Self management and home exercise program prescription



Continuous Passive Motion

Continuous Passive Motion (CPM): refers to passive motion that is performed by a mechanical device that moves a joint slowly and continuously through a controlled range of motion.

[pic]

Fig. (1): Continuous Passive Motion Device for the Knee.

Benefits of Continuous Passive Motion

1- Preventing development of adhesion, contracture and joint stiffness.

2- Providing a stimulating effect on the healing of tendons and ligaments.

3- Minimizing the effect of immobilization.

4- Increasing the synovial fluid of the joint so increase rate of intra-articular healing.

Indications

1- After joint surgery, including anterior cruciate ligament (ACL)

2- After knee arthoroplasty

3- After surgical repair of stable intra-articular or extra-articular fractures

4- After meniscectomy

5- After osteochondral repair

[

Contraindication

Continuous passive motion is contraindicated in cases for which the device can cause unwanted translation of opposing bones, overstressing the healing process.

Precautions

1- The use of CPM in conjunction with anticoagulation therapy may produce an intra-compartmental haematoma.

2- Skin irritation from the straps or carriage cover may develop.

Clinical Application of Continuous Passive Motion

General Principles

1- The CPM unit is often applied in the recovery room immediately after surgery even when the patient is wearing brace or surgical bandages.

2- The arc of motion for the joint is determined. Often a low arc of 20 to 30 degrees is used initially and progressed to 10 to 15 degrees per day.

3- The rate of motion is usually 1 cycle per 45 seconds or per 2 minutes.

4- The amount of time on the CPM machine ranges from 1 hour, three time a day to continuous for 24 hours. After surgery use is for 6 to 8 hours a day.

5- Physical therapy treatment is provided during the time the patient is not on the CPM machine.

6- Duration minimum for CPM is usually less than one week when a satisfactory range of motion is reached.

[[

The following protocol is provided as an example for a post-ACL reconstructive surgery.

Setup and Application

1- Measure the length of the patient’s thigh from the ischial tuberosity to the joint line of the knee. Adjust the proximal carriage so that the proximal end meets the bottom of the buttocks.

2- Determine the length of the lower leg by measuring from the joint line of the knee to approximately ¼ inch beyond the heel. Adjust the distal portion of the carriage accordingly.

3- Place the lower extremity in the unit with the joint line of the knee aligned to the articular hinge of the CPM unit.

4- Adjust the foot in the footplate so that the tibia is placed in the neutral position. Internal or external rotation of the tibia can result in increased stress on the ACL.

5- Set the Rom as prescribed by the surgeon. Usually started with a limited ROM (0 to 60 degrees) and progress to the full ROM as healing occurs.

6- Set the speed of the treatment (e.g., cycle time of 4 minutes; 15 cycles per hour).

7- Give the patient the hand held control and provide instruction on how and when to use it, including increasing speed and ROM and termination of the treatment.

8- After termination of the treatment remove the machine and clean the mechanical housings with soap specially if the unit become soiled with blood or synovial fluid.

9- Dispose of the carriage cover or wash it according to the manufacture’s instructions.

Active Range of Motion Exercises

Definition:

Active range of motion exercise (AROM) is exercise in which movements are produced by voluntary effort of the patient through the active contraction of the muscles crossing the joint.

Indication of AROM Exercises

AROM Exercises are Indicated When

Whenever a patient is able to actively contract the muscles and move the joint, active range of motion exercises with or without assistance are used.

Active muscle contraction is desired.

Resistive exercises may be too difficult.

Motor planning, muscular control and coordination are desired.

Goals of AROM Exercises

Prevent or decrease negative effects of immobilization as contractures, tightness and pain.

Increase circulation.

Improves proprioception and kinesthesia.

Maintain physiologic elasticity and contractility of the contracted muscles.

Minimal strength gains in muscles with fair strength or less.

AROM exercises may also improve

Cardiac efficiency

Tendon-bone interface

Coordination

Be Cautious with AROM when

There is soft tissue or joint pain

There is swelling

Symptoms increase

Condition intensifies

Substitutions are used

Contraindications to AROM Exercises

Some patients with cardiopulmonary dysfunction.

Unhealed and unprotected fracture or surgical site.

