This PPT contains a detailed explanation about resisted exercises, different types of exercise, indications & contraindications, manual & mechanical techniques.

1. RESISTANCE
EXERCISES
DR. MEGHAN PHUTANE (PT)
CARDIORESPIRATORY PHYSIOTHERAPIST

2. MUSCLE PERFORMANCE & RESISTANCE
EXERCISES
 3 elements of muscle performance – strength,
power & endurance – can be enhanced by some
form of resistance exercises.
 Alteration in each element depends on -
 How principles of resistance training are applied &
 How factors like intensity, frequency & duration are
manipulated.

3. POTENTIAL BENEFITS OF RESISTANCE
EXERCISES
 Enhance muscle performance
 Increase strength of connective tissue
 Greater BMD or reduces bone demineralization
 Decrease stress on joints
 Reduce risk of soft tissue injury
 Improves capacity to repair or heal damaged soft
tissues
 Possible improvement in balance
 Enhances physical performance during ADLs,
recreational activities & occupation
 Improves body composition : increase lean muscle
mass & reduce body fat
 Enhance feeling of physical well being & so QOL.

4. STRENGTH
 Ability of a contractile tissue to produce tension &
resultant force based on demands placed on the
muscles / Greatest measurable force exerted by muscle
or group of muscles to overcome resistance during a
single maximum effort.
 Functional strength – ability of a neuromuscular system
to produce, reduce or control forces imposed during
functional activity in a smooth coordinated manner.
 Strength training – systemic procedure of a muscle or
muscle group of lifting, lowering or controlling heavy
loads (resistance) for a relatively lower number of
repetitions or a short period of time.
 Increases maximum force producing capacity of muscle
& muscle fiber size (neural adaptation).

5. POWER
 Muscle power is related to strength & speed of
movement & is defined as work produced by
muscle per unit time. (force×distance/time).
 Power training –
 By increasing work of muscle for specific time or
reducing time for specific work of muscle.
 Greater the intensity & shorter the time period taken to
generate force – greater the muscle power.

6. ENDURANCE
 Endurance refers to the ability to perform low
intensity, repetitive or sustained activities over a
prolonged period of time.
 Muscle endurance is the ability to contract
repeatedly against a load, generate & sustain
tension & resist fatigue over an extended period of
time.
 Endurance training – low intensity muscle
contraction, large number of repetitions for
prolonged time period.

7. PRINCIPLES
1. Overload principle
2. SAID principle
3. Reversibility principle

8. OVERLOAD PRINCIPLE
 To improve muscle performance, a load that
exceeds the metabolic capacity of the muscle must
be applied.
 Progressive loading of muscle can be done by
manipulating intensity or volume of exercises.

9. SAID PRINCIPLE
 Specific adaptation to imposed demands
 Exercise program should be built on specificity principle.
 It’s a extension of Wolf’s law.
 Specificity of exercise refers to the adaptive effects of
training like strength, power & endurance, are highly
specific to the training methods employed.
 Considered relative to mode & velocity of exercise; joint
angle; movement pattern during exercise.
 Basis of specificity of training is related to morphological
& metabolic changes in muscles & neural adaptation to
the training stimulus with motor learning.

10. REVERSIBILITY PRINCIPLE
 Adaptive changes in body system (strength,
endurance) due to resistance exercises are
transient unless improvement is used for functional
activities or as a maintenance program.
 Detraining (reduced muscle performance), starts in
a week or two after exercise cessations & continues
until training effect are lost.

11. DETERMINANTS OF RESISTANCE EXERCISE
 Many elements (variables) determine whether a
resistance exercise program is appropriate,
effective & safe.
 All elements are interrelated & should be addressed
to improve one or more aspects of muscle
performance & achieve desired functional
outcomes.

12.  Alignment – of segments of body during exercise.
 Stabilization –of proximal or distal joint to prevent
substitution.
 Intensity – the exercise load (level of resistance).
 Volume – the total number of repetitions & sets in
the exercise sessions multiplied by the resistance
used.
 Exercise order – the sequence in which muscle
groups are exercised during the exercise session.
 Frequency – the number of exercise sessions per
day or per week.
 Rest interval – time allotted for recuperation
between sets & sessions of exercise.

