Download active movement

Isometric exercises
Definition:
Is static form of exercise without change in the length of the
contracting muscle and without visible joint motion.
-Static contraction produce a great amount of tension and force
output on the contracting muscle.
-During isometric contraction, strength will increase if it is sustained
against resistance for at least 6 seconds.
-in order to develop strength throughout the ROM, resistance must
be applied in several positions.
-The amount of tension produced during the isometric contraction is
directly affected by the length of the muscle of the time of
contraction. Therefore the amount of resistance also must be vary at
different points in the range.
-Resistance can be applied either manually or mechanically.
Examples of Isometric regimens
Brief maximal isometric exercise: in which the patient
performs a singles isometric contraction is held for 5
to 6 seconds.
Brief repetitive isometric exercise: in which the patient
performs five to ten brief maximum isometric
contraction against resistance.
Multiple isometric exercise: in which the patient
performs the isometric exercise against resistance
applied every 10 degrees in the ROM and hold for 10
seconds. This type of exercise improve muscle
strength through the ROM
Equipment used with isometric
exercise
1-Free weights and pully system
2-Isokinetic devices
3-Lifting a weight that provides resistance
greater than the force of the muscle
4-when the patient performs the exercise
against fixed objects( pushing a wall)
Principles
1-Determine the point in the ROM at which the muscle
contraction is to occur and set the patient up
accordingly
2-Appropriate stabilization is need to avoid substitution
3-Instruct the patient to contract the muscle, hold a
least 6 seconds, then relax and repeat
4-Have the patient carry out the exercise at several
points in the ROM
5-Make sure that the patient exhales while exerting his
maximum isometric exercise
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.
ACTIVE ASSISTED EXERCISE
• The principles of assistance:
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.
Technique of Assisted Exercise
The assisting force is applied only to
augment the maximum effort and not to act
as a substitute force.
1- Starting position: stability of the body is
important to ensure that the patient’s
attention is concentrated on the pattern of
the movement and the effort required to
perform it.
Technique of Assisted Exercise
2-Pattern of movement: this can be
explained to the patient by performing it
passively or actively on the sound limb.
3-Fixation: fixation of the proximal part of
the prime movers improves their
efficiency. Avoid trick movements to
occur by proper fixation.
Technique of Assisted Exercise
4- Support: the moved part should be supported
to reduce the load on the muscle. Manual
support is more effective since it can be
provided in any plane suitable for the
movement and adjusted in each successive
part of the range.
5-Traction: preliminary stretching of the weak
muscle provides a powerful stimulus to
contraction because it stimulate the muscle
spindle( Myotatic reflex) which helps in the
initiation of movement.
Technique of Assisted Exercise
6- The antagonistic muscle: a proper starting
position should be selected to reduce the tension
in the antagonistic muscles, e.g. a position in
which the knee flexed is suitable for assisted
dorsiflexion of the foot.
7- The assistance force: the force used in assisting
the action of the muscle must be applied in the
direction of the movement by the PT hands.
Technique of Assisted Exercise
8- The character of the movement: movement is
performed smoothly and its efficiency
depends on the speed of contraction.
9- Repetitions: repetition of the movement
depends on the condition of the
10-The cooperation of patient: this is essential
during this type of exercise. The patient
should be encouraged to exert maximum
effort.
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 patient’s 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
Uses of Active Free 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
cooperation:
during
prolonged
exercise, the depth of respiration is
increased leading to the production
of heat and increasing circulation.
Technique of active free exercise
• The starting position is selected and taught
with care to ensure the maximum postural
efficiency as a basis for movement.
• Instruction is given to gain interest and
cooperation of the patient.
• The speed at which the exercise is done
depends on the effect required.
• The duration of the exercise depends very
largely on the patient’s capacity without
reaching fatigue.
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.
Factors Contribute Muscular Efficiency
• There are five factors which contribute to the
development of muscular efficiency:
1- Speed of contraction
2- coordination
3- Power
4- Endurance
5- volume.
• The last three factors can be built up by use of
resistive exercises.
Factors Contribute Muscular Efficiency
– Power: can be increased when you
training muscle against progressive
resistance (increase overload).
– Endurance: high repetition and low
intensity resistive exercise can develop
endurance.
– Volume: increasing the power and
strength will lead to increase the muscle
volume.
Physiological and mechanical principles of muscle
strength and range of motion
• During muscle contraction through wide
range of movement the tension or
strength are not equally powerful in all
parts of their range. Physiologically;
muscle exert their greatest strength in
their outer range and as they shorten
their force diminishes.
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.
Technique
• When applying resistance, 4 basic rules should be
observed:
1- The resistance must be given smoothly from the beginning
to the end of range.
2- The direction of resistance force must be opposite to the
direction of the movement.
3- It should be diminish gradually from the beginning to the
end of movement.
4- don’t forget to give enough period of relaxation to avoid
fatigue.