Severe soft tissue trauma.

Active Assisted Range of Motion Exercises

Definition:

Active assisted range of motion exercise (AAROM) is a type of active (ROM) in which patient can voluntary produce movement but unable to complete range of motion and assistance is provided by outside force to complete the range of motion. The outside force may be therapist, family member, patient himself (self assisted) or equipment (sling suspension unit, boards, and pulley circuits.

So active assisted range of motion exercise is “exercise in which movement is performed by the voluntary effort of the patient with assistance of external force to complete the range of motion”.

Active assisted ROM exercises are characterized by:

Patient can voluntary activate the muscle and produce muscle contraction.

Patient is unable to fully activate the muscle and complete the range of motion.

Assistance may be provided throughout the range or mostly just at ends, depending upon the patient.

Motion can be performed against gravity or in a gravity-minimized situation (omitting gravity or gravity eliminated).

Indications of AAROM Exercises

AAROM Exercises are Indicated When

Patient is unable to complete ROM actively because of weakness due to

o trauma

o neurologic injury

o muscular or neuromuscular disease

o pain

Pt is not allowed to fully activate muscle following surgery (muscultendinous).

When patient has weak musculature and is unable to move the joint through the desired range of motion, AAROM exercises is used to provide enough assistance to the muscles in a carefully controlled manner so that so that the muscle can progressively be strengthened.

The amount of assistance should be progressively reduced as the muscle strength increase.

Procedures for AROM Exercises

Demonstrate motions using PROM.

Choose the appropriate position to perform the exercise that enable or modify the effect of gravity during the exercise (omitting or against gravity).

Assist only to complete range or make motion smooth and correct. The assistance is given at the part of the range that the patient can not complete

Motion is done within the available pain free ROM.

The patient should be always encouraged to perform the motion through the available range of motion by the clear and sharp order of the therapist.

Application of AAROM Exercises

Manual AAROM Exercises

Shoulder Flexion and extension (eliminating gravity) Fig (1)

Patient Position: Side lying position.

Therapist Position: Stride standing behind the patient at the level of the elbow

Grasp:

The proximal hand stabilize the scapula and the distal hand and forearm carry and support the weight of the patient’s upper limb which may be flexed elbow.

Order: Move your upper limb forward ( for flexion) and backward ( for extension)….More, ……More,……..Good.

Motion: The patient actively move the limb forward or backward as much as he can and the therapist guide and assist the movement at the limited range by moving the limb (mostly at the mid or end of the range).

[pic]

Fig. (1): Active assisted range of motion exercise for shoulder flexion and extension ( eliminating gravity).

Shoulder Flexion and extension (against gravity) Fig (2)

Patient Position: supine lying or sitting position (flexion) and prone or sitting (for extension).

Therapist Position: Stride standing beside the patient at the level of the shoulder

Grasp:

The proximal hand stabilize the scapula and the distal hand under the patient’s hand to provide assistance whenever needed.

Order: Raise your upper limb upward ….More, ……More,……..Good.

Motion: The patient actively move the limb as much as he can and the therapist guide and assist the movement at the limited range by moving the limb (mostly at the mid or end of the range).

[pic]

Fig. (2): Active assisted range of motion exercise for shoulder flexion and extension (against gravity).

Self Assisted AROM Exercises (Figs. 3-10)

With cases of unilateral lesion, the patient can be taught to use the normal extremity to assist and move the involved extremity through ranges of motion at different positions.

Shoulder Flexion and extension (Fig. 3)

Patient Position: supine lying or sitting position

Grasp:

The patient use the normal extremity to grasp the involved extremity around the wrist, supporting the wrist and the hand. The patients starts to move the involved upper limb and use the normal extremity to assist the motion to complete the available pain free range of motion.

[pic]

Fig. (3): Self assisted AROM exercise for shoulder

flexion and extension.

[pic]

Fig. (4): Self assisted AROM exercise for shoulder

internal and external rotation.

[pic]

Fig. (5): Self assisted AROM exercise for wrist motions.

[pic]

Fig. (6): Self assisted AROM exercise for fingers

flexion and extension

[pic]

Fig. (7): Self assisted AROM exercise for thumb motions.