13.  Duration – total time frame of a resistance training
program.
 Mode of exercise – type of muscle contraction,
position of the patient, form of exercise, arc of
movement, or the energy system utilized primary.
 Velocity of exercise.
 Periodization – variation in intensity & volume
during specific period of resistance training.
 Integration of exercise into functional activities
– use of resistance exercise that approximate or
replicate functional demands.

14. TYPES OF
RESISTANCE
EXERCISES

15. CONSIDERATIONS FOR SELECTION OF MODES
OF RESISTANCE EXERCISE
 Cause & extent of primary & secondary
impairments
 Deficits in muscle performance
 Stage of tissue healing
 Condition of joints & their tolerance to compression
& movement
 General physical & cognitive ability of patient
 Availability of equipments
 Patient’s goal
 Intended functional outcomes of the program

16. MANUAL & MECHANICAL RESISTANCE
EXERCISE
Manual resistance exercise –
 Type of active resistive exercise where resistance is
applied manually by therapist, other professional or
self (by patient).
 Resistance cannot be measured quantitatively but
useful in early stage of exercise training.
 Also useful when joint ROM needs to be carefully
controlled.
 Amount of resistance is limited to therapist strength

17. CONT…
Mechanical resistance exercises –
 Type of active resistive exercise where resistance is
applied through the use of equipments or
mechanical apparatus.
 Amount of resistance can be measured
quantitatively & increased progressively .

18. ISOMETRIC EXERCISES (STATIC)
 Static form of exercise in which muscle contracts &
produces force without appreciable change in
length of muscle & without visible joint motion.
 No mechanical work done but measurable amount
of tension & force are produced.
 Sources of resistance –
 Holding against force applied manually
 Holding weight in particular position
 Maintaining position against resistance of body weight
 Pushing or pulling immovable objects

19. RATIONAL & INDICATIONS
 To prevent or minimize muscle atrophy due to
external immobilization
 To activate muscle to begin to res-establish
neuromuscular control but protect healing tissues
when joint movement is not advisable (post
surgical)
 To develop postural or joint stability
 To improve muscle strength when dynamic activity
is not permissible

20. TYPES
 Muscle setting exs –
 Involve low intensity isometric contractions performed against
little or no resistance.
 To decrease muscle pain, promote relaxation & circulation
 Stabilization exs –
 Used to develop a sub-maximal but sustained level of
contraction to improve postural or dynamic stability of a joint
by means of mid-range isometric contraction against
resistance in antigravity & weight bearing position.
 Multiple angle isometrics –
 System of isometric exs where resistance is applied manually
or mechanically at multiple joint positions within available
ROM.

21. CHARACTERISTICS & EFFECTS
 Intensity of muscle contraction –
 Amount of tension generation depends on joint position &
length of muscle fibers during contraction.
 60-80%
 Duration of muscle activation–
 Hold for 6-10secs, post 10secs fatigue.
 Sufficient time to develop peak tension & metabolic changes
 Repetitive contractions –
 Repetitive contractions hold for 6-10secs – decrease muscle
cramping & increase effectiveness of isometric regimen.
 Joint angle & mode specificity –
 gain in muscle strength occur only at or closely adjacent to
the training angle.

22.  Precautions –
 Should be pain free
 Avoid breath holding
 Contraindications –
 High intensity isometrics should be avoided in cardiac &
vascular diseases.

23. DYNAMIC EXS – CONCENTRIC &
ECENTRIC
 Causes joint movement & excursion of body
segment as muscle contracts under tension.
 Concentric exs – form of dynamic muscle loading
where tension develops in muscle & physical
shortening of muscle occurs as resistance
overcomes. (lifting weight)
 Ecentric exs – dynamic loading of muscle beyond
its force producing capacity, causing physical
lengthening of muscle as it attempts to control the
load. (lowering the weight)
 Resistance can be applied by –
 Constant resistance (body wt/simple wt/ wt pulley)
 Weight machine (variable resistance)
 Isokinetic device (controls velocity)

24. RATIONALE
 Concentric contraction accelerate body segment
whereas eccentric contraction decelerate body
segment.
 Combined action is evident in countless daily
activities.
 Eccentric contraction –
 Acts as a source of shock absorption during high impact
activities.
 Essential component of rehabilitation & conditioning
program to reduce risk of muscle injury or re-injury.
 Plyometrics (stretch shortening drills)/ fast velocity,
eccentric isokinetic training – prepare patient for high
demands of activities.

