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Updated: Nov 9 2021

Exercise Science

  • Types of Contractions/Movements
      • Types of Contractions/Movements
      • Type
      • Definition
      • Example
      • Isotonic
      • Force remains constant through ROM -improves motor performance
      • Biceps curls using free weights
      • Isometric
      • Constant muscle length and tension that is proportional to the external load-Causes muscle hypertrophy
      • Pushing against an immovable object
      • Concentric
      • Shortened muscle and tension that is proportional to the external load
      • Biceps curl with elbow flexing
      • Force remains constant as muscle lengthens
      • Most efficient method of strengthening muscle
      • Biceps curl with elbow extending
      • Muscle contracts at a constant velocity through varied resistance.-often used to objectively evaluate muscle strength during injury rehabilitation
      • Require special machines (e.g, Cybex).
      • Plyometric
      • Rapid eccentric-concentric shortening
      • Good training for sports that require power
      • Box jumps
      • Distal end of extremity moves freely
      • Seated leg extensions and curls
      • Closed chain
      • Distal end of extremity is fixed
      • Squats with planted foot
  • Anaerobic vs. Aerobic
      • Anaerobic vs. Aerobic 
      • Anaerobic 
      • Glycolytic
      • Aerobic
      • Energy source
      • Lactic acid
      • Oxidative phosphorylation (Krebs cycle)
        Glycogen and fatty acids 
      • Muscle type
      • Type II (A, B) muscle
        -fast twitching
      • Type I muscle
        -slow twitching
      • Exercise duration
      • 10 seconds of high intensity
      • 2-3 minutes
      • endurance
      • Note
      • Type IIA: aerobic and anaerobic
         Type IIB: primarily anaerobic, last to be recruited
      • Low ATP yield
      • Lactic acidosis after several minutes
      • High yield ATP
      • Requires O2
      • "Slow red ox muscles"
      • First to be recruited
  • Exercise Programs Definitions
    • Periodization
      • strength and conditioning term for planned variation in intensity and duration of a specific workout over a predefined duration of time
    • Dynamic exercise improves cardiac output by increasing cardiac stroke volume
    • Endurance (aerobic) Training
      • results in changes in circulation and muscle metabolism
      • contractile muscle adapts by increasing energy efficiency
      • increases in mitochondrial size, number, and density
      • increases in enzymes involved in Krebs cycle, fatty acid processing, and respiratory chain
      • over time, increased use of fatty acids > glycogen
      • over time, oxidative capacity of Type I, IIA, and IIB fibers increase
        • percentage of more highly oxygenated IIA fibers increases
      • Aerobic Threshold: level of effort at which anaerobic energy pathways become significant energy producer
      • Anaerobic (lactate) Threshold: level of effort at which lactate production > lactate removal
    • Strength Training
      • typically high-load, low-repetition activities
      • results in increased cross-sectional area of muscle due to muscle hypertrophy
        • hyperplasia (increased number of fibers) less likely
      • results in increased motor unit recruitment +/- improved synchronization of muscule activity
      • maximal force production is proportional to muscle physiologic cross-sectional area
      • adolescents can safely participate in appropriate strength training programs
        • gains in strength largely due to improved neuromuscular activation and coordination rather than muscle hypertrophy
        • gains for adolescents are reversible if training is discontinued
  • Aquatic training
    • Benefits
      • decreases joint stress by lowering vertical component of the ground reaction force through buoyancy
      • unique advantages in cardiorespiratory fitness when compared to land training
      • less abrupt increases in heart rate
      • increased oxygen consumption
      • prevents secondary injuries to the lower limb
  • Exercise Induced Laryngeal Obstruction (EILO)
    • Commonly mistaken for exercise-induced bronchoconstriction in athletes
    • Epidemiology
      • gender - more common in females
    • Mechanism - unknown
    • Symptoms
      • dyspnoea
      • wheezing
    • Differential diagnoses
      • exercise-induced bronchoconstriction (EIB, or exercise-induced asthma)
      • hyperventilation
      • cardiac conditions
    • Diagnosis
      • negative bronchodilator reversibility test (with beta2-agonist)
        • positive in EIB
      • negative bronchoprovocation tests (e.g. methacholine challenge, mannitol challenge, eucapnic voluntary hyperventilation test)
        • positive in EIB
      • positive continuous laryngoscopy during exercise (CLE)
    • Types (anatomic location)
      • supraglottic level
      • glottic level
    • Treatment
      • optimum treatment is being investigated
  • Exercise-Induced Hematuria
    • Epidemiology
      • Incidence
        • Microscopic hematuria present in 16.7 - 46.7% of athletes
        • Macroscopic hematuria present in 3.1 - 19.2% of athletes
      • Risk Factors
        • Exercise intensity
        • Posture
        • Age
        • Heat load
        • Altitude
        • Pre-existing kidney disease
    • Pathophysiology
      • Proposed pathophysiology of exercise-induced hematuria
        • Bladder/kidney contusion from up and down motion
