EXERCISE THERAPY

• Exercise therapy is a form of therapy that

involves physical activity to help improve the
health and wellbeing of individuals.
• It is a type of treatment that can be used to
manage and prevent a range of health
conditions, including cardiovascular disease,
diabetes, obesity, and depression, among
others.
• Exercise therapy can involve a variety of
activities, such as aerobic exercise, strength
training, flexibility exercises, and balance
exercises.
• It can also be tailored to the specific needs
and abilities of the individual, and can be done
in a variety of settings, including at home, in a
gym, or in a therapy setting.
• Exercise therapy can have numerous benefits
for individuals, including improving physical
function, reducing symptoms of depression
and anxiety, improving cognitive function,
and reducing the risk of chronic diseases.
• It can also help individuals to manage chronic
pain, improve sleep quality, and enhance
overall quality of life.
• The goal of exercise therapy is to improve an
individual's overall health and well-being,
enhance physical function, reduce symptoms
of illness or injury, and improve overall quality
of life.
STRETCHING
 Indications

• Improves the joint range of motion

• Improves posture by strengthening the back
muscles
• Returns normal neuromuscular balance
between muscle groups
• Reduce injuries, strains and damage
• Before and after exercise to reduce muscle
soreness
 Contraindications

• Limited movement at the joint due to the

presence of a boney block
• Directly after fracture when it has not
completely healed
• Acute inflammation or, infection
• Sharp pain during joint movement
• Hematoma or other soft tissue trauma
• Hypermobility 
 Effects of Stretching
• Improves flexibility delaying impaired mobility
associated with aging
• Improves performance in physical activities as
a result of improved flexibility
• Reduce the risk of injury and damage
• Improves blood circulation reducing muscle
soreness and time for recovery
• Increasing the range of motion.
 PNF STRETCHING
• Proprioceptive neuromuscular facilitation
(PNF) is a stretching technique that can
improve your range of motion.
• PNF is a form of stretching that can boost your
flexibility, range of motion (ROM), and
strength.
 TYPES
• There are three PNF methods:
• contract-relax (CR),
• contract-relax-antagonist-contract (CRAC),
• hold-relax-swing.
 Contract-relax (CR) method
•  Also known as the hold-relax method, this involves
lengthening the target muscle and holding it in that
position while contracting.‌
• You can perform a CR stretch by following these
steps:
• Start with a passive stretch. A passive stretch is when
a muscle is lengthened while not being stimulated to
contract. An example of this is the stretching feeling
in your hamstrings when you reach down to touch
your toes.
• Isometrically contract the muscle that’s being
passively stretched for seven to 15 seconds. An
isometric contraction is when you hold your muscle at
a constant length.
• Relax the muscle for two to three seconds.
• Passively stretch the muscle again. This time, make
sure your muscle stretches further than in step one.
Hold for 10 to 15 seconds.
• Relax the muscle for 20 seconds before doing another
PNF technique.
 Contract-relax-antagonist-contract (CRAC)
method
• Also known as the hold-relax-contract
method, the CRAC is similar to CR but focuses
on antagonistic pairs of muscles.
• In an antagonistic pair, one muscle contracts
while the other relaxes or lengthens. The
muscle that’s contracting is the agonist, while
the muscle that’s relaxing is the antagonist.
• You can perform a CRAC stretch by following these steps:
• Do a passive stretch.
• Hold the muscle that’s being stretched in an isometric
contraction for seven to 15 seconds.
• Relax the muscle while performing an isometric contraction
on its antagonist. Hold for seven to 15 seconds.
• Relax the muscle for 20 seconds before doing another PNF
technique.
• Since there's no final passive stretch, the CRAC method is
one of the safest PNF techniques to perform. 
• Hold-relax-swing method. This technique involves
ballistic or dynamic stretches combined with static
and isometric stretches.
• It’s not recommended for beginners and should only
be done by experienced dancers and athletes who
have achieved a high level of control over their
muscle stretch reflex.‌
• It’s similar to the hold-relax technique, but a
dynamic or ballistic stretch is done instead of a
passive stretch.
 PURPOSE OF STRETCHING
• Increased range of motion. Stretching
lengthens your muscles. ...
• Preventing aches and pains. ...
• Reduced risk of overuse injuries. ...
• Improved performance. ...
• Relaxation and stress relief.
 PHYSIOLOGICAL CHANGES IN MUSCLE TO
STRETCH
• As the tension increases, the collagen fibers in
the connective tissue align themselves along
the same line of force as the tension. Hence
when you stretch, the muscle fiber is pulled
out to its full length sarcomere by sarcomere,
and then the connective tissue takes up the
remaining slack.
• The stretching of a muscle fiber begins with
the sarcomere, the basic unit of contraction in
the muscle fiber. As the sarcomere contracts,
the area of overlap between the thick and thin
myofilaments increases. As it stretches, this
area of overlap decreases, allowing the muscle
fiber to elongate.
• The stretching of a muscle fiber begins with the
sarcomere, the basic unit of contraction in the
muscle fiber. As the sarcomere contracts, the area of
overlap between the thick and thin myofilaments
increases (discussed above).
• As it stretches, this area of overlap DECREASES,
allowing the muscle fiber to elongate. Once the
muscle fiber is at its maximum resting length (all the
sarcomeres are fully stretched), additional stretching
places force on the surrounding connective tissue.
• As the tension increases, the collagen fibers
in the connective tissue align themselves
along the same line of force as the tension.
• So as you continue to stretch, the muscle
fiber is pulled out to its full length sarcomere
by sarcomere, and then the connective tissue
takes up the remaining slack.
 NEUROLOGICAL CHANGES TO MUSCLE TO
STRETCH
• When a muscle lengthens, the muscle spindle
is stretched and its nerve activity increases.
This increases alpha motor neuron activity,
causing the muscle fibers to contract and thus
resist the stretching. A secondary set of
neurons also causes the opposing muscle to
relax.
• Relative to the process of stretching, it is also important
to understand how the brain/neural components of the
musculoskeletal system adapt to stretching.
• When the muscle is stretched, so is the muscle
spindle (a nerve control point located
among groups of muscle fibers). The muscle
spindle records the change in length of the muscle and
how fast this change occurs.  It then sends signals
to the spine, which then conveys this
information to the brain.
• Initially, this information triggers the
stretch reflex, which attempts to
resist the change in muscle
length by causing the stretched
muscle to contract.
• This basic function of the muscle spindle
helps to maintain muscle tone and
to protect the body from injury.  
 Another neural component
• The golgi tendon organ (GTO), goes into action and
takes power over the muscle spindle.  Basically - when
muscles contract (possibly due to the stretch reflex),
they produce tension at the point where the
muscle is connected to the tendon. This
is where the golgi tendon organ is
located. The golgi tendon organ then
records the change in tension, and the
rate of change of the tension, and sends
signals to the spine to convey this
information.
• When this tension exceeds a certain threshold, it
triggers the lengthening reaction, which
inhibits the muscle’s contraction and
instead cause it to relax and lengthen.
• The lengthening reaction is possible only because the
signaling of golgi tendon organ to the
spinal cord is powerful enough to
overcome the signaling of the muscle
spindles telling the muscle to contract.
 Think of the two systems as a “double fail-safe” that
ultimately helps decrease your injury risk.
• “Muscle spindles are structures in the muscle
that sense stretch. For instance, when a calf
muscle is quickly stretched these spindles
detect the changes in muscle length and
transmit signals to motoneurons in the spinal
cord. The motoneurons then send signals back
to the calf muscle, causing the muscle to
contract. This is an example of a stretch reflex.