Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011
-
Upload
allan-besselink -
Category
Health & Medicine
-
view
1.545 -
download
2
description
Transcript of Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011
![Page 1: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/1.jpg)
Mechanisms Of TherapeuticExercise Progression
Allan Besselink, PT, Dip.MDTSmart Life Project
Austin, Texas
![Page 2: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/2.jpg)
Allan Besselink, PT, Dip. MDT 2
Background
Physiotherapist (1988)
McKenzie Diploma (1998)
USA Track and Field
Endurance sports coach (running, triathlon)
![Page 3: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/3.jpg)
Allan Besselink, PT, Dip. MDT 3
Background
Educator (PT; PTA)
Author - “RunSmart: A Comprehensive Approach To Injury-Free Running” (2008)
Author (with Bridget Clark, PT) - “Running Injuries” chapter in 3rd
edition of ”Clinical Orthopedic Rehabilitation” (2011)
![Page 4: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/4.jpg)
Allan Besselink, PT, Dip. MDT 4
Why This Topic?
The vast majority of "treatments" have little to no confirmed scientific basis …
… yet we claim to be focused on "evidence-based practice"
![Page 5: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/5.jpg)
Allan Besselink, PT, Dip. MDT 5
Why This Topic?
There are too many clinicians using yellow theraband forever …
... yet we promote ourselves as the experts in therapeutic exercise
![Page 6: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/6.jpg)
Allan Besselink, PT, Dip. MDT 6
Why This Topic?
We have 50+ years of cellular physiology research …
… and yet we choose to ignore it
![Page 7: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/7.jpg)
Allan Besselink, PT, Dip. MDT 7
Objectives
Identify and examine the current scientific literature on therapeutic exercise and tissue repair
Identify the three primary components of Recovery-Centered Training and explain their relevance to therapeutic exercise progression
![Page 8: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/8.jpg)
Allan Besselink, PT, Dip. MDT 8
Objectives
Discuss the physiological mechanisms underlying tissue repair and development in the context of therapeutic exercise
Define the principles of mechanical loading and their application to therapeutic exercise programs
![Page 9: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/9.jpg)
Allan Besselink, PT, Dip. MDT 9
Objectives
Implement optimized therapeutic exercise progressions utilizing the critical parameters and dosage of various loading strategies
![Page 10: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/10.jpg)
Allan Besselink, PT, Dip. MDT 10
Overview
The Basics Stimulus – Response and Homeostasis
Mechanisms Loading Strategies to attain Desired
Response Tissue- And System-Based
Progressions Symptomatic, Mechanical, And Functional
![Page 11: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/11.jpg)
Allan Besselink, PT, Dip. MDT 11
Overview
Traditional Approaches To Therapeutic Exercise
Optimal Critical Parameters? Competent Self Care – Is It Enough?
What Is The Role Of The PT? Summary
![Page 12: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/12.jpg)
Allan Besselink, PT, Dip. MDT 12
Discussion
In groups of 3 to 5, discuss the scenario presented to you
Assume no "red flags" are present What is the primary mode of therapeutic
exercise required?
![Page 13: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/13.jpg)
Allan Besselink, PT, Dip. MDT 13
The Basics
![Page 14: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/14.jpg)
Allan Besselink, PT, Dip. MDT 14
Principles And Practices
Principles = Why
Practices = What
![Page 15: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/15.jpg)
Allan Besselink, PT, Dip. MDT 15
The Basics
Stimulus – Response Homeostasis Specific Adaptation To
Imposed Demands Wolfe's Law Building Capacity Critical Parameters
![Page 16: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/16.jpg)
Allan Besselink, PT, Dip. MDT 16
“Evidence-BasedCellular Physiology”
50+ years of research in cellular physiology
Apply these well-established principles
![Page 17: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/17.jpg)
Allan Besselink, PT, Dip. MDT 17
Stimulus - Response
![Page 18: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/18.jpg)
Allan Besselink, PT, Dip. MDT 18
Homeostasis
"The maintenance of relatively stable internal physiological conditions under fluctuating environmental conditions"
Are we ever "out of balance"?
Do we ever really, by definition, have a "muscle imbalance"?
![Page 19: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/19.jpg)
Allan Besselink, PT, Dip. MDT 19
Balance Stimulus And Response
![Page 20: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/20.jpg)
Allan Besselink, PT, Dip. MDT 20
Feedback Loops
![Page 21: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/21.jpg)
Allan Besselink, PT, Dip. MDT 21
SAID Principle
Specific Adaptation To Imposed Demands
Wolfe's Law Form Follows Function Astronauts
![Page 22: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/22.jpg)
Allan Besselink, PT, Dip. MDT 22
Building Capacity
Work = "the amount of energy transferred into or out of a system, not counting energy transferred by heat conduction"
Work = Power x time
Work = Force x Velocity x Time
![Page 23: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/23.jpg)
Allan Besselink, PT, Dip. MDT 23
Exercise Is Like Medicine
"Therapeutic Dose" is critical!
