Active Movements

By: Dr.Chaman Lal

B.S.PT, PPDPT, Dip. in sports Injuries, MPPS(PAK),
PG in Clinical Electroneurophysiology (AKUH),
Registered.EEGT (USA),
Member of ABRET, AANEM & ASET (USA).

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Contents
Definition/s
Types of Movements
Classification of Active Movements
Free Exercises
Assisted Exercises
Assisted-resisted Exercises
 Resisted Exercises
References

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 Therapeutic Exercise
The exercise, which is needed for the
treatment purpose, is called as therapeutic
exercise.
The person performing the exercises in
gym are for build the body and for healthy
living.
But the therapeutic exercises are the
exercises, which are performed to come out
from ones ailment or disease.
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Therapeutic Exercise . . . Cont’d

It is believed that the perfect assessment of

the disease is the 75% of the treatment.
Stretching, strengthening, co-ordination
exercises, mobilization and manipulation,
gait correction are the some of the
therapeutic exercises used for treating the
ailment of the patient.

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Active Movement or Voluntary Movement
The movement, which is done by the
patient him/herself is called active
movement or voluntary movement.

It is also defined as;

“ Movement performed or controlled by the
voluntary action of muscles, working in
opposition to an external force”.

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Types of Movements
There are two types of movements

1. Active Movements
i- Free
ii- Assisted
iii- Assisted-resisted
iv-Resisted

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Types of Movements . . . Cont’d

2. Passive Movement

i- Relaxed Passive Movement

ii- Passive Manual Mobilization Techniques

iii- Mobilization

iv-Manipulation

v- Stretching
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1. Active Movements . . . Cont’d

i- Free Exercises:-

These are the exercises, which are performed
by the patient himself without any
assistance and resistance by the external
force except the gravity.
These are of two free exercises,
a)- Localized
b)-Generalized

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i- Free Exercise . . . Cont’d

a) Localized:-
The localized free exercises are planned and
formed to perform to improve one
particular joint range or to increase the
strength power and endurance of the one
group or particular muscles.
Examples:
◦ Exercise to knee joint
◦ Free exercise to shoulder flexor

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i- Free Exercise . . . Cont’d

b) Generalized :-
These types of free exercises are formed to
increased the joint range in multi joints or
to increase the strength of many group or
the total body muscles.
Examples:
Jogging, relaxed walking

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i- Free Exercise . . . Cont’d

Characteristics of the Free Exercises

There are two types of characteristics of the
free exercises namely;
1. Subjective
2. Objective
1. Subjective:-
It means performing the movements within
the perfect anatomical range and pattern.

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i- Free Exercise . . . Cont’d

Patient has to concentrate on the perfection

of the movement, which he performs.
2. Objective:-
There will be some goal to achieve in the
exercise program, but not spoiling the
perfect pattern and anatomical range
movement.
Example:- Bending and touching the great
toe with the middle finger. Here the goal is
set to touch the toe.
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i- Free Exercise . . . Cont’d

Techniques for Free Exercises

F I T T

 Frequency
 Intensity
 Time
 Type

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i- Free Exercise . . . Cont’d

Techniques for Free Exercises

1.Chose the starting position with care to
ensure the maximum postural efficiency as
a basis for movement
2. The instruction is given in a manner
which will gain the interest and co-
operation of the patient and lead him to
understand both the pattern and the purpose
of the exercise.
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i- Free Exercise . . . Cont’d

Techniques for Free Exercises

3. The speed at which the exercise is done
depends on the effect required.
4. The duration of the exercised depends
very largely on the patient’s capacity.
Usually three bouts of practice for each
exercise, with short rest periods, or a
change of activity, between , ensure
sufficient practice without under fatigue.
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i- Free Exercise Uses

Increases the Joint ROM

Increases the muscle Strength,
Increases the muscle Power
Increases the muscle Endurance
Increases the neuromuscular coordination
Increases the circulation and venous
drainage

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 i- Free Exercise Uses . . . Cont’d

Increases the relaxation of the muscle by the

swinging movements and the Pendular
movements especially of hypertonic muscles.
Repeated active movements break the adhesions
and elongates the shortened soft tissues
Regulate the cardiopulmonary function in term
of respiratory and venous return so that O2
supply to muscles and blood circulation to the
muscles increases.

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ii- Assisted Exercises
If the strength or coordination of the muscle
is insufficient to perform an activity, the
external force is utilized to compensate the
lack. The muscle has the strength or
endurance but is not sufficient to perform an
activity or control an action.

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ii- Assisted Exercises . . . cont’d
Types of Assisted Exercise
1. Manual
 i- Active
 ii-Passive
2. Mechanical
Active Assistance:
The patient himself can assist with his opposite
extremity to perform the assisted exercise.
e.g; The opposite leg is used by patient to increase the
flexion movement of the knee in long sitting or prone
lying. etc
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ii- Assisted Exercises . . . cont’d

Main advantage of this is its very much

helpful for the home programming and
patient knows himself the pain limit and
availability of range of movement. So he
can perform exercise within pain limit.
Passive Assistance:
Itis classified into:
1. Manual assisted exercise
2. Mechanical assisted exercise

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ii- Assisted Exercises . . . cont’d
1.Passive assisted exercise:
o The passive assisted exercise may be
given by PT or its assistant or one of the
patient’s attendant.
o This type of assisted exercise is maximum
passive in nature. The patient has to perform
the movement up to his ability.
o In passive movement, there will be no muscle
work while in assisted exercise there will be
muscle work throughout the movement.

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ii- Assisted Exercises . . . cont’d

2. Mechanical Assisted Exercise:

The assisted exercise is done with the help
of the mechanical devices are called
mechanical assisted exercises.
Suspension therapy, pulleys and springs are
the some of the examples for the
mechanical assistance. The same can also
be used for resisted exercise.

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ii- Assisted Exercises . . . cont’d

Principles:

 Range

 Command

 Concentration

 Speed

 Repetition

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ii- Assisted Exercises . . . cont’d
USES:
1.Increase ROM of the joint.
2. Increase the strength, power and endurance of the
muscles.
3.It breaks the adhesions formation around the joint.
4. It reduces the spasm of the muscles
5. It stretches the tightened soft tissues
6.It reminds the coordinated movement of the joint
or muscles
7. Increase the blood circulation and venous return
to the joint and muscle.
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iii- Assisted-Resisted Exercise:
This type of exercise constitutes a
combination of assistance and resistance
during a single movement and whenever
it is possible it is preferable to assisted
Exercise as it meets the needs of the
muscles with greater accuracy.

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 iv- Resisted Exercise:
The activities which are performed by
opposing the mechanical or manual
resistance is called as resisted exercises.
Types of Resisted Exercises:
Resisted Exercises are of two types namely;
1) Manual
2) Mechanical

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Definition:
Resisted exercise is a technique
based on applying resistance (an outside
force which may be manual or
mechanical) to muscle during dynamic
or static contraction to increase the
contractile force (strength) and muscle
size (hypertrophy). In isometric and
isotonic contraction the resistance must
be sufficient to increase the intra-
muscular tension.

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iv- Resisted Exercise: . . . .cont’d
1. Manual resisted Exercises:
In the manual resisted exercise, the
resistance can be given by therapists, some
other medical professionals and relatives or
friends.
The resistance also can be applied by the
patient himself with his opposite extremity,
otherwise it may be taught to the patient’s
attenderes like his relatives or friends.
This will be helpful for home exercises.
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iv- Resisted Exercise: . . . .cont’d
These exercises can be operated by the
following individuals;

1- The therapist

2- Patient himself

3- Any other medical professionals

4- Relatives and friends

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iv- Resisted Exercise: . . . .cont’d
2. Mechanical Resisted Exercises:
If the mechanical devices are used to oppose
the active movement of a person is called as
mechanical resisted exercises.
Mechanical resisted exercises can be
performed by the followings;
1- Weights
2- Springs
3- Pulley
4- Water

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 Several options are
available for resistance
training, including:
 free weights (like
dumbbells, pulleys,
springs).
 weight machines.
 Water
 Body weight of patient.
 The physical therapist.

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 Factors Contribute Muscular Efficiency

• There are five factors which contribute to the

development of muscular efficiency:
1- Speed of contraction
2- Co-ordination
3- Power
4- Endurance
5- volume.
• The last three factors can be built up by use of
resistive exercises.
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 Factors Contribute Muscular Efficiency
◦ Power: can be increased when you
training muscle against progressive
resistance (increase overload).
◦ Endurance: high repetition and low
intensity resistive exercise can develop
endurance.
◦ Volume: increasing the power and
strength will lead to increase the muscle
volume.

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Physiological and mechanical principles of muscle
strength and range of motion
 During muscle contraction through wide
range of movement the tension or strength
are not equally powerful in all parts of
their range. Physiologically; muscle exert
their greatest strength in their outer range
and as they shorten their force diminishes.

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Effect & uses of resisted exercise

1- Strengthening the muscles due to increase tension

through gradual overload of resistance of a muscle or
muscle group.
2- Increase muscle endurance through low intensity
repetitive exercise over a prolonged period of time
without fatigue.
3- Increase coordination.
4- Increase muscle cross section (hypertrophy).
5- Increase blood flow of the working muscle.
6-Increase the power.
Power= force x distance/time

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Effect and Uses . . . . cont’d
Lower intensity exercise carried out for a
longer period of time is called as Aerobic
Exercise.
High intensity exercise carried out over a
short period of time called as anaerobic
Exercise.
Type-I (Tonic-slow twitch)- Aerobic
muscular fiber.
Type-II (Phasic, fast twitch)- Anaerobic
muscle fiber
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Technique
 When applying resistance, 4 basic rules should be
observed:
1- The resistance must be given smoothly from the
beginning to the end of range.
2- The direction of resistance force must be opposite to
the direction of the movement.
3- It should be diminish gradually from the beginning to
the end of movement.
4- Don’t forget to give enough period of relaxation to
avoid fatigue.

