Advanced Rehab and Prehab(S&C)

1. Advanced Rehab and Prehab(S&C) Donnacha Mulcahy B.A, MSc

2. Training Variables • Reps • Sets • Rest Intervals • Tempo • TUT (time under tension)

3. Repetitions (reps) • One complete eccentric and concentric movement of a given exercise The number of reps for a given time under tension dictates the training effect -Shimano et al., 2006

4. Sets • A set is a number of reps performed in one effort Many Eastern Bloc have suggested that there is a inverse relationship between sets and reps. More reps the fewer sets – Hartmann and Tunnemann1995 Example -10 sets of 3 reps = relative strength - 3 sets of 12 = hypertrophy

5. Rest The length of rest interval is dictated by the training goal. • Pinicivero et al., 2004 Strength – Long complete rest Body composition/conditioning – short incomplete rest

6. Tempo • Tempo in weight training is the rhythm at which you raise an lower a weight, including the rest time at the top and bottom of a lift or return of the weight Tempo has a particular numeric scheme to describe different phases. For example, 30X1 means: 1 – The first number “3” is the time in seconds to lower the weight at the top, this is the eccentric phase. 2 – The second number “0” is the pause at the completion of the exercise or at the start of the lift. 3 – The third character “X” means an explosive lift in the concentric phase. 4 – The fourth number “1” is the pause at the top of the lift.

7. Time Under Tension - TUT Time under tension (TUT) is a way of calculating the total amount of work you place on a muscle. It refers to the total time a muscle resists weight during each set. For example, if you completed a barbell curl and it took two seconds to curl the weight up, and two seconds to lower it, that is four seconds of tension per rep. Performing 10 reps at this pace would take a total of 40 seconds. Therefore the TUT for that set is 40 seconds. If you increased the speed of those reps to three seconds, then it would take 30 seconds to complete a 10-rep set. Although, the number of reps and the amount of weight are the same, the second set might not increase your muscle mass to the same level as the first.

8. Training Effects Relative Power Functional Hypertrophy Endurance 1-5reps 6-8reps 9-12reps 12-20reps 0-20sec tut 20-40tut 40-70tut 50-120tut 300-180sec rest 180-120sec rest 120-90sec rest 90sec rest

9. Importance of VMO training

10. Importance of VMO training • The VMO is essential to the medial tracking of the patella with a 55* medial angle • VMO strength helps prevent petellofemoral pain syndrome • Helps to prevent and offset runner’s knee • Increases knee stability • Improves sporting performance and speed by lowering ground contact time • More likely to be weak in females due to increased valgus angle from the hip to knee

11. Poliquin step up (average populaiton) -Top heel elevated by heel raise, as high as ankle flexibility allows 45*+ • -Top leg ext rot 5-15* • -Top leg initiates the movement, no pushing off bottom leg. • -Dorsi flex the bottom leg to prevent this-Push through ball of the working leg • -The more weight in the ball of your foot the more focus on VMO • -Mind muscle connection is very important to stimulate VMO recruitment

12. Peterson Step Up -Top heel elevated no heel raise or support, as high as ankle flexibility allows 45*+ • -Top leg ext rot 5-15* • -Top leg initiates the movement, no pushing off bottom leg. • -Dorsi flex the bottom leg to prevent this • -Push through ball of the working leg • -Rise to full knee ext squeezing VMO • -Lower heel-Rise onto toes again • -Lower by flexing knee, keeping heel elevated and weight in the ball of the foot. • **difficult exercise to master, lots of practice needed to be able to properly demo!

13. Front Step Up Top leg ext rot 5-15* • -Top leg initiates the movement, no pushing off bottom leg. • -Dorsi flex the bottom leg to prevent this • -Push through ball of the working leg • -Rise to full knee ext squeezing VMO • -Use Different forms of loading dumb bells, bar bells on back, bar bell in front.

14. Side Step Up Stand side on a step • -Top leg ext rot 5-15* • -Top leg initiates the movement, no pushing off bottom leg. • -Dorsi flex the bottom leg to prevent this • -Push through ball of the working leg • rise to full knee ext squeezing VMO • -Use Different forms of loading dumb bells, bar bells on back, bar bell in front. • -This will also use Adductors more which are also important knee stabilizers.

15. Step Ups – Points to Remember • Start at low heights, as little as 1 inch and work up to as high as mid shin. • Vary the form of external resistance, i.e. cables, dumb bells, bar bells. • Ensure full knee extension is achieved. • Work on the mind muscle connection of squeezing the vmo for at full contraction. • No cheating by pushing off non working leg. Always work the weaker leg first.

16. Split Squats and Progressions

17. Why split squats and not lunge? Lunges are an excellent exercise for rehab when the client is ready to start loading the joints and muscles; however they have only a partial ROM. When the client has adapted to lunges a split squat progression program has a focus on increasing the ROM of the hip, knee and ankle joint in a unilateral manner bringing the client back to structural balance in strength and flexibility and allowing them to then safely move onto bigger bilateral movements such as squats. It should be noted that most sedentary or active individuals, will not have full ROM in ankle, knee and hip joints and will benefit from split squats. Even advanced athletes should be started at the first progression and worked up.

18. Teaching Points • Front leg does more of the work. • Front foot turned out 5° • Back foot facing forward with heel lifted. • Back heel out to increase psoas stretch. • Descend on an “escalator” not an “elevator”. • Stand on “tracks” not “tight rope”. Bottom position • Hamstrings covering calf belly. • Stay upright (lean back). • Back knee is behind hip. -Back leg is straight. • Back leg internally rotated (heel out).

19. Front Foot Elevated Flat Split Squat Bulgarian Split Squat