Exercise Therapy

To examine and test a Joint Prior to mobilization, the medical history should give enough information to allow the therapist to start by observing the patient arriving, undressing both sides of the body and taking up a well supported position. Testing active range of movement, passive range and resisted range should be followed by accurate recording. Tests of muscle power must also be made and recorded. To Relieve Painful Spasm, the patient is placed in a fully supported position using a large a base as possible. As the patient can often move at another joint and appear to be moving at the painful joint if it is frequently necessary to fix joints in which undesirable movements could occur, so that trick movements and Cheating are prevented. The Accessory Movements sometimes joints are so stiff that anatomical functional movements are not possible. It may be feasible to mobilize the accessory movements before attempting an anatomical movement. The Stretching Soft Tissues which are too tight is usually best brought about by the patient attempting to stretch the tissues himself. There are several techniques which may be used. The Mobilization of Joints in Water promotes relaxation and will also relieve pain so that protective muscle spasm may be reduced.

The muscles which are relatively free from tension and at rest are said to be relaxed. The tension develops in muscles as they work during contraction and this tension is reduced to a variable degree as the muscles come to rest during relaxation. The Muscle Tone Under ordinary circumstances living muscles are never completely free from tension as they retain a quality of firmness known as muscle tone even when they are as relaxed as possible. The postural tone which persists in the muscles concerned with the maintenance of posture is called postural tone. The postural tone is maintained and regulated by a reflex mechanism. The fundamental basis of which is the myostatic or stretch reflex, although the higher centres also exert a controlling influence. The voluntary movement muscles contract as they work to initiate or control movement but at the completion of the movement in question they relax and come to rest. There is a recognized biological principle that activity of living cells tends to be followed by inhibition of that activity. The Mental attitudes are fear, anger and excitement give rise to a general increase in muscular tension which serves a useful purpose by preparing the muscles for rapid or forceful action. The degrees of relaxation is very variable and it is better to regard the term Relaxation merely as and indication that some reduction in tension has taken place. It is often possible to estimate the degree of relaxation achieved by gentle passive movement.

The Preparation of Testing to administer the muscle test. The examiner should observe contour of the part, comparative symmetry of muscle on both sides and any apparent hypertrophy or atrophy. During passive ROM the examiner can estimate muscle tone. The correct positioning of the subject and the body parts is essential to effective & correct evaluation. The subject should be positioned comfortably on a firm surface. The clothing should be arranged or removed so that the aminer can see the muscle or muscles being tested. The muscle grades are standard assignment of muscle grades during the manual muscle test depends on clinical judgment, knowledge & experience of the examiner, especially when determining slight, moderate or maximal resistance. The age, sex, body type, occupation and avocations all influence the amount of resistance that a particular subject can take. Normal strength for an 8 year old girl will be considerably less than for a 25 year old man. Additionally, strength trends to decline with age, and full resistance to the same muscle group will vary considerably from an 80 year old man to a 25 year old man. Muscle strength is relative to the cross-sectional size of the muscle. Larger muscles have greater strength. The weak muscles fatigue easily, results of muscle testing may not be accurate if the subject is tired. There should be no more than three repetitions of the test movement because fatigue can result in grading errors. If the muscle becomes tired as a result of low endurance, pain, swelling, or muscle spasm in the area being tested may also interfere with the testing procedure and accurate grading. Such problems should be noted on the evaluation form. Psychological factors must also be considered in interpreting muscle strength grades.

The many physical disabilities cause muscle weakness. The Loss of strength places slight to substantial limitations on the performance of occupational roles, depending on the degree of weakness and whether the weakness is permanent or temporary. The Causes of Muscle Weakness are lower motor neuron disorders such as peripheral neuropathies & peripheral nerve injuries, spinal cord injury, Guillian- Barre syndrome & carnial nerve dysfunctions and Primary muscle diseases such as muscular dystrophy and myasthenia gravis. The Limitations Resulting from Muscle weakness can restrict the performance of occupational roles and thus prevent pursuit of self care as well as vocational, leisure and social activities.
The patient with fair plus (F+) muscle strength usually has low endurance and will fatigue more easily than one with G to N strength. The patient will be able to perform independently many ordinary ADL but may require frequent rest periods. The Purposes for Evaluating Muscle Strength is essential for diagnosis in some neuromuscular conditions such as peripheral nerve lesions and spinal cord injury. In peripheral nerve root lesions the pattern of muscle weakness may help determine which nerve or nerve roots are involved and whether the involvement is partial or complete. The purposes for evaluating muscle strength is to determine the amount of muscle power available and thus establish a baseline for treatment, to discern how muscle weakens is limiting performance of ADL, to prevent deformities that can result from imbalances of strength and to determine the need for assistive devices as compensatory measures.

There are many ways to use equipment to stretch a contracture and increase joint ROM. The equipment can be as simple as a cuff weight or weight-pulley system or as sophisticated as some orthoses or automated stretching machines. These mechanical stretching devices either provide a constant load with variable displacement or constant displacement with variable loads. The Mechanical stretching devices apply a very low intensity stretch force (low-load) over a prolonged period of time to create plastic deformation of tissues are stretch load which can be applied with a cuff weight. It is often as low as a few pounds, each of these forms of stretch have been shown to be effective, particularly in reducing long-standing contractures and duration of mechanical stretch ranges from 15 to 30 minutes or as long as 8 to 10 hours at a time, 55 depending on the type of device employed, The Low-load mechanical stretch with a cuff weight & self stabilization of the proximal hurlers to stretch the elbow flexors and increase end-range elbow extension. In one study low intensity, prolonged mechanical stretch (5- to 12-Ib stretch force applied by hanging a weight from the involved lower extremity 1 hour per day over a 4-week period of time) is to be significantly more effective than manual passive stretching over an equal timeframe in patients with long standing bilateral knee flexion contractures.