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Therapeutic exercise - Physiotherapy
- 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