25. DYNAMIC EXS – CONSTANT & VARIBLE
RESISTANCE
 The most common system of resistance training
used with dynamic exercise against constant or
variable resistance is progressive resistance
exs.(PRE)
 Dynamic constant external resistance exs (DCER)
–
 Resistance training where limb moves through a ROM
against constant external load, provided by free weights
like weight cuffs, Pulley system.
 Contracting muscle is challenged maximally at only one
point of ROM, where maximum torque of resistance
matches torque output of muscle.

26.  Variable resistance exercise –
 Specially designed resistance equipments imposes
varying levels of resistance to contracting muscle to
load the muscle more effectively at multiple points in
ROM. Eg with elastic tubes or bands.
 Performed against manual resistance, a skilled therapist
can vary the force applied to the contracting muscle
throughout the ROM.

27. ISOKINETIC EXERCISES
 Its a form of dynamic exs in which velocity of
muscle shortening or lengthening & the angular
limb velocity is predetermined & held constant by a
rate limiting device known as isokinetic
dynamometer.

28.  Characteristics –
 Constant velocity
 Range & selection of training velocity
 Reciprocal versus isolated muscle training
 Specificity of training(speed specific)
 Compressive forces on joints
 Accommodation to fatigue
 Accommodation of painful arc

29.  Training effects & carryover function –
 Improves one or more parameters of muscle
performance.
 Isolate single muscle or opposite muscle group
 Involves movement of single joint
 Uniplanar movement
 Does not involve weight bearing.

30.  Special considerations –
 Availability of equipments
 Appropriate set up
 Accommodation to painful arc

31. OPEN CHAIN & CLOSED CHAIN EXS
 Functional activities & exs are commonly
categorized as having weight bearing or non weight
bearing characteristics.
 Also called as “open or closed kinetic chain” &
“open or closed kinematic chain”.
 Open kinetic chain refers to completely unrestricted
movement in space of a peripheral segment of the
body. (waving the hand, swinging the leg)
 Closed kinetic chain movements – peripheral
segment meets with the considerable external
resistance. One joint motion is always accompanied
by adjacent joint motions.

32. OPEN CHAIN EXS CLOSED CHAIN EXS
Distal segment moves in space Distal surface fixed on stationary
support
Independent joint movement Interdependent joint movements
Movement of body segment distal to
the moving joint
Movement of body segment distal &/or
proximal to the moving joint
Muscle activation occurs in prime
movers
Muscle activation of multiple joint
muscles
Performed in non weight bearing
position (typical)
Performed in weight bearing position
(typically but not always)
Resistance is applied to the moving
distal segment
Resistance is applied simultaneously to
multiple moving segments
Use of external rotary loading Use of axial loading
External stabilization usually required Internal stabilization by means of
muscle action, joint compression, etc.

33. GENERAL PRINCIPLES OF
RESISTANCE TRAINING

34. EXAMINATION & EVALUATION
 Thorough examination of patients (history, system
review, selected tests & measurements)
 Determine qualitative & quantitative baseline
parameters (strength, endurance, ROM)
 Implement testing procedures (MMT, RM,
dynamometry, goniometry, level of disability)
 Interpret the findings
 Establish plan of care integrating resistance exs
 Periodical re-evaluation.

35. PREPARATION
 Select & prescribe form of resistance exs that are
appropriate & expected to be effective.
 If using mechanical resistance, determine what
equipment is needed & available.
 Review the anticipated goals & expected functional
outcomes
 Explain the exs plan & procedures.
 Let the patient were nonrestrictive clothing &
supportive shoes appropriate for exs.
 Select firm but comfortable support surface
 Demonstrate each exs & desired movement
pattern.

