ACTIVE MOVEMENT

Dr. Fahad Alanazi

 Classification of Active Movement
1. Free exercise: the working muscles are subjected
only to the forces of gravity acting upon the part
moved or stabilized.
2. Assisted exercise: muscle strength or co-ordination
is inadequate to perform a movement, an external
force is applied to compensate(given ) for the
deficiency.(shortage )
3. Resisted exercise: the forces of resistance offered
to the action of the working muscle are manually
or artificially and systematically increased to
develop the power and endurance of the muscles.
 Active Free Exercise
Free exercises are performed by the patient’s own
muscular efforts without assistance or resistance of any
external force rather than gravity.
 Uses of Active Free Exercise
This type of exercise can be used to obtain the
following:
1. Relaxation: can be induced by exercises which are
rhythmical or pendulum (moving front and back )in
character.
 Uses of Active Free Exercise
2. Joint mobility: the normal
range of joint motion is
maintained by exercises
performed in full range.
Limited range is increased by
rhythmical swinging exercises
incorporated and performed
with pressure at the limit of
free range.
 Uses of Active Free Exercise
3. Muscle power and tone: the power and endurance of the
working muscles are maintained or increased in response to
the tension developed in them. Tension is greater when the
exercise is performed at a speed slower or faster than the
natural speed of movement and also greater with the duration
of exercise. A high degree of tension and low sequent
increase in power is developed by free exercises when
muscles work against the resistance of the body weight and
increased leverage arm.
During fixation of a joint the power can only be maintained or
improved by repeated static contraction.
 Uses of Active Free Exercise
4. Neuromuscular co-ordination: co-ordination is
improved by the repetition of an exercise. As the
pattern of movement is established the conduction
of the necessary impulses along the neuromuscular
pathways is facilitated.
5. Confidence: the achievements of coordinated and
efficient movement assure the patient of his ability
to maintain subjective control of his movements,
giving him confidence to attempt other and new
activities.
 Uses of Active Free Exercise
6. Circulatory and respiratory cooperation: during
vigorous or prolonged exercise, the speed and depth
of respiration is increased leading to the production
of heat.
 Technique of free exercise
1. The starting position is selected and taught with
care to ensure the maximum postural efficiency
as a basis for movement.
2. Instruction is given to gain interest and
cooperation of the patient.
3. The speed at which the exercise is done depends
on the effect required.
4. The duration of the exercise depends very
largely on the patient’s capacity.
 Technique of free exercise
5. Free exercise may be localized to produce
a local or specific effect i.e. to mobilize a
particular joint or strengthen a particular
muscle group, or it may be generalized
involving use of more joints and muscle
groups.
Examples of Active Free Exercises
Examples of Active Free Exercises
Examples of Active Free Exercises
 Active ASSISTED EXERCISE
The principles of assistance:
When the force exerted on one of the body levers by
muscular action is insufficient for the production or
control of movement, an external force may be added to
augment it.
 The principles of assistance
 This external force must be applied
in the direction of the muscle
action but not necessarily at the
same point, as a mechanical
advantage of this assisting force
must be sufficient only to augment
the muscular action and must not
be allowed to act as a substitute
for it. if the muscle strength
increases, the assistance given must
be decreased proportionally.
 Technique of Assisted Exercise
The purpose is to ensure that insufficient
muscles exert their maximum effort to
produce movement under conditions
designed to facilitate their action.
1. Starting position: stability of the body is
important to ensure that the patient’s
attention is concentrated on the pattern of
the movement and the effort required
performing it.
 Technique of Assisted Exercise
2. Pattern of movement: this can be explained
to the patient by performing it passively or
actively on the sound limb.
3. Fixation: fixation of the proximal part of
the prime movers improves their efficiency.
However possible, this fixation should be
achieved by the active means in order that
the weak muscles may receive
reinforcement from the action of the muscle
helping or associating in the production of
the movement.
Avoid trick movements to occur by proper
fixation.
 Technique of Assisted Exercise
4. Support: the moved part should be
supported to reduce the load on the
muscle. Support may be provided
by PT hand, suspension slings, or a
smooth surface. However, manual
support is more effective since it
can be provided in any plane
suitable for the movement and the
assistance can be adjusted in each
successive part of the range.
 Technique of Assisted Exercise
5. The antagonistic muscle: a proper starting
position should be selected to reduce the tension
in the antagonistic muscles, e.g. a position in
which the knee flexed is suitable for assisted
dorsiflexion of the foot.
6. Traction” the action of drawing or pulling a
thing over a surface “: preliminary stretching of
the weak muscle provides a powerful stimulus to
contraction.
 Technique of Assisted Exercise