[pic]

Fig. (8): Self assisted AROM exercise for hip ROM.

[pic]

Fig. (9): Self assisted AROM exercise for knee

flexion and extension

[pic]

Fig. (10): Self assisted AROM exercise for ankle motion

Active Assisted ROM Exercises Using Wand (T-bar) (Figs. 11-12)

A wand (dowel, rod, cane, wooden sticks or T-bar ) could be used to assist to complete ROM of the upper extremities

Shoulder Flexion (Fig. 11)

Patient Position: supine lying, sitting, or standing according to the patient condition.

Grasp: the wand is grasped with the hands a shoulder-width apart. The wand is lifted forward and upward through the available range with the elbow kept in extension.

[pic]

Fig. (11): AAROM exercise for shoulder flexion using a wand.

[pic]

Fig. (12): AAROM exercise for shoulder rotation using a wand.

Active Assisted ROM Exercises Using Overhead Pulleys (Figs. 13-15)

The pulley system is also used to assist an involved extremity in performing ROM. The pulley system consists of two pulleys which are attached to an overhead bar to the ceiling approximately shoulder width apart. A rope is passed over both pulleys and a handle is attached to each end of the rope.

Shoulder Flexion (Fig. 13)

Patient Position: supine, sitting or standing with the shoulder aligned under the pulleys

Grasp: the patient hold one handle in each hand then with the normal hand pull the rope and lift the involved extremity.

|[pic] |[pic] |

| | |

|Fig. (13): AAROM exercise for shoulder flexion |Fig. (14): AAROM exercise for shoulder abduction |

|using overhead pulleys. |using overhead pulleys. |

[pic]

Fig. (15): AAROM exercise for shoulder rotation

using overhead pulleys.

Active Assisted ROM Exercises Using Shoulder Wheel (Figs. 16-17)

The shoulder wheel is permanently attached to a wall. It can be adjusted to various heights and arm lengths. The patient is positioned so that his shoulder joint is at the axis of the wheel and the motion desired is in the arc of the wheel.

Shoulder Flexion and Extension (Fig. 16)

Patient Position: standing sideway with the involved shoulder toward the wheel. The handle is adjusted to match the length of his arm. The patient grasps the handle and moves the wheel forward and backward to the limits of the range of motion

Shoulder Abduction and Adduction (Fig. 17)

Patient Position: standing facing the wheel. The patient moves the wheel forward and backward to the limits of the range of motion

|[pic] |[pic] |

|Fig. (16): Active assisted ROM exercise for shoulder |Fig. (17): Active assisted ROM exercise for |

|flexion and extension using shoulder wheel. |shoulder abduction and adduction using shoulder |

| |wheel. |

Active Assisted ROM Exercises Using Skate Board and Powder Board

The board is simply provide friction free surface to encourage and facilitate the movement. This is done by using skate with rollers or using powder on the surface of the board to enable the patient to perform movement without the resistance of the gravity or friction.

Hip Abduction and Adduction

Patient Position: supine and the hip in neutral position

Procedures: place the board under the involved extremity. Ask the patient to move his lower limb away from the other limb as mush as he can then return it.

Active Assisted ROM Exercises Using Reciprocal Exercise Unit (Fig. 18)

Several devices such as a bicycle, upper body, or lower body ergometer can be set up to provide some flexion and extension to an involved extremity by using the strength of a normal extremity.

[pic]

Fig. (18): Active assisted ROM exercise hip and knee

flexion and extension using stationary bicycle

Active Free Range of Motion Exercises

Definition:

Active free ROM exercise is exercise in which movement is performed by the voluntary effort of the patient through full range of motion omitting gravity or against gravity without external assistance or resistance behind that of the gravity.

Active Free ROM Exercises consists of simple everyday anatomical movements and gymnastics exercises.

Active Free ROM exercises are characterized by:

Mobility activities performed by active muscle contraction.

Can be performed against gravity or in a gravity-minimized situation (omitting gravity or gravity eliminated).

Motions can be in cardinal planes, combined motions, or functional activities.

Indications of Active Free ROM Exercises

Active free ROM exercises may be used for

1- General mobility exercise.

2- Aerobic conditioning exercises.

