Orientation to exercise therapy

1. LECTERER IN PHYSIOTHERAPY
DIVISION OF PM&R
RMMCH
ANNAMALAI UNIVERSITY

3. REHABILITATION
 RE – again
 HABILIATION – behavior & skills

4. PHYSIOTHERAPIST
1. Examination
2. Intervention
3. Prevention
4. Consultation , education & research

5. THERAPEUTIC EXERCISE
 Is the systematic , planned performance of bodily
movements , postures or physical activities intended
to provide a patient / client to optimize overall health
, status , fitness or sense of well being

6. FUNCTION
FUNCTION
STRENGHT ,
POWER &
ENDURANCE
MOBILITY EX’S
BALANCE
&FLEXIBILITY
NEURO
MUSCULAR
CONTROL &
COORDINATION

7. STRENGTH , ENDURANCE ,
POWER & BALANCE
 Ability to generate maximal force
 Ability to sustain
 Rate of work [ speed ]
 COG over body’s BASE OF SUPPORT
 Flexibility [ elongation ]

8. COMMON PHYSICAL IMPAIRMENTS
Pain
Muscular weakness
Decreased muscle endurance
Limitation of ROM
Joint hypermobility
Faulty posture
Muscle tightness
Balance
Incoordination
Delayed motor development
Abnormal tone
Decreased aerobic capacity
Impaired circulation

9. STARTING POSITIONS
 Standing
 Kneeling
 Lying
 Sitting
 Hanging

10. MUSCLE WORK
 ISOTONIC
 ISOMETRIC
 ISOKINETIC

11. ISOTONIC
 CONCENTRIC
 ECCENTRIC
EVALUVATION
By calculating RM

12. MUSCLE STRENGTH
TESTING
 Gold standard is 1RM
Protocol for 1RM testing
STEP 1 – warm up (5-10 rep of 40% to 60%)
STEP 2 – brief rest (1-min)
STEP 3 – 3-5 rep @ 60% - 80% of 1RM
STEP 4 – determine 1RM
- 3 to 5 trails
- 3 to 5 min rest between trails
WIDELY USED – bench press
- leg press

13. MODIFICATION OF RM
TESTING
 E.G : 6 – RM strength test
 5-10 rep at 50% of estimated 6 – RM
 1 min rest
 6 rep 70 % of estimated 6 – RM
 2 min rest
 6 rep at 100 % of 6 RM (adjust wg )
 1 RM prediction
 MEN : 1 RM = wg (lb)/(1.0278 – rep x 0.0278)
 WOMEN : 1 RM = (0.92xwg (kg))+(0.58xrep)-3.41
 OLDER WOMEN : 1 RM = (0.92xwg kg)+(0.79xrep)-

14. ISOMETRIC
 Muscle setting exercise
 Stabilization exercise
 Multiple – angle isometrics ( resisted )

15. MUSCLE STRENGTH –
ISOMETRIC DYNAMOMETRY
 Devices used :-
Hand grip dynamometry : grip strength
Leg & back dynamometry : lower extremity strength

16. MUSCLE STRENGTH –
ISOKINETIC
DYNAMOMETRY
 Assesses strength development at constant speed
 Protocol :
Speed set at 30 – 60*/sec
2-3 submaximal trails , followed by
3-5 maximal trails (till drop in performance noted ) ,
best of maximum trails

17. ASSESSMENT OF POWER
 VERTICAL JUMP TEST
 STAIR SPRINT TEST
 SPRINT TEST

18. ASSESSMENT OF MUSCLE
ENDURANCE
 Suggested techniques :
1. Maximal # of lifts at 70% of 1-RM weight
2. Bench press at fixed weight
 Cadence of 30 reps/min
 Test ends when cadence cannot be maintained
 Men : 80 – lb bar
 Women : 35 – lb bar
3. Push – up test
 Measures # of push-ups completed without rest

19. 12-MIN RUN FITNESS TEST
FOR ENDURANCE
Calculate your estimated vo2 max
 In miles : vo2 max = (35.97xmiles)-11.29
 In Km : vo2 max = (22.351xkilometers)-11.288

20. MOVEMENT
 PASSIVE MOVEMENT
 ACTIVE MOVEMENT

21. PASSIVE MOVEMENT
 Relaxed passive movement & accessory movement
 Passive manual mobilization technique
a. Mobilization
b. Manipulation
c. Passive stretching

22. ACTIVE MOVEMENT
 Free exercise
 Assisted exercise
 Assisted – resisted exercise
 Resisted exercise

23. STRETCHING
 Static stretching
 Ballistic stretching
 Proprioceptic neuromuscular fascilitation stretching

24. RESISTED EXERCISE
 Manual
 Mechanical

25. PROGRESSIVE RESISTED
EXERCISE
1.DE LORME & WATKINS
2.ZINOVIEFF ( OXFORD TECHNIQUE )
3.MAC QUEEN

26. 1.DE LORME & WATKINS
 10 lifts with ½ 1o R.M.
 10 lifts with ¾ 1o R.M.
 10 lifts with 1o R.M.
30 lifts 4 times weekly
Progress 10 R.M once weekly

27. 2.Zinovieff
(oxford technique)
 10 lifts with 10 R.M. minus lb
 10 lifts with 10 R.M. minus 1 lb
 10 lifts with 10 R.M. minus 2 lb
 10 lifts with 10 R.M. minus 3 lb
 10 lifts with 10 R.M. minus 4 lb
 10 lifts with 10 R.M. minus 5 lb
 10 lifts with 10 R.M. minus 6 lb
 10 lifts with 10 R.M. minus 7 lb
 10 lifts with 10 R.M. minus 8 lb
 10 lifts with 10 R.M. minus 9 lb
100 lifts 5 times weekly
Progress 10 R.M. daily

28. 3.Mac queen
 10 lifts with 1o R.M.
 10 lifts with 1o R.M.
 10 lifts with 1o R.M.
 10 lifts with 1o R.M.
40 lifts 3 times weekly
Progress 10 R.M. every 1-2 weeks

29. CO-ORDINATION
 Smooth , accurate and purposeful , is brought about
by the integrated action of many muscles
 Principle of re-education
 Frenkel’s exercise :-
I. Concentration
II. Precision
III. Repetition

30. RE-EDUCATION OF MUSCLE
MRC GRADING
 0-no contraction
 1-flicker of contraction
 2-full range of motion eliminating gravity
 3-full range of motion against gravity
 4-full range of motion against gravity with minimal
resistance
 5-full range of motion against gravity with maximal
resistance

31. Gait training-walking aids
 Gait parameters
 Cructhes , sticks , tripod , quadripod , frames
 Preparation for cructh walking
 Crutch walking

32. OTHER TECHNIQUES
 PNF
 Sensory motor integration
 Neuro developmental therapy