Therapeutic Exercise

Physiological Aspects

muscle contractions: concentric, eccentric, isometric

muscles strengthening: muscle sizes increases when activity stresses the muscles ability to produce tension and force; increased number motor units activated and increased motor unit activation in synchrony contributes to muscle strength

psychological facts: motivation to perform an occupation affect the effort exerted

muscle endurance: ability of a muscle to sustain or perform repeated contractions overtime

muscle endurance is related to muscle strength

Concentric

muscles shortens to move a limb section in the direction of the muscle pull

internal force of the muscle overcomes the external resistance

Eccentric

contracted muscle lengthens to act as a brake against the external force to allow for a smooth controlled movement

Isometric

external and internal force are in equilibrium and the lungs of the contracted muscle remains the same

Biomechanical Approach

maintain or preventing limitations in ROM: immobilization reduces ROM; methods

increases ROM: stretching, active stretching, passive stretching

strengthening: methods; guidelines for strengthening programs

increasing endurance: les than maximal resistance overtime; methods

Maintaining or Preventing Limitation in ROM

functional ROM is necessary range to perform daily occupations

joint remains immobilized: loss of muscle fiber; changes in # and length of sarcomeres; changes in connective tissue; ligament weakness; elastic stiffness; disruption in workings of synovial fluid, synovial membrane and articular cartilage

methods: compression; positioning; movement through the full ROM

Increasing ROM

OT may treat people with limitations Ising the principles of stretch for development of capacious needed for occupational performance

problems that cannot be changed

AROM is preferred over PROM

stretching, active stretching, passive stretching

Stretching

process where tissue is lengthened by an external force → eliminating tightness which could lead to contracture

Active Stretching

use of occupation for stretch based on the idea that a person involved in an interesting and purposeful activity will gain greater ROM because they are relaxed, is not anticipating pain and is motivated to complete the task

Passive Stretching

OT can do this prior to engagement in occupation

relaxed environment

descrie manual stretching (involves tolerable pain)

use ROM movements

stabilize the one proximal and distal to the joint that is to be moved (to avoid compensation)

move the bone smoothly, slowly, and gently to the point of maximal stretching for 15-30 seconds

relief of discomfort should never be immediately follow release o the stretch

if client complains of pain, future stretches should be be done with less force and move slowly

safety precautions: inflamed tissue, sensory loss, avoid over stretching, the more weight the aggressive the stretch will be (slow and gentle stretching)

Strengthening

when the muscle is stressed to the extent that additional motor units are recruited through increase efficiency of the neuromotor system, the muscle hypertrophies and muscle strength increases

grading muscle stretch parameters: Delorme and Watkins principles of resistance and repetition to increase muscles strength still used today; progressive resistive exercise (program which a person lifts 50%, the 75% and finally 100% of their 10 repetition maximum)

Simplified Progressive Resistive Exercise

1 repetition maximum (1 RM) is established by determining the maximum weight a warmed up muscle can move smoothly through the ROM one time

if a person is untrained or has not lifted weighs consistently in the past year, 60% of the 1-RM is moved through the full ROM 10 times followed by the break

for a person who is trained or who has been doings strength training consistently for more than 1 year, 80% of the 1 RM is moved through the full ROM 10 times followed by a rest break

4 sets of 10 repetitions are completed for each muscle’s strengthening program (whether the client is trained or untrained

repeat entire program 3x/week for untrained client and 2x/week for trained client

Guidelines for a Strengthening Program

isometric exercise: weak muscles is isometrically contracted to its maximal force 10 times with rest periods between each contraction

isotonic assistance (active assistance ROM; aka AAROM): weak muscles are concentrically or eccentrically contracted throng has much ROM as achievable; OT or external device provides assistance for rest of motion

isotonic active (AROM): client contracts muscles to move part through full ROM

isotonic active resistance (active resistive ROM; aka ARROM): client contracts muscles to move part through full available ROM against resistance

Contraindications for Strengthening

if a client has hypertension or cardiovascular problems; isometric contraction should be avoided because isometric contraction of either large or small muscles increases the blood pressure and heart rate

Increasing Endurance

exercise to increase muscle endurance uses moderately fatiguing activity for increasingly longer periods with intervals of rest to allow metabolic recovery

mild activity with increased repetition

guide client to engage in longer periods of exercise at 40-60% of their repetition maximum (RM)