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: