The molecular bases of training adaptation

The Molecular Bases of Training Adaptation

Vernon G. Coffey and John A. Hawley
School of Medical Sciences, Exercise Metabolism Group, RMIT University, Melbourne, Victoria, Australia

Sports Med 2007; 37 (9): 737-763 REVIEW ARTICLE 0112-1642/07/0009-0737/$44.95/0 / 2007 Adis Data Information BV. All rights reserved.

Skeletal muscle is a malleable tissue capable of altering the type and amount of protein in response to disruptions to cellular homeostasis. The process of exercise induced adaptation in skeletal muscle involves a multitude of signalling mechanisms initiating replication of specific DNA genetic sequences, enabling subsequent translation of the genetic message and ultimately generating a series of amino acids that form new proteins. The functional consequences of these adaptations are determined by training volume, intensity and frequency, and the half-life of the protein. Moreover, many features of the training adaptation are specific to the type of stimulus, such as the mode of exercise. Prolonged endurance training elicits a variety of metabolic and morphological changes, including mitochondrial biogenesis, fast-to-slow fibre-type transformation and substrate metabolism. In contrast, heavy resistance exercise stimulates synthesis of contractile proteins responsible for muscle hypertrophy and increases in maximal contractile force output. Concomitant with the vastly different functional outcomes induced by these diverse exercise modes, the genetic and molecular mechanisms of adaptation are distinct. With recent advances in technology, it is now possible to study the effects of various training interventions on a variety of signalling proteins and early-response genes in skeletal muscle. Although it cannot presently be claimed that such scientific endeavours have influenced the training practices of elite athletes, these new and exciting technologies have provided insight into how current training techniques result in specific muscular adaptations, and may ultimately provide clues for future and novel training methodologies. Greater knowledge of the mechanisms and interaction of exercise-induced adaptive pathways in skeletal muscle is important for our understanding of the aetiology of disease, maintenance of metabolic and functional capacity with aging, and training for athletic performance. This article highlights the effects of exercise on molecular and genetic mechanisms of training adaptation in skeletal muscle.

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Postoperative orthopaedic rehabilitation protocols

I just came across a wonderful website with many postoperative orthopaedic rehabilitation protocols. Amazing work and useful especially for Physical Therapists that work in hospitals.

I have also found two books that offer a more detailed presentation of port-op orthopaedic treatment guidelines:

1. Treatment and Rehabilitation of Fractures, authors: Stanley Hoppenfeld, Vasantha L. Murthy, publisher: Lippincott Williams & Wilkins.

Written by leading orthopaedists and rehabilitation specialists, this volume presents sequential treatment and rehabilitation plans for fractures of the upper extremity, lower extremity, and spine. The book shows how to treat each fracture--from both an orthopaedic and a rehabilitation standpoint--at each stage of healing.Introductory chapters review the fundamentals of fracture management--bone healing, treatment modalities, biomechanics, assistive devices and adaptive equipment, gait, splints and braces, therapeutic exercise and range of motion, and determining when a fracture is healed. Subsequent chapters focus on management of individual fractures.Each chapter on an individual fracture is organized by weekly postfracture time zones, from the day of injury through twelve weeks. For each time zone, the text discusses bone healing, physical examination, dangers, x-rays, weight bearing, range of motion, strength, functional activities, and gait/ambulation. Specific treatment strategies and rehabilitation protocols are then presented. More than 500 illustrations complement the text.

2. Rehabilitation for the Postsurgical Orthopedic Patient, 3rd Edition, authors: Lisa Maxey & Jim Magnusson, publisher: ELSEVIER Health Sciences.

With detailed descriptions of orthopedic surgeries, Rehabilitation for the Postsurgical Orthopedic Patient, 3rd Edition provides current, evidence-based guidelines to designing effective rehabilitation strategies. Coverage of each condition includes an overview of the orthopedic patient's entire course of treatment from pre- to post-surgery. For each phase of rehabilitation, this book describes the postoperative timeline, the goals, potential complications and precautions, and appropriate therapeutic procedures. New to this edition are a full-color design and new chapters on disc replacement, cartilage replacement, hallux valgus, and transitioning the running athlete. Edited by Lisa Maxey and Jim Magnusson, and with chapters written by both surgeons and physical therapists, Rehabilitation for the Postsurgical Orthopedic Patient provides valuable insights into the use of physical therapy in the rehabilitation process.

