Therapeutic exercise

1
Therapeutic exercise

• Rachawan Suksathien
• Department of rehabilitation medicine

2
Question

• What is exercise ?
• What is therapeutic exercise ?

3
Muscle Energy

• All active exercise ? Active muscle contraction
• All muscles use energy from ATP
• ATP is available from
• creatinine phosphate
• anaerobic (lactic) pathway
• aerobic pathway

4
Exercise ?

• ??????????????????????????????????????????????????
  ???????????????????????????????????????????????

5
Therapeutic exercise

• ??????????????????????????????????????????????????
  ????????????????? ???????????? ???????????????????
  ???????????????????????

6
???????????????? Exercise

• ???????????????????
• ????????????????
• ??????????????????????????????????

7
?????????????????????????????

• Range of motion
• Strength Endurance
• Coordination
• Relaxation

8
???????????????????????????????????????

• Passive ROM exercise ( PROM )
• Active-assistive ROM exercise
• Active ROM exercise ( AROM )

9
??????????????????????????????????????????????????
???????

• Static / isometric exercise
• Dynamic / isotonic exercise
• concentric exercise
• Eccentric exercise
• Isokinetic exercise

10
Range of Motion Exercise

• ???????????? Mobility exercise
• ROM ex. ? Stretching exercise

11
ROM exercise

• Maintain mobility within the available range
• 3-5 times
• 1-2 times daily
• At least 3 times per week

12
ROM exercise

• Passive ROM exercise ( PROM )
• Active-assistive ROM exercise
• Active ROM exercise ( AROM )

13
Stretching exercise

• Increase ROM
• Passive stretching ( manual, traction, serial
  cast, splint )
• 15-30 sec
• 5-10 repetitions
• Very slowly gently
• Avoid ballistic stretching

14
Contraindication of passive stretching

• Bony block
• hypermobility
• Recent fracture
• Acute inflammation or infection at stretched area
• Hematoma or uncontrolled bleeding
• Joint effusion
• Contracture are needed to provide joint stability
  or increased functional ability

15
Strength Endurance

• Muscle Strength ?
• ????????????? ???????????????????????????????????
  ???????
• Muscle Endurance ?
• ?????????????????????????????????????????????????
  ???

16
Strength ???????????

• Cross-sectional size of the muscle
• Length-tension relation ship
• Recruitment of motor unit
• Type of muscle contraction
• Type of muscle fiber
• Speed of contraction
• Motivation of patient

17
Strengthening exercise

• Exercise to the point of fatique
• Max load few repetitions ?????????????
  endurance ??? moderate load many repetitions
• Neural factor (first 2 weeks) ? hypertrophy

18
Strengthening exercise

• Isometric / static exercise
• Isotonic / dynamic exercise
• Isokinetic exercise

19
Isometric exercise

• ??????????????????
• ?????
• ???????????????????????????????????
  ????????????????????? (??????????? contracture)
• ?????????????????
• ?????????

20
Isometric exercise

• ???????
• ???????????????????
• ????????????? ? ??????????
• Angle-specific

21
Isometric exercise

• ????????? 5-6 sec
• 8-10 repetitions/set
• 2-3 sets/day

22
Isotonic exercise

• Constant load
• Uncontrolled speed ???????????????????????????????
  ????
• Progressive resistive exercise ( PRE )
• 10 RM, 1RM
• 50of 10RM ? 75 ? 100
• 70of max load 8-12 repetition, 3 sets/day,
  slowly

23
Isokinetic exercise

• Constant angular joint velocity
• ??????????????????????????
• ??????? ?????????????????
• ????????????????????????? ???????
• ???????????????????????????????????

24
?????

• Specificity exercise ?????? ??? strength
  ???????
• Reversibility ????????????? ????????????????

25
Endurance exercise

• Muscle endurance
• General endurance / exercise for cardiopulmonary
  fitness / aerobic exercise

26
Muscle endurance

• 15-40 of max load, 20-30 repetition/set
• To the point of fatique

27
General endurance

• Aerobic exercise
• Exercise for cardiopulmonary fitness

28
Energy source

• creatinine phosphate
• anaerobic (lactic) pathway
• aerobic pathway

29
Aerobic exercise

• Large muscle groups jogging, bicycling,
  swimming,
• 60-80 of HRmax / ????????????????????????????????
  ????
• 15-45 min.
• At least 3 times/week
• Warm up cool down

30
Aerobic exercise

• Mode
• Intensity
• Duration
• Frequency

31
Exercise for coordination

• Component of coordinated motions
• Strength
• Sensory feedback
• Motor engram
• Central coordination center

32

• steps toward coordinated movement
• isolate muscle contraction
• isolate joint motion
• multiple joint motion
• Simple ? complicate
• ?????
• Relax ??????????
• Avoid fatique

33
Relaxation exercise

• Local systemic
• Muscle strain, MPS, COPD
• Environment
• Positioning
• Consciously ? unconsciously

34
Summary

• Think what effect you want
• Assign proper exercise
• Therapeutic exercise medicine

35
??????? specify

• Type
• Mode
• Intensity
• Duration
• Frequency
• precaution

36
Questions ?
37
Practice

• Therapeutic exercise for common musculoskeletal
  disorders

38
Neck exercise

• ROM exercise
• Isometric exercise
• Stretching exercise

39
Back exercise

• Flexion-type exercise
• Williams exercise
• Abdominal strengthening exercise (sit up)
• Pelvic tilting
• Knee-to-chest exercise
• Finger-to-toe / hamstring stretching

40
Back exercise

• Extension-type exercise
• Mc.Kenzies exercise

41
Shoulder exercise

• Pendulum exercise / Codmans exercise
• Passive
• active
• Wall climbing exercise / Finger ladder exercise
• Towel exercise

42
Knee exercise

• Isometric quadriceps exercise
• Last 30º knee extension exercise
• One straight leg raising exercise
• PRE quadriceps
• Opened kinetic chain
• Closed kinetic chain

43
Knee exercise

• Isometric hamstrings exercise
• Stretching exercise
• Quadriceps
• Hamstrings