        • Vascular spasm to kidney
    • Presentation
      • History
        • Presence of hematuria correlates with increased exercise intensity
      • Symptoms
        • Asymptomatic
    • Differential
      • Urinary tract infection or Sexually transmitted infection
        • Pyuria and dysuria
      • Papillary necrosis
        • Personal or family history of Sickle cell trait or disease
      • Kidney Contusion
        • Blunt impact to flank and flank pain
      • Kidney Stone
        • Dysuria and flank pain
    • Treatment
      • Nonoperative
        • Cessation of exercise, repeat urinalysis in 48-72 hours
        • Further workup indicated if:
          • Hematuria persists >7 days after cessation of exercise
          • Age >50
  • Weight training
    • Effects on muscles
      • increased cross-sectional area
      • increased strength
      • increased mitochondria
      • increased capillary density
      • thickened connective tissue
    • Adult strength gains are associated with muscle hypertrophy
    • Adolescent strength gains occur more from increased muscle firing efficiency and coordination
  • Nutritional training
    • Carbohydrate loading
      • involves increasing carbohydrates three days prior to an event and decreasing physical activity to build up carbohydrates stores
      • increases the stores of muscle glycogen to provide improved endurance, especially in events lasting > 90 minutes when the bodies normal supply of glycogen runs low
      • best technique for athlete is to instead maintain normal diet
    • Fluid loading and replacement
      • magnitude of core temperature and heart rate increase accompanying work are proportional to the magnitude of water debt at the onset of exercise
      • best technique is to replace enough water to maintain prepractice weight
    • Fluid carbohydrate and electrolyte replacement
      • best done with low osmolarity (< 10%) fluids of carbohydrates and electrolyties which enhances absorption in the gut
        • glucose polymers decrease osmolarity
  • Muscle Injury
    • Muscles soreness
      • caused by edema and inflammation in the connective tissue
        • leads to increased intramuscular pressure
        • occurs primarily in Type IIB fibers
      • worse with unaccustomed eccentric exercise
      • often with delayed onset: Delayed-Onset Muscle Soreness (DOMS)
        • peaks at 24-72 hours
      • elevated CK levels seen in serum
    • Muscles strain
      • occurs commonly at myotendinous junction (often during eccentric contraction which produces highest forces in skeletal muscle)
      • pathoanatomy in inflammation followed by fibrosis
    • Muscle contusion
      • non-penetrating blunt injury
      • leads to hematoma and inflammation
      • extracellular connective tissue forms within 2 days, peaks between 5-21 days
      • healing characterized by late scar formation, variable muscle regeneration
      • myositis ossificans (bone formation within the muscle tissue)
        • most apparent 4 weeks post-injury
    • Muscle laceration (complete tear)
      • typically occur near myotendinous junction
      • characterized by abnormal muscle countour
      • fragments heal by dense connective scar tissue
        • mediated by myofibroblasts
          • TGF-beta stimulates differentiation and proliferation of myofibroblasts
      • regeneration and renervation: unpredictable and likely incomplete
  • Muscle Immobilization
    • Can result in shorter muscle position and atrophy
    • Leads to decreased ability to generate tension and increased fatigability
    • Results in fatty infiltration
    • Atrophy occurs faster in muscles crossing a single joint
    • Atrophy occurs at a non-linear rate
      • most changes occur during initial days of disuse
      • seen at cellular level: loss of myofibrils within the fibers
      • related to duration of immobilization
    • Atrophy is more prominent if immobilization occurs without tension
      • quadriceps atrophy greater than hamstrings with knee immobilization in extension
  • Treatment
    • Local treatments designed to assist with soft tissue recovery or rehabilitation
    • Goals of treatment
      • decrease inflammation
      • increase local blood flow
      • increase tissue compliance
    • Modalities include
      • cryo or heat treatments
      • massage
      • ultrasound
      • electrical stimulation
      • Iontophoresis
        • use of an electrical current to drive charged molecules of medicine through the skin to the deep tissues
        • medications including steroids, local anesthetics, salicylates, and non-steroidal anti-inflammatory drugs (see table below)
        • indications - see table below
        • contraindications
          • susceptibility to applied currents e.g. cardiac pacemakers
          • hypersensitivity/allergy to drug used
          • Iontophoresis
          • Indication
          • Iontophoresis Drug/Solution
          • Hyperhydrosis
          • Tap water, glycopyrrolate
          • Muscle spasm
          • Magnesium sulfate, calcium chloride
          • Edema
          • Hyaluronidase
          • Adhesive conditions
          • Iodine
          • Inflammation
          • Dexamethasone, hydrocortisone, prednisone, lidocaine, salicylates
          • Calcific tendinitis
          • Acetic acid
          • Myositis ossificans
          • Acetic acid
          • Open wounds
          • Zinc oxide, tolazoline hydrochloride
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