Active Movements

Dr. Pooja Soni

MPT (Preventive & Community Health)
Definition
Movement performed or controlled by
voluntary action of muscles, working in
opposition to an external force.
Classification

Free Assisted
exercise Exercise

Assisted
Resisted
-resisted
Exercise
Exercise
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 that of
gravity
Classification
• Localised exercises are designed

Localise primarily to produce some local

and specific effect
• For example, to mobilize a
d particular joint or to strengthen
particular muscle group

• General exercises usually

involve the use of many joints

General and muscles all over the body

and the effect is widespread
• For example, as in running
Character of Free Exercise
Subjective
• Exercises which are subjective are usually
formal and consist of more or less anatomical
movements performed in full range.
Objective
• Objective exercises are those during the
performance of which the patient's attention is
concentrated on the achievement of a particular
aim which will result from his efforts, e.g. to
throw a ball.
Techniques of Free Exercise

Starting Position

Instruction

Speed

Duration
Effects & Uses of Free Exercise
The effect and consequent uses of any
particular free exercise depend on the
nature of the exercise, its extent and the
intensity and duration of its performance.
Effects & Uses of Free Exercise
1. Relaxation
Rhythmical swinging movements and
those which are pendular in character
assist the relaxation of hypertonic muscles
in the region of the joint moved.
Effects & Uses of Free Exercise
2. Joint Mobility
The normal range of joint movement is
maintained by exercises performed in full
range. If and when the range of movement
is limited, rhythmical swinging exercises
incorporating over- pressure at the limit of
the free range may serve to increase it.
Effects & Uses of Free Exercise
3. Muscle Power and Tone
The power and endurance of the working
muscles are maintained or increased in
response to the tension created in them
Effects & Uses of Free Exercise
4. Neuromuscular Co-ordination
Co-ordination is improved by the repetition
of an exercise.
As the pattern of movement is established,
it is simplified and becomes more
efficient.
Effects & Uses of Free Exercise
5. Confidence
The achievement of co-ordinated and
efficient movement assures the patient of
his ability to maintain subjective control of
his body, giving him confidence to attempt
other and new activities, together with a
feeling of exhilaration and satisfaction
when they are accomplished, for example,
jumping a rope, or shooting a goal.
Effects & Uses of Free Exercise
6. Circulatory and Respiratory Co-operation
During vigorous or pro- longed exercise it
is apparent that the speed and depth of
respiration is increased, that the heart beat
is faster and more forceful, and that heat
is produced, whereas in light exercise
these changes are so slight that they are
not noticed.
Assisted Exercise
When muscle strength or co-ordination is
in adequate to perform a movement an
external force is applied to compensate
for the deficiency
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.
This external force must be applied in the
direction of the muscle action.
Principles of Assistance
The magnitude of this assisting force
must be sufficient only to augment the
muscular action and must be allowed to
act as a substitute for it.
As the power of the muscle increases, the
assistance given must decrease
proportionally.
Technique of Application
1. Starting Position: Comfort and stability
for the body as a whole ensure that the
patient’s whole attention in concentrated
on the pattern of movement and the effort
required to perform it.
Technique of Application
2. Pattern of Movement: This must be
well known and understood by the patient.
It can be taught by passive movement or
in the case of limb movements by active
movement of the contralateral limb.
Technique of Application
3. Fixation: Adequate fixation of the bone
of origin of the prime movers improves
their efficiency.
Whenever possible this fixation should be
achieved by active means in order that the
weak muscles may receive reinforcement
from the action of those muscles with
which they normally associate for the
production of voluntary movement.
Technique of Application
4. Support: The part of the body moved is
supported throughout to reduce the load
on weakened muscles by
counterbalancing the effects of the force
of Gravity
This support may be provided by the
physiotherapist’s hands, suspension slings
and re-education board.
Technique of Application
5. The Antagonistic Muscles: Every
efforts must be made to reduce tension in
the muscles which are antagonistic to the
movement.
The starting position for the movement
should be chosen to ensure that tension in
these muscles is minimal. E.g. a position
in which the knee is flexed is suitable for
assisted dorsiflexion of the foot.
Technique of Application
6. Traction: Preliminary stretching of the
weak muscles to elicit the myotatic reflex
provides a powerful stimulus to
contraction and traction maintained
throughout the movement helps to
facilitate joint movement.
Technique of Application
7. The Assisting force: The force used to
augment the action of the muscles is
applied in the direction of the movement,
preferably by means of the
physiotherapist’s hands, which should be
placed in such a way that they rest on the
surface of the patient’s skin which is in
the direction of the movement.
Technique of Application
8. The character of Movement: The
movement is essentially smooth as this is
characteristic of efficient voluntary
movement and it is performed in response
to a forceful command which demands the
patient’s full attention.
The speed of movement depends on the
muscles involved as each has its own
optimum rate of contraction which varies
according to its structure and the load.
Technique of Application
9. Repetition: The number of times the
movement is repeated depends on whether
it is considered advisable or injurious to
fatigue.
In the case of stiff joints where there is no
joint lesion and the muscles are weak from
disuse the movement can be continued as
long as the patient can be persuaded to
make the effort to improve the range.
Technique of Application
10. The Co-operation of the patient: it is
essential during this type of exercise, the
aim being for him to achieve controlled
active movement without assistance.
The use of mirror to observe results may
be helpful especially when co-ordination
is poor.
Effects and Uses of Assisted Exercises
The working muscles co-operate in the
production of movement which they are
incapable of achieving unaided.
Provided the maximum effort of which
they are capable is demanded from weak
muscles and the assisting force utilized is
only complementary, these muscles will
gain in strength and hypertrophy.
E.g., Recovery from flaccid paralysis.
Effects and Uses of Assisted Exercises
The memory of pattern of coordinated
movement is stimulated by correct
performance of a movement which the
patient is unable to achieve without
assistance.
By frequent repetition of the correct
pattern with decreasing assistance, the
patient may relearn to control the
movement.
Effects and Uses of Assisted Exercises
Confidence in the ability to move painful
joints is established when the patient
observes the movement and the fact that his
muscles cooperate in producing it.
The contraction of the agonist also ensures
reciprocal relaxation of the antagonist
muscles which would otherwise tend to go
into protective spasm because of pain or the
fear of it.
E.g., Rheumatoid Arthritis
Effects and Uses of Assisted Exercises
The range of movement may be increased
by assisted exercise; however, as both
range and control are often dependent on
the efficiency of the muscles working over
that joint.
Where over pressure is given in an attempt
to increase the range, results are probably
achieved by repeated mechanical stretching
of the soft structures limiting the
movement.
Thank you…!!