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Re: Static contraction training
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Re: Static contraction training - November 15, 2005 8:56:00 AM
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JLS_PT_OCS
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This is what I mean about someone on one side of a debate hearing only the most opposite viewpoint and not taking what was said in context.
For clarification, Tom-
Neither I nor Randy disagrees with your perspective on specificity of training and relating function to training.
Neither I nor Randy are saying that static contraction training or SAQs for PFPS should be the only mode of training, merely that in some programs, for some clients/patients, it may have a place, and should not be dismissed as it has potentially useful characteristics in an individual case.
To speak of your discussion of open chain exercise being reliable but not valid: Either you do not understand the meaning of these terms, or you mis-typed what you meant.
I have posted evidence, see above link and below text, of a study directly comparing open vs closed chain exercise and their effects on long term function for patients with patellofemoral knee pain. I will paste some pertinent information from the abstract here, for ease of use. This was a study with an N of 60, it is a well-constructed trial with long term followup. The size of the trial was large enough to avoid Type II error for a medium or larger effect size, and significance was set at P<.05 to avoid Type I error. One group did ONLY open chain exercise, another did ONLY closed chain exercise.
What is not "valid" but merely "reliable" about these results?
I agree that a functional approach should be taken with all patients and that this study did not attempt to identify impairments related to an individual case and classify them into a group where they were most likely to succeed with specific therapy [for example hip weakness for proximal strength and control or overpronation for foot biomechanical aspects, etc], as this may be another classification issue.
However, to say the results of this large and well-constructed trial are reliable but not valid speaks to a lack of understanding of research literature and appraising evidence.
I do use SAQs occasionally in those with PFPS, especially if the exercise is nonpainful, they do not tolerate closed chain exercises as well, they have an extension lag, or marked quadriceps weakness. Taken as only ONE PART of a complete rehab program addressing function, strength, and pain....it may have value for many patients. This type [open chain] of exercise has been shown to be effective in the rehabilitation of people with patellofemoral pain.
Am J Sports Med. 2004 Jul-Aug;32:5; 1122-30
Open versus closed kinetic chain exercises in patellofemoral pain: a 5-year prospective randomized study.
BACKGROUND: Today, no clinical studies have been undertaken to examine the long-term effects of an open kinetic chain or closed kinetic chain program. HYPOTHESIS: The long-term follow-up results after a conservative exercise protocol are significantly worse than the short-term results. The long-term effect of closed kinetic chain training is significantly better compared to the effect of open kinetic chain training. STUDY DESIGN: Prospective randomized clinical trial. METHODS: Sixty patients were randomized into a 5-week conservative program, consisting of only closed kinetic chain exercises or only open kinetic chain exercises. Assessment of muscular characteristics, subjective symptoms, and functional performance was evaluated in this study at the time of initial physical examination, at the end of the treatment period, and 5 years later. RESULTS: At the 5-year follow-up, both groups demonstrated maintenance of good subjective and functional outcomes achieved immediately after the conservative treatment. No significant difference between both groups was observed at the 5-year follow-up for the majority of the examined parameters. However, on 3 of the 18 visual analog scales, the open kinetic chain group showed significantly less complaints compared to the closed kinetic chain group. CONCLUSIONS: On the basis of these results, the authors conclude that both open kinetic chain and closed kinetic chain programs lead to an equal long-term good functional outcome.
_____________________________
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: Static contraction training - November 16, 2005 3:15:00 AM
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Randy Dixon
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Well, I have forgotten to reply to this post earlier and Jason addressed most of what I wanted to say. Tom seemed to polarize the discussion into Static contraction versus functional training, which is better? Or SAQ's vs functional training. But this was not the question or the arguments presented.
There is sport specific and skill specific training and there is training for specific physiological attributes. These are different, and why we often need to cycle training for athletes and differentiate them for patients.
The implication of my initial question is that functional training, sport and skill specific training, is the most valuable. Yet in many sports during the competition season, strength and muscular weight both decrease. I was wondering if this could be addressed by Static Contraction without taking excessive time away from more valuable training.
I think the argument against this is that if there is enough stress induced by the training to increase strength and size then we can easily tip over into overtraining or at least diminishing the other training being done. SC has less physical work being done, but the physiological work may be equivalent.
