Exercise prescription presentation 08.10.16

@Physiocouk #manchesterphysio facebook.com/physiocouk

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Exercise Prescription for Sports and Massage Therapists
With:
Richard Gregory - Msc (hons) Physiotherapy; Bsc (hons)
Sport Science)
Katie Emmett - Bsc (hons) Sports Therapy
Welcome

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Katie’s LinkedIn: www.linkedin.com/katieemmett
Twitter: @KatiePhysiocouk
Rich’s LinkedIn: www.linkedin.com/in/richard-gregory-60712887
Twitter: @RichPhysiocouk
Who are we?

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Website: www.physio.co.uk
Twitter: @physiocouk
Facebook: www.facebook.com/physiocouk
Let’s connect

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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
Itinerary

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

• 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
Muscle Fibre Types

What happens to injured
individuals?

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

Specific Exercise
Prescription

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

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

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…
Tendon’s love Isometric’s
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.

…How does
White Goodman
do it?
Training for Strength

PERIPHERAL FACTORS…
The peripheral factors that might affect strength gains include:
•Hypertrophy
•Hyperplasia
•Muscle fibre type shifts
Conceptual Basis For
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
Strength Gains

Training For Strength-
Intensity

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)
Load and Volume

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
Training For Strength- Rest
Intervals

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
Frequency

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

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 Motor Control

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.
Training For Power

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

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

Sport-specific Explosive
Power

•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)
Plyometrics

Stretch-shortening Cycle

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 - Prescription

Plyometrics –Upper Limb

Plyometrics –Lower limb

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

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…

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Thanks for coming!
Don’t forget to follow us on Twitter: @physiocouk

Exercise prescription presentation 08.10.16

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