Therapeutic Exercises
Dr. Abdel Hamid Nabil
Lecture I
INTRODUCTION
• The official definition
of physical therapy says
“it is the art and science
of treatment by means
of heat, cold, light,
water, manual
manipulation,
electricity, therapeutic
exercise and other
physical agents.
INTRODUCTION
• According to the American Physical Therapy
Association (2006), physical therapists (PTs) are
health care professionals who diagnose and treat
people of all ages who have medical problems or
other health-related conditions that limit their
abilities to move and perform functional activities
in their daily lives.
INTRODUCTION
• Physical therapy or physiotherapy is the provision
of services to people and population to develop,
maintain and restore maximum movement and
functional ability throughout the lifespan. It
includes the provision of services in
circumstances where movement and function are
threatened by the process of ageing or that of
injury or disease.
INTRODUCTION
• Physical therapy is concerned with identifying
and maximizing movement potential, within the
spheres of promotion, prevention, treatment and
rehabilitation. It involves the interaction between
physical clients, families and care givers, in a
process of assessing movement potential and in
establishing agreed upon goals and objectives
using knowledge and skills unique to physical
therapists.
INTRODUCTION
• Physical therapy interventions may include:
manual handling; movement enhancement;
electrotherapeutic and mechanical agents,
functional training, provision of aids and
appliances, patient related instruction and
counseling, documentation and coordination, and
communication.
INTRODUCTION
• PTs also help prevent
conditions associated with
loss of mobility through
fitness and wellness
programs that achieve
healthy and active
lifestyles.
INTRODUCTION
• PTs examine individuals and
develop plans using
treatment techniques that
promote the ability to move,
reduce pain, restore function,
and prevent disability. They
provide care in hospitals,
clinics, schools, sports
facilities, and more.
Examination of patient
Assessment
• Assessment includes:
1- subjective information:
- name, age, sex, address, occupation, diagnosis.
- How the patient perceive his symptoms.
- Describe the behavior of the symptoms.
- Related History of any previous medical or
surgical history.
Examination of patient
Assessment
• Objective data:
- By Inspection (observation).
- By palpation.
- By measurement:
Muscle palpation, muscle testing,
functional ability, ROM, round and
long measurement, muscle tone,
special tests.
Examination of patient
Assessment
• Goals of treatment: according to assessment
results.
- Long term goals.
- Short term goals.
• Plane of treatment.
INTRODUCTION
• Therapeutic exercises can help injured part to
resume normal function. Physical therapist done
this by evaluating, planning, organizing, and
directing the programs for the care of individuals
whose ability to function is impaired.
Aims of Therapeutic Exercises
Therapeutic exercise seeks to achieve the
following goals:
1- To improve circulation.
2- To improve strength and power.
3- To stimulate and increase sensory
awareness of movement.
4- To maintain and increase mobility of the
joints.
Aims of Therapeutic Exercises
5- To restore the physiological properties of
the muscle (excitability, contractility, and
elasticity).
6- To improve co-ordination and
neuromuscular control.
7- To increase muscle performance and
functional capacity (endurance).
8- To gain relaxation (general or local).
Aims of Therapeutic Exercises
9- To facilitate proprioceptive neuromuscular
function.
10- To improve respiratory capacity.
11- To assist subject to control and improve
his balance.
12- To reduce pain.
Aims of Therapeutic Exercises
13- To help regaining of proper postural
alignment (improve and correct posture).
14- To increase and maintain flexibility of the
muscles, tendons, ligaments, and fascia.
15- To increase physical fitness.
16- To improve gait and ambulation (assist
subject to walk properly).
Human Positions and Posture
• The position in which the
parts of your body are
hold upright against
gravity while standing,
sitting, or lying down is
called posture.
Human Positions and Posture
• Your posture
constantly changes
depending on the
activity, but no matter
what you are doing,
you must keep holding
and moving your body
in a balanced and
efficient way, that is
called good posture.
Human Positions and Posture
• To gain good posture you
must training your
muscles, bones, and joints
to stand, walk, sit, and lie
with least strain and
effort.
Proper Posture
To achieve proper posture:
1- Keeps correct alignment of
bones and joints to
help muscles used properly.
2- Decrease the abnormal
wearing of joint surfaces
that could result in arthritis by
proper alignment.
Proper Posture
3- Decreases the stress on
the ligaments holding the
joints of the back.
4- Prevents the spine from
becoming fixed in
abnormal positions.
Proper Posture
5- Prevents fatigue because
muscles are being used more
efficiently, allowing the body
to use less energy.
6- Prevents strain or overuse
problems.
7- Prevents backache and
muscular pain.
Factors Affect Posture
There are some factors
contribute to bad posture as:
• OBESITY
• PREGNANCY
Factors Affect Posture
• muscle weakness.
• use high-heeled shoes.
Factors Affect Posture
 shortening of muscles.
 decrease flexibility and
ignorance
of
good
posture.
Starting Positions
• Also called fundamental positions.
• They are five positions.
1- Standing position.
2- Kneeling position.
3- Sitting position.
4- Lying position.
5- Hanging position.
1- Standing
• it is the most difficult
position to maintain
because the body is
balanced and
stabilized on a small
base which needs
coordination work of
many muscle groups.