36. APPLICATION
 Warm up – (5-10mins, non resisted exs)
 Placement of resistance –
 Typically on distal end of segment
 May be applied across intermediate joint
 Revise placement if pressure is uncomfortable
 Direction of resistance –
 Concentric exs – opposite direction
 Eccentric exs – same direction
 Stabilization –
 Necessary to avoid unwanted or substitute motion
 Non weight bearing – proximal stabilization
 Weight bearing – muscle control

37.  Intensity of exs / amount of resistance –
 Initially minimal load; progress slowly
 Volume / no of reps & sets & rest intervals –
 Generally, 8-12reps with moderate load; followed by rest
 For progression initially increase no of reps & sets then
increase resistance
 Verbal / written instructions –
 Use simple instructions that are easy to understand
 Avoid medical terminologies
 Monitoring the patient –
 Before, during & after exs
 Cool down –
 Rhythmic, unresisted movements

38. PRECAUTIONS
 Select ambient room temperature
 Select clothing that facilitate heat dissipation
 Exs should be pain free
 Initiate with low loads/ avoid high intensity
 Do not apply pressure to unstable joint or distal to fracture site
 Avoid valsalva maneuver
 Avoid uncontrolled ballistic movements
 Prevent incorrect or substitute motion
 Avoid exercise that put excessive, unintended secondary
stress on body
 Be aware of medications a patient is using
 Avoid fatigue
 Discontinue exs if pt experience pain, dizziness or unusual
shortness of breath
 Prevent pathological fractures

39. CONT…
 Overtraining –
 Declined physical performance in healthy individuals
participating in high intensity, high volume strength
training program.
 Other terms are chronic fatigue, staleness, burnout
 Due to inadequate rest intervals, too rapid exs
progression, inadequate diet & fluid intake.
 Preventable, reversible phenomenon
 Overwork –
 Termed as overwork weakness
 Progressive deterioration of strength in muscles already
weakened by nonprogressive neuromuscular disease
 Prevention is better than cure

40. CONT…
Exs induced muscle soreness –
 Acute muscle soreness –
 During or directly after strenous exs
 Delayed onset muscle soreness (DOMS) –
 DOMS begins to develop 12-24hrs after the cessation of
strenuous activity; intensifies & peaks 24-48hrs later
 Can be prevented by gradual progression of intensity &
volume of resistance; warm up & cool down; slow
stretches before & after exs

41. CONTRAINDICATIONS
 Acute inflammation / acute disease
 Pain
 Severe cardiopulmonary disease

42. SKELETAL MUSCLE FUNCTION
&
ADAPTATION TO RESISTANCE
EXERCISE

43. FACTORS INFLUENCING TENSION GENERATION IN
NORMAL SKELETAL MUSCLES
FACTOR INFLUENCE
Cross section & muscle
size
Larger ms diameter – greater tension producing capacity
Fiber length &
arrangement
•Short fibers (pinnate/multipinnate) – high force
producing capacity (quads, deltoid, gastrocnemius)
•Long parallel fibers –high rate of shortening; less force
production (sartorius)
Fiber type distribution •High % type I – low force production,fatigue resistant
•High % type II – rapid high force production & fatigue
Length tension
relationship
Greater tension is produced near or at physiological
resting position during contraction

44. CONT…
FACTOR INFLUENCE
Motor unit
recruitment
Greater no & synchronization of motor unit firing –
greater force production
Frequency of motor
unit firing
Higher frequency of firing – greater the tension
Type of muscle
contraction
Force output from greatest to least : eccentric,
isometric, concentric muscle contraction
Speed of muscle
contraction
Concentric contraction - ↑speed - ↓tension
Eccentric contraction - ↑speed - ↑tension

45. ADDITIONAL FACTORS
 Energy store & blood supply –
 Adequate energy source is needed to contract, generate
tension & resist fatigue.
 3 main energy systems are :
 ATP-PC system
 Anaerobic/glycolytic/lactic acid system
 Aerobic system
 Fatigue – complex phenomenon affecting muscle
performance.
 Muscle (local) fatigue – the diminished response of muscle
to a repeated stimulus-is reflected in progressive decrement
in amplitude of motor unit potential.
 Cardiopulmonary (general) fatigue – diminished response
of an individual as a result of prolonged physical activity.`

