THERAPEUTIC EXERCISES

Therapeutic Exercise
Therapeutic exercise as bodily movement prescribed to correct an impairment, improve musculoskeletal function, or maintain a state of well-being. It may vary from highly selected activities restricted to specific muscles or parts of the body, to general and vigorous activities that can return a convalescing patient to the peak of physical condition.

Definition
Therapeutic exercise is the systematic and planned performance of body movements or exercises which aims to improve and restore physical function.

EXERCISE
Activity that is performed or practiced in order to develop or improve a specific function or skill for the sake of developing and maintaining physical fitness

AIM Of The Therapeutic Exercise

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Enable ambulation Release contracted muscles, tendons, and fascia Mobilize joints Improve circulation Improve respiratory capacity Improve coordination Reduce rigidity Improve balance Promote relaxation Improve muscle strength and, if possible, achieve and maintain maximal voluntary contractile force (MVC) 11. Improve exercise performance and functional capacity (endurance)

Importance Of The Therapeutic Exercise

1. The ultimate goal of a therapeutic exercise program is the achievement of an optimal level of symptoms free movement during basic to complex physical activities. 2. To improve and restore physical function.

Importance Of The Therapeutic Exercise

3. To enhance a patients functional capabilities and prevent loss of function. 4. To prevent and decrease impairment and disability 5. To optimize overall health status, fitness and sense of well-being

Prerequisites For Designing Exercise Program

The therapist must have knowledge of anatomy, physiology, kinesiology and pathology and can integrate and apply this knowledge to each condition.

Prerequisites For Designing Exercise Program

The therapist must understand the different forms of exercises and how these exercises affect body system. The exercise program should be individualized to the special needs of each patient.

Steps For Designing Exercise Program

Start with comprehensive examination of the patient. Determine the problems and functional disabilities that the patient has. Set the aims and objectives of the treatment program. Select the proper exercise program that can solve the patients problems and improve functional capabilities.

Steps For Designing Exercise Program

Periodic e-evaluation and examination of the patients should be carried out weekly or monthly depending on the program. According to the result of the re-evaluation, modifications of the program should be made to attain the optimal degree of improvement

Types of Therapeutic Exercises

Range of motion exercises which aims to maintain and increase range of motion Muscle performance exercises to increase muscle strength, power and endurance

Classification of Therapeutic Exercises

Therapeutic Exercises
Passive Exercises

Active Exercises

Relaxed passive Exercises

Forced Passive Exercises

Static Exercise

Active assisted Exercises

Active Free Exercises

PASSIVE MOVEMENT

Passive Movement
These movements are produced by an external force during muscular inactivity or when range of motion is reduced for any cause.

Classification of Passive Movement

1- Relaxed Passive Movements, including accessory movements. 2- Forced Passive movement. 3- continuous Passive movement.

1- RELAXED PASSIVE MOVEMENT

1- RELAXED PASSIVE MOVEMENT

Definition: 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.

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-sever muscle weakness. 8-Acute inflammation or infection as arthritis, osteomylities.

II- Forced passive movement

Definition 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. 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. There is a danger of overextension beyond the range of movement and damage to the joint if the exercise is not carried out carefully.

EFFECTS AND USES OF FORCED PASSIVE MOVEMENTS

As in relaxed passive movement, but specially increasing the limited range of motion.

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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.

Benefits of CPM
1-decreasing the complication of immobilization. 2-decreasing the post operative complication and pain. 3-improving the recovery rate and ROM. 4-improving the circulation through pumping action. 5-prevent adhesions and contracture. 6-prevent joint effusion and wound oedema.

Procedure of CPM
It is important that you understand the use of CPM. The therapist may adjust the device to fit you before surgery. You will begin to use the CPM right after surgery. Your therapist will give you instructions and monitor how you use the device. The CPM is set to allow 45 degrees of motion right after surgery. Generally, motion will be increased about 15 degrees a day. You will need to use the CPM for about 6 weeks after surgery.