Vertebral artery test

Approximately one‐quarter of ischaemic strokes involve the posterior or vertebrobasilar circulation. Stenosis of the vertebral artery can occur in either its extra‐ or intracranial portions, and may account for up to 20% of posterior circulation ischaemic strokes. Stenotic lesions, particularly at the origin of the vertebral artery, are not uncommon. In an angiographic study of 4748 patients with ischaemic stroke, some degree of proximal extracranial vertebral artery stenosis was seen in 18% of cases on the right and 22.3% on the left. This was the second most common site of stenosis after internal carotid artery stenosis at the carotid bifurcation. Such stenotic lesions are now potentially treatable by endovascular techniques.

In marked contrast with carotid artery stenosis, the optimal management of vertebral artery stenosis has received limited attention, and is poorly understood. This partly reflects difficulties in imaging the vertebral artery adequately, and limited surgical treatment options. Recent improvements in imaging and the arrival of vertebral artery angioplasty, however, have opened up new opportunities for intervention in this disease.

Read the rest "Diagnosis and management of vertebral artery stenosis" @ http://www.oxfordjournals.org/en/.

The treatment in such cases is purely medical. However, a Physical Therapist should be aware of this problem, the vertebral artery disease or  vertebrobasilar ischaemia, and should know the basic anatomy, symptoms and assessment test in his everyday practise.

A very nice article on Physiopedia explains these issues clearly.

What to keep in mind:

To test the blood flow in the vertebral artery, one should put the patient on his back and perform an passive extension, followed by a passive rotation of the neck. The rotation should be performed in both directions. The manoeuvre causes a reduction of the lumen at the third division of the vertebral artery, resulting in de decreased blood flow of the intracranial vertebral artery of the contralateral side. It causes an ischemia due to blood loss in the pons and the medulla oblongata of the brain. This results in dizziness, nausea, syncope, dysarthria, dysphagia, and disturbances of the hearing or vision, paresis or paralysis of patients with vertebrobasilar ischaemia.

Below is an alternate vertebral artery test, presented by http://www.thestudentphysicaltherapist.com/.

http://www.patient.co.uk/ offers an extended overview of the Vertebrobasilar Occlusion and Vertebral Artery Syndrome, including treatment and management options.

You Gotta Walk the Walk ... the "Heart Walk"

When it comes to keeping folks heart healthy, our Vanderbilt Heart team takes their job seriously. Add to their knowledge and commitment a little Music City talent, and you've got a catchy song and fun music video on your hands. We hope you enjoy their work, share with your friends and family and take their message about the importance of "walking the walk" to heart!

To learn more about our team and services, visit http://www.VanderbiltHeart.com. 

Atlas of knee MRI anatomy

A beautiful navigation through a complete knee MRI in all three planes. Thanx to http://w-radiology.com.

Scapular dyskinesis guidelines

Abnormal movement of the shoulder blade (scapula) is known as scapular dyskinesis. This occurs in a variety of shoulder problems. It is an important sign of an underlying shoulder disorder and a guide to shoulder rehabilitation.

Based on PhysioPedia, intervention is aimed at reducing posterior capsule and pectoralis minor restriction and restoring periscapular mm balance through exercises promoting early and increased serratus anterior, lower, and middle trapezius activation while minimizing upper trapezius activity.

• Manual gr 4 mobilization to reduce posterior capsule tension, cross-body stretch.
• Manual stretching and soft tissue mobilization to decrease pec minor tension (cadaveric studies imply that a position of 150 degrees elevation with 30 degrees scapular retraction is optimal).
• Exercises of sidelying forward flexion, external rotation, prone extension, and prone horizontal abduction to strengthen middle and lower trapezius over upper trapezius.
• Quadruped and variable push-up positions to activate serratus anterior.

Here is a very nice guideline for treating scapular dyskinesis, offered by the Beth Israel Deaconess Center (a Harvard Medical School teaching hospital).

Online interactive tutorial in Radiology

A very interesting online interactive tutorial in radiology offered by University of Virginia.

Scapulohumeral rhythm

In the healthy shoulder, a natural kinematics rhythm/timing exists between glenohumeral ABD and scapulothoracic lateral rotation. After 30 degrees of abduction this rhythm is 2:1, meaning that for each 3 degrees of abduction, 2 degrees occur in the glenohumeral joint and 1 degree occurs in the scapulothoracic joint.

This very nice video and article by Physio-Pedia makes it very clear.