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Re: Static contraction training - November 18, 2005 10:40:00 AM
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truthseeker
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I will post a response but I haven't had time to do so. Sorry. I didn't mean to start a fight here, just want people to think about other possible paradigms of treatment. I find it interesting that the name of isometrics changed. That is the only reason I responded in the first place. Custodian vs janitor vs sanitation engineer etc ...
There are several studies that I will post that support the avoidance of SAQ for biomechanical reasons. There are far better ways to accomplish the same thing and given that our patients have limited time to do our home programs and are often less than compliant, I try to give them the essentials. I have no problem showing someone isometrics if that is the best exercise for them. if there are other options that meet more than one objective I would rather do that.
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Re: Static contraction training - November 18, 2005 7:02:00 PM
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Randy Dixon
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To tell you the truth Tom, it seemed to me that you were making more of a statement of treatment philosophy than actually responding to what was posted. But we like to pick apart things sometimes. If you have read either mine or Jason's other postings you would have realized you were preaching to the choir.
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Re: Static contraction training - November 19, 2005 2:24:00 AM
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truthseeker
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I have and I think that's why I started, it seemed out of character and I wanted you back in the fold.
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Re: Static contraction training - November 23, 2005 10:13:00 AM
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truthseeker
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as promised, here is my arguement against SAQ. I realize that the discussion went off topic on my account, but I felt I had to respond to Jason's post.
SAQ are non-functional.
Knees rarely get hurt or have pain when they are in the air.
When the affected limb is in the air, the normal proprioceptive input that excites the VMO and all other muscles to contract are absent.
SAQ do not preferentially train any of the quadriceps. The VMO contraction is not exaggerated here over VL contraction. (Gryzlo, et al, JOSPT, July 2004)
SAQ DOES isolate the quads which maximizes PF compression.
Exercise occurs in the range of motion where the least amount of patello-femoral contact occurs. (this is bad)
Exercise occurs in the range of motion where the mechanical advantage of the quads is at its poorest.
This means that the greatest amount of force is occurring across the smallest area of contact in order to do something that is not functional.
(Grood, et al, JBJS June 1984)
Question: when do patients complain of the most pain?
Answer: When descending stairs - a quad dominant activity.
Question: What specifically causes the pain?
Answer: Patellar compression.
Question: Why do we treat compression pain by maximizing compression?
Answer: It really doesn't make any logical sense does it.
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Re: Static contraction training - November 28, 2005 6:18:00 AM
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JLS_PT_OCS
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Hi Tom.
Thanks for your reply.
Did the reliability/validity thing make sense OK?
A couple of questions for you, by way of devil's advocate, since I think we agree in principle about the care of patients here, but I believe you are unnecessarily throwing out the baby with the bathwater.
1. You said SAQ are nonfunctional. Please define nonfunctional. SAQ involves contraction of a muscle against gravity to strengthen it, which seems pretty functional to me. This is analogous to giving shoulder pain patients external-rotation strength exercises, which I do frequently, and I am willing to bet you do as well.
2. I don't understand your contention that the exercise occurs in the ROM where the least amount of contact occurs, and then also say it's bad to treat compression with compression? I believe these are contradictory statements. Can you help me reconcile them?
3. Can you review for me at what points in the range of motion of the knee the PF contact areas and pressures are greatest and least? Lee et al (JOSPT 2003) gave a great summary and indicate that the studies, both in vitro and in vivo are quite conflicting, even between different genders and in open vs closed chain conditions. However, you seem pretty sure of yourself, so maybe you know the real answer, and the researchers haven't taken the same CEU courses you have. Please enlighten me.
4. I don't understand your contention of stairs being a quad dominant activity and how that relates to the discussion. I don't diagree with the prime musculature involved, but since it is closed chain, I'm not sure how that supports your point?
5. Are you certain that PF compression is the "cause" of the pain? If it were that simple, then anything increasing compression would worsen symptoms. Most studies agree that compression increases significantly after 90deg of knee flexion, yet these activities are rarely what our PFPS patients complain of doing.