7- The assistance force: the force used in assisting the action

of the muscle must be applied in the direction of the
movement by the PT hands. Patient may assist the
movement himself so he can thoroughly understand the
procedure. The movement should be possible in full
range. The assisting force may vary in different parts of
the range, since more assistance will be necessary in
some parts than in others. Assistance is mostly required at
the beginning of the movement to overcome initial inertia
and at the end to complete the range.
 Technique of Assisted Exercise
8. The character of the movement: movement
is performed smoothly and its efficiency
depends on the patient’s full attention. The
speed of contraction depends on the type
of muscle whether fusiform or pennated,
etc.
 Technique of Assisted Exercise
9. Repetitions: repetition of the movement depends
on the rate of fatigability‫عب‬BBB‫ ت‬. Therefore, the
condition which caused the weakness must be
known and understood.
10. The cooperation of patient: this is essential
during this type of exercise with the aim to
achieve controlled active movement without
assistance. The patient should be encouraged to
exert maximum effort.
 Effects and uses of assisted exercise
1. The working muscles cooperate in the
production of movement which are unable
to execute unaided‫ذ دون مساعدة‬BB‫نفي‬BBB‫ ت‬and
hence, their strength increases and they
become hypertrophied. This type of
exercise may be used in the early stages of
neuromuscular re-education.
 Effects and uses of assisted exercise
2. The memory of the pattern of coordinated
movement is stimulated. By frequent
repetition of the pattern with decreasing
assistance the patient may relearn to
control the movement himself as the
conduction of impulses is facilitated in the
neuromuscular pathways. These types of
exercises are helpful in training
coordination.
 Effects and uses of assisted exercise
3. Confidence in the ability to move is
established with the performance of
the movement. The feeling of the
patient that the limb is supported
encourages him to produce a
maximum effort. These exercises are
helpful in case with painful joints
such as rheumatoid arthritis.
 Effects and uses of assisted exercise
The range of movement is maintained or
increased by this type of exercises.
Muscular Strength, Endurance and
Power (Resistance Exercises)
Critical to maintain
and improve in each
area in order to
achieve competitive
fitness levels and
return athlete to
functional level
following injury
Strength, Endurance & Power
Muscular Strength
Ability to generate force against some resistance
Important to maintain normal levels for normal healthy living
Imbalance or weakness can impair normal function
Muscular Endurance
Ability to perform repetitive muscular contractions against
some resistance
Power
Ability to generate force quickly
Combination of strength & speed
Performance is limited without power
Types of Skeletal Muscle Contraction
Isometric Contraction” no movement”
Contraction that produces muscle (m.) tension but no
change in m. length
Concentric Contraction” shortening”
Contraction that causes m. shortening while tension
increases to overcome some resistance
Eccentric Contraction” lengthening “
Resistance is greater than the muscular force being
produced & muscle lengthens while producing tension
Types of Muscle Contraction

There is force
No shortning
No lenthining

There is force
shortning
No lenthining

There is force
No shortning
lenthining
Force and Types of Muscle
Contractions
Isometric Exercise
Capable of increasing muscle strength at specific joint angles
 Exercise with no change in muscle length
May produce spikes(increase) in systolic blood pressure
 Could cause life-threatening cardiovascular accident
 To reduce this event to occur - REMIND the person to breath
Widely used in rehabilitation
 Attempt to use positional or functional exercise – work at multiple
angles throughout the range if possible
Contractions should be held for 10 seconds at frequency of 10
or more per hour
Utilized to enhance lift or activity at “sticking point”
Progressive Resistive Exercise (PRE)
Exercises that work through a full range of motion
Isotonic or isodynamic contractions
 Most popular & commonly used technique
Concentric vs. Eccentric
 Greater force can be generated due to lower number of motor units
recruited allowing other motor units to be recruited to generate
increased force
 Oxygen use is much lower with eccentrics
 Efficiency of eccentric exercise is higher than concentric exercise
 Needs of the body – acceleration and deceleration
 Must be able to control body movements – deceleration and eccentrics
allows for this control
 Type of resistance

Surgical Tubing (Theraband) or Exercise

Band
Allow for motion in multiple planes
Ability to perform more functional movement
Can be utilized with PNF & plyometrics

Variable Resistance
Change in force required at different angles to
move a particular resistance
Greatest when joint is at 90 degrees
Accommodating resistance or variable resistance
equipment changes resistance at different points
in range
• Progressive Resistive Exercise Techniques (PRE)
▫ Terminology
 Repetitions
 Repetition maximum (RM) “one time”
 Set
 Intensity
 Recovery period
 Frequency

