Intro of Exercise Therapy.pdf

Exercise therapy

1. INTRODUCTIONTO
EXERCISE
Mahesh Sharma

2. TherapeuticExercise
The exercise, which is needed for the treatment purpose, is called as
therapeutic exercise.
Which are performed to come out from ones ailment ordisease.
The main goal of the therapeutic exercise is preparing or making the patient
independent or symptom-freemovements.

3. TYPES OFMOVEMENTS
1.Activemovement
i.Assisted
ii.Free
iii.Assisted andresisted
iv.Resisted.

4. TYPES OFMOVEMENTS
2.Passivemovement
i.Relaxed passivemovement
ii.Passive manual mobilizationtechniques
iii.Mobilization
iv.Manipulation
v.Stretching.

5. INDICATIONS AND GOALS FORROM

6. PassiveROM
Indications forPROM
Intheregionwherethereisacute,inflamedtissue,
passive motion isbeneficial.
Inflammationafterinjuryorsurgeryusuallylasts2to6
days.
When a patient is not able to or not supposed to actively
move a segment or segments of the body, as when
comatose,paralyzed,oroncompletebedrest,movement
isprovidedbyanexternalsource.

7. PassiveROM
Goals forPROM
Maintainjointandconnectivetissuemobility
Minimizetheeffectsoftheformationofcontractures
Maintainmechanicalelasticityofmuscle
Assistcirculationandvasculardynamics
Enhancesynovialmovementforcartilagenutritionand
diffusionofmaterialsinthejoint
Decrease or inhibitpain
Assistwiththehealingprocessafterinjuryorsurgery
To maintain the patient’s awareness ofmovement

8. Other Uses forPROM
Whenatherapistisexamininginertstructures,PROMis
usedtodeterminelimitationsofmotion,todeterminejoint
stability,andtodeterminemuscleandothersofttissue
elasticity.
Whenatherapististeachinganactiveexerciseprogram,
PROMisusedtodemonstratethedesiredmotion.
Whenatherapistispreparingapatientforstretching,
PROMisoftenusedprecedingthepassivestretching
techniques.

9. ActiveROM
IndicationsforAROM
Ifapatientisabletocontractthemusclesactivelyandmovea
segmentwithorwithoutassistance,AROMisused.
Ifapatienthasweakmusculatureandisunabletomovea
jointthroughthedesiredrange(usuallyagainstgravity),A-
AROMisused.
AROMcanbeusedforaerobicconditioningprograms
Duringimmobilization,AROMisusedontheregionsabove
andbelowtheimmobilizedsegmenttomaintaintheareasin
as normal a condition as possible and to prepare for new
activities,suchaswalkingwithcrutches.

10. ActiveROM
Goals forAROM
Maintain physiological elasticity and
contractility of the participatingmuscles
Providesensoryfeedbackfromthecontracting
muscles
Provideastimulusforboneandjointtissue
integrity
Increasecirculationandpreventthrombus
formation
Developcoordinationandmotorskillsforfunctional
activities

11. LIMITATIONS OF ROMEXERCISES

12. Limitations of PassiveMotion
True passive, relaxed ROM may be difficult to obtain whenmuscleis
innervatedandthepatientisconscious.
Passive motion doesnot:
Prevent muscleatrophy
Increase strength orendurance
Assistcirculationtotheextentthatactive,voluntarymuscle
contraction
does
Limitations ofActive ROM
Forstrongmuscles,activeROMdoesnotmaintainor
increasestrength.
Italsodoesnotdevelopskillorcoordinationexceptinthe movement

14. PRINCIPLESAND
PROCEDURES

15. Examination, Evaluation,and
TreatmentPlanning
1.Examine and evaluate the patient’s impairments and
levelof function,determineanyprecautionsand
prognosis,andplantheintervention.
2.Determinetheabilityofthepatienttoparticipateinthe
ROMactivityandwhetherPROM,A-AROM,orAROM
canmeettheimmediategoals.
3.Determinetheamountofmotionthatcanbesafely
appliedfor
theconditionofthetissuesandhealthofthe
individual.

