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Re: Rehab / Training Myths
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Re: Rehab / Training Myths - March 14, 2005 3:08:00 PM
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jma
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"The pain from exercising will go away in 24 hours"
JMA
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Re: Rehab / Training Myths - March 14, 2005 3:09:00 PM
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jma
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"Its okay to workout 1 hr after eating"
JMA
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Re: Rehab / Training Myths - March 14, 2005 5:52:00 PM
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OAK
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"Lifting weights makes you musclebound."
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Re: Rehab / Training Myths - March 14, 2005 9:26:00 PM
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Randy Dixon
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OK, now that we have some down, how many do you disagree with. I have a couple that at least need qualifiers. The first one, "never let your knee go past your toes". I think there are few nevers that hold up in the world, but as a general rule for most activities I would endorse it.
I think it is okay to workout 1 hour after eating. Unless it's Thanksgiving Day.
You've "got to increase your maximum weight" only if you want to gain absolute strength.
Muscles will only grow if you increase the weight. At some point in time this is true.
I have no problem with occasionally going to failure although it doesn't do anything stupendous. Even for healthy senior citizens. It's a risk benefit thing, so maybe not many need it.
No pain, no gain" Depends on your goals and what you consider 'pain". If you are a competitive athlete you're going to have times that are pretty close to pain.
LET THE GAMES BEGIN!
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Re: Rehab / Training Myths - March 15, 2005 1:56:00 AM
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JLS_PT_OCS
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Randy,
I would agree with those qualifiers.
I also have older patients occasionally go to failure. I agree that it is a judgement call as to when and how. Certainly going to failure on a military press for a senior is not the same as going to failure on calf raises.
I think overall, the knee position thing I mostly disagree with -- I instruct athletes and clients to not let the knee past the toes. Even more important, they are trained away from an adduction/IR position of the femur, and that's more important, in my opinion. Either in strengthening or in plyometric type activities, there is some evidence that that position really increases the torque at the knee, without concomitant muscle activation. Plus, in order to get the knee out there really far past the toes, the spine is pretty much straight, and in my mind that is not a sport-specific or activity-specific position.
I think increasing weight lifted is the best, perhaps only, way to get strength gains. Though Sebastian may have been getting at the point where athletes and clients try to increase their max weight before they are ready, and more often than is safe. Now THAT I wholeheartedly agree with.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Rehab / Training Myths - March 15, 2005 3:05:00 AM
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rn8711
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Randy,
I disagree with "never let your knees go past your toes while exercising" as a blanket rule. One sees the knees project beyond the toes in such activities as Olympic weightlifting, martial arts, wrestling, fencing and football--to name a few--without proving itself as a major cause of knee injury. Is it merely a risk-benefit issue to everyone? IMHO, if an athlete won't train it he/she won't retain it. That's why proper instruction is crucial and of course, practice, practice, practice.
More importantly though, it's not the degree of knee flexion one should worry about but the manner one executes the knee action which will predict the overall risk of injury.
If one haphazardly performs the action e.g. allowing the knee to rotate medially by relaxing the muscles that control the movement, then the risk of injury to the ligaments and the other non-contractile tissues is much greater.
Same deal with "locking the joints during an exercise." IMHO, the manner in which it's done is more important than the act itself. If one voluntarily relaxes the muscles during the lock out, then again the risk of injury to the ligaments and the other non-contractile tissues is much greater. "Locking out" under an external load is needed by many athletes including powerlifters and Olympic weightlifters so why not teach it and train it properly.
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Re: Rehab / Training Myths - March 15, 2005 3:14:00 AM
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rn8711
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Jason,
When you write "increasing the weight lifted is the best, perhaps only, way to get strength gains," are you referring only to the mass of the external load in question?
Russell
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Re: Rehab / Training Myths - March 15, 2005 5:47:00 AM
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JLS_PT_OCS
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Rus,
Good post. I am referring to the concept that progressive resistance must be applied for strength gains to result. Sometimes that is manipulating load, sometimes it is changing the exercise and/or the volume performed.
If the resistance isn't progressive, strength gains will not result.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Rehab / Training Myths - March 15, 2005 5:55:00 AM
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jma
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While locking out is used with powerlifers and olympic weightlifters, they do not compromise the majority of patients I see in the hospital. They are not taught to lock out the joints at all.
JMA
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Re: Rehab / Training Myths - March 17, 2005 4:26:00 AM
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jma
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"Weight belts will prevent hernias"
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Re: Rehab / Training Myths - March 17, 2005 6:14:00 AM
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fapt
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The first principle of resloving back pain is posture corrected.
