1. Therapeutic Exercises Therapeutic Exercises Dr. Abdel Hamid Nabil Lecture I

2. INTRODUCTION The official definition of physical therapy says “it is the art and science of treatment by means of heat, cold, light, water, manual manipulation, electricity, therapeutic exercise and other physical agents.

3. INTRODUCTION According to the American Physical Therapy Association (2006), physical therapists (PTs) are health care professionals who diagnose and treat people of all ages who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives.

4. INTRODUCTION Physical therapy or physiotherapy is the provision of services to people and population to develop, maintain and restore maximum movement and functional ability throughout the lifespan. It includes the provision of services in circumstances where movement and function are threatened by the process of ageing or that of injury or disease.

5. INTRODUCTION Physical therapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. It involves the interaction between physical clients, families and care givers, in a process of assessing movement potential and in establishing agreed upon goals and objectives using knowledge and skills unique to physical therapists.

6. INTRODUCTION Physical therapy interventions may include: manual handling; movement enhancement; electrotherapeutic and mechanical agents, functional training, provision of aids and appliances, patient related instruction and counseling, documentation and coordination, and communication.

7. INTRODUCTION PTs also help prevent conditions associated with loss of mobility through fitness and wellness programs that achieve healthy and active lifestyles.

8. INTRODUCTION PTs examine individuals and develop plans using treatment techniques that promote the ability to move, reduce pain, restore function, and prevent disability. They provide care in hospitals, clinics, schools, sports facilities, and more.

9. Examination of patient Assessment Assessment includes: 1- subjective information: - name, age, sex, address, occupation, diagnosis. - How the patient perceive his symptoms. - Describe the behavior of the symptoms. - Related History of any previous medical or surgical history.

10. Examination of patient Assessment Objective data: - By Inspection (observation). - By palpation. - By measurement: Muscle palpation, muscle testing, functional ability, ROM, round and long measurement, muscle tone, special tests.

11. Examination of patient Assessment Goals of treatment: according to assessment results. - Long term goals. - Short term goals. Plane of treatment.

12. INTRODUCTION Therapeutic exercises can help injured part to resume normal function. Physical therapist done this by evaluating, planning, organizing, and directing the programs for the care of individuals whose ability to function is impaired.

13. Aims of Therapeutic Exercises Therapeutic exercise seeks to achieve the following goals: 1- To improve circulation. 2- To improve strength and power. 3- To stimulate and increase sensory awareness of movement. 4- To maintain and increase mobility of the joints.

14. Aims of Therapeutic Exercises 5- To restore the physiological properties of the muscle (excitability, contractility, and elasticity). 6- To improve co-ordination and neuromuscular control. 7- To increase muscle performance and functional capacity (endurance). 8- To gain relaxation (general or local).

15. Aims of Therapeutic Exercises 9- To facilitate proprioceptive neuromuscular function. 10- To improve respiratory capacity. 11- To assist subject to control and improve his balance. 12- To reduce pain.

16. Aims of Therapeutic Exercises 13- To help regaining of proper postural alignment (improve and correct posture). 14- To increase and maintain flexibility of the muscles, tendons, ligaments, and fascia. 15- To increase physical fitness. 16- To improve gait and ambulation (assist subject to walk properly).

17. Human Positions and Posture The position in which the parts of your body are hold upright against gravity while standing, sitting, or lying down is called posture.

18. Human Positions and Posture Your posture constantly changes depending on the activity, but no matter what you are doing, you must keep holding and moving your body in a balanced and efficient way, that is called good posture.

19. Human Positions and Posture To gain good posture you must training your muscles, bones, and joints to stand, walk, sit, and lie with least strain and effort.

20. Proper Posture To achieve proper posture: 1- Keeps correct alignment of bones and joints to help muscles used properly. 2- Decrease the abnormal wearing of joint surfaces that could result in arthritis by proper alignment.

21. Proper Posture 3- Decreases the stress on the ligaments holding the joints of the back. 4- Prevents the spine from becoming fixed in abnormal positions.

22. Proper Posture 5- Prevents fatigue because muscles are being used more efficiently, allowing the body to use less energy. 6- Prevents strain or overuse problems. 7- Prevents backache and muscular pain.

23. Factors Affect Posture There are some factors contribute to bad posture as: OBESITY PREGNANCY

24. Factors Affect Posture muscle weakness. use high-heeled shoes.

25. Factors Affect Posture  shortening of muscles.  decrease flexibility and ignorance of good posture.

26. Starting Positions Also called fundamental positions. They are five positions. 1- Standing position. 2- Kneeling position. 3- Sitting position. 4- Lying position. 5- Hanging position.

27. 1- Standing it is the most difficult position to maintain because the body is balanced and stabilized on a small base which needs coordination work of many muscle groups.

