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STRINGTH
EXERCISEs
PROGAME
FOR

CALF
MUSCLE
2

: DONE BY
Zahra A. Al-Abd alhai–
ID : 208012493
Ftimah A. Al-Khamis –

ID : 208008394
,, SOAP Note

Subjective : a20 year old Saudi female ,she has right tibia shaft
fracture due to an accident , she had long leg plaster for six weeks ,
. now she has pain at the back of her Rt leg and difficult in walk

: Objective
.Mesomorph pt–
. Pt. came walk assisted by crutches with PWB on her Rt leg–
. There is calf muscle weak in affected leg–
. There is grade 1 tenderness in Rt calf muscle bulk–
ROM : ● knee flexion : 130 / 140 ● ROM of all other–
joints in
dorsiflexion : 15 / 20 both legs in all plane of•
plantar flexion : 40 / 60 motion are within•
normal
. eversion : 15 / 20 ROM•
inversion : 35 / 40•
MT : ● Knee flexors are grade 3 / 5–
Plantar flexors are grade 2+ /5•
Grossly MP of Rt leg muscles are graded 3+ / 5 to 4+ / 5 ,•
. proximal stronger than distal

: assessment

: problem list
pain at Rt calf muscle ;1
. limitation in ROM in Rt ankle joint especially in planter flexion ;2
3

( weakness in knee / ankle plantar flexors ( especially in calf M ;3


:Short term goal
reduce pain ;1
. increase ROM in Rt knee / ankle joints ;2
. strength of calf muscles ;3
:Long term goal
. Patient will be able to walk full WB on Rt leg within 4 Wks

: Plane
: TREATMENT SCEDUAL–
. PT will see the px. 3 sessions per week , for next 5 weeks
. ttt : ● TENS ( 100 mA ) at Rt calf M , at 15 min for 4 sessions–
Exercises program include : circulatory ex , ROM ex , •
. strength ex , endurance ex , stretch ex and balance ex

EXERCISES PROGRAM
; NOTE

.. DON'T hold breathing during contraction of any exercise–


Take 2 sec as relax period between every 2 Repetition ,–
and 5 min
.. between set to another–

: FIRST WEEK Ex's PROGRAME

: 1st session

.. Ex 1 : isometric –static- ex , for calf & hamistring Ms group ҉

Pt in supine position with the knee


slightly flexed , put a pillow under
the ankle joint of an affected leg ,
press on the pillow down by heel .
hold the contraction and count for 5
4

sec , then relax and repeat the contraction and holding for 5
. times , do it for 2 sets

.. Ex 2 : active assisted ROM ex , For ankle joint motions ҉

; For plantar flexion and–

Pt prone with both knees straight , PT


support the heel with the bottom of the
hand , other hand place on the dorsum of
foot and tell to pt. try to move your foot
up, with assisted of PT at begin and end
of ROM to complete the range , repeat at
. 6 times for 2 sets

; For ankle dorsiflexion–

as the same manner above , put the pt. in supine position ,


. repeat at 6 times for 2 sets

; For inversion & eversion–

Pt supine with your knees straight , PT using the bottom


hand , place the thumb medial and the finger lateral to the
joint on either side of the heel , other hand place on the
dorsum of foot and tell to pt try to turn your foot inward and
outward , with assisted of PT at begin and end of ROM ,
. repeat at 6 times for 2 sets

.. Ex 3 : active free ROM ex for knee flexion ҉

While prone position with your knees straight, slowly bend


your knee by moving your foot toward your buttocks , then
straighten to the starting position .. Repeat at 10 times for 2
.sets

: 2nd session
5

. Do the Ex 1 , with 10 Rep , for 2 sets ҉

. Do the Ex 2 , with 10 Rep , for 2 sets ҉

.. Progression of Ex 3 : active free ROM ex for knee flexion ҉

While prone position with your knees straight, slowly bend your
knee , while the bending move your sole of the foot toward
your head , then straighten to the starting position .. Repeat at
. 10 times for 2 sets

: 3rd session

Do the Ex 1 , hold the contraction for 10 sec , with 10 Rep ҉


. and for 2 sets

Do the progression of Ex 3 , Repeat at 15 times for 2 sets ҉

: AT THE BEGININNG OF 2nd WEEK

: Re-assessment
: ROM–
knee flexion : 135 / 140•
dorsiflexion : 18 / 20•
plantar flexion : 45 / 60•
eversion : 18 / 20•
inversion : 37 / 40 :•
MP–
Knee flexors are grade 3+ / 5•
Plantar flexors are grade 3 / 5•