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夏之日，冬之夜，百歲之後，歸于其居。
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Re: Rehab / Training Myths - March 17, 2005 6:18:00 AM
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OAK
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"I don't lift weights because I don't want to look "bulky"."
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Re: Rehab / Training Myths - March 17, 2005 8:52:00 AM
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apolipo
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In regards to what we should train and not train the knee to do, I think we need to keep an important point in mind: during most athletic activities (whether sporting or industrial), it is impossible to maintain concious awareness of what muscle are working and when. This may be possible during weightlifting maneuvers, but not what I would have label "real-life" activities.
With this in mind, shouldn't we train our clients to be able to move in as many directions as possible under a variety of different loads and circumstances? Just a thought, would love to hear others opinions.
mike t
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Re: Rehab / Training Myths - March 17, 2005 9:49:00 AM
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JLS_PT_OCS
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Mike T-
I would agree on the concept of varied load and circumstances, but there is evidence to suggest that neuromuscular retraining can both reduce injury rate and change the mechanics of functional tasks such as jumping and landing.
So I disagree that patients can't be taught those types of things. Indeed, if they can't, I'm spending a lot of time each day that is wasted!
:)
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Rehab / Training Myths - March 17, 2005 6:06:00 PM
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SPORT-Rx
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Athletes should perform long, slow continuous activities to develop an aerobic base.
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Dan McGovern PT,DPT,SCS,ATC,CSCS
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Re: Rehab / Training Myths - March 17, 2005 9:34:00 PM
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Randy Dixon
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I agree with Jason about training proper movement. Obviously every athlete gets in positions that aren't optimal but that doesn't mean that they shouldn't train to get there as often as possible. Oddly this doesn't mean I disagree with Mike.
About the knee over toe. There is a reason why there is a saying "never say never". Of course the knee must come over the toe sometimes. I'm not sure it is even possible to walk or run without it doing so. In anything besides a parallel stance also, the rear knee will usually come past the toe. What I was referring to is squatting from a parallel stance. I would add lunging to that also, since fencing was mentioned and I coach fencing. The forces on the knee are greater, it is in a less stable position, and the force production changes from being generated by the hip extensors to the knee extensors so it is less efficient and forceful. In shallow squats and lunges it probably doesn't make that much difference and I wouldn't worry about a small extension over the toe.
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Re: Rehab / Training Myths - March 18, 2005 4:53:00 AM
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apolipo
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I get the feeling Jason & I are closer to agreement than we realize. My point is that as an athlete regains their previous functional ability following an injury (irregardless of anatomical location), they need to be rehabed/trained to take that body part as far and as fast and as forcefully as they will need to during whatever athletic activity they participate in. Otherwise, whether they are ready to return to action is truly a guess.
I fully agree with Jason's comment on neuromuscular re-ed. It is most of what I do with low and high level patients. I don't feel you can teach some to concentrate on the firing pattern of a particular muscle in the midst of an athletic event, whether it be football, a marathon, or standing in the batter's box waiting for a pitch. There are to many external factors that require the athletes immediate attention.
Should a particular muscle, muscle group, or antagonistic muscles be dysfunctional, we as PTs need to figure out how to develop strength and control, especially at higher functional levels, by designing specific activities to create an enviornment where the muscle/s can work within its capabilities.
This is not to say I might not use self-biofeedback or active attention to muscle contraction, but this is mostly in the initial stages of rehab, to develop better concious awareness of muscle function and how it compares to the contralateral side.
Any thoughts?
mike t
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Re: Rehab / Training Myths - March 18, 2005 5:36:00 AM
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JLS_PT_OCS
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Gotcha, Mike. Now I get it.
We do agree, and I'm sure we all use a similar progression for rehab.
I think it's less about focusing on firing a particular muscle and more about teaching proper and efficient movement. That whole "train movements, not muscles" thing, and it seems we're all doing that.
Thanks for the good discussion...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Rehab / Training Myths - March 18, 2005 6:03:00 AM
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jma
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"Water is all you need to replenish your thirst".
Maybe on the subjective level but on the physiologic level, what else needs to be replenished that plain water just doesn't supply?
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Re: Rehab / Training Myths - March 18, 2005 9:54:00 PM
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Randy Dixon
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I think water does it about 99% of the time. You can get a little boost by adding sugar and caffeine. Of course, electrolytes play a role but they don't usually need to be placed in the liquid. Extreme heat/humidity or long periods of sweating may make it advisable.
What did you have in mind?
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