Active Resisted ROM Exercises PDF

Active Resisted ROM exercises By Dr. Marwa Mostafa An external force may be applied to the body levers to oppose the force of muscular contraction. Tension is increased within the muscles by the opposing forces(or resistance) and the muscles respond by an increase in their powe...

Active Resisted ROM exercises By Dr. Marwa Mostafa An external force may be applied to the body levers to oppose the force of muscular contraction. Tension is increased within the muscles by the opposing forces(or resistance) and the muscles respond by an increase in their power and hypertrophy. As an increase in muscular development occurs in response to the increase in the intramuscular tension it follows that the application of the maximum resistance which is consistent with the ability of the muscles to overcome it will elicit to the maximum development. The resisting force applied must be sufficient to increase intra-muscular tension to the maximum without interfering with the ability of the muscles to produce co-ordinated movement. A maximum increase in intra-muscular tension during an isometric contraction is elicited by a resistance which equals the muscles ability to maintain the hold. There are five factors which contribute of the muscular efficiency, i.e. power, endurance, volume, speed of contraction and co-ordination. The first three are inter-related and can be built up by the use of resisted exercise. Power develops in response to the application of the maximum resistance which is consistent with the ability of the muscles to overcome it, therefore power can be built up when they work against a progressively increasing resistance. As the essential factor in power development is the magnitude of the resistance the method used to promote it is called progressive resistance-low repetition exercise, the number of times the movement is repeated being relatively few to allow the resistance to be as great as possible.  Endurance is the quality which develops in response to repetitive contraction, therefore as it is the number of contractions which is the essential factor, the method used in this case is called low resistance- high repetition exercise. Volume, which can be observed or measured as an indication of hypertrophy, usually develops in proportion to power. It serves as a means of demonstrating progress to the patient although it is not invariably a reliable indication of successful treatment Skill is estimating the capacity of the muscles at every stage of treatment and in matching this with the correct amount of resistance is the keynote to success in the use of resisted exercise. Variations of the power of muscles in different parts of their range Muscles which are capable of producing a considerable range of joint movement are not equally powerful in all parts of their range. Physiologically, muscles are capable of exerting their greatest strength when they are fully extended, i.e. in outer range, and as the shorten their force diminishes. This, however, is modified in the case of some muscles by mechanical factors such as the angle of pull of tension of insertion, i.e. the effect of the pull on the lever is greatest when the angle of pull approaches a right angle.  For example; physiologically the flexors of the elbow are strongest in their outer range, but mechanically stronger at about mid-range. When both these factors are taken into account, and allowance is made for overcoming the initial inertia at the beginning of movement, it can be roughly estimated that the muscles will be most efficient in the outer part of the middle range. This fact, can be proved by experiment. It seems, however, that the relative importance of these factors varies in different muscle groups but, broadly speaking, each group is found to be most powerful in the part of the range in which it is habitually used, i.e. shoulder flexors in the outer range, hip extensors in the inner range. In giving manual resistance these variations in power can be felt and the resistance are not so accurate from this point of view. Techniques of ARROM exercises Starting position Starting position- comfort and stability for the body as a whole ensure that the patient whole attention can be concentrated on the pattern of movement and the effort required to overcome the resistance. The pattern of movement The pattern of movement- this must be well known by the patient and can be taught as passively or a free exercise. The pattern selected should whenever possible, be one which allows contraction of the muscles in full range and it should be based on a natural pattern of purposeful movements. Stabilization Stabilization of the bone or bones of origin of the muscle to be resisted improves their efficiency. This stabilization of the rarely static when a natural pattern of movement is used as it is constantly being adapted to the circumstances of the movement. Provided the muscles normally responsible for the stabilization have remained efficient they should be sued for this purpose, as their action is considered to provide reinforcement for the muscles producing the movement. If, however, there is tendency for movement to be transferred to the neighbouring joints so that the pattern of movement is altered, then additional means of fixation such as manual pressure or a strap must be used to ensure movement at the required joints. traction Traction – preliminary stretching of the muscles to elicit the myotatic ( stretch) reflex provides a powerful stimulus to contraction, and traction maintained