Posts tagged strengthening
Manual Therapy And Exercise Superior To Usual Care For Patients With Neck Pain

Neck pain will affect up to 70% of the population at some point in their lifetimes. Thankfully the vast majority of these cases are not serious in nature and will improve with conservative treatments including Physical Therapy. Within Physical Therapy, a manual therapy (mobilization and manipulation) and strengthening exercise approach has been shown to be more effective than primary care management or usual care Physical Therapy (modalities and exercise). In addition, patients treated with this approach only pay 1/3 the cost of primary care management for neck pain. In the research, as neck symptoms transition from acute to chronic high level exercise becomes even more important in the management of this condition reducing recurrence rates among these patients. A new research study highlights the importance of these interventions for patients with chronic neck pain.


Domingues and colleagues in the journal Clinical Rehabilitation studied the impact of manual therapy and exercise in patients with chronic neck pain (2019). 64 patients were randomized to either 12 visits of manual therapy and exercise approach or 15 visits usual care Physical Therapy. These patients were then assessed at 3 weeks, 6 weeks, and 3 month follow up time periods. Consistent with prior research significant improvements in pain, disability, and perceived recovery were found in the manual therapy and exercise group vs. the usual care Physical Therapy group alone. This study adds to our understanding on the importance of manual therapy and exercise in the management of patients with neck pain.

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Foot Atrophy And Weakness Consistently Found Among Patients With Heel Pain

Plantar heel pain, including pain along the plantar fascia, is one the most common diagnoses in the foot. Individuals often experience pain with the first step in the morning or after prolonged sitting. Symptoms limit their ability to perform many standing, walking, and recreational activities. Researchers have found minimal inflammatory cells within the plantar fascia among patients with heel pain indicating an ongoing healing process of the tissue (plantar fasciosis) similar to what is noted in tendon healing. The lack of inflammation is one reason for the failure of anti inflammatory treatments, such as medications and injections, in the management of this condition.

In addition, researchers are finding significant atrophy and weakness in the arch muscles of the foot within this population. These signs are even more pronounced among patients with long term orthotic use. Conversely strengthening of the arch musculature has been shown to be a promising treatment to reduce sensitivity and symptoms from the tissues of the foot. A new review of the evidence highlights the importance of these exercises.

Osborne and colleagues in the Journal Of Sports And Orthopedic Physical Therapy reviewed the available evidence on muscle structure and performance among patients with plantar heel pain (2019). Authors found weakness in the foot and ankle musculature within the studies,, but results were most consistent in the foot. Patients with plantar heel pain demonstrated significant atrophy and weakness of the foot musculature compared to their asymptomatic peers. This review supports the utilization of foot strengthening exercises to improve the performance of this muscle group in an effort to reduce abnormal forces across the injured tissues in patients with plantar heel pain.

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Which Lower Body Exercise Is Best For Hip and Leg Activation?

Strength training is an essential part of any workout program. Participants should aim for 2 to 3 workouts per week targeting major muscle groups of the upper and lower body. Multi joint movements such as the squat or deadlift provide a more effective and efficient workout compared to single joint exercises (ex. leg extension machine). The exercise prescription (sets, repetitions, and intensity) is more important than a specific exercise when developing muscle strength, but exercise selection remains important for addressing individual needs (weakness, tightness) and when working with a Physical Therapist after returning from injury. A recent research study determined which exercises are best for lower extremity muscle activation.

Delgado and colleagues in the Journal of Strength and Conditioning Research examined the muscle activation levels of the back squat, romanian deadlift, and barbell hip thrust (2019). Researchers captured the activation levels (EMG) of the quadriceps, hamstring, and gluteus maximus muscles during each exercise in a group of trained (> 1 year experience) men. EMG data was collected under two conditions: a 60 kg weight and at the participants one repetition max.

Similar to a previous study, authors found greater gluteus maximus recruitment in the hip thrust compared to the back squat. Interestingly, the hip thrust’s gluteus maximus recruitment was not statistically different than the romanian deadlift. As expected, quadriceps recruitment was greatest in the back squat and this exercise effectively targeted the knee and hip extensors. Conversely, hamstring recruitment was greatest in the romanian deadlift. This study highlights the ability of multi joint exercises to target multiple muscle groups throughout the lower extremity improving effectiveness and efficiency in your workouts.

