Getting Healed with Physiotherapy- Part 2

Every day if you spend some time for exercise you are directly taking a healthy step towards life. Exercise shows great effects on your body as well as mind. Using the exercises in a scientific way for rehabilitation will always show wonders.

Exercise Therapy- Your gateway towards healthy life.

Exercise Therapy

“To enjoy the wealth of good health you must exercise” – John Tunney

Every day if you spend some time for exercise you are directly taking a healthy step towards life. Exercise shows great effects on your body as well as mind. Using the exercises in a scientific way for rehabilitation will always show wonders.

Exercise therapy is one of the main tools used by physiotherapists for treating various disorders.

So, let’s know exercise therapy in details:

What is exercise therapy?

Exercise therapy is defined as a regimen or treatment protocol consisting of various exercises and physical activity used to rehabilitate patients back to his normal life. The main focus of this treatment is to make the patient independent in his/her daily activities after any injury or surgery. Also, it includes rehabilitation in the direction of patient’s occupation. It consists of various types of exercises with scientific basis which totally depends upon the patient’s current capacity and condition.

Who can prescribe exercises?

Physiotherapists are authorized in this field. Along with them, experts in the field of exercise science, exercise physiologist and sports rehabilitation specialist can prescribe exercise. These are very specific exercises related to your physical status, so proper scientific guidance is needed for this. In initial days it is important to perform this exercise and physical activities under the guidance of experts. Sometimes, physiotherapists help the patient for performing some activity by guiding with external manual assistance. When you achieve a good level of independence, a home exercise programme is prescribed.

What are the effects of exercise therapy?

Neurological effects of exercise therapy : 

  • Increase coordination
  • Improve balance
  • Normalise muscle tone
  • Promote relaxation
  • Increases neuronal circuits

Musculoskeletal effects of exercise therapy :

  • Increase joint mobility
  • Increase Muscle strength and endurance
  • Increase muscle power
  • Reduce muscle tightness
  • Improve posture
  • Improve gait pattern
  • Reduce muscle spasm

Cardiac and respiratory effects of exercise therapy:

  • Increase capacity of heart and lungs
  • Increase blood supply to organs, joint and muscle.
  • Increase supply of oxygen.
  • Reduce blood pressure

Other Physiological effects of exercise therapy:

  • Increased level of independence
  • Sense of well being
  • Decrease body fat
  • Maintain blood glucose levels
  • Increased secretions of happy hormones ( Endorphin-Enkephalin)

What are the types of exercise therapy?

types of exercises

Stretching exercise:

This improves joint flexibility and range of motion. Muscles and capsules are stretched by various methods. Stretching can be done by a therapist or sometimes self stretching is taught. Stretching can be static or dynamic. Holding a stretch for 15 to 30sec is effective. It can be done thrice a week depending upon the physical condition.

Strengthening :

There are various methods available for strengthening, starting from passive range of motion to resisted exercises.

Passive range of motion exercises:

In this type of exercises, different types of range of motions of joints are performed by the therapist. Patient does not use his strength to perform any movement. When a patient is not able to move the joint or active range of motion is contraindicated, passive range of motions are used. In case of severe pain, Muscle weakness , change in muscle tone (flaccidity) and when the patient is not oriented such type of exercise plays a crucial role. This Passive range of motions will help to maintain the range of motion of the joint, avoid contracture formation and avoid muscle atrophy.

Active assisted range of motion :

It is the progression of passive range of motion exercise. Along with the therapist, the patient also uses some force to complete the range of motion. Patient is asked to move the joint as much as possible, then further range of motion is completed by the therapist. These exercises are indicated when a patient is not able to complete a full range of motion due to pain, stiffness or weakness.This exercises help to maintain the joint range of motion and strength. Auto assisted exercises are also performed when therapist applied strength is not utilised. In auto assisted exercises, the patient uses some wand or takes help of the other hand or leg to perform the exercises.

Active range of motion exercises:

It is next to active assisted exercises. When a patient has enough energy, no pain, less tightness such exercises are performed. In these exercises the therapist has no contribution. Complete range of motion is performed by the patient without any trick movement in physiological available range of motion. It is low to high intensity exercise. It includes various exercises like jogging, running, dancing, rowing, swimming, zumba Pilates, Yoga, Tai Chi and many more. Duration, intensity, frequency and type of exercise are pre-decided.

