E X E R C I S E
• Joint– functional unit of the musculoskeletal system- the site where two or more bones meet
• Tendon– attachment points where a muscle is connected to the bone
• Ligaments– a tough connective tissue band usually connecting bone to bone
Skeletal Muscle Anatomy
Skeletal Muscle Anatomy
• Agonist– muscles which accomplish a certain movement, such as flexion
• Antagonist– muscles acting in opposition to an agonist
***e.g. elbow flexion
FLEXION EXTENSION
TYPES OF EXERCISES
1. Isotonic (Dynamic) Exercise-muscle shortens to produce muscle contraction & active movement
2. Isometric (Static or Setting) Exercise-there is muscle contraction without moving the joint
3. Isokinetic (Resistive) Exercise-involves muscle contraction or tension against resistance
ISOTONIC EXERCISES
ISOMETRIC EXERCISES
ISOKINETIC EXERCISES
TYPES OF EXERCISES
4.Aerobic Exercise-activity during which the amount of oxygen taken in the body is greater than that used to perform the activity
5. Anaerobic Exercise-involves activity which the muscles cannot draw out enough oxygen from the blood stream, and anaerobic pathways are used to provide additional energy for a short time
- maximum movement that is possible for that joint
RANGE OF MOTION
ROM Exercises– joint movements performed by the
patient himself or by a nurse to move joints in its full range without causing pain
- to prevent contractures
RANGE OF MOTION
KINDS OF ROM EXERCISES
• Active or Isotonic
➢to increase & maintain muscle tone and
joint mobility
• Active-assistive
➢ encourages normal muscle function
• Passive
➢maintains joint mobility only
INDICATIONS AND GOALS FOR ROM
Indications for Active ROM (AROM)
• whenever a patient is able to contract the muscles
actively and move a segment with or without
assistance
• can be used for aerobic conditioning programs.
• when a segment of the body is immobilized for a
period of time
INDICATIONS AND GOALS FOR ROM
Goals for AROM
• maintain physiological elasticity and contractility
of the participating muscles
• provide sensory feedback from the contracting
muscles
• provide a stimulus for bone and joint tissue
integrity
• increase circulation and prevent thrombus
formation
• develop coordination and motor skills for
functional activities
INDICATIONS AND GOALS FOR ROM
Indications for Active-Assistive ROM
(A-AROM)
• when a patient has weak musculature and is
unable to move a joint through the desired range
INDICATIONS AND GOALS FOR ROM
Indications for Passive ROM (PROM)
• in regions where there is acute and/or inflamed
tissue
• when a patient is not able to or not supposed to
actively move a segment or segments of the body
INDICATIONS AND GOALS FOR ROM
Goals for PROM
• maintain joint and connective tissue mobility
• minimize the formation of contractures
• maintain mechanical elasticity of muscle
• assist circulation and vascular dynamics
• enhance synovial movement for cartilage nutrition
and diffusion of materials in the joint
• decrease or inhibit pain
• assist with the healing process after injury or
surgery
• help maintain the patient’s awareness of movement
CONTRAINDICATIONS TO ROM EXERCISES
• any illness or disorder in w/c increasing
the level of energy needed or increasing
the demand for circulation is potentially
hazardous
• if the joints are swollen or inflamed or if
there has been injury to the musculo-
skeletal system in the vicinity of the joint
Reminders in performing ROM Exercises
1. Joints move in different ways.
2. Several movements can be done
together.
3. Discontinue exercises if client
complains of pain or discomfort.
Reminders in performing ROM Exercises
4. Do not grasp the fingernails or toenails.
5. When exercising extremities, work from the proximal joints toward the distal joints.
6. Every joint should receive adequate exercise, but it is crucial that several particular joints remain functional.
Time of Exercise
• bath time
• Other appropriate times might be when the patient is:
– rested in the morning– before bedtime
• Evaluate the effectiveness of the ROM regimen. Then adjust the regimen to the individual needs of the patient.
JOINT MOVEMENTS
• FLEXION• EXTENSION• HYPEREXTENSION• ABDUCTION• ADDUCTION• ROTATION • CIRCUMDUCTION
• EVERSION• INVERSION• PRONATION• SUPINATION
P R O C E D U R E
1. Perform hand washing.
2. Check two forms of client ID & introduce yourself. Explain rationale for procedure to client.
3. Put all joints through ROM slowly and gently. Start at neck.
4. Protect against gravity and detrimental movement when performing ROM exercises.
P R O C E D U R E
5. Never grasp joints directly.
6. Gently cup your hand under the joint and allow the joint to rest on the palm of the hand.
7. All joints should be put through five-range-of-motion exercises to each joint at least BID.
8. Encourage client to do active exercises as soon as possible.
P R O C E D U R E
9. Perform the exercises using different joint movements for different body parts.
10. Reassess client’s ability to perform ROM exercises and adjust schedule accordingly.
11. Reposition client comfortably.
12. Perform hand washing.
ACTIVE ROM EXERCISES
ACTIVE ROM EXERCISES
ACTIVE ROM EXERCISES
PASSIVE ROM EXERCISES
Flexion Extension
NECKPASSIVE ROM EXERCISES
SHOULDER
Internal
rotation External
rotation
PASSIVE ROM EXERCISES
Abduction
Adduction
PASSIVE ROM EXERCISES
SHOULDER
ELBOW
Extension
PASSIVE ROM EXERCISES
WRIST
Rotation
PASSIVE ROM EXERCISES
FINGERS
Extension
Adduction & Abduction
PASSIVE ROM EXERCISES
LOWER TRUNKPASSIVE ROM EXERCISES
Rotation
HIP and KNEE
Flexion (hip and knee) Flexion (hip)
PASSIVE ROM EXERCISES
Abduction Adduction
HIPPASSIVE ROM EXERCISES
ANKLE
Plantar flexion Dorsiflexion
PASSIVE ROM EXERCISES
JOINTS
TENDONS AND LIGAMENTS