What is Therapeutic Exercises ?

-It is a systemic, planned performance of bodily movements, postures or physical activities intended to provide a patient with the means to:

#Remediate or prevent impairments

#Improve, restore or enhance physical function

#Prevent or reduce health- related risk factors

#Optimize overall health status, fitness or sense of well- being

ASPECTS OF PHYSICAL FUNCTION

§ Balance

§ Cardiopulmonary fitness

§ Coordination

§ Flexibility

§ Mobility

§ Muscle performance

§ Neuromuscular control

§ Stability

§ Postural control

COMPONENTS IN THERAPEUTIC EXERCISE

ACTIVE MOVEMENT

§ Active movement is the movement of the segment within the unrestricted that is produced by active contraction of the muscle crossing that joint.

GOALS:

§ Maintains physiological elasticity and contractility of the muscles

§ Provides sensory feedback from the contracting muscles

§ Provides stimulus for bone and joint tissue integrity

§ Increases circulation and prevent thrombus formation

§ Develops coordination and motor skills for functional activities

§ Maintains the range of motion

§ Maintains joint flexibility

§ Stimulates proprioception through closed- kinetic chain exercises

§ Maintains cardiovascular


ADVANTAGES:

§ Restores range of motion within 80% of normal in the unaffected limb

§ Restores joint flexibility as observed in the unaffected limb

§ Begins proprioceptive stimulation through closed isotonic chain exercises

§ Begins pain- free, isometric strengthening exercises on the affected limb

§ Begin unresisted , pain- free functional patterns of sport- specific motion

§ Maintains cardiovascular endurance


INDICATION:

§ Decreased or lack of strength

§ Decreased or lack of muscular endurance

§ Substandard coordination

§ Loss of musculoskeletal functional integrity


CONTRAINDIATION:

§ Joint effusion

§ When motion is disruptive to healing process (acute tears, fractures, surgery, dislocations)

§ Muscular inflammation

§ Fever/ active infection (systemic or local)


TYPES OF ACTIVE MOVEMENT:

1. FREELY

· Movement of the segment within the unrestricted range of motion that is produced by active contraction of the muscles crossing t hat joint

2. FREELY ASSISTED

· When the therapist adopts the grips as for passive movement and assisted the patient to perform the movement

3. FREELY RESISTED

· When mechanical or manual resistance is applied. The mechanical resistance maybe perform as weights, springs, auto loading or the mode of performance of the activity

PROCEDURES TO APPLY:

1.EXAMINATION

· Examine and evaluate patient impairments and level of function, determine any precaution and prognosis and plan the intervention.

-Ability of the patient to participate 

-Decide the best can be meet the goals of:

# Anatomical planes of motion

#Muscles range of elongation

#Combined patterns

#Functional patterns

-Determine the amount of motion

-Monitor patient’s condition and response like vital signs, body temperature, skin colour and others

-Document and communicate finding and intervention

-Re- evaluate and modify the intervention as necessary



2.PATIENT’S PREPARATION

-Communicate with patient

-Free the region from restrictive clothing, linen, splints and dressings

-Position the patient in comfortable condition with proper body alignment

-Proper body mechanics for the therapist

3.APPLICATION

-Patient will perform the movement as by the motion of active movement

-Provides assistance only when needed for smooth motion

-Motion is perform within the available range of motion


MODALITIES USED

JOINT

Classification of joint

-It can be classify based on structure and function.

a)structure:

-Material that binds the bones together and on the presence or absence of joint cavity.

1.) Fibrous joints

-Bones connect by fibrous tissue.

-No joint cavity, little or no movement.

-Types:

Suture (skull)

Syndesmoses (gomphoses)

Interosseus membrane (ulna and radius bone)

2.) Cartilaginous joints

-Bones united by cartilage.

-No joint cavity, little or no movement.

-Types:

Synchondrosis (hyline cartilage unite bone)

Symphysis (fibrocartilage unites bones)

3.) Synovial joints

-Most movable joints in body.

-Have joint cavity (synovial cavity and synovial fluid)

-Articular cartilage (cover end of opposing bones)

-Articular capsule (enclosed joint cavity)

-Reinforcing ligaments

-Bursae

TYPES OF JOINTS

a)Plane joints

-articular surface are plane ,allow only glidding movement.

b)Hinge joints

-cylindrical surface of one joints fits in the trough shape of the other. Allow movement around 1 axis.

c)Pivot joints

-rounded end of one bone forms into a ring bounded by the other bone plus a ligament movement occur in 1 axis.

d)Condyloid

-egg shape surface of one bone fits into concave surface of other. Allow movement in 2 axis.

e)Saddle

-articular surface if both bones are concave and convex(saddle) biaxial joint.

f)Ball and socket

-spherical head of one bone fits into the socket of the other, multiaxial joint.

