Exercise Therapy

Relaxation is given to the patient who is then taught to relax voluntarily, except in cases of flaccid paralysis when this is unnecessary. Fixation is to be limited to a specific joint. The bone which lies proximal to it is fixed by the physiotherapist as close to the joint line as possible to ensure that the movement is localized to that join. The Support is given to the part to be moved, so that the patient has confidence and will remain relaxed. The physiotherapist grasps the part firmly but comfortably in her hand or it may be supported by axial suspension in slings. The Traction is thought to facilitate the movement by reducing interaricular friction. The Range is as full as the condition of the joints permits without eliciting pain or spasm in the surrounding muscles. The Speed & Duration is essential that relaxation be maintained throughout the movement, the speed must be uniform, fairly slow and rhythmical. The relaxation & fixation apply to accessory movements as to relaxed passive movements. Accessory movements contribute to the normal function of the Joint in which they take place or that of adjacent joints. Accessory movements are performed by the Physiotherapist to increase lost range of movement and to maintain joint mobility. Hence they form an important part of the treatment of a patient who is unable to perform normal active movement.

Passive movements are produced by an external force during muscular inactivity or when muscular activity is voluntarily reduced as much as possible to permit movement. It is classified into two types. They are relaxed passive movements including accessory movements and passive manual mobilization techniques consists of three such as mobilizations of joints, manipulations of joints, controlled sustained stretching of tightened structures. The Relaxed Passive Movements performed accurately and smoothly by the Physiotherapist. The Accessory movement is a part of any normal joint movement but may be limited or absent in abnormal joint conditions. The Passive Manual Mobilization Techniques is Mobilizations of joints are usually small repetitive rhythmical oscillatory, localized accessory for functional movements performed by the physiotherapist in various amplitudes within the available range and under the patient’s control. The Manipulations of joints performed by Physiotherapists are accurately localized; single, quick decisive movements of small amplitude and high velocity completed before the patient can stop it. The Surgeon the movements are performed under anesthesia by a surgeon or physician to gain further range. The increase in movement must be maintained by the physiotherapist. The Controlled sustained stretching of tightened structures passive stretching of muscles and other soft tissues can be given to increase range of movement. The movement can be gained by stretching adhesions in these structures or by lengthening of muscle due to inhibition of the tendon protective reflex.

There are five principles of exercises namely standing, kneeling, sitting, lying, and hanging. The standing is necessary to use the Lateral Rotators of the shoulder to keep them in the correct position. The effects and uses of this are relatively small and the centre of gravity high. The state of equilibrium of the body is relatively less stable than in the other fundamental positions. Therefore the standing position is only suitable as a starting position for exercise for those who can maintain it correctly. The kneeling is supported on the knees which may be together or slightly apart. The lower leg rests on the floor with the feet plant flexed or if a plinth is used, the feet may be in the mid position over the edge. The sitting position is taken on a chair or stool, the height and width of which allow the thighs to be fully supported and the hips and knees to be flexed to a right angle. The knees are apart sufficiently to allow the femora to be parallel and the feet rest on the floor with the heels vertically below the knees. The lying is the easiest of the fundamental positions as the body can be completely supported in the supine position and is as stable as is possible. The hanging is suspended by grasping over a horizontal bar, forearms being pronated, arms straight and at least shoulder width apart. The head is held high and the scapule are drawn down and together. So, that the neck appears as long as possible. The trunk and legs hang straight, with the heels together and the ankles plant flexed.

Every movement begins in posture and ends in posture. The Postures from which movement is initiated are known as Starting Positions and they may be either active or passive. There are five basic or fundamental starting positions such as standing, kneeling, sitting, lying and hanging. Standing is the most difficult of the fundamental positions to maintain, as the whole body must be balanced and stabilized in correct alignment on a small base by the co-ordinate work of many muscle groups. The position may be described such as heels are together and on the same line, the toes Slightly apart, knees are together and straight, hips are extended and laterally rotated slightly, pelvis is balanced on the femoral heads, spine is stretched to its maximum length, shoulders are down & back and arms hang loosely to the sides, palms facing inwards towards the body. The muscle work required to maintain the position varies with the circumstances. It is reduced considerably when the body segments are in good alignment & perfectly balanced and increased by faulty alignment or by external forces which tend to disturb equilibrium. Some of the muscle groups involved are plantaflexores of the Ankle, working to balance the lower leg on the foot, extensors of the knee may work slightly, Pre-vertebral neck muscles, working to control excessive extension of the neck and to straighten the cervical spine.