type of exercise

Passive Exercise

  • Definition: Exercises performed without active contraction of the patient’s muscles.
  • Who performs them:
    • Someone else (therapist, caregiver) does the movement for the patient.
    • The patient may participate using an opposite limb or other body part to assist movement.
  • Purpose: Preserve joint range and facilitate movement when active contraction is not possible.

Active Exercise

  • Definition: Involves some degree of muscle contraction in the exercising part.
  • Subtypes:
    • Active assistive
    • Active resistive
    • Active exercise
  • Core idea: The muscle being exercised contributes to the movement, with varying levels of external assistance or resistance.

Active Assistive

  • Definition: Uses some outside source of assistance to handle the weight of the body part.
  • Why it is used:
    • Significant weakness
    • Pain
    • Potential for joint damage when fully unassisted movement is unsafe
  • Practical note: Helps progress ROM and strength gradually when patient cannot move through full range unaided.

Active Resistive

  • Definition: The muscle must handle more than the weight of the body part; movement is resisted.
  • Methods of resistance:
    • Manual (therapist applies resistance)
    • Mechanical (devices)
    • Simple weights (dumbbells, ankle weights, etc.)
  • Why used:
    • Strengthening muscles
  • Training emphasis: Progressive resistance to build muscular strength

Active Exercise (no external resistance)

  • Definition: The muscle does all the work with no outside resistance or assistance.
  • Objective: Train the muscle through its available range with no added load

Stretching

  • Types of stretching include several methods with different mechanisms
  • Key distinction:
    • Active stretching: patient’s own muscle contraction facilitates the stretch
    • Passive stretching: external force (therapist, device) provides the stretch
  • Other type mentioned:
    • Forced motion (contextual note)

Why Stretch?

  • Goal: Increase mobility by increasing tissue extensibility
  • Underlying principle: Limiting factors are extensibility of soft tissues; stretching aims to elongate these tissues over time

Mobilization: A Specific Type of Exercise

  • Definition: Aimed at passively moving joint surfaces
  • Characteristics:
    • Small amplitude motions
    • Gliding and oscillation movements
  • Why used:
    • To stretch specific structures surrounding the joint

Four Key Goals of Physical Therapy Treatment

  • Mobility
  • Strength
  • Coordination
  • Endurance

Mobility

  • ROM exercises: Maintain current length of structures
  • Stretching: Increase structure length
  • Mobilization: Enable increased ROM

Strength

  • Approaches based on muscle weakness level:
    • Very weak muscles: Active assistive
    • Moderately weak muscles: Active (unassisted or light resistance as appropriate)
    • Fairly strong muscles needing more strength: Active resistive
  • Prescription style: Low repetition with high resistance

Coordination

  • Purpose: Improve control (quality) of movement, including:
    • Force, direction, speed, and timing
  • Practice principle: High repetition with good quality; "Practice makes perfect?" – NOT TRUE!
  • Adage: "Perfect practice makes perfect!"

Endurance

  • Purpose: Improve ability to exercise for a prolonged period
  • Components involved:
    • Cardiovascular and respiratory components
  • Prescription style: Low resistance with high repetitions

"Aerobics" and Endurance

  • Aerobics is one example of endurance training
  • Endurance can also be trained with specific individual muscles

Other Goals of Therapeutic Exercise

  • Target specific physiological functions (e.g., circulation; respiration)
  • Relaxation: Contract muscle then relax fully
  • Balance: Achieve stability in a variety of positions

Matching Activity

  • Note: Small group activity to apply concepts

Purpose: Mobility Exercises

  • Primary aim: Maintain or increase range of motion (ROM)

Secondary Effects of Mobility Exercises

  • Sensory input: Proprioception and kinesthetic awareness (body position and movement in space)
  • Circulation: Pressure relief; active exercise is most effective for circulation

Mobility Exercises (Structures Affected)

  • Connective tissue components: joint capsule, ligaments, tendons, fascia
  • Rationale: Prevent adherence of fibers; avoid tissue sticking/stiffening ("Don’t use, you LOSE!")

Muscles, Joints, and Related Structures

  • Muscles:
    • When crossing one joint: range the joint with appropriate technique
    • When crossing two joints: require coordinated motions to range the muscle (e.g., hamstrings)
  • Bones:
    • Stress on bones may aid in preventing demineralization
    • Wolff’s Law: Bone adapts to the stresses placed on it; active loading is generally beneficial
  • Subcutaneous tissue, nerves, blood vessels:
    • Maintain length and pliability
    • Can become tightened if not addressed
  • Skin:
    • Maintain extensibility and elasticity

PROM (Passive Range of Motion)

  • Definition: Motion produced by external force when the patient cannot actively move the joint
  • Example context: Paralysis; coma

PROM Purposes

  • Maintain range of motion
  • Increase range temporarily
  • Provide sensory input to facilitate active movement ("springing action")

PROM: Who Is Responsible?

  • Initial re-gaining of ROM: Physical Therapist (PT)
  • Maintenance of ROM: Nursing staff or family
  • Collaboration across disciplines is common

How Often for PROM?

  • Typical question: Daily, 2x, 3x, 10x per day?
  • Guideline: "Often enough to achieve the purpose of maintaining range"
  • Considerations: Coma patient vs. athlete

Prevention is Easier!

  • Emphasizes proactive management to prevent ROM loss and contractures

Documentation

  • Purpose: Record amount of change occurring
  • Reimbursement implication: If it’s not documented, it’s treated as not happened

Terms to Know

  • Indications: Reasons to perform a procedure
  • Contraindications: Reasons not to perform a procedure
  • Precautions: It can be done but requires close monitoring

Indications for ROM

  • Reasons include:
    • Weakness
    • Pain
    • Anxiety
    • Unconscious state
    • Joint immobilization of nearby joints
    • Abnormal muscle tone
    • Prolonged bedrest
    • Loss of motion

Contraindications for ROM

  • Examples:
    • Unstable vital signs
    • Fresh hemorrhage
    • Joints near a new fracture
    • Severe unending pain during exercise

Precautions for ROM

  • Acute joint inflammation
  • Monitor signs such as pain, swelling, heat
  • Doctors may have varying protocols

Questions?

  • End of content; contact instructor for clarification