6. If the pain is not from simple compression, then perhaps it's some complex interaction between contact area, total pressure and areas of tissue that have exceeded their ability to adapt to the stress? If that's the case, and we agree that studies are mixed regarding angles and conditions of PF stress/contact pressure, then perhaps SAQs are may have a place in the care of an individual patient with PF pain?
Thanks for the discussion.
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: Static contraction training - November 28, 2005 10:59:00 AM
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truthseeker
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I will try to clarify what I meant by my posts.
1. A non-functional exercise is one that is devoid of the typical angles, velocities, and proprioceptive inputs of a life activity. SAQ do contract the quads, they do provide strengthening of the quads but they are devoid of the normal proprioceptive input that normally tells the quads when to contract. i.e. it doesn't matter how strong a muscle is if it does not know when to contract.
2. According to Grood (full reference in my last post) the area of least contact (physical contact, least congruence) between the patella and the femur is in the last 30 degrees of terminal extension. The mechanical advantage in that range is the poorest. Therefore, in order to generate lets say 1 N of knee extension force, 7 N of patello-femoral compression must occur. If this occurs in the angles of the least congruency between the patella and the femur the the N/square cm is maximized. i.e. smaller area and increased force. If the reason the PFS developed is because of poor articular cartilage nutrition, and the poor nutrition occurred because of excessive or prolonged compression of that cartilage, then treating it by maximizing the compression over the smallest area possible (likely the site of the thinnest cartilage and the pain generator) does not make logical sense. I hope that explains that point. I find it hard to describe this without models and my hands.
(articular cartilage is alive but has no blood supply and no sensory nerve endings. It gets nourishment from the "sloshing" of the synovial fluid. If there is constant or excessive contact between joint surfaces, the fluid is not "sloshing". If that occurs for a long enough period of time the cartilage will get sick. When it gets sick, it gets soft. When it gets soft, it is succeptible to shear forces and grows thinner. Then the forces that the articular cartilage are supposed to disperse, get delivered directly into the bone which is highly innervated and causes pain)
3. First of all, I detect a bit of a snotty tone, maybe its just me,but lets keep it civil. I referenced several articles one of which is older but a classic reference and good science. (the Grood article) It outlines the ranges in which, in general, the joint is most and least congruent.
4. I mentioned DESCENDING stairs as a quad dominant activity. I related that to patello-femoral patients and how that is often the most provocative activity that they do. When descending stairs, the hamstrings and gluteals are relatively quiet. Try doing a squat sometime and allow your knees to move in front of your toes. Where is the work being done? It is in your quads and your calves. Feel it with your hands. When ascending stairs, the hip is in a bit more flexion causing the hamstrings and gluteals to work more, dispersing the work and relying less upon the quads. Therefore, there is less patello-femoral compression. My point was to make a parallel between a quad dominant functional activity (descending stairs) and a quad dominant non-functional activity (SAQ) You don't have your patients seek stairs to descend when they have PFS so why would you have them do SAQ that has no functional carryover (even descending stairs which is something I recommend my patients avoid when possible is something that people do in real life, and it offers proprioceptive input at least training the quads when to contract)
5. Passive flexion or active extension past 90 degrees certainly increases total compression because of the angle of the knee and the compression vectors with the change in direction of the forces. But compression per unit area is vastly increased in the last 30 degrees because of the reduced area of contact between the patella and the femur. This is where our patients experience symptoms and SAQ occur in that very range.
6. You are correct in your statement in number 6. I do not, however, understand your leap of logic to the final conclusion that SAQ have a place in the treatment of PFS. It is simply a provocative exercise that exaggerates the very reason that the patient is there in the first place. Also, it does not do what it was intended to do when it was first described. Somebody looked at the knee in the last few degrees of extension and saw a little bulge. They made the assumption that the VMO must be more active in that range. EMG studies have disproven that assertion.
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Re: Static contraction training - November 29, 2005 7:02:00 AM
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JLS_PT_OCS
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Hi Tom.
I'm not trying to be snotty. Perhaps I'm a little curt because I believe you stormed into this thread with little more than opinion to back your points, and an obvious misunderstanding of how to appraise and apply clinical research. I apologize if I came off snotty, wasn't my intention.