3- When a segment of the body is immobilized for a period of time, active free ROM exercise is used on the regions above and below the immobilized segment to maintain the areas in as normal as possible and prepare for new activities.

Active Free ROM Exercises May be Limited by

Muscular strength

Muscular or cardiovascular endurance

Coordination and balance

Application of Active Free ROM Exercises

Demonstrate motions using PROM then ask the patient to perform the motion..

Assist only to make motion smooth and correct

Motion is done within the available pain free ROM.

Motion is done first omitting gravity then against gravity according to the patient condition and the muscle strength.

Procedures

Active free ROM exercises have the same techniques and steps for application as active assisted ROM exercises but the patient is able to perform the movement through full range of motion without assistance of external force. So all the procedures previously mentioned in the application of AAROM exercises can be used for active free ROM exercises.

Active Free ROM Exercises using Finger Ladder

The finger ladder (wall climbing) is a device that can provide the patient with objective motivation for doing shoulder range of motion exercises.

Shoulder Abduction (Fig. 1)

Patient position: standing sideways with the affected shoulder toward the ladder an arm’s length away.

Motion: The patient is asked to place the index or middle finger on a step of the ladder. The arm is moved into abduction by climbing with the fingers. The patient needs to externally rotate the shoulder as the arm is elevated.

[pic]

Fig. (1): Active free ROM exercises to shoulder abduction

using fingers ladder.

Shoulder Flexion

Patient position: standing facing the finger ladder an arm’s length away.

Motion: The patient is asked to place the index or middle finger on a step of the ladder. The arm is moved into flexion by climbing with the fingers. The patient steps closer to the ladder as the arm is elevated.

Active Free ROM Exercises Using Suspension (Figs. 2-4)

Suspension is a technique which is used to free a body part from the resistance of friction while it is moving. The part is suspended in a sling attached to a rope that is fixed to an appropriate point above the body segment.

Benefits of suspension for ROM

1- Active participation is required

2- Relaxation is promoted through secure support and smooth rhythmic motion.

3- Little work is required of stabilizing muscles because the part is supported.

Technique of Application

Axial fixation

The point of attachment of all ropes supporting the part is above the axis of the joint to be moved. The part will move in a flat plane parallel to the floor. This type of fixation allows for maximum movement of the joint.

Vertical fixation

The point of attachment of the rope is over the center of gravity of the moving segment. The part then move like a pendulum as arc. The movement is small range, so this type of suspension is primarily used for support.

Hip Flexion and Extension

Patient position: side lying, the exercised limb is the uppermost. The limb is supported using slings at the level of the knee and ankle to carry the weight of the limb.

Procedures: the point of the attachment of the ropes of the slings is positioned above the axis of the hip joint.

Motion: the patient is asked to move the limb forward as he can to the limit of the range. The patient should be motivated by the therapist to do his best.

[pic]

Fig. (2): ROM exercises for hip flexion and extension

using axial suspension

[pic]

Fig. (3): ROM exercises for hip abduction and adduction

using axial suspension.

[pic]

Fig. (4): ROM exercises for shoulder abduction and adduction using axial suspension

[pic]

Muscle Performance Exercises

Isometric Exercises

MUSCLE PERFORMANCE EXERCISES

Muscle Performance

Muscle Performance refers to the capacity of the muscle to do work. The key elements of muscle performance are strength, power and endurance.

In order to improve muscle performance all these three aspects should be regarded.

Factors Affecting Muscle Performance

Muscle performance is affected by all systems of the body.

1- Morphological qualities of the muscle

2- Neurological, biochemical and biomechanical influences

3- Metabolic, cardiovascular, respiratory, emotional function

Causes of Impaired Muscle Performance

1- Disease, injury, or lesion affecting musculoskeletal or neuromuscular system.

2- Immobilization.

3- Disuse or inactivity.

Muscle Performance Exercises

Are a large category of exercises designed to improve the three elements of muscle performance that is strength, power, and endurance.

Muscle Strength: is the ability to produce tension and the resultant force based on the demands placed upon the muscle.

Muscle strength is expressed as the greatest measurable force that can be exerted by a muscle or muscle group to overcome resistance during a single, maximal effort.

