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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

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Who are we?
Katies LinkedIn: www.linkedin.com/katieemmett
Twitter: @KatiePhysiocouk

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


Twitter: @RichPhysiocouk

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Lets connect
Website: www.physio.co.uk

Twitter: @physiocouk

Facebook: www.facebook.com/physiocouk

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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

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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

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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)

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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

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What happens to injured
individuals?

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The Exercise Detraining
Effect
2 WEEKS
Decrease in VO2 max (up to 7%; Coyle, 1984)

No reductions in strength

No muscle atrophy

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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)

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The Exercise Detraining
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.

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The Exercise Detraining
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)

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Specific Exercise
Prescription

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Training Principles
.GETTING THE BASICS RIGHT:

S.
P.
O .
R .
T .

F .
I .
T .
T .

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Variables to Consider

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

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Force Velocity Curve

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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.

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Training for Strength

How does
White Goodman
do it?

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Conceptual Basis For
Strength Gains
PERIPHERAL FACTORS

The peripheral factors that might affect strength gains include:


Hypertrophy
Hyperplasia
Muscle fibre type shifts

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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

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Conceptual Basis For
Strength Gains
CENTRAL FACTORS

The central factors that might affect strength gains include:

Inter-muscular co-ordination
Motor unit recruitment
Motor unit firing frequency

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Training For Strength-
Intensity

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Training For Strength-
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)

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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

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Training For Strength-
Frequency

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Training For Strength-
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

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

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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)

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Training For Muscular
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)

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Training For Muscular
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

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Training For Motor Control

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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)

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Training For Power

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Training For Power

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

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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.

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Coffee Break

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Practical
Exercise Prescription: Lower Limb

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Hamstring Exercises

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Exercise Selection - Hamstrings

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Glute Max/Glute Med
Exercises

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Exercise Selection Gluteus Maximus

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Exercise Selection Gluteus Medius

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Exercise Selection Gluteals

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Hip adductors

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Exercise Selection Adductors

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Lunch

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Practical
Exercise Prescription: Upper Limb

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Rotator Cuff Exercises

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Exercise Selection Rotator Cuff

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Exercise Selection RC : Infraspinatus

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Serratus Anterior Exercises

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Exercise Selection Serratus Anterior

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Upper/Lower Trap Exercises

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Exercise Selection Upper/ Lower Trapezuis

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Return to Sport

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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

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Sport-specific Explosive
Power

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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)

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Stretch-shortening Cycle

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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)

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Plyometrics Upper Limb

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Plyometrics Lower limb

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Return to Sport Guidelines
Pain free

No effusion

Full (optimal) AROM

Between 90% - 100% strength

Can perform sport specific functional tests

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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

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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

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Case Studies

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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

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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

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In Summary

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Thanks for coming!
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