Strength Training

Strengthening is the ability of the muscles to produce tension. This tension is responsible to stabilize and mobilize the bones of the body. Strengthening is the exercise training that aims to increase muscle strength. It is the process of maintaining health at any age. Strength training can be done for de-conditioning, to increase overall strength, or for bodybuilding.

Startup with an exercise professional or physiotherapist is the best way to get trained properly. The physiotherapist examines, diagnoses, and designs an appropriate strengthening exercise program. He will set goals and design an exercise regime to meet the goals.

Goals are set to help the process of strengthening. The goals should be:
1. Specific
2. Measurable
3. Achievable
4. Realistic 
5. Time-based.

Strengthening may include a simple exercise but the frequency of the exercises and the effort put into each exercise will differ depending on the goals.

Different muscle activation methods are used to minimize injury and assist in the development of muscle strength. A balanced exercise program incorporated in the exercises can involve these types of loadings:
1. Isometric contraction
2. Concentric contraction
3. Eccentric contraction
Isometric contraction is when the muscle contracts without any change in the length of the muscle, it is just a sustained activation of the muscle. Isometric contraction puts less stress on the body and therefore can be used immediately after the injury.
Concentric contraction is when the muscle is shortening or contracted e.g. when the individual lifts the hand to the shoulder while bending the elbow, the biceps are shortened. Concentric contraction is a common action of our body during most sports movements.
Eccentric contraction is when the muscle sustains its contraction while the muscle is lengthened e.g. the biceps is lengthened when the elbow is straightened while muscle tension is sustained. Muscle bulk is developed at a greater rate by eccentric contraction.

Technique and control
Exercise is a challenge and knowing the best technique is another big challenge. One of the big reasons for injuries related to strength training is usually poor technique or lack of control. An individual should always seek advice from his physiotherapist on how to perform the exercises.
Also performing the exercises at different speeds with control is another important element.  Especially while starting an exercise with an appropriate weight that an individual can control with proper technique. Once the control is achieved weight or speed can be increased
The exercises begin with easier movements and progress as strengthening is developed. Strengthening exercises are effective when the muscles are overloaded. Some of the exercises are:
1. Exercising against gravity
2. Exercising against the resistance of water
3. Exercising against a resistance band
4. Exercising with weight
5. Exercising using your body weight as the load

To help build strength, frequency of strength training to get a muscle-building effect and targeting a muscle group every 48 – 72 hours is all that is necessary. Maintenance of muscle strength will occur by performing a minimal resistance exercise. The progression of the weight depends upon how the individual feels the next day.
The repetitions and sets of weight lifts change the overall effect on the body. Fatigue occurs during and after weight training but needs to be gentle fatigue with each session.

Strength
Developing strength involves lifting 1-8 repetitions, 1 to 8 sets with 30 seconds to a few minutes, and rest intervals in between the sets. These exercises increase muscle strength to do everyday work and activities.

Muscle mass
Training to develop muscle mass can be achieved by lifting weights, with repetitions of 8-12 times and 3 – 5 sets and only for 30 seconds to several minutes rest in-between sets. 

Endurance
To increase endurance, fewer intensity exercises for a longer period such as running or cycling are done. These exercises are beneficial for individuals who do physical work for several hours during the day.  Endurance training is a sub-maximal training thus the individual needs to do exercises with weights e.g. 12 or more repetitions, with more sets, and short rest.

Power
Power training is explosive movement training, a process to recruit muscle fibers. This can be achieved by sub-maximal loads of 1-8 repetitions, 1 to 8 sets with complete rest in-between each set with speed or short duration of lifting time. Care should be taken as power exercise can result in a high risk of injury. These are short-duration exercises with maximum intensity. Such types of exercises can be done by weightlifters or sprinters develop. These exercises are ideal for workers who have to lift heavy loads.

Strengthening can be done with a wide variety of equipment. Physiotherapists generally prefer:
1. Free weights, dumbbells, or weight cuffs.
2. Elastic bands, Thera-bands, or tubes
3. Quadriceps table with weights
4. Shoulder wheel with resistance
5. Handgrip exerciser
6. Hand gym kit board
7. Static cycle with adjustable intensity
8. Ankle pedal with adjustable intensity
9. Multi-station home gym
10. Electrical muscle stimulator
11. Own body weight can also be used to strengthen muscles while push-ups, squat planks, and sit-ups, are some examples of exercises that do not require equipment.

Avoiding DOMS
Delayed onset muscle soreness or DOMS, is a phenomenon where a body feels pain after intensive exercise 24-48 hours following the exercise. There are some easy ways to minimize or avoid DOMS following training by a well-planned program as well as appropriate recovery after any training regime.
To reduce DOMS -Start slowly with plenty of rest, proper technique, and greater repetitions with gradual overloading. All these steps are very important in building better strength, using appropriate muscles, and reducing injuries.
Once the individual is comfortable with the exercises, increase the loads and decrease the repetitions and rest periods.

Recovery
Recovery encompasses many elements and diet is one of them. When starting to strengthen for the first time, after injury, or after some time off, remember to start gradually. Poor recovery leads to an increased risk of injury. Recovery encompasses many elements and some of them are:
1. Timing training loads
2. Stretching
3. Sleep,
4. Massage, etc.

Training a muscle every day is not always best, we need to target a muscle group every 48-72 hours to increase strength. Both passive and active recovery should be followed. Active recovery is performing a gentle exercise that moves the muscles without pushing them to fatigue, for example, light intensity exercise, light walk or a swim, etc
Passive methods include rest, massage and cryotherapy, thermotherapy, etc
If recovery is adequate, then the individual can return to exercising but if there is pain that is lasting following any exercise, then it is best to seek the advice of a physiotherapist as he has a better understanding of recovery.

A variety of conditions and injuries can benefit from a strengthening exercise program. Some of them are:
1. Loss of strength after injury (post-injury)
2. Patients who have to undergo surgery (Pre-surgery)
3. Patients who have undergone surgery (Post-surgery)
4. After immobilization (due to muscle atrophy)
5. Movement dysfunction
6. Poor posture.
7. Musculoskeletal conditions such as post-fracture, dislocation, disc degeneration, muscular weakness, etc.
8. Neurological conditions such as stroke, muscular dystrophy, cervical myelopathy, Parkinson's disease, etc.
9. Geriatric conditions such as muscular weakness, arthritis, etc
10. Pediatric conditions such as Developmental delays
11. Pre and post-natal muscle weakness, incontinence, and many more.

Patients who want to increase the strength of specific muscles or group of muscles can benefit from strengthening exercises. After an injury, the patient whose muscle is injured, to rebuild muscle strength, and mass strengthening exercises are helpful. In some cases there is decreased growth due to delayed milestones in children, strengthening exercises can be done to enhance the growth. These exercises can even decrease energy expenditure as muscles are more efficient and thus improve functionality, therefore, reducing the risk of injury and making the individual less prone to falls and fractures.