28. Correct Standing Position 1- The heels are on ground with angle not exceed 45°. 2- Keep your knee straight but not locked. 3- The hips are in extension and slightly rotated laterally. 4- The pelvic is balanced on the femoral head. 5- The spine is stretched to its maximum length and stomach flat.

29. Correct Standing Position 6- The head is hold up straight with chin in. do not tilt your head forward, backward, or sideways. 7- Keep your shoulder blades back.

30. Correct Standing Position 8- The arms are hanged loosely to the sides, palms facing sides of the body. 9- Your weight should be evenly distributed on both legs.

31. 2- KNEELING The body is supported on the knees which may be together or slightly apart. 1- The lower leg rests on the floor with the feet planter flexed. 2- The feet may be in the mid position over the edge of the plinth.

32. 2- KNEELING Effect: uncomfortable position for most people due to difficult balance. Uses: as starting position for backward movements.

33. 3- SITTING the position is taken on chair or stool. 1- It is preferable to leave 2 or 3 inches of space between the back of your knees and the edge of the seat.

34. 3- SITTING 2- The height and width of seat must allow the thighs to be fully supported. 3- The hips and knees are flexed to right angle. 4- The knees are apart and feet rest on the floor. 5- Your weight should be evenly distributed on both buttocks.

35. 3- SITTING Effect: comfortable, natural, and very stable position. Uses: for many non- weight bearing knee and foot exercises.

36. 4- LYING This is the easiest position as the body can completely supported in the supine position and as stable as possible.

37. 4- LYING Effect: The alignment of the body is as in standing. Breathing is impeded slightly by pressure on the posterior aspect of thorax and the pressure of the abdominal viscera on the under surface of the diaphragm is increased. Uses: it is suitable for many exercises.

38. 5- HANGING The body is suspended by grasping over horizontal bar. The arms straight & at least shoulder width apart and forearm being pronated.

39. 5- HANGING - The head is held high and the scapulae are drowning down together. - The legs and trunk hang straight with the heels together and the ankle planter flexed. Uses: it is suitable for athletic persons with high muscle strength.

40. Derived Positions Derived positions are positions used by modification of the arms, legs or trunk in each of fundamental position. The aims of derived positions are: 1- To increase or decrease the base of support. 2- To rise or lower the center of gravity (COG). 3- To gain local or general relaxation. 4- To gain fixation and good control of specific area. 5- To increase or decrease the muscle work required to maintain the position. 6- To increase or decrease the leverage.

41. I- Positions derived from standing A- By alteration of the arms. 1- Wing standing: Hands rest on the iliac crest, fingers extended and adducted, thumbs abducted posterior. Uses: grasp patient during exercises.

42. 2- Bend standing The shoulders are laterally rotated and adducted strongly, the elbows are flexed and the forearms are supinated with wrists and fingers flexed to rest above the lateral border of acromion process.

43. 2- Bend standing Effect: suitable position for subjects with weakness of shoulders abductors (as arm lever is reduced). Uses: Used in trunk exercises as corrective position for upper back and thorax.

44. 3- Reach Standing The shoulders are flexed and the elbows are extended, arms are parallel in the same shoulder width.

45. 3- Reach Standing Effect: The forward raising of the arms brings the center of gravity of the body forward and leading to extension of the lumber spine. Uses: Prior to some arm and trunk exercises in the sagittal plane. Assist balance during balance walking sideways.

46. 4- Yard Standing The arms are straight and elevated sideways to horizontal position. Effect: This position has a mechanical disadvantage, an increase of the lever. The abductors of the shoulder work at a marked mechanical disadvantage as the length of the weight arm of the lever so greatly exceeds that of the power of the arm.

47. 4- Yard Standing Uses: 1- Corrective for the posture of the upper back 2- Facilitates body balance 3- Convenient for the arm swinging exercises 4- The body is steadied for the leg and trunk exercises when one arm only is used or when the hand grasps a support at a suitable height (1/2 yd.st.)

48. 4- Yard Standing 5- When palms are turned forwards (yd.palms f.st.) or upwards (yd.palms u.st.) the latter involving an additional lateral rotation at the shoulder joint with consequent further bracing of the upper back muscles

49. 5- Stretch Standing The arms are fully elevated so that they are in line with the body, parallel to each other and with palms facing forward.

50. 5- Stretch Standing Effect: Strength shortened muscles like pectoralis major, minor and latissimus dorsi. Leading to difficulty in respiration and impede arm circulation by gravity.

51. 5- Stretch Standing Uses: It is unsuitable for weak patients or those who suffer from respiratory condition. It is strongly corrective for the position of the upper back and gives a feeling of stretching the spine.

52. 5- Stretch Standing 3- Elevation of the arms raises the center of gravity of the body and affords additional leverage in many trunk exercises. 4- The hands may grasp some over- head support (str.gr.st) or the finger may be clasped (str.clasp.st.). 5- Useful to treat scoliosis.