7.

EXERCISE THERAPY

7.1. Introduction

First of all it is important to discuss about the concept of exercise and must first be
defined and explain. When we contract skeletal muscles to cause movement or maintain a
given posture, it is generally explained that we are being active. This is in contrast to
being inactive, where we are not voluntarily contraction our skeletal muscles.

Exercise: Activity that is performed the purpose of important maintaining or

expressing a particular type of physical fitness.

Physical activity: The active perfumed by the body for purpose other than the specific
development of physical fitness.

Physical fitness: A state of body function that is characterized by the ability to

tolerate exercise stress. Exercise training the repeated use of exercise to improve physical
fitness.
Exercise therapy: It is the systematic and planned performance of bodily movement
postures or physical activates intended to provide a patient or client with means to:
 Remediate or prevent impairment
 Improve , restore or enhance physical function
 Prevent or reduce health – related risk factors
 Optimize overall health status fitness or sense of well-being
Therapeutic exercise programs designed by therapist are individualizing to the unique
needs of each patient or client. A patient is individual with impairment and functional
limitations diagnosed by a therapist, recovering the therapeutic cart to improve function
prevent disability.

7.2. Effect of therapeutic exercise

Every normal muscular contraction affects not only the muscular skeletal system but also
neuromuscular and cardiopulmonary system of human body. These system respond
according to the force and stress created by such contractions. External and constant force
i.e. gravity also affects these systems .These forces and stresses altogether are essential
for normally of the body and its system. When these forces and stresses decrease or
increase than the normally requirement, bodily dysfunction occur in the from of
osteoporosis, muscle atrophy, deformity, pain and poor cardiopulmonary (cardio
respiratory) fitness etc.

Therapeutic exercise are not only controlled progressive and planned but are also per the
capability of the patient resulting in to the improvement of their functional ability.
Therapeutic exercise affects the development improvement and maintenance of normally.

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Exercise therapy can improve or maintain the following:

 Muscular Strength
 Muscular power
 Muscular endurance
 Cardio - respiratory
 Joint mobility
 Joint flexibility
 Agility
 Body and mental relaxation
 Coordination
 Balance

7.3. Types of muscular contraction.

Traditionally the word contraction has been used to describe different muscle action, i.e.
isometric, isotonic, concentric and eccentric contraction.

A. Isotonic - Iso means equal, tonic means muscle tone which means the tone of muscle
remains same thought out the contraction of muscle. This is the contraction in which the
intramuscular tension or tone remains same or constant as the muscle shortens or
lengthens. The intramuscular tension is accompanied by a change in the length of the
muscle.

B. Isometric - Iso means equal, metric is length i.e. the length of muscle remains same
thought the contraction of muscle .

When there is no noticeable change in the length of muscle that is developing tension the
muscular action is called an isometric contraction No mechanical work is performed in
an isometric to the product of FXd ( F+ force , d = Distance ). There is no distance
involved in an isometric contraction because bother body component or fixed and do not
move during the contraction. However energy is being expended to produce cross –
bridge cycling. Static movement when the muscle remains in partial or complete
contraction without changing its length.

C. Concentric (towards the center ) - The muscles contract isotonically in shortening

to
produces movement. The attachments of the muscles are drawn closer together and
movement is in the direction of the muscle pull (Example, concentric contraction of
elbow flexors).

Positive muscular work is done during concentric exercise because when a concentric
concentration occurs the muscular moment acts in the same direction both are considered
to be positive.

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 D. Eccentric (Away from the centre) - When a force that a muscle generates is
inefficient to offset an opposing force on a lever, the muscle will undergo a lengthening
or eccentric contraction in this type of contraction the muscle acts as brake and controls
the movement of a bony component ( Example , eccentric contraction of elbow flexors ).

The mechanical of work that is done by a muscle during an eccentric contraction is called
negative work, because work is done on the muscle rather than by muscle. The energy
cost of an eccentric contraction is considerably less than of a concentric contraction,
when equal loads are used.

7.4. Active and passive movement

Movement is perfumed by the patient on his own effort with little or without external
support.

7.4.1. Active movements ( Exercise )

Active movements (exercise) can be classified as active free movement (exercise) ,active
assisted and active resisted movement (exercise).

A. Free exercise- are those exercises which are performed by the patient’s voluntary
muscular effort in the absence of any assistance or resistance of external force except
gravity.

Effects of free exercises:

- Relaxation
- Maintenance of muscle tone
- Improving strength and power ( depend up on speed and
duration of the exercise)
- Improving co- ordination maintain flexibility and
mobility

Classification of free exercise

Localized - Whish are to mobilized particular joint or to strengthen a particular muscle
(muscle group) Example, active movement of shoulder joint pendulum movement of
shoulder.
Generalized - Which involve the use of many joint and muscles allover the body and the
effect is generalized as in running, jogging, cycling etc…

B. Active Assisted Exercise - Voluntary contraction of a muscle, which is able to

produce little movement but is not sufficient enough to produce the movement in full
range of motion. In order to produce the movement in full range of motion an external
assistance is provided by the therapist, with voluntary contraction of the muscle.

Indications of active assisted exercise are:

 Strengthening of the weak muscle
 Co- ordination of movement
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C. Active Resisted Movement - A movement or exercise is carried out against the
resistance in available range of motion. The intra-muscular tension is increased as the
resistance is appalled against isometric or isotonic of contraction of muscle.

Resistance can be applied by:

 Therapist
 Patient
 Weight
 Spring
 Therabands
 Weighted Medical ball
 Water

7.4.2. Passive movements

The movement which is not produced by a voluntary effort, so external forces required to
perform the moment. An external force is applied by the hand of therapist, mechanical of
therapist, mechanical device and patient itself.

Classification of passive movement:

 Relaxed passive movement ( widely uses )
 Forced passive movement
 Passive manipulation. Example, Application of Massage
 Passive accessory movement

Effective (indication) of passive movement:

 Maintain range of motion of the joint

 Increase joint range of motion
 Decrease pain
 Relaxation
 Decrease spasticity

Relaxed passive movement - These are slow passive movement performed in the
available range of motion of the joint by the hands of therapist.
Relaxed passive movement are generally given to:
 Maintain joint range of motion and connective tissue mobility.
 Prevent adhesion in the joint space
 Enhance synovial movement for particular cartage nutrition.
 Increase blood circulation
 Decreased pain
Relaxed passive movement can be apples in different part of joint on upper and lower
extremity such as: Shoulder joint, Elbow joint, Wrist joint, Hip joint, Knee Joint, Ankle

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Joint. And on small foot joint like subtalar metarsophalangus (MTP) and interphalageal
(IP).