FBET movements therapy modality social .

Movement of exercise therapy

1. MOVEMENTS AND EXERCISE AS
THERAPEUTIC MODALITY AND
THEIR EFFECTS.
PHYSIOLOGICAL REACTION OF
EXERCISE.

2. Techniques of exercise
therapy
Active
movements
Voluntary
Assisted Free
Assisted-
Resisted
Resisted
Involuntary
Passive
movements
Relaxed
passive
movements
Passive manual
mobilization
techniques

3. Active Exercise
Definition:
Movement performed or controlled by the
voluntary action of muscles, working in
opposition to an external force.
Classification
1.Free Exercise
2.Assisted Exercise
3.Assisted-resisted Exercise
4.Resisted Exercise

4. 1.Free Exercise
Free exercise are those which are
performed by patients own muscular
efforts without the assistance/resistance
of any external force ,other than gravity
Technique :
Starting position
Instruction
Speed
duration

5. Classification:
1.Localized:
○Mobilized a particular joint
○Strengthen particular group of muscle
○Produce-local & specific effect

6. 2.General:
○Uses many joint and muscles
○Effect is wide spread
○Egrunning
Character of particular exercise may:
Subjective
Objective

7. Effects and uses
Relaxation
Joint mobility
Muscle power and tone
Neuromuscular co-ordination
Confidence
Circulatory and respiratory co-operation

8. 2.Assisted Exercise
When the force exerted on one of the body
levers by muscular action is insufficient for the
production /control of movement, an external
force (assistance) may be added to augment it.
Plan is to ensure that the insufficient muscle
exert their maximum effort to produce
movement under conditions designed to
facilitate their action
It must be in direction of muscle action
Not necessarily at same point
Only augment not substitute

9. Technique
Starting position
Pattern of movement
Fixation & support
Antagonist muscles
Assisting force
Character of movement-smooth,
attention,speed
repetition
Co-operation of patient

10. Effects and uses
Neuro-muscular re-education
Training Co-ordination
Confidence
IncROM
Helpful to maintain movement in cases
of painful joints egRA

11. Self-assisted ROM
With cases of unilateral weakness or paralysis or during early stages of
recovery after trauma or surgery, the patient can be taught to use the
uninvolved extremity to move the involved extremity through ranges of motion.
The effects of gravity change with patient positioning, so when lifting the part
against gravity, gravity provides a resistive force against the prime motion and,
therefore, the prime mover requires assistance. When the extremity moves
downward, gravity causes the motion, and the antagonists need assistance to
control the motion eccentrically.
Forms of Self-assisted ROM
Manual
Equipment
Wand or T-bar
Finger ladder, wall climbing, ball rolling
Pulleys
Skate board/powder board
Reciprocal exercise device

12. Guidelines for Teaching Self-assisted ROM
Educate the patient on the value of the motion.
Teach the patient correct body alignment and
stabilization.
Observe patient performance and correct any
substitute or unsafe motions.
If equipment is used, make sure all hazards are
eliminated
Provide drawings and clear guidelines for
number of repetitions and frequency.
Review the exercises at a follow-up session

13. Assisted-Resisted Exercise
Constitute= assistance + resistance in a
single movement

14. Resisted Exercise
An external force is
applied to oppose the
movement/force of
muscle contraction
Incin tension within
muscle
Incpower and
hypertrophy

15. In isotonic contraction-resistance force
should be sufficient enough to inc
intramuscular tension but should not interfere
with movement
In ismometericcontraction-resistance force
should be equal to muscle ability to maintain
hold

16. Factor which contribute to development
of muscular efficiency:
Power: progressive resistance-low repetition
exercise
Endurance: low resistance-high repetition
exercise
Volume: hypertrophy
○Proportion to power

17. Technique:
Starting position
Pattern of movement
Stabilisation
Traction
Resisting force
Character of movement-smooth,speed
repetition
Co-operation of patient

18. Resistances
Physiotherapist
Patient

19. Weights
Weight and pulley circuit
Springs and other elastic
structures
Substance which are
malleable-putty, clay
Water

20. Progression
Inc. weights
Inc. leverage
Alteration of speed
Inc. duration

21. Progressive Resistance Exercise
First describe by de Lormein 1945
The maximum weight which can be lifted
once only through a prescribed range is
called one repetition maximum (1 R. M.)

