Exercise therapy

By dr Abdiasis Omar Mohamed

MBBS
 Introduction

• Exercise therapy is a means of accelerating the

patient’s recovery from injuries and diseases which
have altered his normal way of living.
• The aims of exercise therapy:
1. To promote activity and minimize the effects of
inactivity.
2. To increase the normal range of motion.
3. To strength the weak muscles.
4. To improve the performance in daily activities
Movement and types of movements

• MOVEMENT is a fundamental characteristic of all

animal life and the mean by which the organism
adapts itself to the demands made up on it by the
environment in which it lives.
• Movement used in treatment may be classified as
follows:
1. Active movements
-Voluntary: Voluntary movement-movement
performed or controlled by the voluntary action of
muscle working in opposition to an external force.
- Involuntary reflex
• Assisted exercise: When muscle strength or co
ordination is in adequate to perform a movement an
external force is applied to compensate for the
deficiency.
• This external force must be applied in the direction of
the muscle action but not necessarily at the same
point.
• Free exercise: The working muscles are subject only
to the forces of gravity acting up on the part moved or
stabilized.
• Free exercise are those which are performed by the
patient’s own muscular efforts without the assistance
or resistance of any external force, other than that of
gravity.
• Assisted-Resisted exercise: This type of exercise
constitutes a combination of assistance and resistance
during single movement
• Resisted exercise An external force may be applied to
the body to oppose the force of muscle contraction.
• Tension is increased within the muscle by the
opposing force and the muscle respond by an increase
in their power and hypertrophy.
• There are five factors which contribute to the
development of muscular efficiency, Power,
Endurance, Volume, Speed of contraction and Co-
ordination Resistance force:
• The physiotherapist, patient, Weights, Weight and
pulley circuit, Springs and other elastic structures,
Substances which are malleable and Water
2. Passive movements
• These 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 of Passive Movement
1. Relaxed Passive Movement: These are movements
performed accurately, rhythmical and smoothly by
the physiotherapist through available range of
motion( according to anatomy of joints) .
• The movements are performed in the same range
and direction as active movements.
• The joint is moved through the free range and within
the limits of pain.
• Principles Of Relaxed Passive Movement
1. Relaxation: The selection of a suitable starting
position ensures comfort and support, for both
patient and physiotherapist through the movement.
2. Fixation: Good fixation for the proximal and distal
joint by the physiotherapist to ensure that the
movement is localized to the movable joint.
3. Support: Full and comfortable support is given to
the part to be moved, so that the patient has
confidence and will remain relaxed.
2. Traction: The fixation of the bone proximal to the
joint providing an opposing force to a sustained pull
on the distal bone. Traction is thought to facilitate
the movement by reducing inter- articular friction.
3. Range of movement : The range of movement is
done in painless range to avoid spasm in the
surrounding muscles.
4. Speed and Duration: As it is essential that relaxation
is maintained throughout the movement, the speed
must be slow and rhythmical, with suitable
repititions of the movement.
• Effects And Uses Of Relaxed Passive Movements
1. Maintain range of motion and prevent formation of
adhesions.
2. Maintain the physiological properties of the muscle
(extensibility, elasticity, etc.) and prevent shortening
and contracture.
3. Help in preserving and maintain the memory of the
movement pattern by stimulating the kinaesthetic
receptors.
4. The mechanical pressure resulted from the
stretching of the thin walled vessels which passing
across the moved joint will assist the venous and
lymphatic return ( improving circulation).
5. Can be used in training of relaxation as the rhythmic
continuous passive movements can have a soothing
effect and induce further relaxation and sleep.
6. Improving sense of position and sense of movement.
• Indications Of Relaxed Passive Movement
1. In cases of paralysis, patient who is confined in bed
for a long time or complete rest on bed.
2. When there is an inflammatory reaction and active
movement is painful.
3. When the patient in coma.
4. In relaxation as a factor helping to reduce spasm in
group of muscles.
• Contra-Indications Of Relaxed Passive Movement
1. Unhealed fracture, recent fracture, at the site of
fracture.
2. At site of effusion or swelling.
3. Immediately following surgical procedure to tendon,
ligaments, joint capsule.
4. Immediately after recent tear to ligament, tendon.
5. When a bony block limits joint motion e.g.
myosities ossificans.
6. Recent injuries
7. Severe muscle weakness.
8. Acute inflammation or infection as arthritis,
osteomylities etc
2. Forced Passive Movement: An exercise performed
on a subject by a partner who exerts an external
force not only to produce a passive movement, but
also to increase the range of movement of a joint.
3. The partner presses the joint into its end-position
(i.e. end of range), while the subject’s muscles that
normally carry out the movements are completely
relaxed.
4. There is a danger of overextension beyond the range
of movement and damage to the joint if the exercise
is not carried out carefully.
3. Continuous Passive Motion (CPM): A continuous
passive motion device maintains movement of a
joint after limb sparing surgery.
• This device is usually called a CPM. Continuous
movement limits stiffness and pain. It is very
important to keep joints moving following surgery
so that motion will not become limited.
• The CPM will move the involved leg through its full
range of motion. It is only used in bed, but can be
used while relaxing, eating, or sleeping.
• Fundamental positions
1. Standing
• The heels are together and on the same line, the toes
slightly apart (so that the angle between the feet
does not exceed 45°).
• The knees are together and straight.
• The hips are extended and laterally rotated slightly.
• The pelvis is balanced on the femoral heads.
• The spine is stretched to its maximum length.
• The vertex is thrust upwards, the ears are level and
the eyes look straight forwards.
• The shoulders are down and back.
• The arms hang loosely to the sides, palms facing
inwards towards the body.
2. Kneeling: The body is supported on the knees which
maybe together or slightly apart.
• The lower leg rests on the floor with the feet plantar
flexed, the feet may be in the mid-position over the
edge.
• The rest of the body is held as in standing.
3. Sitting: The position is taken on a chair or stool, the
height and width of which allow the thighs to the
fully supported and the hips and knees to be flexed
to a right angle.
• The knees are apart sufficiently to allow the femoral
to be parallel and the feet rest on the floor with the
heels vertically below the knees.
4. Lying: This is the easiest of the fundamental
positions as the body can be completely supported in
the supine position and is as stable as is possible.
5. Hanging (hg.): The body is suspended by grasping
over a horizontal bar, the fore-arms being pronated,
the arms straight and at least shoulder width apart.
• The head is held high and the scapulae are drawn
down and together, so that the neck appears as long
as possible.
• The trunk and legs hang straight, with the heels
together and the ankles plantar flexed
THE END