1. Therapeutic Exercise
Presented By
Dr. Vivek B. Sathe

2. Definition
Therapeutic exercise are the prescription of bodily movement to correct an impairment, improve musculoskeletal function, or maintain a state of well-being.
It may vary from highly selected activities restricted to specific muscles or parts of the body, to general and vigorous activities that can return a patient to the peak of physical condition.

3. Definition Cont…
Therapeutic exercise is a means of accelerating the patient’s recovery from injuries and disease which have altered his normal way of living.

4. Techniques of Therapeutic Exercise
Active Movements
Passive Movements

5. Active Movements Voluntary Movement Involuntary Movement Free Assisted
Assisted-Resisted
Resisted
Involuntary Movement
Reflex Movement

6. Passive Movements
Relaxed passive movements including accessory movements
Passive manual mobilization technique
Mobilization of Joints
Manipulation of Joints
Controlled Sustained Stretching

7. Free Exercise
Free exercises are those which are performed by the patient’s own muscular efforts without the assistance or resistance of any external force other than the gravity.

8. Effects and Use of Free Exercise
Relaxation
Improvement of joint mobility
Increased muscle power and tone
Neuromuscular co-ordination
Confidence
Circulatory and respiratory co-operation

9. Assisted Exercise
When muscular action is insufficient for the production or control of movement, an external force applied by therapist or some other devices.
The magnitude of the assisting force must be sufficient only help muscular action not as a substitute.

10. Effects and Uses of Assisted Exercise
The incapable muscles are capable to perform movement.
By frequent repetition of correct pattern the muscle develop strength and control.
Confidence in the patient develops
Range in joint increase

11. Assisted – Resisted Exercise
This type of exercise constitutes a combination of assistance and resistance during a single movement
Effects and Use- Same as Assisted

12. Resisted Exercise
An external force is applied to the body levers to oppose the force of muscular contraction.
Resistance can be given in the form of
Resistance by therapist
Resistance by patient
Resistance by weights

13. Effects and Use of Resisted Exercise
Muscle Strength and Hypertrophy
Muscular Power
Muscular Endurance
Neuro - muscular coordination

14. Reflex Movement
Reflex movement is involuntary and may be defined as the motor response to sensory stimulation.
These reflex movements are protective in nature.
The reflex movement is controlled by spinal cord level.

15. Effects and Use of Reflex Movements
It is protective in nature and use involuntary
Normal Joint movements and their extensibility of muscle is maintained
Circulation is improved

16. Passive Movements
These movements are produced by an external force during muscular inactivity or when muscular activity is reduced as much as possible to permit movement.

17. Relaxed Passive Movement
These are movements performed accurately and smoothly by the therapist.
A knowledge of anatomy of joints is required.
The movements are performed in the same range and direction as active movements.
The joint is moved through the existing free range and within the limit of pain.

18. Accessory Movement These occur as part of any normal joint movement.
They consist of gliding or rotational movements which can not be performed in isolation as a voluntary movement but can be isolated by the physiotherapist.

19. Passive Manual Mobilization Technique
Mobilization of Joints:
These are usually small repetitive rhythmical functional movement performed by the physiotherapist.
These can be done very gently and are graded according to the part of available range in which they are performed.

20. Passive Manual Mobilization Technique Cont...
Manipulation of Joints:
By Physiotherapist: These are accurately localized single quick movement of small amplitude and very high velocity completed before the patient can stop it.
By Surgeon: The movement are performed under anesthesia to gain further range. The increase in movement must be maintained by the physiotherapist.

21. Passive Manual Mobilization Technique Cont...
Controlled Sustained Stretching of Tightened Structure:
Passive stretching of muscle and other soft tissue can be given to increase range of movements

22. Effects and Use of Passive Movements as a Whole
Adhesion formation is prevented
When active movement is impossible it preserve the memory of movement pattern
Accessory movements contribute to normal function of the joint
The slow stretch produces a relaxation and lengthening of the muscle.

23. THANK YOU