throughout the range facilitates joint movement, and maintains tension on the muscles and so augments the effect of resisting. The resisting force The resisting force – a variety of means may be employed to supply the force used to resist the contraction of the working muscles, e.g. manual pressure, weights, springs, etc., but in every case it should be applied in manner which ensure that the pressure is exerted on the surface of the patient skin which is in the direction of movement. The advantage of manual pressure is that it can be adjusted accurately to match the power of the muscles in all circumstances and in every part of the range, but it also has the disadvantage of not being easily measurable. Mechanical resistance are usually measurable and therefore proved a useful means of recording progress,  The magnitude of the resistance force, in relation to that of the muscle power, varies according to the purpose for which it is used, maximal resistance elicit maximal effort on the part of the muscles and it is therefore used to develop power and hypertrophy. As the quality of muscle endurance is developed by repeated contraction against resistance which is considerably less than maximal to allow a greater number of repetition to make place. The character of the movement The character of the movement- the movement is essentially smooth and controlled throughout, the effort involved commanding the patient full attention. The speed of movement is consistent with the optimum rate of contraction for the particular group of muscles in relation to the resistance which constitutes the load. The range of movement is full whenever possible, but resistance can be applied in any part of the range which is convenient or desirable and the muscles can also be resisted so that they work statically at any particular point in their range. Repetition Repetition- the number of times the muscles are thrown into action against resistance varies according to the condition and the individual patient. Low resistance- high repetition exercises appear to be more suitable for weak or elderly patients whose muscles are less resilient than those of the young and strong, and they have proved to be effective in such condition as osteoarthritis. High resistance –low repetition exercises on the other hand undoubtedly build-up power and hypertrophy in muscles suffering from disuse as a result of traumatic injury or in connection with orthopedic surgery, e.g. menisectomy, when there is effusion or joint changes are present. As in rheumatoid arthritis, static resisted contraction of the muscles passing over the joint with a high repetition figure are valuable for retaining muscular efficiency and can be performed an any part of the range which is pain free. The co-operation of the patient The co-operation of the patient -the effort exerted by the patient and is interest in the treatment play an important part in the development of his muscles by means of resisted exercise. Interest is stimulated by precision in applying the resistance, regular measurement and recording of progress, verbal encouragement and, in suitable cases, by competition. Resistance A resistance force other than that provided by gravity and friction may be provided by: The physiotherapist The patient Weights Weight and pulley circuits Springs and other elastic structures Substances which are malleable. water 1. Resistance by the physiotherapist 2. Resistance by the patient 3. Resistance by weight 4. Resistance by weight and pulley circuit 5. Resistance by substances which are malleable 6. Resistance by water Methods of increasing resistance There are four methods of increasing resistance to muscle action. Each method may be used singly or in combination with any other method: 1. Increase in weight of the resisting force 2. Increase in leverage of the resisting force 3. Alteration in the speed of movement 4. Increase in the duration of exercise Effects and uses of ARROM 1. Muscle power can only be maintained or increased by contraction, and in theses exercises the working muscles are strengthened and hypertrophied in response to the tension created in them by resistance. Resisted exercises are used to build up weak muscles and so to restore the balance of muscle power which is essential for stability and co- ordinated movement. 2. The blood flow to the working muscles is increased in proportion to the amount of work in order to provide the materials for repair and hypertrophy. Although the flow is impeded during the actual contraction, the amount of blood contained in the muscles immediately after contraction may be as much as ten times as great during strenuous exercise as the amount contained during the rest This increase in the blood flow to the muscles continues for sometime after exercise, bringing oxygen and nutrition to the part and assisting the removal of metabolic products. 3. A general rise in blood pressure frequently anticipates exercise and may be increased by the mental effort required to perform these exercise correctly. 4. Heat, which is produced as a result of strenuous muscular activity, stimulates the heat-regulating center causing vasodilatation in the skin. This follows a constriction of these vessels which occurs in the first place to compensate for the increase in the blood flow to the muscles. If there has been sufficient exercise, the skin feels warm and moist and appears pink, indicating that heat is being lost from the surface to balance the gain from muscle activity and so keep the body temperature within normal limits