Traction (分离牵引）
swing
Comparison
Revolving And Swing
circle.
"back and forth revolve"
repeated
Traction
With traction mobilization , the proximal joint component is fixed and the distal component is moved in a distal direction by the traction.
The Three Stages of Traction And Gliding
Traction and gliding mobilization is administered in the following three stages:
Stage I. Joint loosening, in which the tension of adhesion is relieved.
Stage II. Joint tensing, in which contraction tension is relieved.
Stage III. Joint stretching, in which the residual tension is relieved.
The Four Grades of Mobilization
Grade Ⅰ Joint movement from the beginning of PROM.
Grade Ⅱ Joint movement in the middle of PROM, not touch both the ends of PROM.
Grade Ⅲ Joint movement in the area of PROM and to the end of PROM.
Grade Ⅳ Joint movement around the end of PROM.
Function of the four grades
Grade 1
Grade 2
Grade 3
Grade 4
Rhythm Rate and Speed
treat patients with a slow speed , smooth and rhythmic mobilization, without sudden changes in direction and speed
Higher speed to inhibit pain
Lower speed to inhibit muscle guarding
Therapeutic exercise
Concept the systematic implementation of planned physical movements, postures, or activities.
strength
1RM : the largest weight that can be lifted once and only once through the full range of motion of a given joint
10RM
Physiological cross sectional area: the cross section at the bulkiest part of the muscle for long parallel muscles
Absolute muscle strength:
muscle strength physiological cross section area
Value=3.6kg/c㎡
Newer devices involving electronic programming and compressors permit the partial counterbalancing of the subject’s weight to permit upper body chin and dip exercise for subjects whose upper body strength would not otherwise be great enough to permit these rather severe exercises.
Physical activity
"any bodily movement produced by skeletal muscles that results in energy expenditure".
Therapeutic exercise
It is designed to:
1) remediate or prevent impairments;
2) enhance function
3) enhance fitness and well being .
increase strength
increase range of motion,
increase cardiovascular endurance .
exercise programs
treat patient impairments
protect joints
prevent disease process.
exercise program
designed with:
the stage of the disease
the number of joints
the degree of inflammation.
the goals in acute injury 1
decrease pain
decrease inflammation
maintain range of motion
maintain strength
the goals in acute injury 2
slow the atrophy
prevent contractures
maintain nutrition.
the goals in the subacute and chronic stages
increase muscle strength
increase range of motion
increase function.
chronic stages
dynamic isotonic exercises
passive range of motion.
aerobic exercises
OA and RA
aerobic exercises
strengthen exercises
The Centers for Disease Control and Prevention and the American College of Sports Medicine
recommend
> 30 min physical activity on most days of the week .
Therapeutic exercise seeks to accomplish the following goals:
Enable ambulation
Release contracted muscles, tendons, and fasciae
Mobilize joints
Improve circulation
Improve respiratory capacity
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Therapeutic exercise seeks to accomplish the following goals:
Improve coordination
Reduce rigidity
Improve balance
Promote relaxation
Improve muscle strength and, if possible, achieve and maintain maximal voluntary contractile force (MVC).
Improve exercise performance and functional capacity (endurance)
Therapeutic exercises goals
Achieving
Maintaining
4 major categories
Endurance training that requires isotonic (dynamic) exercise technique
Muscle strength training that requires isometric (static) exercise technique
Techniques to maintain flexibility
Isokinetic exercise technique
Isotonic (dynamic) muscle contraction
Isotonic exercise also is called active range of motion (AROM) exercise.
The muscle shortens during isotonic exercise.
Isotonic exercise
rise heart rate
increase in stroke volume
increase in cardiac output
decrease in peripheral resistance
rise blood pressure, but the diastolic pressure usually remains unchanged.
Eccentric VS Concentric
Eccentric isotonic training does not increase muscle strength
concentric isotonic training does increase muscle strength
isometric exercise increasing the muscle contractile force.
isotonic exercise increase endurance
isotonic exercise not increase muscle strength.
Application to healthy individuals
Exercises
walking, running
jogging, dancing
stair climbing
cycling, swimming
rowing, skating,
skiing
intensity of 60 90% of maximum heart rate or to a heart rate at 50 85% of maximum O2 uptake.
AAMHR
If the maximum attained heart rate (HR max) has not been estimated, the age adjusted maximum heart rate (AAMHR) can be calculated from the following formula:
HR max = 220 – Age
Note: that this formula can be inaccurate in the ill or elderly patient.
endurance training
5 minutes warm up activity
30 minutes training
5 minute cool down
The minimum duration of endurance training for healthy men and women recommended by the American College of Sports Medicine (ACSM) is 20 60 minutes 3 5 days a week.
Application to patients
with cardiac or respiratory disease
a less intense training regimen
heart rate < 50 60% of maximum O2 uptake.
In the absence of data regarding the maximum attained heart rate measurements, it is prudent not to allow the patient to exceed the heart rate of 130 beats per minute (bpm).
In elderly patients and patients at risk, the intensity, frequency, and duration of therapeutic exercise should be established for each patient individually through prior medical evaluation.
Isometric (static) Exercise
Isometric (static) muscle training
resistive strength training (RST)
resistive exercise
Daily 6 seconds
two thirds of maximal contractile force,
increase of muscle strength
Formula(公式) :Work= force × distance → W = F · S
Isometric exercise lacks distance, however, a high degree of tension is achieved
For example : sitting upright without support and maintaining good posture . The erector spinae (竖脊肌) will be exercised
effect
increase in the resistance
frequency of training
enhances duration of resistance
Isometric training requires great caution because it causes a rise in heart rate.
Within a few seconds of the start of isometric exercise, both the systolic and diastolic blood pressures rise.
Application to healthy individuals
For healthy men and women
at least one set of 8 12 repetitions
8 10 RST exercises
at least twice a week
Application to patients
Intensity
Frequency
duration
established for each patient individually
Since this form of training requires great caution, it may be prudent, especially in patients with cardiovascular diseases, not to extend the duration of an isometric contraction beyond 6 seconds.
The pause between 2 isometric contractions should equal or exceed 20 seconds to allow time for the reconstitution of Aspects of Physical Fitness.
Isokinetic Exercise
The velocity remains constant throughout the movement.
A machine must be used.
Techniques for the maintenance of flexibility
Active assistive range of motion (AAROM) exercises
weak muscles
joint pain limits movement.
avoid forcing the joint and/or soft tissue beyond the point of pain.
If cannot exercise actively
than
passive range of motion (PROM) exercise
to
prevent joint stiffness and muscle contracture.
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