46. CONT…
 Recovery from exs –
 Adequate time of recovery from fatiguing exs must be
built
 Both inter-session & intra-session
 Age –
 Muscle performance changes through out the life span.
 Psychological & cognitive factors –
 Positive or negative influence
 Attention
 Patient must focus on given task to perform it correctly
 Motivation & feedback-

47. PHYSIOLOGICAL ADAPTATIONS TO RESISTANCE
EXS
VARIABLE STRENGTH TRAINING ADAPTATION
Skeletal muscle
structure
•Hypertrophy of muscle fiber (more in type II)
•Hyperplasia of muscle fibers
•Fiber type composition: remodelling (type IIB to
IIA; no change in type I)
• Capillary bed density - ↓ or no change
•Mitochondrial density & volume: ↓
Neural system •Motor unit recruitment: ↑
•Rate of motor unit firing: ↑(↓twich contraction
time)
•Synchronization of firing: ↑
Metabolic system •ATP & CP storage: ↑
•Myoglobin storage: ↑
•Stored triglycerides: not known

48. VARIABLE STRENGTH TRAINING ADAPTATION
Enzymes •Creatine phosphokinase: ↑
•Myokinase: ↑
Body composition •Lean body mass: ↑
•% body fat: ↓
Connective tissue •Tensile strength of tendons, ligaments &
connective tissue: ↑
•Bone: ↑BMD; no change or possible ↑ in bone
mass

50. MANUAL
RESISTANCE
EXERCISES

51. DEFINITION
 Manual resistance exs is a form of active resistive
exs in which resistance force is applied by the
therapist to either a dynamic or static muscular
contraction.

52. ADVANTAGES
 Most effective during early stage of rehabilitation
 Effective during transition from assisted to
mechanically resisted movements
 More finely graded resistance
 Resistance can be adjusted throughout ROM
 Muscle works maximally at all portions of ROM
 Joint ROM can be carefully controlled
 Useful for dynamic & static strengthening
 Manual stabilization prevents substitute motions
 Can use variety of patient positions
 Placement of resistance can be easily adjusted

53. DISADVANTAGES
 Exs load is subjective; cannot be measured to
document
 Amount of resistance will be limited to the strength
of therapist
 Little value to strong muscle group
 Speed of movement is slow to moderate
 Cannot be performed independently by the patient
 Not useful in home program
 Labor- & time- intensive for therapist
 Impractical to improve muscle endurance

54. GUIDELINES
 Body mechanics of the therapist –
 Table/patient bed height
 Position close to patient
 Wide standing
 Application of manual resistance & stabilization
 Stabilize proximal attachment
 Vary resistance through out ROM
 verbal commands –
 Coordinate timing of verbal commands with resistance
application
 Simple, direct commands
 No of reps & sets; rest intervals –
 No depends on patient’s response & therapist strength
 Adequate rest interval after 8-12 reps

55. TECHNIQUE
 For eccentric contraction, direction of limb
movement would be opposite .
 Involves non weight bearing positions & isolate
individual muscle or muscle group
 Variation in therapist position, hand placement or
alternate patient position may be necessary
depending on size & strength of therapist & patient.
 Opposite motions are often alternately restricted
where strength & balanced neuromuscular control
in both agonist & antagonist are desired.

56. MECHANICAL
RESISTANCE
EXERCISE

57.  Mechanical resistance exercise is any form of
exercise in which the resistance is applied by
means of some form of exercise equipment.
 Integral component of rehabilitation & conditioning
program.

58. ADVANTAGES
 Establish quantitative baseline measurement– improvements
can be monitored.
 Most appropriate in intermediate & advanced phases of
rehabilitation (muscle strength ≥4/5 or ≥therapist strength)
 Increase in level of resistance can be incrementally
&quantitatively documented.
 Quantitative improvement – effective source of motivation for
patient.
 Useful for improving static & dynamic muscle strength.
 Adds variety to resistance training program.
 Some equipments provide variable resistance throughout the
ROM.
 High velocity resistance training is possible & safe.
 Appropriate for independent home exercise program.

