K.SUNDARAGANESH

LECTERER IN PHYSIOTHERAPY DIVISION OF PM&R

RMMCHANNAMALAI UNIVERSITY

THERAPEUTIC EXERCISE

REHABILITATIONRE – againHABILIATION – behavior & skills

PHYSIOTHERAPIST1. Examination 2. Intervention3. Prevention4. Consultation , education & research

THERAPEUTIC EXERCISEIs the systematic , planned performance of

bodily movements , postures or physical activities intended to provide a patient / client to optimize overall health , status , fitness or sense of well being

FUNCTION

FUNCTION

STRENGHT , POWER &

ENDURANCE

MOBILITY EX’S

BALANCE &FLEXIBI

LITY

NEURO MUSCULAR CONTROL &

COORDINATION

STRENGTH , ENDURANCE , POWER & BALANCE

Ability to generate maximal forceAbility to sustainRate of work [ speed ]COG over body’s BASE OF SUPPORTFlexibility [ elongation ]

COMMON PHYSICAL IMPAIRMENTSPainMuscular weaknessDecreased muscle enduranceLimitation of ROMJoint hypermobilityFaulty postureMuscle tightnessBalanceIncoordinationDelayed motor developmentAbnormal toneDecreased aerobic capacityImpaired circulation

STARTING POSITIONSStandingKneelingLyingSittingHanging

MUSCLE WORKISOTONICISOMETRICISOKINETIC

ISOTONICCONCENTRICECCENTRIC

EVALUVATIONBy calculating RM

MUSCLE STRENGTH TESTING Gold standard is 1RMProtocol for 1RM testingSTEP 1 – warm up (5-10 rep of 40% to 60%)STEP 2 – brief rest (1-min)STEP 3 – 3-5 rep @ 60% - 80% of 1RMSTEP 4 – determine 1RM - 3 to 5 trails - 3 to 5 min rest between trailsWIDELY USED – bench press - leg press

MODIFICATION OF RM TESTINGE.G : 6 – RM strength test5-10 rep at 50% of estimated 6 – RM1 min rest6 rep 70 % of estimated 6 – RM2 min rest6 rep at 100 % of 6 RM (adjust wg )1 RM predictionMEN : 1 RM = wg (lb)/(1.0278 – rep x 0.0278)WOMEN : 1 RM = (0.92xwg (kg))+(0.58xrep)-3.41OLDER WOMEN : 1 RM = (0.92xwg kg)

+(0.79xrep)-3.73

ISOMETRICMuscle setting exercise Stabilization exerciseMultiple – angle isometrics ( resisted )

MUSCLE STRENGTH – ISOMETRIC DYNAMOMETRYDevices used :-Hand grip dynamometry : grip strengthLeg & back dynamometry : lower extremity

strength

MUSCLE STRENGTH – ISOKINETIC DYNAMOMETRYAssesses strength development at constant

speedProtocol :Speed set at 30 – 60*/sec2-3 submaximal trails , followed by 3-5 maximal trails (till drop in performance

noted ) , best of maximum trails

ASSESSMENT OF POWER

VERTICAL JUMP TESTSTAIR SPRINT TESTSPRINT TEST

ASSESSMENT OF MUSCLE ENDURANCE

Suggested techniques :1. Maximal # of lifts at 70% of 1-RM weight2. Bench press at fixed weight Cadence of 30 reps/min Test ends when cadence cannot be maintained Men : 80 – lb bar Women : 35 – lb bar3. Push – up test Measures # of push-ups completed without

rest

12-MIN RUN FITNESS TEST FOR ENDURANCE

Calculate your estimated vo2 maxIn miles : vo2 max = (35.97xmiles)-11.29In Km : vo2 max = (22.351xkilometers)-

11.288

MOVEMENTPASSIVE MOVEMENTACTIVE MOVEMENT

PASSIVE MOVEMENTRelaxed passive movement & accessory

movementPassive manual mobilization techniquea. Mobilizationb. Manipulationc. Passive stretching

ACTIVE MOVEMENTFree exerciseAssisted exerciseAssisted – resisted exerciseResisted exercise

STRETCHINGStatic stretchingBallistic stretchingProprioceptic neuromuscular fascilitation

stretching

RESISTED EXERCISEManual Mechanical

PROGRESSIVE RESISTED EXERCISE

1.DE LORME & WATKINS2.ZINOVIEFF ( OXFORD TECHNIQUE )3.MAC QUEEN

1.DE LORME & WATKINS10 lifts with ½ 1o R.M.10 lifts with ¾ 1o R.M.10 lifts with 1o R.M.

30 lifts 4 times weeklyProgress 10 R.M once weekly

2.Zinovieff (oxford technique)10 lifts with 10 R.M. minus lb

10 lifts with 10 R.M. minus 1 lb10 lifts with 10 R.M. minus 2 lb10 lifts with 10 R.M. minus 3 lb10 lifts with 10 R.M. minus 4 lb10 lifts with 10 R.M. minus 5 lb10 lifts with 10 R.M. minus 6 lb10 lifts with 10 R.M. minus 7 lb10 lifts with 10 R.M. minus 8 lb10 lifts with 10 R.M. minus 9 lb100 lifts 5 times weeklyProgress 10 R.M. daily

3.Mac queen

10 lifts with 1o R.M.10 lifts with 1o R.M.10 lifts with 1o R.M.10 lifts with 1o R.M.

40 lifts 3 times weeklyProgress 10 R.M. every 1-2 weeks

CO-ORDINATION Smooth , accurate and purposeful , is brought

about by the integrated action of many muscles

Principle of re-educationFrenkel’s exercise :-I. Concentration II. PrecisionIII. Repetition

RE-EDUCATION OF MUSCLEMRC GRADING0-no contraction1-flicker of contraction2-full range of motion eliminating gravity3-full range of motion against gravity4-full range of motion against gravity with

minimal resistance5-full range of motion against gravity with

maximal resistance

Gait training-walking aidsGait parametersCructhes , sticks , tripod , quadripod , framesPreparation for cructh walkingCrutch walking

OTHER TECHNIQUESPNFSensory motor integrationNeuro developmental therapy

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