Exercise Therapy

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The body is suspended by grasping over a horizontal bar, the forearms being pronated, the 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. The Flexors of the Fingers work strongly to grasp the bar. All the musclesround the wrist work strongly to reduce the strain on the joints and to act as synergists and fixators for the Flexors of the Fingers. As the muscle work for the arms and upper back is extensive and strong the position is only suitable for those in whom muscular strength and body weight are well balanced. As the weight of the shoulders is taken off the spine and the weight of the legs exert traction upon it, it is straightened and elongated.

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1. The starting position is selected and taught with care to ensure the maximum postural efficiency as a basis for movement.
2. 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
3. The speed at which the exercise is done depends on the effect required. It is usually slow during the period of learning and later the patient is either allowed to find his own natural rhythm, or the speed required is dictated by the physiotherapist. It often helps the patient to maintain his natural rhythm at home if, during practice under supervision, he is encouraged to count aloud.
4. The duration of the exercise depends very largely on the patient’s capacity. Usually three bouts of practice for each exercise, with short rest periods, or a change of activity, between, ensure sufficient practice without undue fatigue.

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Noncontractile soft tissue permeates the entire body and is organized into various types of connective tis-sue to support the structures of the body. Ligaments, tendons, joint capsules, fasciae, noncontractile tis-sue within muscles and skin all have connective tissue characteristics that will lead to the development of adhesions and contractures and thus affect the flexibility of the tissues crossing the joint. When these tissues restrict ROM and require stretching, it is important to understand how they respond to the intensity and duration of stretch forces and to recognize that the only way to increase the extensibility of connective tissue is by remodel-ing its basic architecture.

Muscle is composed of both contractile tissue and noncontractile connective tissues. The contractile el-ements of muscle give it the characteristics of contractility and irritability. The noncontrac-tile connective tissue within and around muscle has the same properties as all connective tissue, including the ability to resist deforming forces as well as viscoelasticity. The connective tissue structures of the muscle-tendon unit are the endomysium, which is the innermost layer that separates individual muscle fibers and myofibrils; the perimysium, which encases fiber burrelles; and the epimysium, which is the enveloping fascial sheath around the entire muscle. It is the connective tissue framework of muscle that is the primary
source of a muscle’s resistance to passive elongation. When contractures develop, adhesions within and between collagen fibers restrict movement.

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