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Classification, technique & effects of movement - Coggle Diagram

- - - - -Where movement in a joint is limited. These movements are carried beyond the existing free range, in an attempt to restore normal range by:
        -1. A sudden but controlled application of force at the linit of the existing range or by
        -2. A steady & sustained passive stretching of the tightened structures.
        
        These movm aim at increasing the existing range of movm in a stiff jnt by stretching the limiting structures.
        Techniques:
        • Similar to that of passive movm but differs frm it in range & speed.
        • Incr in range may be achieved in 2 ways, in which fixation & accuracy of movement are v imp, & traction is often maintained throughout the movement.
        
        Techniques:
        
        forceful overpressure-at the limit of the movm
        
         the resistance of the limiting structures may be overcome by a sudden forceful overpressure-at the limit of the movm.
         this must be done once only, with care n control, to ensure that it takes place in the direction required & that its not carried too far.
         The patient must try to remain relaxed, but sudden stretching & paim which results will inevitably elicit spasm & trauma to the ms may occur.
         Some exudation into the periarticular structures will result frm the stretching and tearing of adhesions.
         So measures must be taken to ensure its absorption and to maintain the newly won ROM-
         Otherwise new adhesions will form.
         This type of forced passive movement must be only performed under the direct supervision of the doctor, unless the PT is experienced in their use.
        
        Steady & sustained traction
        
         Steady & sustained traction on shortened ms & ligs may succeed in lengthening these structures without traumatizing them.
         Any passive stretching of a ms beyond the middle range will elicit a reflex contraction known as the myotatic, or stretch reflex- which will protect the underlying fibrous structures frm strain.
         If however the stretching is steady n prolonged, the muscles relaxes & the fibrous structures takes the strain.
         The collagenous fibers of which these structures are composed are strong, inelastic & inextensible in response to an intermittent & moderate degree of tension,-but give way & elongate when submitted to prolonged strain.
         Mechanical means such as a turnbuckle plaster, balanced traction and splintage are egs of sustained passive stretching, but more temp methods such as head & limb traction or manual stretching prove effective.
        
        Effects & uses:
        
        1.Recently formed adhesions can be broken down by sudden forceful overpressure exerted at the line of limit of the free range of movement, which is thus increased.
        2.Accessory movems which cannot be localized actively, but which normally contribute to the function of the jnt in which they takes place, or that of adjacent jnts can be freed passively.
        a.For eg: movm at the intercarpal jnts which takes place during wrist movms or movms at the subtaloid jnt during inversion & eversion of the foot.
        3.A sudden forceful movm when the jnt is distracted may replace or alter the position of an interarticular structure.
        4.A steady & prolonged passive stretch can overcome the resistance of shortened ligs, fascia, & fibrous sheaths of ms as
        a.For eg: in manipulative stretching & progressive splintage of talipes equino-varus
    - - -These are forced movements performed by a surgeon, when the patient is relaxed by means of a general anesthetic or when the local pain receptors are anaesthetized by injection.
        -They are designed to break down consolidated adhesions.
        
        these are performed by the surgeon with the patient under a general or local anesthetic
        
        which eliminates pain & protective spasm & allows the use of greater force.
        
        even well-established adhesions can be broken down
        
        but when they are numerous, it is usual to regain full range progressively, by series of manipulations, to avoid excessive trauma & marked exudation.
        
        maximum effort on the part of the patient & the PT must be exerted after the manipulation to maintain the ROM gained at eaxh session.
        
        otherwise, fibrous deposits frm the inevitable exudation will form new adhesions.
    - - A state of relaxation is presupposed, & the joint is moved through the existing free range, & within the limits of pain
        
        The PT requires much control and knowledge of jnt anatomy to perform thr movements for the patient smoothly & with accuracy.
        
        Technique:
        
        Relaxation:
        
        • A brief explanation to what is to happen is given to the patient, who is then taught to relax voluntarily,
        • Except in cases of flaccid paralysis, when this is unnecessary.
        • The selection of a suitable starting position ensures comfort & support.
        • And the bearing of the PT will do much to inspire confidence & cooperation in maintaining relaxation throughout the movement.
        
        Fixation:
        
        Support:
        
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        • Where movement is to be limited to a specific jnt, the bone which lies proximal to it is fixed, to ensure the movement is localized to the jnt,
        • Otherwise, any decrease in the normal range is readily masked by compensatory movements occurring at other jnts in the vicinity.
        
        Effects & uses:
        
        1.Adhesion formation is prevented,
        -& the present free range of movement maintained.
        -One passive movm, well given & at frequent intervals, is sufficient for this purpose.
        -But the usual practice is to put the jnt through 2 movm twice daily.
        
