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.
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.
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Indications
1- After joint surgery, including anterior cruciate ligament
(ACL)
2- After knee arthoroplasty
3- After surgical repair of stable intra-articular or extraarticular 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.
-48-
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.
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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.
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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.
Active Range of Motion Exercises
Active assisted range
of motion exercises
Active free range of
motion exercises
Indication of AROM Exercises
AROM Exercises are Indicated When
1- 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.
2- Active muscle contraction is desired.
3- Resistive exercises may be too difficult.
4- Motor planning, muscular control and coordination are
desired.
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Goals of AROM Exercises
1- Prevent or decrease negative effects of immobilization as
contractures, tightness and pain.
2- Increase circulation.
3- Improves proprioception and kinesthesia.
4- Maintain physiologic elasticity and contractility of the
contracted muscles.
5- Minimal strength gains in muscles with fair strength or
less.
6- 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
1- Some patients with cardiopulmonary dysfunction.
2- Unhealed and unprotected fracture or surgical site.
3- Severe soft tissue trauma.
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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 gravityminimized situation (omitting gravity or gravity
eliminated).
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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.
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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).
Fig. (1): Active assisted range of motion exercise for shoulder
flexion and extension ( eliminating gravity).
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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).
Fig. (2): Active assisted range of motion exercise for shoulder
flexion and extension (against gravity).
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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.
Fig. (3): Self assisted AROM exercise for shoulder
flexion and extension.
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Fig. (4): Self assisted AROM exercise for shoulder
internal and external rotation.
Fig. (5): Self assisted AROM exercise for wrist motions.
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Fig. (6): Self assisted AROM exercise for fingers
flexion and extension
Fig. (7): Self assisted AROM exercise for thumb motions.
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Fig. (8): Self assisted AROM exercise for hip ROM.
Fig. (9): Self assisted AROM exercise for knee
flexion and extension
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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.
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Fig. (11): AAROM exercise for shoulder flexion using a wand.
Fig. (12): AAROM exercise for shoulder rotation using a wand.
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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.
Fig. (13): AAROM exercise
for shoulder flexion using
overhead pulleys.
Fig. (14): AAROM exercise
for shoulder abduction using
overhead pulleys.
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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.
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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
Fig. (16): Active assisted ROM Fig. (17): Active assisted ROM
exercise for shoulder flexion and exercise for shoulder abduction
extension using shoulder wheel.
and adduction using shoulder
wheel.
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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.
Fig. (18): Active assisted ROM exercise hip and knee
flexion and extension using stationary bicycle
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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 gravityminimized 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.
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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.
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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.
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.
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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.
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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.
Fig. (2): ROM exercises for hip flexion and extension
using axial suspension
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Fig. (3): ROM exercises for hip abduction and adduction
using axial suspension.
Fig. (4): ROM exercises for shoulder abduction and adduction
using axial suspension
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Muscle Performance
Exercises
Isometric Exercises
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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.
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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.
Muscle Performance Exercises
Endurance Exercises
Resisted Exercises
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.
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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.
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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.
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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
movement is not possible
joint
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.
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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.
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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.
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.
Fig. (2): Short arc quadriceps.
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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.
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.
.
Fig. (4): Gleuteal Sets.
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Abdominal And Back
Exercises
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ABDOMINAL AND BACK EXERCISES
Function Of Abdominal And Back Muscles
1- 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.
2- Abdominal muscles support the trunk, allow movement, and
hold organs in place by regulating internal abdominal
pressure.
3- The abdominal muscles support the lower back. People with
weak abdominal muscles tend to suffer from back pain.
4- 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.
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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.
Fig. (1): Rectus abdominus muscle
Fig. (2): External oblique and internal oblique muscles
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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
Fig. (3): Trunk Extensors
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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.
5- 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.
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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
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
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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.
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)
Fig. (6): Curl Up with arms forward.
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Fig. (7): Curl Up with arms across the chest.
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.
-90-
Fig. (9): Diagonal Curl-Ups with arms forward.
Fig. (10): Diagonal Curl-Ups with arms across the chest.
Fig. (11): Diagonal Curl-Ups with arms behind the head.
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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.
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.
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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.
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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
Fig. (15): Back Exercises with arms beside the body.
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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)
Fig. (16): Back Exercises with arms behind the back.
Fig. (17): Back Exercises with arms behind the head
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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.
Fig. (19) : Superman position to strengthen trunk
and hip extensors.
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