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By: D. Thordir, M.B. B.CH. B.A.O., M.B.B.Ch., Ph.D.

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Strength is the ability of the neuromuscular system to venogenic erectile dysfunction treatment generic manforce 100mg line produce internal tension (in the muscles and connective tissues that pull on the bones) to erectile dysfunction bangalore doctor cheap manforce 100mg online overcome an external force impotence doctor generic 100mg manforce visa. The specific form of strength produced is based on the type and intensity of training used by the client (principle of specificity). Generally, strength adaptations should use low to moderate repetition routines with moderate to high volume and moderate to high intensity. Heavier weights and higher volumes of training are used to improve the function of motor units, while placing stress on the muscles to increase size or strength. Power is the ability of the neuromuscular system to produce the greatest possible force in the shortest possible time. An increase in either force (weight) or velocity (speed with which weight is moved) will produce an increase in power. To maximize training for this adaptation, both heavy and light loads must be moved as fast and as controlled as possible. Many of these styles of resistance training programs remain popular today because of good marketing or "gym science," not because they have been proven to be scientifically superior to other forms of training programs that bring about increases in stabilization, strength, and power. Research has shown that following a systematic, integrated training program and manipulating key training variables achieve optimal gains in strength, neuromuscular efficiency, hypertrophy, and performance (4,27,28). There are numerous training systems that can be used to structure resistance training programs for a variety of effects. Several of the most common training systems currently used in the fitness industry are presented in this chapter (Table 13. It is usually recommended that single-set workouts be performed two times per week to promote sufficient development and maintenance of muscle mass (60). Personal trainers are encouraged to explore the benefits and options of single-set workouts to further customize individual program design options. Single-set training systems are often negatively perceived for not providing enough stimuli for adaptation. However, when reviewing the physiology of how the human movement system operates, this notion may not be true (65). By encouraging clients to avoid lifting more than they can handle, synergistic dominance (synergists overcompensating for weak prime movers) and injury can be avoided. The resistance (load), sets, and repetitions performed are selected according to the goals and needs of the client (66). Multiple-set training can be appropriate for both novice and advanced clients, but has been shown to be superior to single-set training for more advanced clients (29,66,67). The increased volume (sets, reps, and intensity) is necessary for further improvement, but must be administered appropriately to avoid overtraining (5). In the light-to-heavy system, the individual typically performs 10 to 12 repetitions with a light load and increases the resistance for each following set, until the individual can perform 1 to 2 repetitions, usually in 4 to 6 sets. This system can easily be used for workouts that involve only 2 to 4 sets or higher repetition schemes (12 to 20 repetitions). The heavy-to-light system works in the opposite direction, in which the individual begins with a heavy load (after a sufficient warm-up) for 1 to 2 repetitions, then decreases the load and increases the repetitions for 4 to 6 sets. The first variation includes performing two exercises for the same muscle group back to back. For example, an individual may perform the bench press exercise immediately followed by push-ups to fatigue the chest musculature. Completing two exercises in this manner will improve muscular endurance and hypertrophy because the volume of work performed is relatively high. This style of supersets can use two, three (a tri-set), or more exercises (a giant set) for the target muscle group. The greater the number of exercises used, the greater the degree of fatigue experienced and demands on muscular endurance.