        2.When active movm is impossible, because of muscular insufficiency, these movm may help preserve the memory of movement patterns by stimulating the receptors of kinesthetic sensation.
        
        3.The venous & lymphatic return may be assisted slightly by the mechanical pressure & by - stretching of the thin-walled vessels which pass across the jnt moved.
        
        -Relatively quick rhythmical & continued passive movms are required to prod this effect.
        -They are used in conjunction with the elevation of the part to relieve oedema when the patient is unable, or unwilling to perform sufficient active Ex.
        
        4.The rhythm of continued passive movms can have a soothing effect & induce further relaxation & sleep.
        -They may be tried in training relaxation & if successful, the movm is made imperceptibly & progressively slower as the patient relaxes.
        
        Relaxation
        Fixation
        Support
        Traction
        Movement
        Range
        Speed & duration
- - - - • 2.Assisted Ex
        
        Technique:
        
        Starting position:
        
        Pattern of movement:
        
        Well known & understood by the patient.
        
        Taught by passive movement or active movement on contralateral limb
        
        fixation
        
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        Comfort & stability for the body as a whole ensure that the patient’s whole attention is concentrated on the pattern of the movement & the effort required to perform it.
        
        Effects & uses
        
         The working ms corporate in the production of the movement which they are incapable of achieving unaided. Provide that the max effort they are capable is demanded frm the weak ms. & the assisting force utilized is only complementary. These ms will gain strength & hypertrophy. Can be used in early stages of neuromuscular reeducation
         The memory of the pattern of coordinated movement is stimulated by the correct performance of a movement which the patient is unable to achieve without assistance. (“freq reps-decr in assistance-relearn control of the movement)
         Confidence in the ability to move painful joint is established when the patient observes the movement & the fact that his ms corporate in producing it.
         The range of movmnt may be incrd by assisted Ex depending on the efficiency of the ms working over the joint.
        
        When muscle power/coordination is inadequate to overcome the resistance of gravity or another external force applied in the direction of the muscle pull to perform movement or to stabilize a joint.
        
        When the force exerted on one of the body levers by muscular action is sufficient for the production or control of the movement & external force can be added to argument it.
        -The external force must be applied in the direction of ms action, but not necessarily the same point as mechanical advantage can be gained by increasing the leverage.
        
        The magnitude of the external force must be sufficient to argument the muscular action & must not be allowed to act as a substitute to it.
        
        When ms power or coordination is inadequate to overcome the resistance of gravity or another external force, it can be augmented by the use of an external force applied in the direction of the muscle pull to perform movm or to stabilize a jnt.
      - • 1.Free Ex
        
        The working ms are subject only to the forces of gravity acting upon the part moved or stabilized.
        
        Are those which are performed by the patient’s own muscular efforts without the assistance any external force, other than that of gravity.
        
        they vary widely in character & effect, not only because of the nature & extent of the movement, but according to the manner in which they are performed.
        
        this type of Ex can be used to obtain any of the effects which are prod by Ex as a whole, if & when its used judiciously.
        
        a degree of relaxation is induced by exercises which are rhythmical or pendular in character, ms tone is maintained & power increased according to speed, leverage & duration of the Ex, and the relationship of the part moved to gravity, coordination is trained or improved as the natural pattern of group action is employed, and confidence in the ability to perform & control movement is established.
        
        The working muscles are only subjected only to the forces of gravity acting upon the part moved or stabilized.
        
        Classification:
        
         Localized:
        
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         Generalized:
        
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        Character of free exercise:
        
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      - • 3.Resisted Ex
        
        The forces of resistance offered to the action of the working ms are artificially & systematically increased to develop the power & endurance
        
        The forces of resistance offered to the action of the working muscle are artificially or systematically increased to develop the power & endurance of the muscle.
        
        Definition:
        
        resistance Ex is any form of active Ex in which dynamic or static ms contraction id resisted by an outside force applied manually or mechanically
        
        strength:
        
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        Potential benefits of resistance Ex
        
        1.Enhance ms performance:
        -Restoration, improvement or maintenance of ms strength, power & endurance.
        
        2.Increased strength of connective tissue:
        -Tendons, ligs, intrams conn tissue.
        3.Greater bone mineral density or less bone demineralization.
        4.Decr stress on joints during physical activity.
        5.Red risk of soft tissue inj during physical activity
        6.Possible improvement in capacity to repair & heal damaged soft tissues due to positive impact on tissue remodeling.
        7.Possible improvement in balance.
        8.Enhanced physical performance during daily living, occupational, & recreational activities.
        9.Positive changes in body composition: incr lean ms mass or decr body fat.
        
        Enhanced feeling of physical well-being.
        
        11.Possible improvement in perception of disability & quality of life.
        12.increases basal metabolic rate.
        Tables pic 1 &2
        
        Guiding principles of resistance training
        
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