ACTIVE MOVEMENT

INTRODUCTION
The exercise, which is needed for the treatment
purpose, is called as therapeutic exercise. The
person performing the exercises in gym and
jogging are to 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. These therapeutic
exercises are totally different from the bodybuilding
exercises. The main goal of the therapeutic
exercise is preparing or making the patient
independent or symptom-free movements. It
brings back the diseased or injured patient to
the normal state, and it plays the major role in
the rehabilitation of an individual. To perform
the therapeutic exercise one should have
thorough knowledge on anatomy, physiology,
orthopedic, neurology, kinesiology, pathology,
cardiopulmonary and some of the physiotherapy
related medical fields. It is believed that the
perfect assessment of the disease is the 75
percent of the treatment. The perfect assessment
to be made before starting any sort of the
therapeutic maneuver. Stretching, strengthening,
coordination exercises, mobilization
and manipulation, gait correction are the some
of the therapeutic exercises used for treating
the ailment of the patient.
TYPES OF MOVEMENTS
There are two types of movements.
1. Active movement
i. Assisted
ii. Free
iii. Assisted and resisted
iv. Resisted.
2. Passive movement
i. Relaxed passive movement
ii. Passive manual mobilization techniques
iii. Mobilization
iv. Manipulation
v. Stretching.
ACTIVE MOVEMENTS
(ACTIVE—BY HIS /HER OWN)
The movement, which is done by the patient
himself, is said to be active movements. Active
movements are the voluntary action of the
muscles. This may be classified into four
varieties.
1. Assisted
2. Free
3. Assisted and resisted
4. Resisted.
Assisted Exercise
If the strength or the 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.
Assisted exercise  i)Active
                              ii)Passive
                                   a)manual
                                   b) Mechanical
Types of Assisted Exercises
The assisted exercises can be performed
manually and mechanically again the manual
assisted exercise having the two divisions, i.e.
active and passive.
Active assistance: The patient himself can assist
with his opposite extremity to perform the
assisted exercise.
For example,
a. The opposite leg is used by the patient to
increase the flexion movement of the knee
in long sitting or prone lying.
b. Upper limbs are used to move the lower
limb or opposite side upper limb.
This type of active assisted exercise is very
much helpful for the home programming
exercise. The main advantage is the patient,
he himself only knows the pain limit and
availability range of movement. So, that he can
perform the exercise conveniently within the
pain limit.
Passive assistance: It is classified into:
1. Manual assisted exercise
2. Mechanical assisted exercise.
Manual assisted exercise: The passive assistance
may be given by the therapist or by any of the
medical professionals or sometime by the
patient’s relatives and friends. This type of
assisted exercise is maximum passive in nature.
The patient has to try to perform the movement
up to his ability. In passive movement, there
will not be a muscle work but in assisted
exercise the muscle will be acting throughout
the movement.
Mechanical assisted exercises: 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 the
resisted exercises.
Principles
Range: The assistance given is changeable
depends on the range. Normally, in the
beginning and end range, the muscles strength
will be less while comparative with the middle
range. So, that the assistance provided should
be more in the beginning and end range than
the middle range.
Command: Some command is needed to
activate the patient and perform the effective
movement the command gives perfect guideline
to the patient to practice an activity.
Concentration: Concentration of the patient is
the must in the assisted exercises otherwise
the movements will be passive in character.
Therapist has to make the patient to concentrate
on the treatment well for effective
performing the assisted exercises.
Speed: Speed determine the assisted exercises
more, if the speed is increased it shows the
passive character and also the patient cannot
cop up the movement.
Repetition: The movement has to be repeated,
so that the joint range and the muscle power
can be improved.
Uses
• Increase the ROM of the joint.
• Increase the strength, power and the
endurance of the muscles.
• It breaks the adhesion formation around the
joint.
• It reduces the spasm of the muscles.
• It stretches the tightened soft tissue.
• It reminds the coordinated movement of the
joint or a muscle.
• Increase the blood circulation and venous
return to the joint and muscle.
Free Exercise
These are the exercises, which are performed
by the patient himself without any assistance
and resistance by the external force except the
gravity. There will not be any of the manual or
mechanical assistance or resistance given in
this type of exercise. It is much more useful
for the home program schedule. The patient
can perform without depending on anybody. But
the same has the more disadvantage also. There
is the possibility to perform the improper or
irrelevant movements and accessory movements,
which results in the wrong or the insufficient
neuromuscular activation. So, that there
should be proper supervision or proper guidance
to the patient to perform the free exercises.
There are two types of free exercises.
1. Localized
2. Generalized
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 exercises to shoulder flexor.
Generalized: These types of free exercises are
formed to increase the joint range in multijoints
or to increase the strength of many group
or the total body muscles.
Examples: Jogging relaxed walking.
NOTE
{Characteristics of the Free Exercises
There are two types of characteristics of the
free exercises namely subjective and objective.