59. DISADVANTAGES
 Not appropriate when muscles are very weak or
early stage of soft tissue healing (exception –
equipments that provide assistance, support or
control against gravity.)
 Equipment that provide constant external
resistance maximally loads the muscle at only one
point in ROM.
 No accommodation for painful arc (except with
hydraulic, pneumatic or isokinetic equipment).
 Expenses for purchase & maintenance of
equipment.
 With free weights & weighing machine, gradation
depends on manufacturer's increments of
resistance.

60.  Use in rehabilitation –
 To eliminate or reduce deficits in muscle strength, power
& endurance caused by an array of pathological
conditions.
 To restore or improve functional abilities.
 Use in conditioning –
 Important component of comprehensive conditioning
program to improve or maintain physical fitness & health
through out most of the lifespan.

61. GUIDELINES IN CONDITIONING PROGRAM FOR
HEALTHY ADULTS
 Prior to training, warm up followed by flexibility exs
 Perform dynamic muscle exs targeting major muscle
groups of body for total body fitness.
 Balance flexion & extension dominant (pulling /
pushing)exs; concentric & eccentric (lowering / lifting)
exs.
 Use full, available, pain free ROM.
 Use moderate intensity (8-10reps; 1-3sets; 2-3min rest
interval.)
 Use slow, moderate speed, rhythmic, controlled, non-
balliastic movements.
 Exercise should not interfere normal breathing.
 Frequency – 2-3times/wk
 Increase intensity gradually
 Cool down after completion of exercises.

62. CHILDREN & RESISTANCE TRAINING
 Questionable….
 Now evidence states that children do achieve health
related benefits & so can safely engage in supervised
weight training program.
 Resistance by using body weight or equipments
designed specifically for children are safe.
 Guidelines :-
 No training below 6-7 yrs age
 Start without weights then with light weights
 Close & continuous supervision
 Focus on proper form, technique & safety
 Emphasize low intensity, short duration, play oriented exs with
low exercise loads & frequency 2-3/wk
 Use warm up & cool down exs
 Initial progression by increasing reps & not resistance.

63. OLDER ADULTS & RESISTANCE TRAINING
 Major goal is to maintain or improve level of
functional independence & reduce risk of age
related diseases.
 Improves muscle strength, balance, speed of
walking, ability to rise in chair & minimize risk of fall.
 Guidelines :-
 Secure approval from physician
 Close supervision with vital parameters monitoring
 5-10 mins warm up
 Begin with low intensity, low repetitions exs
 Throughout avoid high resistance exs
 Frequency: 2-3 times/wk

64. SELECTED RESISTANCE
TRAINING PROGRAM

65. PROGRESSIVE
RESISTANCE EXERCISE

66.  PRE is a system of dynamic resistance training with
constant external load to contracting muscle by
some mechanical means & incrementally
increased.
 RM (repetition maximum) – basis for determining &
progressing the resistance.
 Beneficial in variety of pathological conditions
(muscle injuries, osteoarthritis, osteoporosis,
hypertension, diabetes, COPD, etc)
 Various regimens are:-
 Delorme
 Oxford
 Macqueen
 DAPRE

67. DELORME REGIMEN
 Introduced around 1945
 Originally known as heavy resistance training &
later as load resisting exercise to describe system
of strength training.
 Uses 3sets of 10 RM with progressive loading
during each set.
 It builds a warm up period into the protocol
 Incorporate rest intervals between sets,
incrementally increase the resistance over time &
there is training induced strength gain over time.