Muscle Power: is the rate of performing work. It is the work (force X distance) produced by a muscle per unit of time (force X distance / time)

Muscular endurance: The ability of muscle to perform a greater number of contraction or hold against a load over an extended period of time.

Types Of Muscular Contraction

Isometric (Static) Contraction: Involves muscular contractions with increasing muscle tension without movement of the joint.

Isotonic Dynamic Contraction: Involves muscular contractions with joint movement and excursion of a body segment.

Dynamic exercises involves either concentric (shortening) or eccentric ( lengthening) contraction.

Concentric Contraction: is a shortening contraction when the muscle contract with increasing tension and a decrease the distance between the origin and insertion(shortening).

Eccentric Contraction: is a lengthening contraction when the muscle is loaded behind its force producing capacity causing physical lengthening of the muscle as it attempts to control the load.

This type of muscular contraction serves to check the rate of motion of an extremity, acting as a braking action.

Isometric Exercises

Definition

Isometric exercise also known as static exercise. It is exercise which involves muscular contractions without movement of the involved parts of the body. So it involves muscular contractions against a load which is fixed or immovable or is simply too much to overcome.

Isometric comes from the Greek "iso-", equal + "metron", measure = maintaining the same measure, dimension or length.

Isometric exercise is “exercise in which a muscle contracts and produces force without an appreciable change in length of the muscle and without visible joint motion.

Isotonic exercise: Exercise in which a contracting muscle shortens against a constant load, as when lifting a weight.

Types of Isometric Exercises

1- Muscle setting exercises.

2- Stabilization exercises

3- Multiple angle isometrics

Muscle Setting Exercise

Definition: is low intensity isometric exercise performed against little to no resistance.

As muscle setting is not performed against any appreciable resistance, it will not improve muscle strength except in very weak muscles

Importance

1- Muscle setting can retard muscle atrophy in the stage of rehabilitation of a muscle when immobilization is necessary.

2- It is used to promote muscle relaxation and circulation and to decrease muscle pain and spasm after injury to soft tissues during the acute stage of healing.

3- Muscle setting maintain mobility between muscle fibers as they heal.

Indications of Isometric Exercises

1- During immobilization as joint movement is not possible due to immobilization by casts, splints, braces, or various types of traction apparatus.

2- After joint surgeries or injuries, when movement is too painful, or when movement may interfere with the healing process.

3- When the muscle weakness is confined to a definite angle or part of the range.

Aims of Isometric exercises

1- Prevent or minimize muscle atrophy when joint movement is not possible

2- Activate muscle and facilitate muscle contraction specially after surgeries or when acute injury of the joint or the soft tissue surrounding it.

3- Develop posture or joint stability.

4- Improve muscle strength when use of dynamic resistance exercises could harm the condition.

5- To develop static muscle strength at particular points of the range consistent with specific task related needs.

Contraindications and precautions

1- Isometric exercise can increase blood pressure and heart rate to levels that would be dangerous for anyone with undiagnosed cardiac problems.

2- Isometric exercise also increases intra abdominal pressure to dangerously high levels.

3- Be wear to instruct the patient not to hold breathing during isometric exercise to avoid valsalva maneuver.

Points to remember

• Muscular strength is only at the specific angle at which the exercise is performed. Hence, to make isometric exercise effective at increasing functional strength it must be repeated at many different joint angles.

• Isometric exercise does not increase muscular endurance or functional capacity in real world situation as dynamic exercise

• Isometric improvements have also been shown to be rate specific. Isometric exercise is best effective at slower movements

• Isometric exercises on their own are not recommended for strength training. They are only part of a complete exercise program.

• The great thing about isometric exercises is they can be performed just about anywhere and at any time.

Clinical Application of Isometric Exercises

Principles of Application

• To achieve effect, it's necessary to maintain isometric contraction for 6 to10 seconds.

• The exercise should be repeated 5 to 10 times.

• Any one isometric exercise will only increase muscle strength at one joint angle. Strengthening the other joint positions requires repetition of further corresponding exercises.

• Allow a period of rest following each sets of contraction to avoid fatigue.

Quadriceps Setting (Fig. 1)

Patient position: supine lying. Involved lower limb straight and the other lower limb may be flexed or straight.