Thanks for your clarifications, I'll address them here:
1. Thanks for defining functional, I understand more of what you mean now. Are you saying that so-called "nonfunctional" exercises are inappropriate for rehabilitation? If so, do you not give patients conditioning and strength exercises such as: prone shoulder/scapular work, standing or lying shoulder ER strength, prone Lx strengthening, or SLRs for the knee? None of these exercises meet your definition of 'functional' yet I believe we can all agree that they may have a place in the rehab of an individual patient, and are in fact quite commonly recommended based on EMG studies of activation. Surely if you are throwing out SAQs on this principle, then you must reject the others I mentioned as well, right?
2. I understand your point about the compression/contact area now, and I have read the Grood article. Have you never seen a patient with PFPS that wasn't painful in an SAQ? Is the area of painful cartilage in every PFPS patient always the same exact spot that absorbs force in the SAQ? Perhaps your sample of PFPS patients is more....homogenous than mine. I've met lots of people with chronic PFPS (including me) who get no knee pain and a good quad strength workout from a properly prescribed SAQ at the right point in their rehab. Of course, that's only part of the complete program. So my direct experience contradicts your assertion, in addition to the study I cited earlier about open chain vs closed chain rehab in PFPS patients, the knee extension machine was a part of the rehab program in the open chain group, by the way.
3. Snottiness. Addressed above. My nose has been wiped. :)
4. You mentioned that stair descending is a functional but painful exercise, and I mentioned SAQs as a nonfunctional, freqently not painful, supplementary exercise that might be useful. For people with very poor hip musculature control (Powers et al) who cannot tolerate single leg closed chain exercise, I would give an SAQ to them if the circumstances were right. Especially if the "functional" stuff is painful and strength/bulk of quadriceps is a possible issue.
5. This is my point in that it is about an interaction between compression amount, contact area, and certain areas of the cartilage that have had their capacity to absorb force reduced. If an SAQ (or substitute any exercise you like here) does not cause symptoms by irritating the same area of cartilage that is overworked, then why should it be rejected out of hand?
6. I am actually not making the VMO argument, but you are right, people do tend to still do that. I wish I had a nickel for every PFPS patient referred with a request for "VMO strength"... quite an outdated paradigm, I agree.
Athletes still do the bench press even though very few sports involve lying on your back and pushing up. But it is a great multi-joint conditioning exercise. Jumpers still squat for the same reasons. Both of these exercises have shown good correlation to more "functional" performance. Patients rehabbing their injuries, in my clinic anyway, will sometimes perform what are considered "nonfunctional" exercises at some points in their rehab for the same reasons.
I think the functional revolution thing is great, but like all new paradigms, it tends to go further than the research support for it actually allows. It's proponents also tend to demonstrate an "irrational exuberance" at times for it's promulgation. I just think readers of the forum should not think using a sound treatment philosophy and approach(functional paradigm) means that all other methods are faulty and have no value. That is not the case.
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: Static contraction training - November 30, 2005 8:28:00 AM
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truthseeker
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First of all, I disagree with you when you say that I don't understand how to appraise and apply clinical research. My opinions are based upon what I read, what I observe, and what I learn at continuing education courses, same as you. I have a successful practice, my patients get better and like what they do. I am not a salesman or a zealot. I simply look for the most effective treatments. They must pass the smell test, they must be logical, and if they have research to support it, even better. As you said, when paradigms shift, there is a wealth of philosophy and a dearth of research initially. Powers is doing a great job of doing some research. It seems to support the concept of functional training to address the underlying failures of our patient's movement patterns that cause them to develop one diagnosis or another. That said, I am not eager to throw certain exercises out with the bath water, but if you agree in principle with the concept of functional training being generally superior to non-functional training, and assuming that your patients have as little disposable time as mine to do their home programs, and given the direction that health care is going with regard to capitation and health care savings accounts, we had better become more efficient in our treatments. We cannot expect to generate $190 per visit. No one will pay that out of their own pocket. Why? Because it is outrageous.
Now to respond to your points one by one.