Critical parameters – dosage, frequency, timing
Exercise is no different – enough for the desired response
![Page 24: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/24.jpg)
Allan Besselink, PT, Dip. MDT 24
Traditional Systems
Cardiovascular / Aerobic system
Endurance = the capacity to withstand physiological or psychological stressors over a sustained period of time
The heart is a muscle!
![Page 25: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/25.jpg)
Allan Besselink, PT, Dip. MDT 25
True Systems Thinking
Involves understanding the behavior of the system as a whole (Peter Senge "The Fifth Discipline")
Recovery-Centered Training – A Model Of Human Performance
Mechanical Diagnosis And Therapy (MDT)
![Page 26: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/26.jpg)
Allan Besselink, PT, Dip. MDT 26
Recovery-Centered Training
Mechanical
Neuro-musculo-skeletal Cardiovascular
Cognitive
Central nervous system Endocrine system Immune system
Nutritional
![Page 27: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/27.jpg)
Allan Besselink, PT, Dip. MDT 27
MDT
Mechanical Diagnosis and Therapy (MDT)
A systems thinking approach to musculoskeletal care
Mutually exclusive diagnostic categories based on system behavior (responses to repeated movements and sustained loading)
Derangement, Dysfunction, Posture, Other
![Page 28: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/28.jpg)
Allan Besselink, PT, Dip. MDT 28
Scenarios
Stress reaction Osteoporosis Osteoarthritis Capsular tightness Tendinopathy Derangement Weight loss
Muscle strength Muscle endurance Post-surgical ROM Neuromotor facilitation Neuromotor inhibition Flexibility Aerobic capacity /
deconditioning
![Page 29: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/29.jpg)
Allan Besselink, PT, Dip. MDT 29
Mechanisms
![Page 30: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/30.jpg)
Allan Besselink, PT, Dip. MDT 30
Mechanisms
Mechanisms of Optimal Human Performance=
Mechanisms of Injury Recovery=
Mechanisms of Injury Prevention
(Besselink 1992)
![Page 31: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/31.jpg)
Allan Besselink, PT, Dip. MDT 31
Mechanisms
Stimulate appropriate cellular activity to attain desired cellular response
Critical parameters of mechanical loading to attain desired cellular response
Appropriate Symptomatic, Mechanical and Functional Responses
![Page 32: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/32.jpg)
Relationship Between Function And Cellular Activity
Cellular Level Protein synthesis Collagen synthesis Mitochondrial density
etc
Changes In ... Tendon tensile
strength Muscle strength Cartilage volume
etc
![Page 33: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/33.jpg)
Allan Besselink, PT, Dip. MDT 33
It All Starts With The CNS
![Page 34: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/34.jpg)
Mechanotransduction
Khan KM, Scott A. Mechanotherapy: how physical therapists' prescription of exercise promotes tissue repair. Br J Sports Med 2009;43:247-252.
Kaneko D et al. Temporal effects of cyclic stretching on distribution and gene expression of integrin and cytoskeleton by ligament fibroblasts in vitro.Connect Tiss Res 2009; 50(4), 263-269.
![Page 35: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/35.jpg)
Allan Besselink, PT, Dip. MDT 35
Mechanisms
Tissues Connective Muscle Nervous
(Epithelial) Systems
Traditional i.e. Cardiovascular "Systems Thinking" (incl. MDT)
![Page 36: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/36.jpg)
Allan Besselink, PT, Dip. MDT 36
Mechanical Loading Strategies
What mechanical loading strategy is required to stimulate the desired cellular activity and to "turn on the gene"?
Which mechanical loading strategy is required to attain the desired functional response(s)?
![Page 37: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/37.jpg)
Allan Besselink, PT, Dip. MDT 37
Critical Parameters
Every training session/exercise has an intent – and a desired cellular response
Critical parameters of dosage/potency and frequency
![Page 38: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/38.jpg)
Allan Besselink, PT, Dip. MDT 38
Connective Tissue
Bone Tension, compression, shear Fluid flow
Collagen Tendon - tension Cartilage - compression Ligament - tension
![Page 39: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/39.jpg)
Allan Besselink, PT, Dip. MDT 39
Muscle Tissue
Number of muscle fibers recruited
Velocity of muscle fiber recruitment
Mitochondria = cellular powerhouse (active muscle fibers only) = endurance
Tension / Load / Resistance
![Page 40: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/40.jpg)
Allan Besselink, PT, Dip. MDT 40
Nervous Tissue
CNS Recruitment
Motor patterns
Synaptogenesis
Facilitation and inhibition
![Page 41: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/41.jpg)
Allan Besselink, PT, Dip. MDT 41
Discussion
In your original groups, discuss the scenario presented to you
With what you now know, what is the primary mode of therapeutic exercise (mechanical loading strategy) required to attain the desired cellular response?
What are the critical parameters necessary to do so?
