Strengthening of lower limbs , Physiotherapy.

Strengthening protocol for lower limbs in physiotherapy

1. Strengthening of lower limbs Presented by : AMULYA BODKE BPT 4 TH YR, Apollo college of Physiotherapy, Jubilee Hills, Hyderabad .

2. What is strength? Muscle strength is a broad term that refers to the ability of contractile tissue to produce tension and a resultant force based on the demands placed on the muscle . More specifically, muscle strength is the greatest measurable force that can be exerted by a muscle or muscle group to overcome resistance during a single maximum effort.

3. What is strength training? The development of muscle strength is an integral component of most rehabilitation or conditioning programs for individuals of all ages and all ability level. Strength training (strengthening exercise) is defined as a systematic procedure of a muscle or muscle group lifting, lowering, or controlling heavy loads (resistance) for a relatively low number of repetitions or over a short period of time. The most common adaptation to heavy resistance exercise is an increase in the maximum force-producing capacity of muscle, that is, an increase in muscle strength, primarily as the result of neural adaptations and an increase in muscle fiber size.

4. The art of training or strengthening muscles lies in creating the conditions under which they are called upon to work to full capacity against an ever increasing resistance.

5. INDICATIONS : CURATIVE : Muscle – weakness or paralysis Bone – to increase density Aerobic system – improves aerobic capacity Other connective tissues – improves pliability . 2. PREVENTIVE : To preserve muscle power in all conditions where muscle weakness is anticipated / to live a healthy life with high levels of fitness. 3 . PREPARATIVE : To prepare for some specific activity where the adaptations of resistance exercise will be useful, ex. – training for arm muscles of a boxer will prepare him for a better performance. 4. RECREATIVE : Various forms of resistance training is used as sports & recreation activity.

6. At the beginning of the treatment, assessment of the strength of the muscles is essential. A suitable resistance is then selected, which includes consideration of the poundage of the resisting force, the leverage, the speed, the duration of the movement. As treatment continues, progression of one or all of these factors is made as muscle strength develops. Account must be taken of all work the muscles in question are called upon to do, whether it be exercises in the physiotherapy dept. ,occupational therapy, specific home exercises, work or ordinary activities of everyday life.

7. Technique of re-educating muscles grade wise : Muscles with severe paralysis or weakness are evaluated by MMT and re-educated from grade-0 to grade-5 as follows : Grade 0 RE-EDUCATION BOARDS ELECTRICAL MUSCLE STIMULATION SUCH AS INTERRUPTED DIRECT CURRENTS FOR DENERVATED MUSCLES FARADIC AND HVG CURRENTS FOR INNERVATED MUSCLES

8. GRADE – 1 & 2

9. GRADE 2 TO 3 HYDROTHERAPY AND PULLEYS

10. GRADE 3 TO 4 PROGRESSIVE RESISTED EXERCISES SAND BAGS WEIGHT CUFFS FUNCTIONAL EXERCISES MANUAL RESISTANCE EXERCISES DUMBBELLS STARTING WITH LOW WEIGHT THERABANDS

11. GRADE 4 TO 5 ALL ABOVE EXERCISES INCREASING RESISTANCE GRADUALLY MANUAL RESISTED EXERCISES WITH INCREASING LEVERAGE, WEIGHT , NUMBER OF REPETITIONS INCREASING MECHANICAL WEIGHTS

12. Overload principle If muscle performance is to improve, a load that exceeds the metabolic capacity of the muscle must be applied; that is, the muscle must be challenged to perform at a level greater than that to which it is accustomed . If the demands remain constant after the muscle has adapted, the level of muscle performance can be maintained but not increased.

13. Increase in strength and hypertrophy occur in response to an increase in intra muscular tension set up by the factors which oppose their contraction. It is, therefore, essential that these opposing factors, which constitute the resistance, must be increased as the strength of the muscles improves.

14. An increase in resistance which is too rapid results in overloading, which prevents contraction and may damage the muscles. Underloading will not increase strength, but may be sufficient to prevent wasting of muscles.

15. Re-education may be regarded as a continuous process which begins, while the muscles are still paralyzed, in the form of an attempted initiation of contraction, and extends until maximum function is achieved. Once the power of contraction has been regained, the muscles are strengthened progressively until maximum function is obtained.

16. The affected muscles must be strengthened progressively by resisted exercises, which are specific for the group to which the muscles belong. RANGE – The range of movement is increased. b. TYPE OF MUSCLE WORK – concentric, eccentric and static muscle work are elicited. c. RESISTANCE – The resistance is increased by: Increasing the poundage of the resistance ; Increasing the leverage of the resistance . d. SPEED – increase or decrease in the speed of movement is a progression for concentric work. Decrease in speed is a progression for eccentric work. Lengthening of the contraction period is a progression for static holding. e. DURATION – Increase in number of times an exercise is performed or decrease in the rest period between each series of exercises, or a combination of both according to circumstances, makes more work for the muscles.

17. TYPES OF EXERCISES USED TO STRENGTHEN MUSCLES AND RESTORE FUNCTION

18. Concentric muscle contraction Eccentric muscle contraction Isometric exercise is a static form of exercise in which a muscle contracts and produces force without an appreciable change in the length of the muscle and without visible joint motion

19. Types of isometric exercises

20. Dynamic exercises A dynamic muscle contraction causes joint movement and excursion of a body segment as the muscle contracts and shortens (concentric contraction) or lengthens under tension (eccentric contraction).

21. During concentric and eccentric exercise, resistance can be applied in several ways: constant resistance, such as body weight, a free weight, a simple weight pulley system; a weight machine that provides variable resistance an isokinetic device that controls the velocity of limb movement.

22. PHYSIOLOGICAL CHANGES & BENEFITS FROM STRENGTHENING EXERCISES

23. Intrinsic foot muscles

24. Toe abduction

25. The dorsiflexors Tibialis anterior Extensor digitorum longus Extensor hallucis longus Fibularis / Peroneus tertius

26. ACTIVITIES : Walking Walking uphill Climbing Bicycling with pedal straps Long jump

27. The plantar flexors Gastrocnemius Soleus plantaris

28. ACTIVITIES: Walking Running Jumping Balance walk Cycling

29. The Invertors : Tibialis anterior Tibialis posterior

30. ACTIVITIES : Walking Running Balancing on uneven surface Kicking a football

31. THE EVERTORS : Peroneus longus Peroneus brevis

32. Toe standing , balance on surface which slopes downwards or medial wards

33. THE KNEE EXTENSORS : QUADRICEPS 1.Rectus femoris 2. Vastus lateralis 3. Vastus medialis 4. Vastus intermedius 5. Sartorius 6. Articularis genu

34. THE KNEE FLEXORS : HAMSTRINGS / BACK OF THIGH MUSCLES : SEMITENDINOSUS SEMIMEMBRANOSUS BICEPS FEMORIS ADDUCTOR MAGNUS ( HAMSTRINGS PART )

35. ACTIVITIES :

36. THE HIP EXTENSORS : GLUTUES MAXIMUS HAMSTRINGS

37. ACTIVITIES :

38. THE HIP FLEXORS : PSOAS MAJOR ILIACUS assisted by 3. QUADRICEPS

39. ACTIVITIES :

40. THE HIP ABDUCTORS : GLUTEUS MEDIUS GLUTEUS MINIMUS TENSOR FASICAE LATA

41. ACTIVITIES :

42. THE HIP ADDUCTORS : ADDUCTOR BREVIS ADDUCTOR LONGUS ADDUCTOR MAGNUS PECTINEUS GRACILIS

43. ACTIVITES :