1. No I don't intruct my patients in lying ER/IR exercises initially. Why? Because the damaged rotator cuff muscles failed or developed an -itis because they were overloaded, not necessarily because they were weak. It is more sensible (to me anyway) to integrate ER/IR contractions into functional patterns and improve the function of the muscle groups and movement patterns that were inadequate and caused the problem in the first place. The target muscles get loaded, but are not isolated. Eventually, I may isolate ER or IR mm but certainly not first. Analogy: If you have a person who loves to sing but has no talent and they insist upon singing in church, does the choir director assign them a solo or do they bury them in the chorus? They have them sing in the chorus until they are better, then they remove backup. I.e. they put them in a quartet, then a duet, then a solo.
SLR, yes I teach them but only until the patient is able to lift their foot into and out of bed. Once they can do that, they have met that functional goal and no longer need to do it.
Prone scapular work: I work mostly in sitting and standing since that is the orientation to gravity that those muscles function in. I have instructed people in those exercises if they are going to need increased load to reduce scapular posture imbalances, for example if they intend to continue to do bench press and such.
Bench press: this exercise is taught by coaches and is used as a measurement to determine basic strength. When I was in high school football they tested bench press, 40 yd dash, and 12 minute run. only one of these things is predictive of function (football is at least in part, a measure of individual function, not a measure of who is the storgest) Often, the lineman who could bench the most was not the best lineman.
EMG - the EMG studies that I have read do clearly identify what muscles are activated in the clinic and at what angles and positions. Unfortunately, most of them are not testing the person while doing a functional activity. There are some, and I am sorry, I don't have the links but Google "function and emg" and you will find some. Because the muscle can and does contract in a certain exercise does not mean that it is the best way to elicit a meaningful contraction. The point is, if a muscle does not know when to contract, it does not matter how strong it is.
2. Of course my population is not homogeneous and of course there are people who have no pain with SAQ and do have pain with minisquats. And of course it is not the same exact place in the lateral patellar facet that causes the pain. We are not talking about individuals we are talking about efficiency of our rehab process. We know lots of exercises and methods of reducing PFS. I simply submit that there are gajillions of more effective ways to do so than SAQ that are not potentially harmful AND strengthen the right muscles AND are ususally less painful when done correctly.
3.
4. If single leg weight bearing activities are too painful, can you think of no other functional activity that is non-provocative and still achieve the same functional goals? How about bilateral weight bearing, or frontal plane VMO stimulation(pronation/supination), or transverse plane motion with bilateral weight bearing or even single leg with less knee flexion? If the functional stuff is painful, I think you may not have a sufficient number of variations that still provoke a proprioceptive/automatic muscular response.
5. Since articular cartilage is devoid of sensory nerves, if your SAQ are not painful, you are loading a different area of the joint. That does not make it appropriate. By increasing the load in that region (the non-painful one) I believe that you are accelerating the degenerative changes in THAT area and accomplishing very little.
6. Wow, we agree!
If you had to chose between doing low velocity squats with big weight and plyometric vertical hops to improve jumping performance, which would you chose? If you had to predict who would be a better offensive lineman with one test, would you chose the bench press or a medicine ball throw? If you wanted to hire a warehouse worker and you could do one test and one test only would you see how many isloate Frank Jobe shoulder flexion exercises to 90 degrees with 10 pounds they could do or would you see how many power cleans they could do? I'm guessing that you would pick the latter in each case.
When you consider that the likelihood of compliance increases with the simplicity and familiariy of the home exercise program, and that people have limited time to do the HEP don't you think that the functional is better than the non-functional? If so, if you are able to fill out someone's HEP with functional exercises, Why would you throw in non-functional ones that can potentially do harm when you can substitute a functional one that has less chance of doing harm?
I don't understand the attachment to SAQ. Many people do them because they were taught to do them.
Paradigms are hard to change. Try not to cling to hard to old thoughts and I will try not to be closed minded about some of the things I learned in AT and PT school. I have come to the fundamental assumption that muscles need to have a cue to fire independently of conscious thought in order to react before injury occurs. If we train movement patterns, instead of isolated strengthening, we are reinforcing the pattern. If we are isolating, we are reinforcing the muscle's contraction without propriceptive input. That is, we may be DE-TRAINING its function.
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Re: Static contraction training - December 1, 2005 3:56:00 AM
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JLS_PT_OCS
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Tom-
I think this debate is growing more polarized and less helpful for us and everyone else.