Order: Keeping your knee straight, tighten your thigh muscle by pushing the back of your knee down on the bed. Hold for a count of 5. Relax. Do 20 repetitions.

[pic]

Fig. (1): Quadriceps setting.

Terminal Knee Extension ( Short arc Quadriceps):

Patient Position: supine Lying on with a roll under the knee, so that it is slightly bent.

Order: straighten your knee and hold for a count of 5. Relax. Do not lift your leg off the roll. Do 20 repetitions.

[pic]

Fig. (2): Short arc quadriceps.

Straight Leg Raising (Fig. 3)

Patient Position: supine Lying. The unexercised limb may be flexed for relaxation of the back. The exercised limb is straight.

Order: slowly lift your leg up, making sure to lift the heel first. Lift only as high as your other leg. Now slowly lower your leg back down. Do not hold. Do 20 repetitions.

[pic]

Fig. (3): Straight Leg Raising.

Gluteal Sets ( Fig. 4)

Patient Position: supine lying with the legs straight.

Order: Squeeze your buttocks together. Hold for 5 counts. Relax. Repeat.

[pic].

Fig. (4): Gleuteal Sets.

[pic]

Abdominal And Back Exercises

ABDOMINAL AND BACK EXERCISES

Function Of Abdominal And Back Muscles

5- The abdominal muscles and back muscles are key components of the muscular network providing the strength to keep the body upright and for movement. When these muscles are in poor condition, additional stress is applied to the spine as it supports the body and back injury or back pain is more likely.

6- Abdominal muscles support the trunk, allow movement, and hold organs in place by regulating internal abdominal pressure.

7- The abdominal muscles support the lower back. People with weak abdominal muscles tend to suffer from back pain.

8- Back muscles help the vertebrae in providing support to the body.

Abdominal Muscles

Rectus abdominus: (Fig. 1)

Slung between the ribs and the pubic bone at the front of the pelvis. The main action of the rectus abdominus is trunk flexion.

External oblique muscles: (Fig. 2)

These flank the rectus abdominus. The external oblique muscles allow the trunk to twist (trunk rotation), but to the opposite side of whichever external oblique is contracting. For example, the right external oblique contracts to turn the body to the left.

Internal oblique muscles: (Fig. 2)

These flank the rectus abdominus, They operate in the opposite way to the external oblique muscles. For example, twisting the trunk to the left requires the left hand side internal oblique and the right hand side external oblique to contract together.

[pic]

Fig. (1): Rectus abdominus muscle

[pic]

Fig. (2): External oblique and internal oblique muscles

Back Muscles (Fig 3)

There are several back muscles which are function as trunk flexors.

Erector spinae: iliocostalis thoracis and lumborum, longissimus thoracis, spinalis thoracis, semispinalis thoracis and multifidus

[pic]

Fig. (3): Trunk Extensors

Benefits of strong abdominal and back muscles

1- Help to maintain good posture.

2- Reduce the likelihood of back pain episodes.

3- Provide protection against injury by responding efficiently to stresses

4- Help to avoid back surgery in some cases.

9- Facilitate healing after a back injury or spine surgery

Technical Principles

1- Avoid performing exercises immediately after meals. don't eat for around two to three hours before starting your exercise.

2- The key focus point for this exercise is the speed you perform the movement. Avoid momentum and bouncing off the floor, keep the action smooth and slow.

3- The movement should be slow. the slower the motion, the harder the exercise. 

4- Hold at the end of the motion momentary to assure stabilizing action of the muscles ( don’t return quickly).

5- Stabilize the lower limbs to avoid substitution using the lower extremities.

6- Perform 8 - 12 reps in a slow controlled manner, rest for 20 seconds and repeat again. Increase repetition as the muscle strength increased.

7- Never push through back pain. Stop immediately at even the slightest twinge in the lower back. 

Abdominal exercises

Pelvic Tilt: (fig. 4)

Patient position: crock lying position with feet parallel and arms to the side.

Action: the patient is asked to tighten lower abdominal muscles (isometric contraction), pulling the lower back toward the floor, without using buttocks or leg muscles; hold for 5 seconds.