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These phases systematically progress all clients through the three main adaptations of stabilization erectile dysfunction treatment in islamabad order cheap manforce online, strength erectile dysfunction hiv medications generic manforce 100 mg with amex, and power erectile dysfunction forum discussion generic manforce 100 mg without a prescription. It is also necessary to cycle back through this level after periods of strength and power training to maintain a high degree of core and joint stability. In addition, it allows the body to actively rest from more-intense bouts of training. The primary means of progressing (or increasing the intensity of training) in this period is by increasing the proprioceptive demands of the exercises. Another important component of stabilization training is that it may help to ensure activity-specific strength adaptations (such as standing on one leg to kick a ball, climbing up stairs, or simply walking) (79). Stabilization Endurance Training (Phase 1) Stabilization Endurance Training is designed to create optimal levels of stabilization strength and postural control (Table 14. This will allow for proper recovery and maintenance of high levels of stability that will ensure optimal adaptations for strength, power, or both. The primary focus when progressing in this phase is on increasing the proprioception (controlled instability) of the exercises, rather than just the load. This phase of training focuses on: Increasing stability Increasing muscular endurance Increasing neuromuscular efficiency of the core musculature Improving intermuscular and intramuscular coordination In addition to increasing proprioceptive demand, acute variables can be progressed by increasing the volume (sets, reps) and intensity (load, exercise selection, and planes of motion), and by decreasing rest periods. A client in this category will generally stay in this phase of training for a 4-week duration. This period prepares clients for the demands of the Strength Endurance Phase (Phase 2). It is designed to maintain stability while increasing the amount of stress placed on the body for increased muscle size and strength. This period of training is a necessary progression from stabilization for anyone who desires to increase caloric expenditure, muscle 66485457-66485438 Strength Endurance Training (Phase 2) Strength endurance is a hybrid form of training that promotes increased stabilization endurance, hypertrophy, and strength. This form of training entails the use of superset techniques in which a more-stable exercise (such as a bench press) is immediately followed with a stabilization exercise with similar biomechanical motions (such as a stability ball push-up). Thus, for every set of an exercise/body part performed according to the acute variables, there are actually two exercises or two sets being performed. Similar to Phase 1, acute variables can be progressed by increasing proprioceptive demand, volume, (sets, reps), and intensity (load, exercise selection, planes of motion), and by decreasing rest periods. Hold each tender area for 30 sec Static Stretch: Calves, Hip Flexors, Lats 1 30 s. Hold each stretch for 30 sec Coaching Tips: Resistance program can be split into 2, 3, or 4-day workout routine. Because the goal of this phase of training is primarily hypertrophy, the fitness professional will want to increase volume and intensity of the program. A client in this category will generally stay in this phase of training for a 4-week duration, before cycling back through Phase 1 or 2 or progressing on to Phase 4 or 5. Coaching Tip Brisk walk Hold each tender area for 30 sec Hold each stretch for 30 sec Coaching Tips: Resistance program can be split into 2, 3, or 4-day workout routine. Maximal intensity improves: Recruitment of more motor units Rate of force production Motor unit synchronization Maximal strength training has also been shown to help increase the benefits of power training used in Phase 5. Because the goal of this phase of training is primarily maximal strength, the personal trainer will want to increase intensity (load) and volume (sets). A client in this category will generally stay in this phase of training for a 4-week duration before cycling back through Phase 1 or 2 or progressing on to Phase 5. This form of training uses the adaptations of stabilization and strength acquired in the previous phases of training and applies them with more realistic speeds and forces that the body will encounter in everyday life and in sports. Power training is usually not a common practice in the fitness environment, but has a very viable and purposeful place in a properly planned training program. Therefore, any increase in either force or velocity will produce an increase in power.

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The reason for this is that the regenerating fibers from the proximal stump may be guided to erectile dysfunction causes alcohol discount 100 mg manforce fast delivery an incorrect destination in the distal stump; for example icd 9 code for erectile dysfunction due to diabetes order manforce american express, cutaneous fibers may enter motor endoneurial tubes and vice versa erectile dysfunction generic drugs discount 100 mg manforce with mastercard. Figure 3-48 Photomicrographs of motor neurons of the anterior gray column of the spinal cord. Inadequate physiotherapy to the paralyzed muscles will result in their degeneration before the regenerating motor axons have reached them. The presence of infection at the site of the wound will seriously interfere with the process of regeneration. If one assumes that the proximal and distal stumps of the severed nerve are in close apposition, the following regenerative processes take place. The Schwann cells, having undergone mitotic division, now fill the space within the basal lamina of the endoneurial tubes of the proximal stump as far proximally as the next node of Ranvier and in the distal stump as far distally as the end-organs. Where a small gap exists between the proximal and distal stumps, the multiplying Schwann cells form a number of cords to bridge the gap. Figure 3-49 the changes that may take place in a nerve cell body following division of one of its processes. Each proximal axon end now gives rise to multiple fine sprouts or filaments with bulbous tips. These filaments, as they grow, advance along the clefts between the Schwann cells and thus cross the interval between the proximal and distal nerve stumps. Many such filaments now enter the proximal end of each endoneurial tube and grow distally in contact with the Schwann cells. It is clear that the filaments from many different axons may enter a single endoneurial tube. However, only one filament persists, the remainder degenerate, and that one filament grows distally to reinnervate a motor or sensory endorgan. While crossing the gap between the severed nerve ends, many filaments fail to enter an endoneurial tube and grow out into the surrounding connective tissue. It is interesting to note that the formation of multiple sprouts or filaments from a single proximal axon greatly increases the chances that a neuron will become connected to a sensory or motor ending. It is not known why one filament within a single endoneurial tube should be selected to persist while the remainder degenerate. Once the axon has reached the end-organ, the adjacent Schwann cells start to lay down a myelin sheath. This process begins at the site of the original lesion and extends in a distal direction. By this means, the nodes of Ranvier and the Schmidt-Lanterman incisures are formed. Figure 3-50 Photomicrograph of a longitudinal section of the distal stump of the sciatic nerve showing evidence of degeneration and axon regeneration following injury. If, however, one takes into consideration the almost certain delay incurred by the axons as they cross the site of the injury, an overall regeneration rate of 1. Even if all the difficulties outlined above are overcome and a given neuron reaches the original end-organ, the enlarging axonal filament within the endoneurial tube reaches only about 80% of its original diameter. For this reason, the conduction velocity will not be as great as that of the original axon. Moreover, a given motor axon tends to innervate more muscle fibers than formerly; thus, the control of muscle is less precise. Regeneration of Axons in the Central Nervous System In the central nervous system, there is an attempt at regeneration of the axons, as evidenced by sprouting of the axons, but the process ceases after about 2 weeks. The regeneration process is aborted by the absence of endoneurial tubes (which are necessary to guide the regenerating axons), the failure of oligodendrocytes to serve in the same manner as Schwann cells, and the laying down of scar tissue by the active astrocytes. It has also been suggested that there is an absence of nerve growth factors in the central nervous system or that the neuroglial cells may produce nerve growth-inhibiting factors. Research has shown that the Schwann cell basal laminae contain laminin and cell adhesion molecules of the immunoglobulin family, both of which stimulate axon growth. In the embryo, when axon growth actively takes place in both the central and peripheral nervous systems, growth-promoting factors are present in both systems. Myelin in the central nervous system inhibits axonal growth, and it is interesting to note that myelination in the central nervous system occurs late in the development process when growth of the main nervous pathways is complete. In tissue culture, peripheral axons are more successful at growth than central axons.

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When a rupture occurs erectile dysfunction prostate buy manforce discount, it produces a characteristic clinical appearance of an abnormal anterior axillary crease can erectile dysfunction cause prostate cancer cheap 100mg manforce. Unilateral absence of all or part of the pectoralis major is a relatively common congenital abnormality zolpidem impotence generic manforce 100 mg amex. The deltoid is a superficial muscle that gives the shoulder its normal rounded contour. Its broad origin begins anteriorly along the lateral third of the clavicle and continues across the acromioclavicular joint, along the lateral border of the acromion, and finally posteriorly along the scapular spine. These three segments, or heads, taper to a common tendon of insertion on the lateral aspect of the humerus. Lateral edge of the acromion is more visible when an anterior dislocation of the shoulder is present. The biceps is well known to the lay public because its muscle belly is quite prominent and contributes greatly to the appearance of muscularity. Rupture of the short head tendon of the biceps almost never occurs, but rupture of the long head tendon is common and often associated with rotator cuff injury. This injury is usually accompanied by pain and ecchymosis, which often accumulates distal to the site of injury. Rupture of the long head of the biceps causes a characteristic deformity, as the muscle belly bunches up distally when elbow flexion is attempted. This is sometimes called a Popeye deformity, after the appearance of the biceps of the famous cartoon character. From this perspective, the biceps is seen in profile, along with the triceps brachii, the primary extensor of the elbow, which constitutes the bulk of the posterior arm. The medial and lateral heads arise from the humerus itself, whereas the long head arises from the inferior aspect of the posterior glenoid and is sometimes the site of painful tendinitis in throwing athletes. Inspection of the posterior aspect of the shoulder provides a valuable perspective on shoulder anatomy and function. The scapula is a flat triangular bone that is enveloped almost entirely by muscle. One side of this triangle, the medial border, is oriented parallel to the thoracic spine in a roughly vertical manner. The glenoid fossa is perched this point of insertion, the deltoid tubercle, is usually visible as a small depression in the lateral arm. The deltoid is a major motor of the arm, producing abduction, flexion, and extension. Deltoid atrophy may occur as the nonspecific result of disuse of the shoulder or as the specific result of injury to the axillary nerve. As noted, deltoid atrophy increases visibility of underlying bony prominences such as the acromion, the scapular spine, the coracoid process, and humeral tuberosities. Pain at the deltoid insertion is, therefore, almost always the result of rotator cuff pathology, although patients may be extremely skeptical of this assertion. The subacromial bursa (subdeltoid bursa) lies deep to the acromion and deltoid and is therefore not normally visible. Because the subacromial bursa has a synovial lining, it may become inflamed in rheumatoid arthritis and cause swelling in the anterior superior shoulder. Swelling related to subacromial bursitis or synovitis in the glenohumeral joint is more likely to be visible in the presence of disorders such as rheumatoid arthritis, owing to the deltoid atrophy that often accompanies these diseases. It is primarily a flexor of the elbow and supinator of the forearm, although its attachments to the glenoid and coracoid give it some limited function in shoulder flexion. The first, or long head tendon, originates at the superior glenoid labrum, passes distally through the shoulder joint, then continues through the groove between the greater and the lesser tuberosities of the humerus. The second, or short head tendon, originates from the coracoid process in a common tendon with the coracobrachialis muscle. A, acromion; B, deltoid; C, deltoid tubercle; D, biceps brachii; E, triceps brachii.

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