68. SETS REPETITIONS AMOUNT OF RESISTANCE
1 10 50% of 10 RM
2 10 75% of 10 RM
3 10 100% of 10 RM

69. OXFORD REGIMEN
 Zinovieff regimen
 Regressive loading in each set
 Diminishes the resistance as the muscle fatigues
 Incorporate rest intervals between sets,
incrementally increase the resistance over time &
there is training induced strength gain over time.
SETS REPETITIONS
AMOUNT OF
RESISTANCE
1 10 100% of 10 RM
2 10 75% of 10 RM
3 10 50% of 10 RM

70. MAC QUEEN REGIMEN
SETS REPETITIONS
AMOUNT OF
RESISTANCE
1 10 100% of 10 RM
2 10 100% of 10 RM
3 10 100% of 10 RM
4 10 100% of 10 RM

71. DAPRE REGIMEN
 Daily adjustable progressive resisted exercises
 More systematic & takes into account the different
rates at which individuals progress during
rehabilitation or conditioning program.
 Based on 6RM working weight
SETS REPETITIONS AMOUNT OF RESISTANCE
1 10 50% 6RM
2 6 75% 6RM
3 Max possible 100% 6RM
4 Max possible 100% of adjusted working weight

72. CIRCUIT WEIGHT TRAINING

73.  Pre-established sequence(circuit) of continuous
exercise is performed in succession at individual exs
stations that target variety of major muscle groups for
total body conditioning.
 Exs performed at an exs station for a specified no of
repetitions & sets (high reps, low intensity), minimum
amount of rest interval (15-20secs)
 Progression is by increasing no of sets or reps, the
resistance, no of exs stations, or no of circuit revolution.
 Exs order is important consideration; exs should
alternate among UL, LL, trunk to minimize fatigue.
 Large muscle groups before small muscle groups;
multijoint exs before isolated muscle group.
 Eg. Bench press→leg press/squats→sit ups →upright
rowing →hamstring curl →shoulder press →heel raise
→push ups →leg lifts or lowering.

74. PLYOMETRIC TRAINING

75.  “Plyometric training” / “stretch shortening drill” /
“stretch strengthening drill” is a system of high
velocity training characterized by rapid eccentric
contraction during which the muscle elongate
immediately followed by rapid reversal of
movement with a resisted shortening contraction of
same muscle.
 Amortization phase – period between stretch &
shortening cycle; should be brief.
 Integrated into advanced phases of rehabilitation to
train neuromuscular system to react quickly.
 Source of resistance –body weight/equipment.
 Eg. Catching & throwing ball, dribbling the ball,
jumping forward or sideways, etc.

76. NEUROLOGICAL & BIOMECHANICAL INFLUENCE
Augment force production
Releases energy during
concentric contraction
Create elastic energy during
eccentric contraction
Spring like property of ms
tendon
Improves reactivity of NM
system
↑excitability of NM receptors
Stimulates proprioceptors
Stretch – shortening cycle

77.  Effects –
 Enhance physical
performance
 Enhance muscle’s
dynamic restraint
capabilities
 ↓ LL injury incidence
 Contraindications –
 Inflammation
 Pain
 Joint instability
 Progression –
 Speed of drill
 Intensity
 Repetitions & frequency
 Precautions –
 Don’t include if high
stress, shock absorbing
activities are not
permissible.
 For children or elderly
do not include high
impact heavy load
activities
 Patient should have
adequate flexibility &
strength
 Warm up & cool down
 Teach safe techniques
 Allow adequate time of
recovery (48-72hrs)
 Stop if indicated by
patient

78. ISOKINETIC REGIMEN

79.  Should be performed at velocities that closely
match to velocity of specific movement of task.
 Generally medium or fast velocity
 Speed specific training
 Selection of velocity –
 Medium (60or90 -180 degrees)
 Fast (180-360degrees)
 Repetitions, sets & rest –
 1-2 sets of 8-10 or maximum 20 repetitions of agonist &
antagonist muscle groups at multiple velocities
 15-20sec rest between sets; 60sec rest in exs velocity
 Intensity –
 Warm up followed by submaximal efforts.