SECOND WEAK Ex's PROGRAME


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: 1st session

, Ex 4 : active free ROM ex ҉

.. for plantar flexion –

While prone position with your


knee straight , move your foot up
then return back slowly . do it 10
. Rep for 2 sets
For dorsiflexion & eversion & –
,, inversion
Sit on a chair with both feet on the
ground , slowly move your foot up
and return to starting position ,
then move it inward and outward ,
. repeat at 10 times for 2 sets

Ex 5 : active free ROM ex , for knee ҉


.. flexion
From standing position , Hold table with one
hand and Slowly bend your knee , so foot lifts
up behind you , hold the position for 2 sec then
Slowly lower your foot back down. repeat at 10
. times for 2 sets

Ex 6 : Multiple angle isometric ҉


, ex

.. for plantar flexion–


pt. in prone lying position with
both knees straight and feet out
the edge , by the therapist's hand
stabilize the leg above ankle joint ,
and by other hand grasp the foot
then ask the pt. to lift her foot up ( about 20° of plantar
flexion ) & hold while the therapist push the foot down ,
count at 5 sec , repeat at 6 times .
Then repeat the ex with patient's
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foot actively lifted up about 40° ( then about 60° ) , for 6 Rep
. . Do the ex for 1 set

.. for knee flexion–


pt. prone and by therapist's forearm stabilize the pelvis ,
other hand resisted motion above the ankle while the pt.
bends her knee for 30° of flexion ( then for 60° / after that
for 90° ) , and ask the pt. to push against therapist
. resistance and hold . Repeat at 10 times for 1 set

: 2nd session

Ex 7 : static ex , for ankle plantar ҉


.. flexion
Pt. sit in a chair with both feet on the
ground , pushing down through the toes ,
raise your heel off the ground , hold this
position for 6 sec , then slowly return back .
. repeat at 10 times for 2 sets

Do the Ex 5 , BUT hold the table with ҉


. one finger , repeat at 15 times for 2 sets

, Do the Ex 6 : Multiple angle isometric ex ҉


. for plantar flexion .. do it at 10 Rep for 1 set–
. for knee flexion .. do it at 10 Rep for 1 set–

: 3rd session

Do the Ex 7 : WHEN you hold raising heel position count of ҉


. 10 sec , do it at 10 Rep for 2 sets

Ex 8 : active resisted –manual- ex , ҉


.. for knee flexion

From prone lying position , with both


knees straight bend an affected knee
while the therapist applied moderate to
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maximum resistance on the above ankle joint , then Slowly


. lower your foot back down , repeat at 10 times for 2 sets

, Do the Ex 6 : Multiple angle isometric ex ҉


. for plantar flexion .. do it at 10 Rep for 2 - 3 sets–
. for knee flexion .. do it at 10 Rep for 2 - 3 sets–

: AT THE BEGININNING OF 3rd WEEK

: Re-assessment
: ROM–
. Full ROM for all Rt leg joints in all plans of motion

MP : ● Knee flexors are grade 4 / 5–


Plantar flexors are grade 3+ /5•

THIRD WEAK Ex's PROGRAME

: 1st session

.. Ex 9 ; self stretching ex , for calf muscle ҉


can be done using a towel or a sheet ,
Hold the ends of the towel, and loop
the middle around your toes , Keep
your knee straight with your toes
pointing up , Pull the towel ends,
pulling your toes towards your body ,
hold this position for 20 sec , repeat at
. 4 times for 2 set

Ex 10 : active self-resisted ex , for ҉


.. plantar flexion
By a resistance band around your foot , and
your foot and ankle held up towards your
head. Slowly move your foot down against
the resistance band and comfortable
tightening your calf muscle . Slowly return
back to the starting position , repeat 10
. times for 2 sets
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Ex 11 : active resisted –mechanical- ex , ҉


.. for knee flexion
Pt. in prone lying position and put 1 Kg
weight above ankle of an exercised leg , ask
the pt. to bend her knee at 90° for 10 Rep at
. 2 sets

: 2nd session

Ex 12 ; stretching ex , for calf muscle and ҉


.. hamistring
Pt. standing with one leg on a chair and toes
move toward the body , then move trunk
forward , hold this position for 20 sec , repeat it
. at 3 times for 2 sets

, Ex 13 : active resisted ex ҉
From supine position , therapist stabilize the lower leg by–
one hand and by other apply resistance to
the plantar surface of the foot at the
metatarsals to resist plantar flexion , ask
the pt. to move her foot against therapist's
. hand , repeat at 6 Rep for 2 sets
Therapist apply resistance to the dorsum–
of the foot just above the toes to resist
dorsiflexion , ask the pt. to move her foot
against therapist's hand , repeat at 6 Rep
. for 2 sets
Therapist apply resistance to the medial–
aspect of the first metatarsal to resist
inversion and to the lateral aspect of the
fifth metatarsal to resist eversion , ask the
pt. to move her foot against therapist's
. hand , repeat at 6 Rep for 2 sets

