their current performance status?
 Based on tests, what resistance will they tolerate and for how
many repetitions?
 What is the best mode to perform the exercise

Program Progression
• Exercises can be progressed many ways (e.g. increasing

exercise intensity, to changing complexity of exercise.
• Goal is to narrow/eliminate gap b/t the patient’s current

status and desired functional status.

Therapeutic Exercise Intervention for
Prevention, Health Promotion and
Wellness
 Dosage for Strength Training
 Dosage for Endurance Training
 Dosage for Power Training
 Dosage for Advanced/Elite Athlete
 Plyometrics
Similar training (and safety) strategies employed for athletes as

for patients. Focus of sport or state of wellness tends to
dictate level of exercise intensity and difficulty.

Summary
 Muscle performance = strength, power, and endurance.

 Clarify when using “strength” as a qualifier in terms of
force, torque, and work.
 Muscle actions – static and dynamic.
 Muscle morphology – thorough knowledge is needed for
appropriate prescription of intervention.
 Dynamic action is the preferred term over isotonic.

Summary (cont.)
 Dynamic actions can be further divided into
concentric and eccentric actions.
 The sliding filament theory describes the events that
occur during muscle contraction. Force gradation
occurs by rate coding and size principles.
 Basic muscle fiber types are slow oxidative, fast
glycolytic, and fast oxidative glycolytic.
 Force gradation occurs by rate coding and the size
principle.

Summary (cont.)
 Overload training – changes in hypertrophy

(primarily) and hyperplasia.
 Strength – must be evaluated relative to muscle
length.
 Specificity of training exists.
 Adaptation to training – initially neurologic and
precedes morphologic changes.
 Form fatigue – point at which individual must
discontinue exercise or sacrifice technique.

Summary (cont.)
 Impaired muscle performance – results from
neurologic pathology, muscle strain, disuse, or length-
associated changes.
 Adaptations to resistive exercise include bone,
connective tissue & cardiovascular system.
 Activities to improve muscle performance – isometric,
dynamic, plyometric, and isokinetic exercise.
 Dynamic exercise may include free weights, resistive
bands, pulleys, weight machines, or body weight.

Summary (cont.)
 Dosage of exercise depends on the goal.

 Precautions and contraindications must be known to
ensure safety.

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Chapter 5

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Force – Agent that produces or tends to produce a

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Perpendicular distance from the line of action of the

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

1. Changing the force magnitude

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Power – Rate of performing work.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

The ability of a muscle to sustain forces

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Dynamic (NOT isotonic) – Concentric

 Isokinetic – Concentric or eccentric w/

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Capacity to produce force depends on

Emphasis of therapeutic exercise intervention

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

1. The force the muscle can produce is directly

2. The velocity and working excursion of the muscle

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Intensity, duration, frequency are related and considered

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

For General Strength:

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Program Design – looking at the overall training session.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Body composition changes to 27–40% of body mass

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Biologic structures are in a state of excellent

 Emphasis should be based on balanced fitness

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Possible to reverse muscular weakness in old

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Demonstrate cells with increased mitochondrial size, number,

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Isometric Exercise (strength base for dynamic

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Strength Training – 60–70% of 1RM, 8–12 reps.

 Power Training – 1–3 sets 30–60% of 1RM.

 Endurance Training – 10–15 reps, 10–25 reps

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Exercises can be progressed many ways (e.g. increasing

• Goal is to narrow/eliminate gap b/t the patient’s current

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Similar training (and safety) strategies employed for athletes as

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins