Some General Principles in Administering Therapeutic Exercises

1. Assessing the condition of the person it is to be decided whether the exercises would be administered for the purpose of prevention or cure or rehabilitation.

2. The exercises must be suitable, simple and in progressive order, and follow certain standardized procedure, [simple to complex. Positioning of the patient should be proper and easy so that exercises may be performed without difficulty.

3. Exercises should be done slowly and within possible range. The exercise level may move from starting position to the limit of deviation, and then come back to the starting position. Movements should precede in steps, in part method. Limited numbers of exercises are to be given at a time so that the patient can pick up and perform. Later additions should be based on the previous exercises.

4. There should be live demonstration or through pictures and charts.

5. Importance of the exercise should be impressed upon the patient. If necessary prescriptions may be given in writing.

6. Patient’s mental capacity and emotional state should be considered. Ample relaxation should be provided throughout training.

7. Steps are to be taken cautiously; but incentives may be offered where necessary.

8. Therapist should see that the patient does not substitute other muscles too in performing a particular movement. But one particular muscle group should not be allowed to be stronger lest other muscle groups, when put to exercise, feel pain and easily become fatigued.

In order to avoid such a condition and also to avoid any deformity, non-acting muscles in the same group as well as different muscle groups are given exercise.

9. Different types of activities with different types of movements are given so that stress on different parts are equilibrated.

10. Some static type of activity better is avoided as far as possible so that quality of muscles and mobility of body parts are not affected.

11. Regularity of exercise must be maintained, whatever be the schedule.

Qualities of a muscle

(i) Power, (ii) Elasticity, and (iii) Co-ordination.

Power is the ability to contract, i.e., having irritability, contractility, extensibility etc.

Elasticity is the ability to change shape up to limit and again come back; it is the ability to be stretched.

Co-ordination is co-operation between different fibers and different groups of muscles. Without this co-operation easy, graceful and economical movement is not possible.

Power building exercises:

With stimulus acting as source of contraction, muscles work against resistance (and naturally against gravitational force also).

To develop power, exercises are generally fast movements – fast contraction and fast relaxation. Slow movements and holding movements are also used in some cases. Fast as well as slow movements are isotonic, and holding movements are isometric. If any of these two types’s of movements are performed for longer duration, endurance develops.

Dose of power building exercises depends on the amount of contraction against resistance (or against gravity). Amount in weight and repetition in time are the two factors that determine how much power can be built. Of course, it is necessary to work in progression up to the optimum point. If beyond limit, it may harm not only power-building but also the muscle itself.

Muscle power is reduced in (a) inactivity (b) over stretching, and due to (c) muscle-atrophy, lesion, and accumulation of certain metabolites.

Elasticity building exercises:

It is a sort of deconstruction i.e., leaves the stage of contraction and tension in normal motion. When tired muscles loose mobility, and in prolonged work, there is gradual loss in the elastic property. Also diminishes due to faulty management at exercise or during rest. If not used, or overused or overstretched, or kept at a static contraction stage for a long time elasticity is lost.

Contracture is the state when muscle is kept at the same form of contraction i.e., at reduced length. In prolonged rest, there is no chance of lengthening. Again, with stimulus if it is kept in lengthened position for a good long time, there is no chance of relaxation, the effect is loss of elasticity. When there is any continuous disturbance or ‘crossing the limit’ in the formal contraction and relaxation, there may be loss of power or elasticity.

In the condition of muscle spasm (a forced contraction state) there occurs rigidity and temporary loss of the property of elasticity.

To develop elasticity it is necessary to assess the present phase of elasticity and to find out the cause of loss, if any. If there is any pain it is to be relieved either by giving rest or by administering medicine. Then slow contraction and slow relaxation be allowed through isotonic and isometric movements. In a case of tension, muscles are to be relaxed. In rigidity, both relaxation and passive exercises are to be provided.

Co-ordination building exercises:

A combinitation of power and elasticity, when applied at the right time and place with right intensity, and there is a balanced co-operation amongst muscles, co-ordination results. Contraction and relaxation in an economical, effortless way, without spending much of energy results in co-ordination. When there is lack of co-operation between power and elasticity, the disturbance results in poor functioning and awkwardness. Incorrect timing as well as incorrect quantitative effort also results in lack of co-ordination.

In prescribing exercises for co-ordination, the cause of the lack of co-ordination is to be found out. The lacking element is to be developed through exercise, keeping in view the question of co-operation. Balanced movements are to be given; unnecessary movements are to be eliminated and corrected.