ACTIVE MOVEMENT

Definition:
Movement performed within the unrestricted ROM controlled by the voluntary contraction of the muscle.

Classification of Active Movement

1- Active assisted exercise: In which assistance is provided by an outside force, either manual or mechanical when muscle strength is inadequate to complete the motion. 2- Active free exercise: In which the voluntary contraction of the muscle can perform full ROM against gravity. 3- Active resisted exercise: In which the voluntary contraction of the muscle is resisted by an outside force.

 The principles of assistance:

ACTIVE ASSISTED EXERCISE

1-When the voluntary contraction of the muscle is insufficient to produce movement, 2- An external force may be added to complete range. 3- This external force must be applied in the direction of the muscle action. 4-The magnitude of this assisting force must be sufficient only to augment the muscular action but not allowed to act as a substitute for it. 5-As the muscular power is increasing, the assistance given must be decreased proportionally.

Effects and uses of assisted exercise

1-When the patient has weak musculature( poor to fair minus muscle test grade). Active assisted exercises is used to provide enough assistance to strength the weak muscle. 2-Maintain physiologic elasticity and contractility of the muscles which will gain strength and hypertrophy. 3-provide sensory feedback from the contracting muscle to be used in early stages of neuromuscular re-education.

4-provide stimulus for bone integrity, so the range of effective joint movement may be increased. 5-The repetitive assisted exercises on the correct pattern learn the patient to control the movement by himself, so helping in training co-ordination. 6-Confidence of the patient in his ability to move and helping to co-operate.

Contra-indications of assisted exercise

1-Acute tears and fracture. 2-Greater swelling ,fever and redness. 3-Immediatlly followed myocardial infarction. 4-If active assisted exercises induced pain during movement.

Active Free Exercise

Free exercises are those which are performed by the patients own muscular efforts without the assistance or resistance of any external force other than gravity. And classified into: 1-Localized: to strengthen muscle group. 2-General: to use many muscles all over the body.

Uses of Active Free Exercise

This type of exercise can be used to obtain the following: 1-Relaxation: can be induced by exercises which are rhythmical or pendulum( swinging) in character.

Uses of Active Free Exercise

2- Joint mobility: the normal range of joint motion is
maintained by exercises performed in full range. 3- Muscle power and tone: the power and endurance of the working muscles are maintained or increased in response to the tension developed in them. Tension is greater when the exercise is performed at a speed slower and long duration of exercise

4- co-ordination: is improved by the repetition of exercise. As the pattern of movement is established the conduction of impulses along the neuromuscular pathways. 5- Confidence: the achievements of coordinated and efficient movement assure the patient of his ability to maintain and control of his movements, and new activities. 6-Circulatory and respiratory

Uses of Active Free Exercise

cooperation: during prolonged exercise, the depth of respiration is increased leading to the production of heat and increasing circulation.

Examples of Active Free Exercises

Examples of Active Free Exercises

Examples of Active Free Exercises

Examples of Active Free Exercises

Examples of Active Free Exercises

Examples of Active Free Exercises

Active Resisted Exercise

Definition:
Resisted exercise is a technique based on applying resistance (an outside force which may be manual or mechanical) to muscle during dynamic or static contraction to increase the contractile force (strength) and muscle size (hypertrophy). In isometric and isotonic contraction the resistance must be sufficient to increase the intra-muscular tension.

Several options are available for resistance training, including: free weights (like dumbbells, pulleys, springs). weight machines. Water Body weight of patient. The physical therapist.

Effect and uses of resisted exercise

1- Strengthening the muscles due to increase tension through gradual overload of resistance of a muscle or muscle group. 2- Increase muscle endurance through low intensity repetitive exercise over a prolonged period of time without fatigue. 3- Increase coordination. 4- Increase muscle cross section (hypertrophy). 5- Increase blood flow of the working muscle. 6-Increase the power.