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  <head>
    <title>032-02 Load, tissue adaptation, movement economy, and rehabilitation physiology</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Load, adaptation, and rehabilitation">
      <outline text="Force transfer and the limiting variable">
        <outline text="Neural command through muscle, tendon, joint, bone"/>
        <outline text="Loss at any link feels like weakness">
          <outline text="Pain inhibits recruitment"/>
          <outline text="Stiffness shortens usable range"/>
        </outline>
        <outline text="Identify the limiting variable"/>
      </outline>
      <outline text="Motor units and recruitment">
        <outline text="One alpha motor neuron and its fibres"/>
        <outline text="Size principle: small low-threshold units first">
          <outline text="Economical activity, high-force reserve kept"/>
        </outline>
        <outline text="Discharge frequency summates force"/>
        <outline text="Synchronisation and rate coding adapt early">
          <outline text="Strength before hypertrophy"/>
        </outline>
        <outline text="Denervation sprouting: larger units, less control"/>
      </outline>
      <outline text="Sarcomere mechanics and leverage">
        <outline text="Isometric force peaks near optimal overlap"/>
        <outline text="Concentric force falls as velocity rises"/>
        <outline text="Eccentric resists more force at lower cost">
          <outline text="Lowering possible when lifting is not"/>
          <outline text="Unfamiliar eccentric work causes soreness"/>
        </outline>
        <outline text="Torque equals force times moment arm"/>
        <outline text="Co-contraction: stability, energy, compression"/>
        <outline text="One test angle samples one mechanical state">
          <outline text="Restore force through range and task speed"/>
        </outline>
      </outline>
      <outline text="Power and ageing">
        <outline text="Power equals force times velocity"/>
        <outline text="Independence needs power more than static strength"/>
        <outline text="Ageing loses fast units and type-two area">
          <outline text="Power falls before manual grades change"/>
        </outline>
        <outline text="Chair rise, stairs, gait speed as tests"/>
        <outline text="Moderate resistance moved with rapid intent"/>
      </outline>
      <outline text="Energy systems and fatigue">
        <outline text="Phosphocreatine, glycolysis, oxidation overlap"/>
        <outline text="Lactate shuttles carbon and reducing equivalents">
          <outline text="Level reflects production, oxidation, clearance"/>
        </outline>
        <outline text="Fatigue is task-specific, central or peripheral"/>
        <outline text="Heat, dehydration, glycogen depletion limit work"/>
        <outline text="Record heart rate, speed, force, recovery time">
          <outline text="Name the limiting system"/>
          <outline text="Match recovery interval to that system"/>
        </outline>
      </outline>
      <outline text="Hypertrophy and unloading">
        <outline text="Mechanical tension, synthesis exceeds breakdown"/>
        <outline text="Satellite cells donate nuclei"/>
        <outline text="Protein, energy, age, anabolic resistance"/>
        <outline text="Bed rest: muscle, insulin, bone, orthostasis">
          <outline text="Brief frequent loading preserves function"/>
        </outline>
      </outline>
      <outline text="Bone strength and remodelling">
        <outline text="Toughness needs collagen and mineral together"/>
        <outline text="Cortical geometry drives bending resistance"/>
        <outline text="Trabecular perforation weakens beyond mineral loss"/>
        <outline text="Density predicts population, not individual strength"/>
        <outline text="Osteocyte fluid flow lowers sclerostin">
          <outline text="Novel dynamic strain favours formation"/>
          <outline text="Rest restores mechanosensitivity"/>
        </outline>
        <outline text="Resorption precedes refilling">
          <outline text="High turnover creates temporary weakness"/>
        </outline>
        <outline text="Glucocorticoids: fragile bone and weak muscle"/>
        <outline text="Intermittent parathyroid hormone builds bone"/>
      </outline>
      <outline text="Fracture repair and weight bearing">
        <outline text="Haematoma provides signals and matrix"/>
        <outline text="Relative stability: bridging callus"/>
        <outline text="Absolute stability: direct remodelling"/>
        <outline text="Excess motion disrupts vessels and mineral"/>
        <outline text="Weight bearing not set by pain alone">
          <outline text="Fixation, bone quality, wound, falls risk"/>
          <outline text="Progress from below gait deterioration"/>
        </outline>
        <outline text="Train other limbs, trunk, cardiopulmonary system"/>
      </outline>
      <outline text="Cartilage, joints, and tendon">
        <outline text="Interstitial fluid first carries compression">
          <outline text="Sustained load shifts it to solid matrix"/>
        </outline>
        <outline text="Ligaments: end-range restraint and sensation"/>
        <outline text="Laxity and altered proprioception persist"/>
        <outline text="Joint swelling inhibits the quadriceps"/>
        <outline text="Tendon pain does not gauge damage">
          <outline text="Symptom-guided progressive loading"/>
          <outline text="Complete rest and sudden return both harm"/>
        </outline>
      </outline>
      <outline text="Return and exercise prescription">
        <outline text="Return not set by absent rest pain"/>
        <outline text="Symmetry guarantees nothing if both sides weak"/>
        <outline text="Connective tissue heals slower than muscle">
          <outline text="Scar restores continuity, not architecture"/>
        </outline>
        <outline text="Dose: load, speed, frequency, novelty, recovery"/>
        <outline text="Build reserve so daily life uses less capacity"/>
        <outline text="State starting dose, progression, review time"/>
      </outline>
    </outline>
  </body>
</opml>