If the patient not understand, The therapist may put the hand under the lumber region and ask the patient to press on his hand

[pic]

Fig.(4): Pelvic tilt.

Curl-Ups (trunk flexion) (Figs. 5-8)

This exercise emphasis on the rectus abdominus muscle

Patient Position: crock lying position with feet parallel and arms to the side (Fig. 5).

Therapist Position: Standing at the level of the patient’s feet to stabilize the feet and knees.

Action: the subject is asked to

1- perform the drawing in maneuver and the lift the head

2- lift the head

3- progress by lifting the shoulders until the scapulae and thorax clear off the bed to an approximately 30 -45 degrees. Do not rise all the way up to sitting position, as this is done with the leg muscles and not the abdominals.

[pic]

Fig. (5): Curl Up with arms beside the body.

For further progression ( to make the exercise more difficult) change the position of the arm position as following

• The arms are forward (Fig. 6)

• The arms are folded across the chest (Fig. 7)

• The arms are behind the head (Fig. 8)

[pic]

Fig. (6): Curl Up with arms forward.

[pic]

Fig. (7): Curl Up with arms across the chest.

[pic]

Fig. (8): Curl Up with arms behind the head.

Diagonal Curl-Ups (trunk Rotation) (Figs. 9-11)

This exercise strength the oblique muscle.

The same patient position and progression but the patient is asked to turn and reach one hand toward the opposite knee while curling up. And then repeat turning to the other side.

[pic]

Fig. (9): Diagonal Curl-Ups with arms forward.

[pic]

Fig. (10): Diagonal Curl-Ups with arms across the chest.

[pic]

Fig. (11): Diagonal Curl-Ups with arms behind the head.

Double Knee to Chest (Fig. 12)

This exercise emphasis the lower rectus abdominus and oblique muscles.

Patient Position: Supine lying with arms beside the body.

Action: ask the patient to do pelvis tilt then bring both knees to the chest remain for 5 seconds and return. For progression decrease the angle of hip and knee flexion.

[pic]

Fig. (12): Double knee to chest.

Abdominal Crunch (fig. 13)

The abdominal crunch is an excellent exercise for keeping the contraction within the abdominal muscles.

Patient Position: Supine lying

Action: the patient clears both feet off the floor, makes a right angle with the legs, whilst shoulders are just off the floor.

[pic]

Fig. 13: Abdominal Crunch.

Bilateral Straight Leg Raising

Patient Position: Supine lying .

Action: with the knees straight the patient flex both hips

This exercise should be performed with caution under the inspection of the therapist as it may harm the spine if the patient has back problem ( increase intradisc pressure).

Back Exercises (Trunk Extension)

Aching the back

Patient position: supine lying arms at the side

Action: the patient arch the back by pressing against the bed by the back of the neck and the sacrum.

[pic]

Fig. (14): Arching the back.

Second Step

Patient Position: prone lying arms beside the body (Fig. 15)

Therapist position: stride standing at the level of the patient’s lower limb to stabilize the lower limbs.

Action: the patient is asked to tuck chin in and lift the head and thorax

[pic]

Fig. (15): Back Exercises with arms beside the body.

For further progression ( to make the exercise more difficult) change the position of the arm position as following

• The arms are folded behind the back (Fig. 16)

• The arms are behind the head (Fig. 17)

• The arms reaching overhead (Fig. 18)

[pic]

Fig. (16): Back Exercises with arms behind the back.

[pic]

Fig. (17): Back Exercises with arms behind the head

[pic]

Fig. (18): Back Exercises with arms reaching overhead.

Leg Lefts

Patient Position: Prone Lying, both legs straight. The patient hold onto the side of the treatment table to stabilize the thorax.

Action: the patient brings left only one leg, alternate with the other and finally lift both legs and extend the spine.

Superman (Fig.19)

To strengthen the trunk and hip extensors.

Patient Position: prone lying

Action: the patient lifts both trunk and lower extremities simultaneously off the table.

[pic]

Fig. (19) : Superman position to strengthen trunk

and hip extensors.

-----------------------

Endurance Exercises

Resisted Exercises

Muscle Performance Exercises

Active assisted range of motion exercises

Active free range of motion exercises

Active Range of Motion Exercises

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download