Exercise Therapy

It has appropriate alignment and effective stabilization is fundamental components of muscle testing and goniometry as well as ROM and strengthening exercises. They are also essential elements of effective stretching. Alignment influences has the amount of tension present in soft tissue and consequently affects the range of motion available in joints. The alignment of muscles & joint to be stretched as well as the alignment of the trunk and adjacent joints must all be considered. The Stabilization is to achieve an effective stretch of a specific muscle or muscle group and associated particular structures. It is imperative to stabilize either the proximal or distal attachment site of the muscle tendon unit being elongated. The intensity of a stretch force is determined by the load placed on soft tissue as it is being elongated. There is general agreement among clinicians and researchers that stretching should be applied gently. That is, at a low intensity by means of a low load. The duration of stretch is one of the most important decisions a therapist must make when selecting and implementing a stretching intervention is to determine the duration of stretch that is expected to be safe, effective and efficient for an individual patient. The static stretching is the most common term used to describe a method by which soft tissues are lengthened just past the point of tissue resistance and then held in the lengthened position for an extended period of time with a sustained stretch force.

The contributing factors has some examples such as prolonged immobilization extrinsic, intrinsic, posture at mal alignment, neuromuscular disorders & diseases, designation of contractures by location, contracture versus contraction, types of contractures, myostatic contracture, pseudomyostatic contracture, arthrogenic & periarticular contractures, fibrotic contracting & irreversible contracture, interventions to increase mobility of soft tissues, interventions to increase mobility of soft tissues, contraindications to stretching, manual or mechanical/passive or assisted stretching, self-stretching, neuromuscular inhibition techniques, joint mobilization/manipulation, soft tissue mobilization and manipulation, neural tissue mobilization, selective stretching and overstretching & hypermobility.
The Selective stretching is a process whereby the over-all function of a patient may be improved by applying stretching techniques selectively to some muscles and joints but allowing limitation of motion to develop in other muscles or joints. The Overstretching is a stretch well beyond the normal ROM of a joint & the surrounding soft tissues, resulting in hyper mobility are Creating selective hyper mobility by overstretching may be necessary for certain healthy individuals with normal strength & stability participating in sports that require extensive flexibility & Overstretching becomes detrimental & creates joint instability when the supporting structures of a joint & the strength of the muscles around a joint are insufficient and cannot hold a joint in a stable functional position during activities. Instability of a joint often causes pain and may predispose a person to musculoskeletal injury.

Resisted Exercise is an external force may be applied to the body levers to oppose the force of muscular contraction. Tension is increased within the muscles by the opposing force and the muscles respond by an increase in their power of hypertrophy. The resisting force applied to an isotonic contraction must be sufficient to increase intra-muscular tension to the maximum without interfering with the ability of the muscles to produce co-ordinate movement. The variation of power of muscles in different parts of their range of joint movement is not equally powerful in all parts of their range. For example physiologically the Flexors of the Elbow are strongest in their outer range, but mechanically strongest at about mid-range. The techniques of resisted exercises are starting position, pattern of movement, stabilization, traction, resisting force, and character of the movement, repetitions and co-operation of the Patient. A resisting force other than that provided by gravity and friction may be provided by the physiotherapist, patient, Weights, weight & pulley circuits, springs & other elastic structures, Substances which are malleable and Water. The resistance by the physiotherapist is usually applied manually in the line of the movement & the physiotherapist’s hand is placed on the surface of the skin which is in the direction of the movement, and resistance by the patient can resist his own movements with the sound limb or by using his own body weight.

The Movement performed or controlled by the voluntary action of muscles, working in opposition to an external force. It is classified into three exercises namely free exercise, assisted exercise and assisted-resisted exercise. The technique of free exercises are starting position is selected and taught with care to ensure the maximum postural efficiency as a basis for movement. The instruction is given in a manner which will gain the interest and co-operation of the patient and lead him to understand both the pattern and the purpose of the exercise. The effect and consequent uses of any particular free exercise depend on the nature of the exercise, its extent & the intensity and duration of its performance. The Assisted Exercise is the force exerted on one of the body levers by muscular action is insufficient for the production or control of movement, an external force may be added to augment it. The effects and uses of assisted exercise working muscles co-operate in the production of movement which they are incapable of achieving unaided. They provided the maximum effort of which they are capable is demanded for the weak muscles and the assisting force utilized is only complementary, these muscles will gain in strength and hypertrophy. The movement must be maintained in spite of pain in joints.

This is a technique together which their effects and uses cover a very wide field which is beyond the scope. Manipulations performed by a surgeon or physician are usually given under a general or local anaesthetic which eliminates pain and protective spasm and allows the use of greater force. Even well-established adhesions can be broken down but when these are numerous, it is usual to regain full range progressively by a series of manipulations, to avoid excessive trauma and marked exudation. The Principles of Giving Controlled Sustained Stretching of Tightened Structures patient is comfortably supported and as relaxed as possible in an appropriate position. With suitable fixation the part is grasped by the physiotherapist and moved in such a way that a sustained stretch can be applied to the contracted structures for a period of time within a functional pattern of movement. Mechanical means can be used as example turnbuckle plaster. The Effects and Uses of Controlled Sustained Stretching are Steady and sustained stretching may be used to overcome spasticity patterns of limbs. The slow stretch produces a relaxation & lengthening of the muscle and a steady & prolonged passive stretch can overcome the resistance of shortened ligaments, fascia & fibrous sheaths of muscles as example in controlled stretching and progressive spintage of talipes equinovarus.