B)FUNCTION

-Synarthroses = immovable joint (suture)

-Amphiarthroses = slightly movable joints (fibrous connection, intervetebral discs)

-Diarthroses = freely movable joints (synovial)

STRENGTHENING EXERCISES

DEFINITION

-Strength is the ability of contractile tissue to produce tension and resultant force based on muscle

-Strengthening exercise is a systemic procedure of a muscle or muscle group lifting, lowering or controlling heavy loads ( resistance ) for a relatively low number repetition or over a short time of period

-Power defines as a work ( force x distance ) produced by the muscle per unit of time ( force x distance / time )

-Endurance is the ability to perform low intensity, repetitive or sustained activities over a prolong period of time


MASCULAR WEAKNESS & PARALYSIS 
 -Loss of movement or stability of a particular joint

-Muscle imbalance which affects all the groups concerned in the production of coordinated movement



CAUSES OF MUSCLE WEAKNESS 
 -Lesion affecting anterior horn cell

-Lesion affecting the motor pathways

-Lesion affecting muscle tissue

-Disuse of normal nerve and muscle tissue


GOALS OF RESISTANCE EXERCISES

-To increase muscle strength, power or endurance

-To maintain muscle strength, power or endurance

-To improve balance and coordination

-To reduce body fat and increase muscle mass

-To improve in perception of disability and quality of life


USE OF RESISTANCE EXERCISES

-Restoration of muscular strength

-Restoration of muscular coordination 
 
-Restoration of flexibility

-Restoration of cardiovascular endurance 

-Improvement of agility

-Improvement in speed

-Pain reduction

-Maintenance of general body conditioning


INDICATION
-Athlete
-Obesity
-Post operation surgery ( Total Knee Replacement (TKR) )
-Lower motor neuron patient
-Third phase of healing process for fracture

CONTRAINDICATION

-Inflammation 
   *Not indicated when joint or muscle is inflamed or swollen
   *Resistance will cause more damage to muscle or joint

-Pain
    *If patient experience severe joint pain or muscle pain during exercise or for more than 24    hours after exercise, the activity should be entirely eliminated or reduced

-Joint effusion
    *Accumulation of fluid in surrounding tissue
    *Will lead to pain


-When motion is disruptive to healing process ( acute tears, fractures, surgery, dislocations )

-Fever or active infection


PRECAUTION  

-Post-myocardial infarction or cardiac surgery

-Local muscle fatigue

-Total body fatigue

-Osteoporosis

-Exercising into pain 

-Diagnosis prohibiting exercise

-Uncontrolled hypertension

MODALITIES USED

PASSIVE MOVEMENT

-Passive movement is the anatomical position which performed by the therapist for the patient.

GOALS FOR PASSIVE MOVEMENT:

-Maintain joint and connective tissue mobility.

-Minimize the effect of the formation of the contractures.

-Maintain mechanical elasticity of muscle.

-Assist circulation and vascular dynamics.

-Enhance synovial movement for cartilage nutrition and diffusion of material.

-Decrease or inhibit pain.

-Assist with the healing process after injury or surgery.

-Help maintain the patient awareness of movement.

OTHER USES FOR PASSIVE MOVEMENT:

-Passive movement is used to determine limitations of motion.

-To determine joint stability.

-To determine muscle and other soft tissue elasticity.

-When a therapist is teaching an active exercise, passive movement is used to demonstrate the desired motion.

-When a therapist is preparing a patient for stretching, passive movement is often used preceding the passive stretching techniques.

ADVANTAGE OF PASSIVE MOVEMENT:

-To examining inert structures.

-To determine limitations of motion.

-To determine joint stability, muscle, and soft tissue elasticity.

-To demonstrate the desired motion.

DISADVANTAGE OF PASSIVE MOVEMENT:

-Does not prevent muscle atrophy.

-Does not increase strength or endurance.

-Does not assist circulation to the extent that active, voluntary muscle contraction does.

INDICATION OF PASSIVE MOVEMENT:

-Poor muscle contraction.

-Paralyze or stroke.

-Post operation patient i.e shoulder arthroscopy , total knee replacement.

-High pain score (VAS).

-Patient with poor cognitive.

CONTRAINDICATION OF PASSIVE MOVEMENT:

-Patient with venous stasis and thrombus formation.

-Interruption of healing process.

-Infection or fever.

-Joint inflammation.

-Joint effusion.

PROCEDURE FOR APPLYING PASSIVE MOVEMENT:

*Examination

- Examine and evaluate patient impairments and level of function, determined any precaution and prognosis, and plan the intervention.

-Ability of the patient to participate.

-Decide best pattern can be meets the goals of :

-Anatomical planes of motion.

-Muscle range of elongation.

-Combined pattern.

-Functional pattern.

*Patient preparation

-Communicate with the patient.

-Free the region from restrictive clothing, linen, splints, and dressings.

-Position the patient in comfortable position with proper body alignment.

-Proper body mechanics for the therapist.