16. 4.Decidewhatpatternscanbestmeetthegoals.ROM
techniquesmaybeperformedinthe
a. Anatomic planes of motion: frontal, sagittal, transverse
b.Musclerangeofelongation:antagonistictothelineofpullof
themuscle
c.Combinedpatterns:diagonalmotionsormovements
that incorporateseveralplanesofmotion
d.Functionalpatterns:motionsusedinactivitiesofdailyliving
(ADL)
5.Monitor the patient’s general condition and responses during and
aftertheexaminationandintervention;noteanychangein vital
signs, any change in the warmth and color of the segment, and
any change in the ROM, pain, or quality of movement.
6.Documentandcommunicatefindingsandintervention.

17. Patient Preparation
1.Communicatewiththepatient.Describetheplanand
methodofinterventiontomeetthegoals.
2.Freetheregionfromrestrictiveclothing,linen,splints,and
dressings.
Drapethepatientasnecessary.
3.Positionthepatientinacomfortablepositionwith
properbodyalignmentandstabilizationbutthatalso
allowsyoutomovethesegmentthroughthe
availableROM.
4.Positionyourselfsoproperbodymechanicscanbeused.

18. Application ofTechniques
1.To control movement, grasp the extremity around the joints.If
thejointsarepainful,modifythegrip,stillproviding support
necessary forcontrol.
2.Supportareasofpoorstructuralintegrity,suchasa
hypermobilejoint,
recentfracturesite,orparalyzedlimbsegment.
3.Movethesegmentthroughitscompletepain-freerangeto the
point of tissue resistance. Do not force beyond the available
range. If you force motion, it becomes a stretchingtechnique.
4.Performthemotionssmoothlyandrhythmically,with5to10
repetitions.Thenumberofrepetitionsdependsonthe
objectivesoftheprogramandthepatient’sconditionand

19. 1.DuringPROMtheforceformovementisexternal,being
providedbyatherapistormechanicaldevice.When
appropriate,apatientmayprovidetheforceandbe
taughttomovethepartwithanormalextremity.
2.Noactiveresistanceorassistanceisgivenbythe
patient’smusclesthat
crossthejoint.Ifthemusclescontract,itbecomesan
activeexercise.
ThemotioniscarriedoutwithinthefreeROM,that
is,therangethatisavailablewithoutforcedmotion
orpain.
Application ofPROM

20. Application ofAROM
1.DemonstratethemotiondesiredusingPROM;thenask
thepatienttoperformthemotion.Haveyourhandsin
positiontoassistorguidethepatientifneeded.
2.Provideassistanceonlyasneededforsmooth
motion.Whenthereisweakness,assistancemaybe
requiredonlyatthebeginningortheendoftheROM,or
whentheeffectofgravityhasthegreatestmomentarm
(torque).
3.ThemotionisperformedwithintheavailableROM.

21. ACTIVE MOVEMENTS
(ACTIVE—BY HIS /HEROWN)
Assisted Exercise:
•If the strength or the coordination of the muscle is insufficient to perform
an activity, the external force is utilized to compensate thelack.
•The muscle has the strength or endurance but is not sufficient to perform an
activity or control anaction.

22. TypesofAssistedExercises

23. Activeassistance
•The patient himself can assist with his opposite extremity to perform the
assistedexercise.
Forexample,
a. The opposite leg is used by the patient to increase the flexion movement of
the knee in highsitting.
•The main advantage is the patient, he himself only knows the pain limit and
availability of range ofmovement.
•So, that he can perform the exercise conveniently within the painlimit.

24. Passiveassistance
It is classifiedinto:
1.Manual assistedexercise
2.Mechanical assistedexercise.

25. PrinciplesofAssistedExercise
•Range
•Command
•Concentration
•Speed
•Repetition

26. Uses
•Increase the ROM of thejoint.
•Increase the strength, power and the endurance of themuscles.
•It breaks the adhesion formation around thejoint.
•It reduces the spasm of themuscles.
•It stretches the tightened softtissue.
•It reminds the coordinated movement of the joint or amuscle.
•Increase the blood circulation and venous return to the joint andmuscle.

