A one year plan - physiotherapeutic clinical reasoning, considerations of biomechnics, in rehabilitation
Your condition shouldn’t have movement forced upon it, as this will only create muscle spasms and potential functional instability. In the early phases movement should be directed in the directions of comfort. Early phase rehab should aim to reduce muscle spasms and increase the range of movement in a functionally stable manner. So, one side of the coin is ‘stability’ and the other side ‘mobility’ and the combination of the two are synergistic co-ordination and 'agility'.
Slow movement activate the 'red' slow twitch muscle fibres which are the endurance postural and joint stabilisers. Fast movement are the fast twitch ‘white’ muscle fibres which have no resistance to fatigue. They are the 1-10 RPM muscles versus the endurance muscle repetitions of 3-4 sets of 20-40 reps, with rest time between sets being roughly the length of time it took to do the set (and sometimes) up to double that length of time. Whereas, 1-10RPM are usually of such a significant load that only 1 set is carried out or if there were 3 sets of 3 RPM then the length of time between sets would be quite long.
The clinical stage, severity as well as the irritability of the condition should be taken into consideration when considering where the emphasis of the exercise training regime lies.
Training volume
Training progression
Training factors/considerations
Since writing the above, post injury training regimes, rehabilitation programs have become less conservative. Balance and proprioception exercises can be undertaken quite early in the process. The process is a continuum, whereby various stages of recovery have different aims and objectives. In the acute or relapse phase, emphasis will be on 'unloading' the area whilst using other muscle synergies to protect the area, whereas in other stages emphasis will be on 'loading' the affected area progressively, taking into account clinical factors as well as age and cardiovascular condition. Importantly, some things take time. ACL, Achilles tendon ruptures involve at least a 6-9 month process, POTS may require a similar amount of time, whereas a sprain ankle or back may be a matter of 3-6 weeks. Immune-metabolic factors as well as the persons lifestyle need to be considered. With any training prescription, my first question is 'how much time do you realistically have to do exercises?' Realistically, 6-8 exercises of 3 sets of 7-15 repetitions will take 40 minutes.
Biomechanics - velocity in training regimes
Power = force x velocity Work = force x time = force x displacement
- therefore, you can use speed (min weight) to create power
Momentum = mass x velocity
- inertia dictates that a body will stay at rest or uniform motion
Moment of Inertia (of a spinning person) = mass x (radius squared)
- energy is always conserved, hence, as the person brings their arms to their side, their angular and linear velocities will increase (since the mass is constant)
Impulse = force x time (change of momentum) = mass x velocity - mass x initial velocity
- therefore, 'timing' is important for training stability and co-ordination
Kinetic Energy = 1/2 mass x velocity squared = Potential energy = mass x gravity x height
- height can be used to increase potential energy which in turn can create increases in velocity
- alternatively, velocity may be used to create potential energy
- additionally, increases in weight whilst maintaining constant velocity, increases kinetic energy
Newtons Third Law : "for every action there is an equal and opposite reaction"
- therefore poor technique will result in an equal and opposite reaction in the plane of motion eg. whilst swimming freestyle and stroking too wide will result in an equal and opposite compensatory motion in the leg
- elevation of the right arm will result in equal and but opposite vector creation on the contralateral side of the body in order to maintain stability
- read a good book
Orthotics and Biomechanics of Gait
Original : 22 July 2006
Latest Update : 25 November 2021
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