Ex 14 : active resisted –mechanical- ex , ҉


.. for knee flexion
10

Pt. in standing position and hold a table or a chair by bothe


hand , and put 1 Kg weight above ankle of an exercised leg ,
. ask the pt. to bend her knee at 90° for 10 Rep at 2 sets

: 3rd session

Ex 15 : static - stretching ex , for calf ҉


.. muscle
From standing position with leg step -
backward , and support both hand against a
chair ( or wall ) , Ask pt. to move her trunk
toward the chair , maintain this position for
. 20 sec , 5 Rep , 1 set

Do the Ex 14 : with 2 kg , at 10 Rep for 2 ҉


. sets

,, Ex 16 : Calf Raises on a Leg Press Machine ҉


Sitting in a leg press machine and extend
your legs straight out . move your feet to
the leg press platform so that the balls of
your feet are firmly at the edge of the
platform. Then, let your heels move flex so
your calf are in a stretched position. Exhale
and raise onto your toes while keeping your
knees straight. Hold for a brief second at the
top and then slowly return to the starting position . Do it for 10
. Rep for 2 sets

: AT THE BEGININNING OF 4th WEAK

: Re-assessment
Knee flexors 4+ / 5
Plantar flexors 4 / 5

FOURTH WEAK Ex's PROGRAME


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: 1st session

. Do the Ex 15 : with 5 Rep , 2 sets ҉

Ex 17 : strength & endurance ex , both knee / ҉


,, ankle joints
STATIONARY BICYCLE , Adjust your bike seat so that
when sitting on the seat, your leg is slightly bent
when the pedal is at its lowest point .Begin
pedaling slowly with little resistance. Perform for 5
. min

.. Ex 18 : isometric ex , for calf muscle ҉


Begin this exercise standing at a bench or chair for
balance , facing forwards and slowly move up onto
your toes , raising your heels as far as possible ,
maintain this position for 6 sec . Then slowly lower
. back down , repeat at 10 times for 2sets

: 2nd session

,, Ex 19 : PNF stretch technique ҉


start from standing position , raise the heel up and hold this
position for 15 sec ,, Then return bake , and take few second
for relax . Then push against the wall for 20 sec . Perform 5 Rep
. for 1 sets

Do the Ex 17 : strength & endurance ex , both knee / ankle ҉


. joints ,, Do it with moderate resistance , for 5 min

Ex 20 : isometric ex , for calf muscle ҉


..
Standing with your heels dropped below
the level of a step as demonstrated.
Ensure you have something to hold
onto for balance. Slowly move up onto
your toes, raising your heels as far as
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possible and maintain this position for 6 sec . Then slowly lower
. back down. Perform 10 Rep for 2 sets

: 3rd session

Do the Ex 19 : PNF stretch technique ,, Perform 5 Rep for 2 ҉


. sets

Do the Ex 17 : strength & endurance ex , both knee / ankle ҉


. joints ,, Do it with moderate resistance , for 5 min

.. Ex 20 : isometric ex , for calf muscle ҉


standing on one leg with your heels dropped
below the level of a step. hold something onto
( eg. Chair ) for balance. Slowly move up onto
your toes , maintain this position for 6 sec . Then
slowly lower back down. Perform 10 Rep for 2
. sets

,, AT THE BEGININNING OF 5th WEAK


: Re-assessment
Plantar flexors 4+ / 5

This weak for maintenance muscle power . So , do these


; exercises as you can
,, PNF stretch technique ҈
start from standing position , raise the heel up and hold this
position for 15 sec ,, Then return bake , and take few second
for relax . Then push against the wall for 20 sec . Perform 5 Rep
. for 1 sets

strength & endurance ex , both knee / ankle ҈


,, joints
STATIONARY BICYCLE , Adjust your bike seat so that
when sitting on the seat, your leg is slightly bent
when the pedal is at its lowest point .Begin pedaling
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slowly with moderate to maximum resistance. Perform for 5


. min

.. isometric ex , for calf muscle ҈


standing on one leg and holding a weight , with your
heels dropped below the level of a step , hold
something onto ( eg. Chair ) for balance. Slowly
move up onto your toes , maintain this position for 6
sec . Then slowly lower back down. Perform 10 Rep
. for 2 sets