Subjective: It means performing the movements
within the perfect anatomical range and
pattern. Patient has to concentrate on the
perfection of the movement, which he performs.
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.}
Uses
• Increases the joint range.
• Increases the muscle strength, power and
endurance.
• Increases the neuromuscular coordination.
• Increases the circulation and venous drainage.
• Increases the relaxation of the muscle by
the swinging movements and the pendular
movements.
• Repeated active movement breaks the
adhesion formation and elongates the
shortened soft tissues.
• Regulating the cardiorespiratory function,
and the active exercise increases the
respiratory and venous return so that the
O2 supply to muscles and blood circulation
to the muscle increases.
Resisted Exercises
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
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 attenders like
his relatives or friends. This will be helpful for
the home exercises. These exercises can be
operated by the following individuals:
1. The therapist
2. Patient himself
3. Any other medical professionals
4. Relatives and friends.
Mechanical resisted exercise
If the mechanical devices are used to oppose
the active movement of a person is called as
mechanical resisted exercise.
Mechanical resisted exercises can be
performed by the followings:
1. Weights
2. Springs
3. Pulleys
4. Water
Examples: Weights, springs, pulleys and
water are needed for the resisted exercise.
The resisted exercise increases the muscle
strength and the muscle bulk earlier than any
other exercise program. These resisted
exercises can be stated when the muscle power
is 2., i.e. from gravity eliminated position.
We can increase the resistance by altering
the below mentioned factors.
• By altering the leverage
• By increasing the weight
• By altering the speed
• By changing the duration.
By altering the leverage: The resistance of an
object felt by the muscle differs and depends
on the position of the fulcrum. If the application
of the resistance is near from the fulcrum, the
resistance will be less. It is the reverse if the
application of the resistance is far away from
the fulcrum.
Example: The resistance offered by the
application of the resistance over the elbow
region for the shoulder flexion is less while
comparing with application of the resistance
over the wrist region.
By increasing the weight: While performing the
resisted exercise with the particular amount
of weight for a particular period of time the
muscle group able to achieve the full range of
contraction. If the muscle power increases, the
person feels the insufficient with the same
weight. So, in that circumstance proportionally
weight has to be added to increase the
resistance to the movement.
By altering the speed: The muscle can contract
most efficiently when it moves with natural
speed. The increasing and decreasing the speed
may alter the effect of resistance. The speed of
the contraction increases the effect of the
resistance in the concentric muscle work.
Reducing the speed increases the power of
contraction in the eccentric contraction. These
varieties in speed are as under:
• Natural speed
• Reduced speed
• Increased speed.
Natural Speed
If the movement is performed in the natural
speed requires the less effort of the muscle and
also it may vary with the individuals. Generally,
all the exercise performed to the natural speed
is the beneficial and effective.
Reduced Speed
If the speed is decreased the greater muscle
work is required to perform the full ROM.
During the reduced speed exercise, the gravity
exerts more resistance on the muscles.
Increased Speed
The increased speed exercise needs the greater
muscular effort. In the more speed exercise the
full ROM may be sometimes neglected. It may
lead to trick movement or inaccurate movement.
Generally, relaxed passive movement has
to practice in the slow speed, i.e. decreased
speed and the active movements have to be
performed in the natural speed.
By changing the duration: The repeated
contraction of the muscle leads fatigue. The
fatiguability reduces the efficiency of muscle
contraction and increases the effect of the
resistance.
Uses of Resisted Exercises
1. Resisted exercises increase the strength of
the muscle earlier. The weak muscle can
be strengthened much earlier than the any
other exercise regimen. This can be started
from the muscle power 2 onwards. Strength
of the muscle is directly proportional to the
tension created inside the muscle. The
resisted exercise can create the more
amount of intramuscular tension.
Strength α Tension
2. Increases the endurance of the muscle.
3. Powerful muscle contraction increases the
blood flow of the muscle fiber and it gets
nutrition and the O2.
4. Resisted exercise increases the muscular
power. Power is related to the strength of
the muscle and the speed.
Power = Force × Distance / Time
The force creating the particular motion or
the movement of the body lever for the
particular duration is meant as power.
The force or tension created inside the
muscle is high in restricted exercise. Some
theories are explained about the power, which
is the high intensity of muscle activity. High
intensity exercise carried out over a short
period of time called as anaerobic power, lower
intensity exercise carried out for a longer period
of time is called as aerobic exercise.
{NOTE
Type II ( Phasic, fast twitch)—Anaerobic
muscle fiber
Type I (Tonic, slow twitch)—Aerobic muscular
fiber.}
The strenuous exercise increases the body
heat and the resisted exercise too. It stimulates
the vasodilator center and dilates the blood
vessels. As a result the muscles are getting good
blood supply and nutrition. The body-builders
are mostly performing the resisted exercise to
build the muscle bulk.