*Application passive movement

-Forced of movement is external ( manually by therapist or devices)

-No active resistance or assistance is given by patient muscle.

-Motion is carried out within the free Range Of Motion without forced motion or pain.

EXERCISE OF PASSIVE MOVEMENT:

OSTEOPOROSIS

Do You Know That Every Year on 20th October is the WORLD OSTEOPOROSIS DAY?

It’s time to gain a better understanding of osteoporosis.

What do we know about osteoporosis? Apart from recognising it as an illness that affects the bones and that millions of people around the world suffer it, there is a general lack of awareness of this disease.

Osteoporosis is a pediatric disease which shows itself mainly when people are more than 50 years old. You are never too young to take preventative measures.

The disease may be classified as either primary type 1 or type 2 and secondary osteoporosis.[1] Osteoporosis is most common in women after menopause, and is referred to as primary type 1 or postmenopausal osteoporosis. Primary type 2 osteoporosis or senile osteoporosis occurs at age 75 years and older and is seen in both females and males in a 2:1 ratio. The onset of secondary osteoporosis is at any age, and affects both men and women equally.

Common symptoms include:

*Restriction of movement of the joint.

*Cracking sound and pain every time a joint is moved.

*Numbness and stiffness of joints.

*Swelling in and around the joints.

Other factors :

*Age-those above 30 years old.

*Weight

*Genetics.

How to prevent osteoporosis :

Exercise

One of the best ways to forestall osteoporosis is to do regular weight-bearing exercises. Begin a regular exercise program and stay with it. Start light and gradually build up to 30 to 40 minutes of exercise several times a week. Of course, consult your physician before you begin any exercise program and if you feel pain after you've begun.

Calcium

One of the most important ways to help prevent osteoporosis is to get enough calcium in your diet.

Anlene protects your bones.

Sufficient calsium intake, combine with a healthy and active lifestyle, help maintain bone health and reduce the risk of osteoporosis.

DON’T WAIT TILL IT’S TOO LATE.TAKE ACTION NOW !

By: Yasminnadia Binti Yusuf

2010611236

Rheumatoid Arthritis

 
 Rheumatoid arthritis (RA) is a disease that causes chronic inflammation of the joints. Rheumatoid arthritis also can cause inflammation of the tissue around the joints. The illnesses that occur are when the body tissues are attacked by its own immune system. It also can affect other organs of the body. Rheumatoid arthritis is referred as a systemic illness and sometimes we called it rheumatoid disease. While rheumatoid arthritis is a chronic illness, which mean it can last for years and patients may experience long periods without symptoms. However, rheumatoid arthritis is a progressive illness which has a potential to cause joint destruction and functional disability.

 Rheumatoid arthritis is a common rheumatic disease which three times more common in women as in men. It affects people of all races equally. The disease can begin at any age, but often starts after age 40 and before 60. In some families, multiple members can be affected, suggesting a genetic basis for the disorder.

The difference between normal, healthy joints and arthritic joints

A joint is where two bones meet to allow movement of body parts. Arthritis means joint inflammation. The joint inflammation of rheumatoid arthritis causes:

-Swelling

-Pain

-Stiffness

-Redness in the joints.

The inflammation of rheumatoid disease also can occur in tissues around the joints:

-Tendons

-Ligaments

-Muscles.

In some patients with rheumatoid arthritis, chronic inflammation leads to the destruction of:

-Cartilage

-Bone

-Ligaments

It causes deformity of the joints. Damage to the joints can occur early in the disease and progress as the individual ages.

-The symptoms of rheumatoid arthritis

-Fatigue

-Lack of appetite

-Low-grade fever

-Muscle

-Joint aches

-Stiffness.

 Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. Arthritis is common during disease flares. Also during flares, joints frequently become red, swollen, painful, and tender. This occurs because the lining tissue of the joint becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). The lining tissue of joint also thickens with inflammation (synovitis). In rheumatoid arthritis, multiple joints are usually inflamed in both sides of the body. The small joints of both the hands and wrists are often involved. Simple tasks of daily living, such as turning door knobs and opening jars can become difficult during. The small joints of the feet are also commonly involved. Chronic inflammation can cause damage to body tissues, cartilage, and bone. This leads to a loss of cartilage and erosion and weakness of the bones as well as the muscles, resulting in joint deformity, destruction, and loss of function.

Treatment of Rheumatoid Arthritis

 There is no specific treatment for Rheumatoid arthritis. However, physiotherapists work to reduce inflammation and pain, maintain joint ranges of motion (ROM) and maintain and increase muscle strength. Physiotherapy also do an assessment of a rheumatoid patient starts with observing the persons gait and observing any joint deformities and movement difficulties. Deformities badly can affect function and mean the person is unable to manage normal daily tasks. Physio treatment includes splinting, ice, analgesia, joint protection, rest and joint movements to keep the functions of the joints as the condition eases. A multidisciplinary plan is necessary for successful RA management due to the complexity of the condition.