How can you know the goals of therapeutic exercises?

The goals of therapeutic exercise

include the

prevention of dysfuntion

as well as the development,

improvement,restoration and

mainteneance

of:

1.Strength

2.Endurance and cardiovascular fitness

3.Mobility and flexibility

4.Stability

5.Relaxation

6.Coordination,balance and funtional skills

Strength :

A major goal that can be achived through therapeutic exercise is the development,enchancement or maintenance of strength. Strength is the ability of a muscle or muscle group to produce tension and a resulting force during a maximal effort, either dynamically or statically, in relation to the demands placed upon it.

The changes in the neuromuscular system that lead to increased strenghth are :

1. Hypertrophy - The strength capacity of a muscle is directly related to the physiologic corsssectional area of the muscle fiber.The diameter of a muscle fiber is related to sectonal area of the muscle bulk. With exercise specifically designed to develop strength, the size of the individual skeletal muscle fibers can be increased. This is callled hypertrophy

2. Recruitment - Another important factor that affects a muscle's capacity to increase strength is the recruitment of increased numbers of motor units during exercise. The greater the numberof motor units firing, the greater the force output of a muscle. It has been shown that strength can be increased without muscle hypertrophy.

Guidelines to develop strength :

"The overload principle"-to increase strength, a load that increase the metabolic capacity of the muscle must be used during exercise. This will lead to hypertropy and recruitment and therefore to an increase in strength of the muscle.

The capacity of a muscle to produce greater tension can be achieved primarily with high-intensity exercise carried out for a relatively low number of repetitions. In both cases the uscle must be exercised to the point of fatigue for adaptive increases in strength to occur.

Endurance and Cardiovascular Fitness :

Muscular endurance or total-body endurance can also be improved or maintained with therapeutic exercise. Endurance is necessary for performing repeated motor tasks in daily living and carrying on a sustained level of functional activity, such as walking or climbing stairs. Both type of endurance refer to work performed over a prolonged period.

Types of endurance :

1. Muscular Endurance :The ability of a muscle to contract repeatedly or generate tension, sustain that tension and resist fatigue over a prolonged period of time. As endurance increases a muscle will be able to perform a greater number of contractions or hold against a load over an extended period.

2. General body endurance : The ability of an individual to sustain low-intensity exercise, such a s walking,jogging or climbing over an extended period. Endurance exercise also called aerobic exercise or conditioning is performed to enhace the cardiovascular or pulmonary fitness of an individual.

The changes in the muscular, cardiovascular and pulmonary systems that lead to increased endurance :

a. Immidiate change during exercise:

- increased blood flow to muscle because of increased demands of for oxygen.

- Increased heart rate

- increased arterial pressure with heavy exercise. This is due to increased stroke volume, increased cardiac output, increased heart rate, and increased peripheral resistance to blood flow.

b. Adaptive changes :

muscle changes : The vascularization of the muscle or the density of the capillary bed increases. When a muscle contracts at low intensity for many repetitions to the point of fatigue, aerobic activity occurs in the muscle to provide energy for muscle contraction.Oxygen is neccessary for this process to occur. Greater amount of oxygen can be made available to the muscle as the capillary bed becomes more dense and blood supply to the muscle increases. Adaptive changes in the type I and type IIa muscle fibers are associated with increases in muscular endurance.

cardiac and vascular changes : cardiac output and stroke volume increase,this leads to an increase in the efficiency of the working capacity of the herat.Resting herat rate decreases. During exercise, ofcourse heart rate increases but as endurance improves the heart rat returns to aresting level more rapidly after exercise.

Guidelines for developing endurance :

muscular endurance - active exercise performed repeatedly against a moderate load to the point of fatigue will increase the endurance of a muscle.An increase in muscle endurance will also occur in exercise programs designed to increase strength.

general endurance - the aerobic capacity of an individual is related to the effective transport of oxygen and maximal oxygen uptake, exercises that challenge the oxygen tranport system will increase enduranc,aerobic capacity and overall cardiopulmonary fitness.

Mobility and Flexibility :

In addition to strength and endurance, mobility of contractile and noncontractile soft tissues and joints is necessary for the performance of normal functional movements.

1 Soft tissue mobility/flexibilty :

a.muscle-because of the contractile and elastic properties of a muscle, it shortens when stimulated and relaxes after contraction, and it can also be steretched passively.THe procedures for lengthening shortened muscles may be done actively or passively.

b connective tissue-normal connective tissue composed of a network of collagen and ground substance.Although it is inert and has no contractile properties, it is somewhat supple and will elongate slowly with a maintained stretch and will adaptively shorten if immobilized.

c skin-the normal mobility of skin must also be maintainded if normal movement is to occur.The suppleness of skin allows it to yield to stretch during active or passive movements of the body.

2.Joint mobility :

for any normal motion to occur, proper joint kinematics are necessary.adequate capsule laxity is necessary to allow normal roll-sliding to occur betwween the body surfaces within the joint.

Guidelines for developing mobility :

a Passive stretching- Manual,mechanical or positional stretch to soft tissue in which the force is applied opposite to the direction of shortening.

b Active inhibition-a reflex inhibition and subsequent elongation of muscles using neurologic principles to reduce tension and lengthen the contractile elements within muscles.

c Flexibiltity exercise-general term used to describe exercises performed by a person to passively or actively elongate soft tissues without the assistance of a therapist.

d Joint mobilition-passive traction and gliding movements to joint surfaces that maintain or restore the joint play normally allowed by the capsule, so that the normal rollglide mechanics can occur as a person moves.

Stability :

Stabilty refers to the synergistic coordination of the neuromuscular systemt to provide a stable base for superimposed functional movements or activities.stability is usually required in more proximal structures such as trunk,hips and shoulder girdle for efective positioning and motion of the arms and hands or legs and feet.

Stabilization exercises are the means by which one can learn to control proximal areas of the body and maintain a stable, well aligned position while carrying out functional activities.

Relaxation :

Relaxation refers to conscious effort to relieve tension in muscles,through therapeutic exercise an individual can become aware of prolonged muscle tension and can be taught to control or inhibit it.

after an active contraction of skeletal muscle a reflex relaxation occurs.The stronger the contraction the greater the subsequent relaxation of that muscle.

Coordination, balanceand functional skills :

Coordination refers to the ability to use the right muscles at the right time with appropiate sequencing and intensity.

Balance refers to the ability to maintain the center of gravity over the base of support, usually while in an upright position.

Functional skills refer to the varied motor skills necessary to function independently in all aspects of daily living.

General principles of exercise to develop coordination and balance and functional skills :

Learning or relearning functional motor skills involves constant repetition of simple to more complex motor activities use of sensory cues to enhance motor performance and removal of sensory cues to enhance problem solving and motor learning.

Movements can be initially practiced in simple anatomic planes of motion and then carried out using combined or diagonal movements.

proximal stability is often emphasized before distal mobility.

As the quality of movement improves one should target on the speed and timing of movements.