I know we are on the same page about the general functional approach to rehab, and that we agree.
However, I am not willing to discard any supplementary conditioning exercise out of hand because it does not fit a certain paradigm of thought.
Once again, do not turn this debate into an either/or situation such as your comments here:
"If you had to choose between doing low velocity squats with big weight and plyometric vertical hops to improve jumping performance, which would you chose? If you had to predict who would be a better offensive lineman with one test, would you chose the bench press or a medicine ball throw? If you wanted to hire a warehouse worker and you could do one test and one test only would you see how many isloate Frank Jobe shoulder flexion exercises to 90 degrees with 10 pounds they could do or would you see how many power cleans they could do? I'm guessing that you would pick the latter in each case."
No one is arguing these general points with you. Randy cautioned against this very phenomenon in his NOV 16th post. It is not a question of SAQs OR functional rehab. No one, I mean, no one is arguing this point. The only difference between us is that you seem willing to reject a supplementary conditioning exercise as useless and state that it has been "soundly disproven" when much clinical experience and peer-reviewed evidence supports it's use.
Using a functional paradigm while keeping supplementary methods and procedures for individual patients is "not" analogous to doing EITHER functional rehab OR mindlessly pursuing as you said "soundly disproven" exercises.
Hence the baby-bathwater example.
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: Static contraction training - December 1, 2005 5:53:00 AM
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Shill
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You guys need to look into superiority of outcomes with "this technique versus that technique, or this exercise versus that exercise". The problem with these is that they dont exist, save for one or two comparisons of open versus closed chain, which shows that both can be helpful, as Jason pointed out.
We simply dont know if functional exercise is better, and non-functional is inferior. Sure it is logical, plausible, etc, etc, but we just dont know. There is a whole lot of uncertainty that will probably not go away. You gentlemen are undoubtedly both excellent therapists who get excellent results. You demonstrate the reflective thought processes of expert level clinicians. You can agree to disagree with this one, neither is right or wrong.
Im just glad you are not arguing over healing touch versus craniosacral.
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Steve Hill PT
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Re: Static contraction training - December 1, 2005 12:26:00 PM
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truthseeker
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Thanks Shill. You are right. We must agree to disagree.
I have to get to some of my energy patients now. {:-)
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Re: Static contraction training - December 1, 2005 8:12:00 PM
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Randy Dixon
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Besides every knows that healing touch is better.
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Re: Static contraction training - December 2, 2005 5:51:00 AM
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JLS_PT_OCS
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Tom, did you get that craniosacral referral patient I sent you? I couldn't get him any better with my proprietary "Myofascial Reflex Release" stuff...
:)
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: Static contraction training - December 2, 2005 6:08:00 AM
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avalon
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Hi all,
I definetely think that functional/natural exercises are better than artificial =>
Mood alterations in mindful versus aerobic exercise modes.
Netz Y, Lidor R.
School of Physical Education, The Zinman College of Physical Education and Sports Sciences, Wingate Institute, Israel. neyael@macam.ac.il
The results of most recent studies have generally indicated an improvement in mood after participation in aerobic exercise. However, only a few researchers have compared mindful modes of exercise with aerobic exercise to examine the effect of 1 single session of exercise on mood. In the present study, the authors assessed state anxiety, depressive mood, and subjective well-being prior to and following 1 class of 1 of 4 exercise modes: yoga, Feldenkrais (awareness through movement), aerobic dance, and swimming; a computer class served as a control. Participants were 147 female general curriculum and physical education teachers (mean age = 40.15, SD = 0.2) voluntarily enrolled in a 1-year enrichment program at a physical education college. Analyses of variance for repeated measures revealed mood improvement following Feldenkrais, swimming, and yoga but not following aerobic dance and computer lessons. Mindful low-exertion activities as well as aerobic activities enhanced mood in 1 single session of exercise. The authors suggest that more studies assessing the mood-enhancing benefits of mindful activities such as Feldenkrais and yoga are needed.
PMID: 14629072 [PubMed - indexed for MEDLINE]
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Re: Static contraction training - December 2, 2005 10:56:00 AM
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nari
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I have just read through this thread for the first time, and found it quite insightful. Shill is quite right - there is not much in the way of evidence that isometric is definitely superior to isotonic in any or certain situations.