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No Strength Gain Differences Found Between Low and High Load Exercise IF Reps Are Taken To Failure

In our previous blogs we have discussed the errors most exercise participants make when selecting intensity (amount of weight) while at the gym. Humans are often poor estimators and when it comes to strength training they often select weights below the intensity required to promote optimal strength and muscle gains. Trying to base a weight off a one repetitions maximum is time consuming, impractical, and possibly contraindicated for some weight training participants. Conversely, research articles continued to support using fatigue as an alternative to the 1 repetition maximum weight selections. Fatigue takes the guesstimation out of exercise weight selection and can be very effective at promoting optimal strength gains.

Dinyer and colleagues in The Journal Of Strength And Conditioning Research randomized untrained women to either a low or high intensity weight training program (2019). All of the women underwent clinical and body mass (% fat free mass) testing before and after the 12 week training program. Each group was assigned to a weight equaling a low (30% of 1 rep max) or high (80% of 1 rep max) intensity for 2-3 sets during 4 exercises (lat pulldown, military press, leg extension, and leg curl). Both groups took their workout sets to fatigue. Authors reported while both groups improved their maximum strength at the end of the 12 weeks there were no differences between the low or high intensity groups. In addition no changes in fat free mass were noted in the groups.

This study highlights the importance of working with a sub maximal weight and lifting it a maximum number of times for optimal strength gains. We recommend selecting a repetition range first (ex. 8-12 reps) then selecting a weight, but adjusting this weight higher if you can perform more repetitions than your established rep range.

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Strengthening Cuts Hamstring Injury Rates In Half

Hamstring injuries are common and can occur in any sport with any athlete. The three muscles of the hamstring are put through rapid lengthening and shortening contractions making them susceptible to strains or minor tears. Due to the common occurrence of these injuries, it is important to target proper strength and conditioning regimes to decrease the risk of injury to this muscle.

A recent article by the British Journal of Sports Medicine investigated the available research on the effectiveness of hamstring strengthening utilizing the Nordic Hamstring Exercise and its’ impact on injury rates (van Dyk. 2019). The review included over 8,459 athletes and found when the athlete's strengthening program included the Nordic Hamstring Exercises, the risk of injury to the hamstring decreases by 51%. As mentioned by a previous blog, the Nordic Hamstring Exercise recruits the hamstring more evenly with a eccentric contraction (contraction of muscles while lengthening) consistent with the demands of sport.

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Strengthening Exercises For Patellofemoral Pain

Patellofemoral pain, or pain around the kneecap, is one of the most common types of knee pain we treat at MEND. It impacts up to 23% of the general population and 40% of those people have persistent symptoms that can last for years! Exercise programs targeting the hip and the knee have been proven effective in managing hip and knee pain.  Most of the exercise programs studied to date have either not provided sufficient exercise progression to improve strength and power or have not been extended long enough to sustain gains in strength or power (which may result in recurrence of symptoms).

 A recent study (Barton et al 2019) reported significant improvements in patellofemoral pain, function and hip muscle capacity with a 12-week progressive strengthening program that can easily be performed at the gym. The key differentiator of this study was that the exercises were progressive – either the challenge of the exercise increased (ie: 2-leg squat to 1-leg squat) or the resistance of the exercise was progressed to ensure participants stayed in a perceived exertion range of 7-9 (which typically means you are only able to perform 1-2 reps in your set).

The exercises included in this study were:

1.     Bridging – 3 sets of 12 repetitions

Double to Single leg

2.     Hip abduction - 3 sets of 12 repetitions

a.     Sidelying to Standing Progression

3.     Plank progressions 3 x 60 sec

a.     Front and Side Planks

4.     Optional quad exercises including squats and single leg squats.

5.     Hamstring Strengthening including body weight and machine.

Authors concluded the 12 week progressive resistance training program was safe and effective for improving pain and function in patients with patellofemoral pain. Stay tuned to our social media for an exercise videos.

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