23. Effects and Uses
Muscle power
Co-ordinated movements
Inc. Blood flow
Inc. blood pressure
Heat

24. Passive Movements
movements are produced by an external
force during muscular inactivity or when
muscular activity is voluntarily reduced as
much as possible to permit movement.
Classification
a. Relaxed Passive Movements,
including accessory movements.
b. Passive Manual MobilisationTechniques
i.Mobilisationsof joints
ii.Manipulations of joints
iii.Controlled sustained stretching of tightened
structures

25. Indications for PROM
-In the region where there is acute, inflamed tissue, passive motion is
beneficial; active motion would be detrimental to the healing process.
Inflammation after injury or surgery usually lasts 2 to 6 days.
-When a patient is not able to or not supposed to actively
move a segment(s) of the body, as when comatose, paralyzed, or on
complete bed rest, movement is provided by an external source.
-PROM is indicated after surgical repair of contractile tis-
sue when active motion would compromise the repaired
muscle.
Goals for PROM
decrease the complications that would occur with immobilization
Maintain joint and connective tissue mobility.
Minimize the effects of the formation of contractures.
Assist circulation and vascular dynamics.
Enhance synovial movement for cartilage nutrition and diffusion of materials in
the joint.
Decrease or inhibit pain.
Assist with the healing process after injury or surgery.
Help maintain the patient's awareness of movement.

26. Other Uses for PROM
When a therapist is examining inert structures, PROM is used to
determine limitations of motion, joint stability, muscle flexibility,
and other soft tissue elasticity.
When a therapist is teaching an active exercise program, PROM
is used to demonstrate the desired motion.
When a therapist is preparing a patient for stretching, PROM is
often used preceding the passive stretching techniques.
Limitations of Passive Motion
True passive, relaxed ROM may be difficult to obtain when
muscle is innervated and the patient is conscious. Passive
motion does not:
Prevent muscle atrophy
Increase strength or endurance
Assist circulation to the extent that active, voluntary muscle
contraction does

27. Relaxed Passive Movements
A knowledge of the anatomy of joints is
required.
The movements are performed in the same
range and direction as active movements.
The joint is moved through the existing free
range and within the limits of pain.
Technique:
Relaxation
Fixation and support
Traction
Range
Speed and duration

28. Effects and uses
Prevention of adhesion formation
Helps to preserve memory of movement
pattern
Extensibility of muscle is maintained
Prevention of adaptive shortening
Assist venous and lymphatic drainage
Relaxation

29. Continuous passive motion
(CPM)
refers to passive motion performed by a
mechanical device that moves a joint
slowly and continuously through a
controlled ROM.
developed by Robert Salter

30. Benefits of CPM
Preventing development of adhesions and
contractures and
thus joint stiffness
Providing a stimulating effect on the healing of
tendons and ligaments
Enhancing the healing of incisions over the moving
joint
Increasing synovial fluid lubrication of the joint and
thus increasing the rate of intra-articular cartilage
healing and regeneration
Preventing the degrading effects of immobilization
Providing a quicker return of ROM
Decreasing postoperative pain

31. Physiological reaction of exercise.
The physiological response to exercise is
dependent on the
intensity,
duration
frequency
environmental conditions.

32. The shift in body metabolism occurs
through a coordinated activity of all the
systems of the body: neuromuscular,
respiratory, cardiovascular, metabolic,
and hormonal
Effects can be;
Immediate
Longterm

33. The short term effects of exercise on the
muscles:
1. Working muscles produce heat
2. Increased muscle fatigue due lactate
accumulation
3. Blood is re-distributed to working
muscles
(Shunting)

34. Cardiovascular

35. 1. On blood
Mild hypoxia
due to
exercise
Stimulate JG
apparatus
Secrete
erythropoietin
Stimulate
bone marrow
Release RBC

36. 2. Blood volume
Heat
produced
Thermal
system
activation
Sweat –
fluid loss
Decrease
blood
volume

