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