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 Progressive Resisted Exercise
While performing the resisted exercise
with the weights, it is very much difficult to
find out how much weight has to be done
by the injured patients after recovering.

At the same time, if the more weight is

lifted more time, the muscles gets fatigue
or sometime possibility for microteras.

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Repetition Maximum
The maximum amount of the weight a
person can lift through the range of
motion exactly 10 times. Some authors
recommended the lifts between 6-15
considering as the repetition maximum.
The exercise regimens may vary depends
on the condition or the disease and from
one patient to another.

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Progressive Resisted Exercise Regimens
At present 3 types of progressive resisted
exercise regimens are available.

1. DeLorme & Watkins

2. MacQueen

3. Zinovieff (Oxford Technique)

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1.DeLorme & Watkins
10 times with ½ 10 RM
10 times with ¾ RM
10 times with 10 RM
Progression:-
i) 30 times weekly 4 sessions
ii) Every week 10 RM progression

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1. DeLorme & Watkins . . . . Cont’d
For Example:
Consider 10RM -1kg
First Week:
1/2 of 10 RM - 1/2kg
3/4 of 10 RM - 3/4kg
Full of 10 RM - 1kg
Exercise Regimen:
10 times with 1/2 kg
10 times with 3/4 kg
10 times with 1kg
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1. DeLorme & Watkins . . . . Cont’d
Second Week:
Progression 10 RM
=10 RM + 10 RM
=1kg +1kg
= 2kg
Exercise Regimen:
10 times with 1kg
10 times with 1½ kg
10 times with 2kg
Exercise is carried on every alternative day
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2. MacQueen
1. 10 times with 10 RM
2. 10 times with 10 RM
3. 10 times with 10 RM
4. 10 times with 10 RM
Progression:
i- 40 times 3 sessions weekly
ii- Every 1-2 weeks progression 10RM

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2. MacQueen . . . . . Cont’d
First Week: Consider 10RM=1kg
1. 10 times with 1kg
2. 10 times with 1kg
3. 10 times with 1kg
4. 10 times with 1kg
Second Week:
Progression 10 RM
Second week 10RM=10RM+10RM

=1kg+1kg
Second week 10RM =2kg
Exercise is carried 3 sessions a week with 2 days rest
between each exercise day.
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3. Zinovieff (Oxford Technique)
10 times with 10RM
10 times with 10RM minus 1lb
10 times with 10RM minus 2lb
10 times with 10RM minus 3lb
10 times with 10RM minus 4lb
10 times with 10RM minus 5lb
10 times with 10RM minus 6lb
10 times with 10RM minus 7lb
10 times with 10RM minus 8lb
10 times with 10RM minus 9lb
10 times with 10RM minus 10lb
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3. Zinovieff (Oxford Technique) . . . . Cont’d
Progression:
100 times 5 sessions weekly
10 RM progression daily
For Example:
Consider 10 RM = 20lb
10 times with 20 lb 10 times with 15 lb
10 times with 19 lb 10 times with 14 lb
10 times with 18 lb 10 times with 13 lb
10 times with 17 lb 10 times with 12 lb
10 times with 16 lb 10 times with 11 lb
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3. Zinovieff (Oxford Technique) . . . . Cont’d
Second Day:
Progression 10 RM daily
Second day 10 RM = 10RM+10RM
= 20lb +20lb
=40lb
10 times lift with 40 lb
10 times lift with 39 lb
10 times lift with 38 lb
10 times lift with 37 lb
10 times lift with 36 lb.
10 times lift with . . . . 31lb

Exercise is carried out 5 days a week with 2 days rest for

next week regimen.
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Mechanical Advantage of Lever
Definition:
Mechanical advantage is defined as the ratio
of load to effort.
Consider the example of a lever of 1st kind.
In equilibrium position torque of effort is
always equal to the torque of load.
i.e.
Clockwise torque = Anti clockwise torque

Torque of effort = Torque of load

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 Mechanical Advantage of Lever

 OReffort x effort arm = weight x weight arm

 P x OA = W x OB
 OA = W x OB/P
 W/P = OA/OB
 but [W/P = M.A.]
 M.A = OA/OB
 OR M.A. = Effort arm / weight arm

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 Mechanical Advantage of Lever

Thisequation shows that mechanical

advantage of lever can be increased:

1. By increasing effort arm.

2. By decreasing weight arm

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