80. EQUIPMENTS FOR
RESISTANCE TRAINING

81.  Limitless selection of exercise equipments
 Range from simple to complex; compact to space
consuming; inexpensive to expensive
 Most equipments are load resisting but few are load
assisting to improve strength of weak ms.
 Can be used for static or dynamic exs, concentric
or eccentric exs, open or closed chain exs
 To improve muscle strength, power or endurance;
neuromuscular stability or control & cardio
pulmonary endurance
 Choice of equipment depends on –
 Individuals needs, abilities & goals
 Availability
 Cost of purchase & maintenance
 Ease of use
 Versatality
 Space requirement

82. FREE WEIGHTS & SIMPLE PULLEY SYSTEM
 Graduated weights or applied to extremities or trunk
 Dumbbells, barbells, weighted ball, cuff weights,
weighted vest, sand bags, simple weight pulleys
 Can be used for home exs program
 Can be used in various positions
 Can be used isometric/dynamic exs, weight bearing
& non weight bearing exs

84. VARIABLE RESISTANCE MACHINE
 Falls in 2 broad categories as :-
 Specially designed weight cables (weight pulley) – same
ms group contracts concentrically & eccentrically; exs at
slow velocity.
 Hydraulic &pneumatic units – concentric work of agonist
& antagonist; no eccentric work; safe at fast velocities;
allow to accommodate pain free arc.
 Advantages –
 Muscle is loaded maximally at multiple points
 Isolate & exs a specific muscle group
 Mostly allows single plane movements; new machines
dual axis movements
 Provides external stabilization to guide or limit
movements
 Disadvantages – initial expenses & maintenance
cost

85. ELASTIC RESISTANCE BANDS & TUBING
 Use is widespread in rehabilitation; effective method of
providing resistance (variable resistance).
 Two broad categories as elastic bands (available in
various grades & thickness) & tubes (in graduated
diameters & wall thickness)
 Color coding denotes grade of resistance.
 Selection should be based on thickness of material
(level of resistance)
 Length should be sufficient to attach at both ends & not
taut at the beginning of exercise.
 One end should be secured on firm surface & other end
grasped or tied to limb segment.
 Progression - ↑ no of reps with same resistance or using
higher grade of elastic band or tubing.

86.  Advantages –
 Portable
 Relatively inexpensive
 Resistance is not significantly gravity dependant
 Safe to exs at moderate to fast velocities
 Disadvantages –
 Difficult to determine which grade to start with & to what
extent changing grade of band or tubing changes level
of resistance.
 No source of stabilization
 Effects of material fatigue are small, still should be
replaced on a routine basis to ensure patient safety.
 Some products contains latex; eliminate use if allergy to
latex.

88. EQUIPMENTS FOR CLOSED CHAIN TRAINING
 Body weight resistance–multipurpose exs system
 Uses glide board that can be inclined at various angles
 Enables to perform unilateral or bilateral activities
 Balance boards (wobble board)–
 Proprioceptive training in UL & LL
 Slide boards –
 Moving platform that slides side to side
 Mini trampolines –
 Begin gentle, bilateral or unilateral bouncing activities on
resilient surface

90. RECIPROCAL EXERCISE EQUIPMENTS
 Strengthens multiple muscle groups at multiple
joints
 Appropriate for low intensity, high reps resistance
training to increase muscular endurance &
reciprocal coordination of UL, LL & improve
cardiopulmonary fitness.
 Often used in warm up & cool down.
 Variety of equipments are –
 Stationary exs cycle
 Portable resistive reciprocal exs unit
 Stair stepping machine
 Elliptical trainers
 Upper extremity ergometer

92. EQUIPMENTS FOR DYNAMIC STABILIZATION
TRAINING
 Swiss ball –
 Usually 20-30inches in diameter
 Used for variety of trunk & extremities stabilization
 Body blade –
 Dynamic, reactive form of resistance exs that use
principle of inertia as the source of resistance to
produce dynamic stability.

94. ISOKINETIC TESTING & TRAINING EQUIPMENTS
 Provides accommodating resistance during
dynamic exs of extremities or trunk.
 The equipment supplies resistance proportional to
the force generated by person using machine.
 Features –
 Computerized testing capability
 Passive & active modes that permit open chain,
concentric & eccentric testing & training
 Adjustable velocity settings
 Used even for CPM
 Allows limb movement in specific joint range
 Single joint uniplanar movements are common but some
multiplanar movements are possible.