![Page 42: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/42.jpg)
Allan Besselink, PT, Dip. MDT 42
Building Capacity
Work = Force x Velocity x Time
Intensity is your friend, not your enemy
![Page 43: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/43.jpg)
Allan Besselink, PT, Dip. MDT 43
Critical Parameters
Tissues Connective – bone; cartilage; collagen Muscle Nervous
Systems RCT – signs of under-recovery MDT – directional preference
![Page 44: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/44.jpg)
Allan Besselink, PT, Dip. MDT 44
Scenarios
Stress reaction Osteoporosis Osteoarthritis Capsular tightness Tendinopathy Derangement Weight loss
Muscle strength Muscle endurance Post-surgical ROM Neuromotor facilitation Neuromotor inhibition Flexibility Aerobic capacity /
deconditioning
![Page 45: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/45.jpg)
Allan Besselink, PT, Dip. MDT 45
Tissue Repair And Remodeling
Acute Phase = 1 to 3 days = "your friend, not your foe"
Fibroplastic = up to 3 weeks = "prime time" for mechanical loading
Remodeling = 6 weeks to 2 years = still very responsive to mechanical loading
![Page 46: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/46.jpg)
Allan Besselink, PT, Dip. MDT 46
Progressions
![Page 47: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/47.jpg)
Allan Besselink, PT, Dip. MDT 47
Progression
Based on Symptomatic, Mechanical, and Functional Responses to Loading Strategies
Need benchmarks and baselines!
![Page 48: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/48.jpg)
Allan Besselink, PT, Dip. MDT 48
Responses To Loading Strategies
Symptomatic
Mechanical
Functional
![Page 49: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/49.jpg)
Allan Besselink, PT, Dip. MDT 49
Progression
Progression will vary depending on the ability of the patient to adapt to the imposed demands
Age Metabolic state
![Page 50: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/50.jpg)
Allan Besselink, PT, Dip. MDT 50
Progression And Limiters
Be aware of the signs and symptoms of “under-recovery” (Recovery-Centered Training)
Mechanical Cognitive Nutritional
Safety
Hurt Not Harm
![Page 51: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/51.jpg)
Allan Besselink, PT, Dip. MDT 51
Traditional Approaches ToTherapeutic Exercise
![Page 52: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/52.jpg)
Allan Besselink, PT, Dip. MDT 52
Traditional Approaches
Insufficient or inappropriate exercise parameters to elicit desired (or optimal) physiological response
Garbage In, Garbage Out
Modalities as a passive mechanical loading strategy
![Page 53: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/53.jpg)
Allan Besselink, PT, Dip. MDT 53
Woollard et al (2011) JOSPT
"Change in Knee Cartilage Volume in Individuals Completing a Therapeutic Exercise Program for Knee Osteoarthritis"
Loss of cartilage volume
![Page 54: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/54.jpg)
Allan Besselink, PT, Dip. MDT 54
Therapeutic Exercise Program
Stretching, quadriceps setting, SLR Leg press at 70% of 1-RM: 3 x 10 PT 2x per week for 6 weeks HEP 2x per week for 4 weeks Based on the critical parameters, would I
expect anything different?
![Page 55: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/55.jpg)
Allan Besselink, PT, Dip. MDT 55
Problem
“The inability to challenge our belief systems in the face of good scientific evidence is the primary limiting factor in the advancement of both health care and coaching, as well as human performance and injury prevention”
(Besselink 2008)
![Page 56: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/56.jpg)
Allan Besselink, PT, Dip. MDT 56
Competent Self Care - Is It Enough?
![Page 57: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/57.jpg)
Allan Besselink, PT, Dip. MDT 57
Competent Self Care
Can the patient perform the necessary loading strategies to promote optimal repair and remodeling on their own?
What is the role of the PT?
Competent self care and health mentorship is an opportunity for the PT profession
![Page 58: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/58.jpg)
Allan Besselink, PT, Dip. MDT 58
Summary
![Page 59: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/59.jpg)
Allan Besselink, PT, Dip. MDT 59
Challenge Your Thinking!
“We can't solve problems by using the same kind of thinking we used when we created them.”
(Einstein)
![Page 60: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/60.jpg)
Allan Besselink, PT, Dip. MDT 60
For More Information:
Smart Life Project
www.allanbesselink.com/slp www.allanbesselink/subscribe “RunSmart: A Comprehensive
Approach To Injury-Free Running”
![Page 61: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/61.jpg)
Allan Besselink, PT, Dip. MDT 61
Move Forward (APTA)
www.moveforwardpt.com
![Page 62: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/62.jpg)
Allan Besselink, PT, Dip. MDT 62
The Finish Line Is Upon Us!
![Page 63: Mechanisms Of Therapeutic Exercise Progression - TPTA Annual Conference 2011](https://reader038.fdocuments.us/reader038/viewer/2022110119/5565b14ed8b42a4c6f8b4d7e/html5/thumbnails/63.jpg)
Allan Besselink, PT, Dip. MDT 63
Photo Credits
http://www.flickr.com/photos/monsieurlui/
http://www.flickr.com/photos/emilianohorcada/
http://www.flickr.com/photos/pinksherbet/
http://www.flickr.com/photos/53921113@N02/
http://www.flickr.com/photos/panduadnyana/
Allan Besselink
All others public domain or fair use Creative Commons