Resisted exercises:

It is the highest type strengthening exercise, in which some resistance is used to build up the muscle strength. Amount of resistance is dependent on physical built, vital parameters, pain, strength and stage of recovery. Starting with low load, a progression is always made in resistance training. Different types of theraband, pulleys, dumbles, free weights and kettlebells are used for strengthening. Sometimes, body weight can be used for strengthening.

Balance and Vestibular training:

This is used specially in ligament injuries, neurological conditions and geriatric population where risk of fall increases. So, as to avoid further injuries, various balance training regimens are used. One can exercise sitting balance, standing balance and walking balance. By using various assistive devices, different types of floors, different visual and auditory input one can challenge the balance.

Postural Correction :

Due to abnormal postures many orthopedic conditions arise.Even in cases like stroke and parkinsonism alteration in posture is seen, which leads to many complications. So, correction of posture plays a crucial role in any rehabilitation. Due to muscle imbalance certain postural problems arise. So, in postural correction exercises along with strengthening, certain muscles are made to stretch. This will overcome the muscle imbalance.

Coordination Exercises :

These exercises play a vital role in neural rehabilitation. In certain conditions like Parkinson’s, stroke, cerebellar ataxia there is loss of coordination in the movement. This leads to alteration in daily activity. So, coordination exercises are performed to make the action smooth and synchronized. Starting from fine movement to gross movement activity many exercises are included. In some cases hand to eye coordination is also trained. Activities like touching the tip of the nose, touching the tips of two fingers, writing, drawing and tying shoe lace comes under this exercises.

NDT/PNF/MRP:

These types of exercises are important in neurological rehabilitation. Some of these techniques can be used in the paediatric population as well. Therapists also assist in this type of exercises to redirect the movement and the force. This specifically is used to retrain specific movement loss.

Injury prevention and performance:

These exercises are particularly used for sport players and athelets. Specific training according to the sport is given so as to avoid further injury. This includes the right technique of playing a sport, specific muscle strengthening and appropriate postural alignment. This will help to sustain our body against injury and the player can continue the sport without any injuries.

Agility training:

Agility is the ability to move quickly and change direction with ease. This also plays a primary role in sports training. Post and pre injury agility training should be done. Plyometric agility hurdle, ladder drills, Plyometric box drills , tuck jumps and dot jumps are included in this training. This exercises increase strength as well.

Plyometrics exercises:

In these exercises, muscles have higher forces in a short duration of time. Goal of this exercise is to increase power. These exercises are used for sport players, athletes and runners. This exercise follows eccentric contraction quickly after concentric contraction. These exercises help to improve muscle performance and sport activity.

Common conditions treated with exercise therapy?

1) Neurological conditions: Stroke, Guillain Barre syndrome, Spinal cord injury, Brain trauma, Cerebral palsy, Parkinsonism, etc

2) Orthopaedic conditions: Ligament injury, Frozen shoulder, Muscle tear, Osteoarthritis, Spinal pathologies, etc

3) Post surgery: Ligament transplant, Meniscus repair, Rotator cuff surgery, Total knee replacement, Hip replacement, Tumour excision, Craniotomy, Abdominal surgeries, Cardiac surgeries, etc

4) Other: Obesity,Diabetic complications, PCOD, Psychological trauma, etc.

So, by using various forms of exercises, the rehabilitation process can be made interesting. Equal focus should be given on various exercises.

Along with exercise therapy, one can use electrotherapy, QRT and manual therapy as part of treatment. This combined effect will show excellent results with patients.

Read More:

Part 1: Getting Healed with Physiotherapy- Basics

Part 3: Manual therapy- Healing Hands of Physiotherapists

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Dr Mandar Dharmadhikari
Dr Mandar is the founder of ARPIT Rehab Centre and director of Quantesla Medical Technologies, Pune.He has successfully treated more than 40,000 patients over 20 years. Dr. Mandar enjoys treating a diverse clientele using a balanced approach of Celtron, Exercise, Manual therapy and Counselling, specific to the needs of each patient. He regularly conducts seminars and workshops of Quantum Resonance Therapy for Physiotherapists, students and doctors.
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