As a rider, I might add that PFPS has slid into a bit of a misnomer here, like the old term RSI. It has not much to do with the poor patella, which has been blamed for all sorts of misdemeanours, because it is visible and easier to blame.
But I have to agree with Tom's line of reasoning, however valid or not it may be. Functional weightbearing is the crucial factor. There was a study done (sorry, I haven't access to it right now) where post-THR patients were all mobilised at the same time, but one group was given all the exercise stuff as well as mobilising; the other group did no "exercise" orders, only WB mobility.
Both groups did equally well. Isometric/isotonic stuff made no difference to outcomes....
There are gajillions of other ways to 'strengthen' the knee other than SAQs, squats etc, and carry much less risk of antagonising a cranky peripheral structure.
I suspect that nonfunctional, nonweightbearing exercise with minimal stimulus will be proven one day to be inferior to most other "treatments".
A good understanding of pain physiology makes me reason this way. It's an opinion, sure, at present. I think this is what Tom is really saying....right Tom?
Nari
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Re: Static contraction training - December 2, 2005 4:26:00 PM
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truthseeker
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I think we understand each other Nari. It is the patella that hurts, but it is not the patella's fault. The fault usually lies in the foot in my experience, and you can't train the foot to do better when it is in the air.
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Re: Static contraction training - December 2, 2005 8:17:00 PM
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Randy Dixon
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And here I thought that this thread had ended. I won't offer my opinion on SAQ's. Again, we are all in virtual agreement on functional movement, I don't understand how come that isn't clear.
I just returned to this thread because of something Tom had posted earlier
"If you had to choose between doing low velocity squats with big weight and plyometric vertical hops to improve jumping performance, which would you chose? If you had to predict who would be a better offensive lineman with one test, would you chose the bench press or a medicine ball throw? If you wanted to hire a warehouse worker and you could do one test and one test only would you see how many isloate Frank Jobe shoulder flexion exercises to 90 degrees with 10 pounds they could do or would you see how many power cleans they could do? I'm guessing that you would pick the latter in each case."-Tom
In the first example, it would depend entirely on the patient I was dealing with. If the deficiency is in absolute strength, which is sometimes the case in rehab, often the case in beginner's, and very often the case with girls, then I would definitely choose high weight/low velocity squats over plyometrics. That is the two choices I was given right? I know that adequate leg strength is a prerequisite to plyometrics to prevent injury. Of course, I wouldn't confine myself to an either/or position which is what the question requires.
The other two example are tests, not exercises. There is little doubt that the best test, most closely resembles that which we want tested. If I want to know how much someone can lift, then I have them lift. This doesn't mean that having them do the same lift that is required is the best or only way to improve that function.
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Re: Static contraction training - December 2, 2005 9:18:00 PM
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truthseeker
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true Randy, but most of real life function is essentially plyometrics if I define it as a contraction preceded by a quick stretch. In those terms, throwing a frisbee or simply supinating your foot is technically a plyometric exercise. I did not say earlier in this thread what I meant about plyometrics, but you could do low intensity plyometrics (not the traditional application I understand). You can't unload well unless you load well and that is the basis of function. I do not disagree that absolute strength is important, but in rehab, it is more critical to have the muscle contract when it is supposed to than it is to make it contract with big force.
Balance is just the interplay between your eyes, inner ear, and a whole bunch of stretch reflexes that sense changes in position. Balance equals proprioception, and good proprioception equals protection against injury (or re-injury). Go back to PNF, how do we make a muscle contract that can't? We apply a quick stretch. How do you jump? You go down first. How do you stimulate the VMO? I would work in the frontal plane since that is more the orientation of the VMO (rather than the sagittal) by starting with pronation followed quickly by supination.
Just think about it before you respond because I think that this is the foundation of functional rehab.
If you agree with the concept, then sidelying ER is less important in shoulder rehab than a (for the right shoulder) a L LE lunge done in concert with a D2 diagonal so that it looks sort of like a baseball throw in reverse. The elegance of that exercise is that you can reduce or increase the force AND you train the butt, trunk, scapular, and rotator cuff muscles to fire in the right sequences.
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