27. FreeExercise
•There are two types of freeexercises.
1.Localized
2.Generalbody.

28. Characteristicsofthe FreeExercises
•Subjective
•Objective
•Example: Bending and touching the great toe with the middle finger. Herethe
goal is set to touch thetoe.

29. Uses
•Increases the jointrange.
•Increases the muscle strength, power andendurance.
•Increases the neuromuscularcoordination.
•Increases the circulation and venousdrainage.
•Increases the relaxation of the muscle by the swinging movements and the pendularmovements.
•Repeated active movement breaks the adhesion formation and elongates the shortened soft
tissues.
•Regulating the cardiorespiratory function, and the active exercise increases the respiratoryand
venous return so that the O
2 supply to muscles and blood circulation to the muscleincreases.

30. ResistedExercises
•Performed by opposing the mechanical or manual resistance is called as
resistedexercises.
•TypesofResistedExercises
1.Manual
2.Mechanical

31. ManualResisted
•These exercises can be operatedby:
1.Thetherapist
2.Patienthimself
3.Relatives andfriends

32. MechanicalResisted
•Mechanical resisted exercises can be performed by:
1.Weights
2.Springs
3.Pulleys
4.Water

33. MechanicalResisted
•These resisted exercises can be stated when the muscle power is 2., i.e. from
gravity eliminatedposition.
•We can increase theresistance;
•By altering theleverage
•By increasing theweight
•By altering thespeed
•By changing the duration.

34. UsesofResistedExercises
•Resisted exercises increase the strength of the muscleearlier.
•The weak muscle can be strengthened much earlier than the any other exercise
regimen.
•Can be started from the muscle power 2onwards.
•Strength of the muscle is directly proportional to the tension created inside the
muscle.
•The resisted exercise can create the more amount of intramuscular tension.
Strength αTension

35. UsesofResistedExercises
•Increases the endurance of themuscle.
•Powerful muscle contraction increases the blood flow of the muscle fiber
and it gets nutrition and theO
2.
•Resisted exercise increases the muscularpower.
•Power is related to the strength of the muscle and the speed.
Power = Force ×Distance /Time

36. Progressive ResistedExercise
•Repetition Maximum:
The maximum amount of the weight a person can lift throughout the range
of motion exactly 10times.
3 types of progressive resisted exercise regimens areavailable.
1.DeLorme andWatkins
2.MacQueen
3.Zinovieff (Oxfordtechnique).

37. De Lorme andWatkins
•10 times with 1/2 10RM.
•10 times with 3/4 10RM.
•10 times with 10RM.
Progression
i.30 times weekly 4 sessions
ii.Every week 10 RMprogression.

38. De Lorme andWatkins
•a. Forexample:
Consider 10RM—1kg
Firstweek.
1/2 of 10 RM—1/2kg.
3/4 of 10 RM—3/4 kg
Full of 10 RM—1kg
Exercise regimen is 10 times with 1/2 kg, 10 times with 3/4 kg, 10 times with 1kg

39. De Lorme andWatkins
•Second week
Progression 10RM
= 10 RM + 10RM
= 1 kg +1kg
= 2kg
Exercise Regimenis
10 times with 1kg
10 times with 11/2kg
10 times with 2kg

40. De Lorme andWatkins
•In this exercise regimen, the weight is increased, i.e. first with 1/2 kg
followed by 3/4 kg and 1kg.
•Each and every session the patient has to lift the above said three typesof
weights 10 timeseach.
•So, that daily 30 times lifting beendone.

41. De Lorme andWatkins
•In each and every session 30 times the exercise should be done with 2
breaks by the patient. i.e. 10 times 1/2 10 RM (1/2 kg) → Break → 10 times
with 3/4 10 RM (3/4 kg) → Break→ 10 times 10 RM (1kg)
•Weekly 4 sessions the exercise has to be practiced.
Forexample:
Monday, Wednesday, Friday, Sunday (i.e. every alternative day’s) exercise has to
be practiced and remaining days, i.e. Tuesday, Thursday, Saturday givenrest.

42. Thankyou