• Recommended Techniques of Resistance Training

▫ Must consider 4 areas
 Amount of weight to be used
 Number of repetitions
 Number of sets
 Frequency of training
The healing process must dictate the program!
Intensity is key
Multiple potential routines
 Single set – 1 set 8-12 reps at a slow speed
 Tri-sets – 3 exercises for 1 muscle group, 2-4 sets with no rest
 Multiple sets – 2-3 warm-up sets with progressively increasing resistance
followed by several sets at the same resistance
 Superset – multiple exercises, 1 set of 8-10 repetitions or 1 or 2 exercises,
with multiple sets of 8-10 repetitions
 Pyramid – multiple sets decreasing repetitions and increasing resistance
 Split routine – Workouts exercise different groups of muscles on different
days
Circuit Training
Group of exercise (flexibility, rhythmical,
strength, brief aerobic)
Used to increase strength or endurance
Move from one station to the next, performing
exercise for a given time period or number of
repetitions
 Resistance Training Techniques Used in
Rehabilitation
DeLorme’s method
Based on repetition
maximum of 10
Designed for early rehab
Designed for beginning
rehab
Introduced PRE –
“progressive loading”
Builds in warm-up period
50%, 75% and 100% of 10
RM
Start easy and end up with hard
Oxford method
Used during early,
intermediate & advanced
levels of rehabilitation
Percentages of 10 RM Repetiti
Diminishes(less) resistance
as muscle fatigues –
“regressive load”
100%, 75%, 50% of 10 RM
Opp of Delorme
Isokinetic Exercises
Involves muscle contractions where length change of
muscle is set at a constant velocity
Maximal resistance throughout the range of motion
Variety of machines/manufacturers are available
Can be used with eccentrics & concentric exercise
Image courtesy of Westside Physical Therapy
Isokinetics as a Conditioning Tool
Maximal effort for maximal strength gains
Dynamometer will move at a set speed whether maximal or
half of maximal effort is put forth

Isokinetics in Rehabilitation
Provide objective means of athlete/patient evaluation
Training at fast vs. slow speeds
Functional speeds
Plyometric Exercise
• Encompass a rapid stretch of muscle eccentrically followed
by a rapid concentric contraction to facilitate the
development of explosive power

• Greater stretch relative to resting length = greater resistance

muscle can overcome
– Speed of stretch is emphasized ‫ اهم‬over magnitude

• Used to develop eccentric control of dynamic movements

• Exercises should be performed technically correct

Plyometric Exercise
Change the steps as fast as
can
Core Stabilization Strengthening
• Fundamental component of rehabilitation
• Strengthening of core (lumbo-pelvic complex)
• Used to
▫ Improve dynamic postural control
▫ Ensure appropriate muscular balance & joint movement
about the core
▫ Improve neuromuscular efficiency and expression of
dynamic functional movement
• Provide optimal stabilization of kinetic chain and
balanced muscular functioning throughout the chain
al is open to Proximal is open to move
move
Open vs. Closed Kinetic Chain Exercises
Anatomical & functional relationships that exist in the
upper and lower extremity

Open kinetic chain

May be needed when lower extremity is to be non-weight-
bearing

Closed kinetic chain

Useful in rehabilitation
 Most activities call for weight bearing of foot or hand in some
capacity
 May be more functional than open chain activities in some instances
Training for Muscular Strength vs. Muscular Endurance
Strength and endurance are closely related
As one improves, the tendency is for the other to do the
same

For strength development

Heavier weight and low repetitions should be used

Endurance training
Lighter weight and high repetitions (10-15) are suggested
 More intensity

More
More
More

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Isometric Exercise
Used during initial stages of rehabilitation
Serve to increase static strength, decrease atrophy, create
muscle pump to reducing edema

Progressive Resistive Exercise (PRE)

Most commonly used strengthening technique
Incorporates free weights, machines and tubing
Utilizes isotonic contractions (concentric and eccentric
contractions)
Isokinetic Exercise
Incorporated in later stages of
rehabilitation
Uses fixed speeds with
accommodating resistance
Provides maximal resistance
through full range of motion
Commonly used as criteria
for return of athlete to
functional activity
Plyometric Exercise
Generally incorporated in later stages of
rehabilitation
Encourages dynamic movements associated with
power
Due to the need to generate power in athletic
activities, it is critical to incorporate it within a the
rehabilitation process
Core Stabilization
Essential for functional
strength
Core functions to
dynamically stabilize
the kinetic chain
Core strength enables
distal segments to
function optimally and
efficiently during force
and power generation
Definitions of Some Terminology

 Repetition: number of times you repeat specific

movement.
 Repetition Maximum (RM): maximum number of
repetitions at a given weight.
 Intensity: the amount of weight or resistance lifted.
 Recovery Period: the rest interval between
repetitions.