37. 3. Venous return
Increase due to muscle pump
Respiratory pump

38. 4. On heart rate
Increase with exercise even thought of preparation due to
impulses from cerebral cortex to medullary center which
decrease vagal tone
• Moderate exercise 180 beats/min
• Severe exercise 240 to 260 beats/min
Brain
Increase in HR is due to
-Impulses from proprioceptor. These impulses act through
higher centers and increase HR
-Increased CO2 tension which acts through medullary
centers
• Rise in body temperature, which acts on cardiac centers via
hypothalamus, increased temperature also stimulates SA
node directly
Circulating catecholaminessecreted during exercise

39. 5. Cardiac output
CO increase up to 20 L/min in moderate
exercise to 35 L/min during severe
exercise
• CO=HR*SV
• Stroke volume increases due to
increased force of contraction

40. 6. Blood pressure
• Isotonic exercise
-Increase systolic pressure due to HR and
SV but diastolic pressure reduce due to
decrease peripheral resistance (Vasodilation).
• Isometric exercises
-Increase systolic as well as diastolic
pressure due
to increase peripheral resistance

41. 7. On blood flow to skeletal
muscle
Resting is 3-4 ml/100 mg of the muscle
During moderate exercise 60 to 80 mL
and severe exercise 90 to 120 mL

42. RESPIRATORY SYSTEM

43. Effect on
• Pulmonary Ventilation
• Diffusion capacity of 02
• Consumption of 02
• 02 dept
• Vo2 max
• Respiratory Quotient

44. 1. Pulmonary ventilation :
• It is amount of air that enters and leaves the
lungs in 1 min
• In normal condition PV=TV*RR
6 ltr=500 ml *12
• During exercise
60 Itr=2000 ml* 30
• In severe exercise it can go upto100 Itrper
minute also.

45. • Factors responsible for increased ventilation:
-Higher center
-Chemoreceptor's (central, peripheral)
-Proprioception
-Body Temperature
-Acidosis
2. Diffusion capacity of 02
• 02 diffusion capacity increases from 21ml/min
to 45 to 50 ml/min because of increased blood
flow through pulmonary capillaries.

46. 3. Consumption of 02
• 02 consumption increases during exercise
by muscles.
• Vasodilatation cause greater blood flow to
muscle
• Which causes greater oxygen supply to
muscle
• Oxygen utilization by muscle is directly
proportional to amount of oxygen available.

47. 4. 02 debt
• Oxygen debt is extra amount of oxygen required by
muscle during recovery from severe muscle exercise.
-02 debt increase 6 times than normal resting
conditions
-Extra oxygen is required for
Reformation of glucose from lactic acid, accumulated
during exercise
Resynthesisof ATP and creatinephosphate
Restoration of amount of oxygen dissociated from
hemoglobin and myoglobin

48. 5. Effect on vo2 max
• It is amount of o2 consumed under maximum aerobic
metabolism.
VO2 max= CO* Amount of 02 consumed by muscle
• In normal health
• Male
-35 to 40 ml/kg body weight per minute
• Female
-30 to 35 ml/kg body weight per minute
• During exercise it increase by 50%
6. Effect on respiratory quotient
• It is the molar ratio of CO2 production to 02
consumption.
• During exercise it increases to 1.5 to 2
• However at end of exercise it reduces to 0.5

49. Metabolic Adaptation
Mitochondria
Fat metabolism
Carbohydrate metabolism

50. Muscular System
Hypertrophy
-Increase myofibril volume.
-Increase protein synthesis by amino acids
Hyperplasia
-Increase no of muscle fiber.
-Due to longitudinal splitting of fiber.
Muscle fiber adaptation
-Long distance trainer have high protein of slow twitch muscle fiber.
-Sprinters have fast twitch muscle fiber.
Body composition
-Strengthening exercise cause decrease fatty mass and increase lean
body mass
-Endurance exercise cause only decrease fatty mass.

51. Bone
-Regular weight bearing exercise
increases bone mineral density
-Also prevent risk of fracture, injury, and
age related bone loss changes.
Connective tissue adaptation
-Increase tensile strength of tendons &
ligaments

52. Nervous system adaptation
Exercise increases Neural drive (It is a
measure of the combined motor unit
recruitment and rate coding of active
motor units within a muscle)
Increased motor unit firing
Increases nerve excitability and NCV
less fatigue.

54. Thank you