Correct Standing Position
1- The heels are on ground with angle
not exceed 45°.
2- Keep your knee straight but not
locked.
3- The hips are in extension and
slightly rotated laterally.
4- The pelvic is balanced on the
femoral head.
5- The spine is stretched to its
maximum length and stomach flat.
Correct Standing Position
• 6- The head is hold up straight
with chin in. do not tilt your
head forward, backward, or
sideways.
• 7- Keep your shoulder blades
back.
Correct Standing Position
• 8- The arms are hanged
loosely to the sides, palms
facing sides of the body.
• 9- Your weight should be
evenly distributed on both
legs.
2- KNEELING
• The body is supported on
the knees which may be
together or slightly apart.
• 1- The lower leg rests on
the floor with the feet
planter flexed.
• 2- The feet may be in the mid
position over the edge of the
plinth.
2- KNEELING
• Effect: uncomfortable
position for most people
due to difficult balance.
• Uses: as starting position
for backward movements.
3- SITTING
• the position is taken on
chair or stool.
• 1- It is preferable to leave
2 or 3 inches of space
between the back of your
knees and the edge of the
seat.
3- SITTING
• 2- The height and width of
seat must allow the thighs to
be fully supported.
• 3- The hips and knees are
flexed to right angle.
• 4- The knees are apart and feet
rest on the floor.
• 5- Your weight should be
evenly distributed on both
buttocks.
3- SITTING
• Effect: comfortable,
natural, and very stable
position.
• Uses: for many nonweight bearing knee
and foot exercises.
4- LYING
• This is the easiest
position as the body can
completely supported in
the supine position and
as stable as possible.
4- LYING
• Effect:
• The alignment of the body is as
in standing.
• Breathing is impeded slightly by
pressure on the posterior aspect
of thorax and the pressure of the
abdominal viscera on the under
surface of the diaphragm is
increased.
• Uses: it is suitable for many
exercises.
5- HANGING
• The body is suspended
by grasping over
horizontal bar.
• The arms straight & at
least shoulder width
apart and forearm being
pronated.
5- HANGING
• - The head is held high
and the scapulae are
drowning down together.
• - The legs and trunk hang
straight with the heels
together and the ankle
planter flexed.
• Uses: it is suitable for
athletic persons with high
muscle strength.
Derived Positions
• Derived positions are positions used by modification of
the arms, legs or trunk in each of fundamental position.
The aims of derived positions are:
1- To increase or decrease the base of support.
2- To rise or lower the center of gravity (COG).
3- To gain local or general relaxation.
4- To gain fixation and good control of specific area.
5- To increase or decrease the muscle work required to
maintain the position.
6- To increase or decrease the leverage.
I- Positions derived from standing
A- By alteration of the
arms.
• 1- Wing standing:
• Hands rest on the iliac
crest, fingers extended
and adducted, thumbs
abducted posterior.
•
Uses: grasp patient
during exercises.
2- Bend standing
The shoulders are laterally rotated
and adducted strongly, the elbows are
flexed and the forearms are supinated
with wrists and fingers flexed to rest
above the lateral border of acromion
process.
2- Bend standing
• Effect: suitable position for
subjects with weakness of
shoulders abductors (as arm
lever is reduced).
Uses:
• Used in trunk exercises as
corrective position for upper
back and thorax.
3- Reach Standing
• The shoulders are flexed
and the elbows are
extended, arms are
parallel in the same
shoulder width.
3- Reach Standing
Effect:
The forward raising of the arms
brings the center of gravity of the body forward
and leading to extension of the lumber spine.
Uses:
•Prior to some arm and trunk exercises in the
sagittal plane.
•Assist balance during balance walking
sideways.
4- Yard Standing
• The arms are straight and elevated
sideways to horizontal position.
• Effect:
This position has a mechanical
disadvantage, an increase of the lever.
The abductors of the shoulder work at
a marked mechanical disadvantage as
the length of the weight arm of the
lever so greatly exceeds that of the
power of the arm.
4- Yard Standing
Uses:
1- Corrective for the posture of the upper
back
2- Facilitates body balance
3- Convenient for the arm swinging
exercises
4- The body is steadied for the leg and
trunk exercises when one arm only is used
or
when the hand grasps a support at a
suitable height (1/2 yd.st.)
4- Yard Standing
• 5- When palms are turned
forwards (yd.palms f.st.) or
upwards (yd.palms u.st.) the
latter involving an additional
lateral rotation at the shoulder
joint with consequent further
bracing of the upper back
muscles
5- Stretch Standing
• The arms are fully elevated
so that they are in line with
the body, parallel to each
other and with palms
facing forward.
5- Stretch Standing
• Effect:
• Strength shortened muscles
like pectoralis major, minor
and latissimus dorsi. Leading
to difficulty in respiration and
impede arm circulation by
gravity.
5- Stretch Standing
• Uses:
• It is unsuitable for weak
patients or those who suffer
from respiratory condition.
• It is strongly corrective for
the position of the upper
back and gives a feeling of
stretching the spine.
5- Stretch Standing
3- Elevation of the arms raises the
center of gravity of the body and
affords additional leverage in
many trunk exercises.
4- The hands may grasp some overhead support (str.gr.st) or the
finger may be clasped
(str.clasp.st.).
5- Useful to treat scoliosis.