10 Common Myths And Facts About Physiotherapy That You Need To Know

There is a tremendous rise in the demand for physiotherapy as patients have been experiencing continuous positive results from it. Though we are all familiar with physiotherapy, as most of us shall have availed the service for ourselves or any of our near ones. Physiotherapy is used to treat a wide variety of health issues, related to Old age Problems, Neurological Conditions, Women's Health Conditions, Musculoskeletal Conditions, or any Sports-related Injuries. Most of us have a general idea of what physiotherapy is, but you must have noticed that we sometimes assume something about any field that is not actually true. The same thing applies to physiotherapy. Here are some facts and misconceptions about physiotherapy that you need to know. In this blog, we have discussed several myths and misconceptions that prevent people from availing of physiotherapy treatment.

MYTH: Physiotherapy Treatment is just for Sports Injuries.
FACT: People think that physiotherapists treat only sports injuries or are involved with sports teams. Whereas, physiotherapy can be used to treat a diverse group of people suffering from various illnesses like neurological conditions, pediatric conditions, geriatric conditions, musculoskeletal conditions, etc.

MYTH:  The patient needs a referral to see a Physiotherapist.
FACT: This is not actually true. Physiotherapists are well-trained professionals who can determine whether the patient requires medical attention or else requires sole physiotherapy treatment. A physiotherapist can examine, access, and diagnose the patient and plan a treatment protocol. Thus, the patient can seek physiotherapy treatment without consulting a doctor.

MYTH: Physiotherapist only gives Exercises.
FACT: Exercise can form a major component of a physiotherapy treatment plan. But, exercises aren’t the only treatment a physiotherapist renders, there are other forms of techniques used to create personalized treatment plans. These can include electrotherapy(TENS, shockwave therapy, ultrasound therapy, etc), manual therapy (joint mobilizations, deep tissue massage, trigger point release), taping, acupuncture, postural education, postural advice, etc.

MYTH: Physiotherapy is only about Massage Therapy.
FACT: Physiotherapists are not just massage therapists, their treatment may or may not include soft tissue manipulation, and this is often a small and sometimes non-existent adjunct to overall treatment. Physiotherapy is a practice that cures pain and treats disabilities while massage is a practice for relaxation.

MYTH: Physiotherapists cannot make a Diagnosis.
FACT: Physiotherapists diagnose illness at a very initial stage. They check sensation, muscle imbalances, bone issues, postural problems, and many more conditions by using manual diagnostic tests. And thus, are well-trained to diagnose a condition.

MYTH: Physiotherapists treat only Muscle Pain.
FACT: Physiotherapists are qualified to treat a variety of conditions and their treatment is not limited to muscle pain and related issues, but there are many more conditions that can be treated by physiotherapists like disc problems, arthritic joints, joint stiffness, scoliosis, nerve problems, tendon problems, foot problems, headaches, vertigo, women’s health issues such as incontinence, neurological issues like balance and coordination problems and stroke rehab, post-surgery hip & knee replacements, knee & shoulder reconstructions, etc.

MYTH: Physiotherapy is a part of Orthopedics.
FACT: This is one of the most common misconceptions that people have about physiotherapy, which is not true. Physiotherapy plays a vital role in orthopedics but this does not make it a part of orthopedics. Physiotherapists can treat all kinds of patients including Orthopaedic, Cardiovascular, Neurology, Pediatrics, Geriatrics, and many more.

MYTH: Some patients believe that the Physiotherapy clinic is just a gym center.
FACT: Physiotherapy clinics are usually for patients and the gym is for people who require fitness. Therapeutic exercises recommended by the physiotherapist are completely different from the exercises taught by a gym trainer, no gym trainer can teach therapeutic exercises to a patient. As physiotherapists need to maintain the fitness of their patients therefore their clinics can have fitness equipments also.

MYTH: Surgery is the final/only option. 
FACT: Physiotherapy is a non-surgical treatment process and aims to reduce pain, improve movement & restore functionality in order to improve the patient’s health. From treating degenerative disc conditions, osteoarthritis, and rotator cuff tears to meniscal tears, physiotherapy has proven to be as effective as surgery. Therefore, surgery is not the only option. In many cases, physiotherapy has tremendous results and thus prevents surgery in a wide range of conditions.

MYTH: The patient can do Physiotherapy on their own.
FACT: Some people think that physiotherapy isn’t worth the money. They think that they can do the exercises on their own and see the same results.

Physiotherapists have specialized knowledge about physiotherapy and know the body’s anatomy & nervous system better than the patient. They study everything about physiotherapy for multiple years & learn tons through that. So, when physiotherapists treat patients there is a lot of background that they use to settle on the simplest intervention and how they should perform a certain exercise, and what would be the simplest way to try to handle a specific patient. There are many more things that the patient cannot do just by themselves by googling something or by just reading a piece or article. Physiotherapists use various ways to treat people through electrical modalities or exercises or manual therapy and physiotherapists actually show how to do the exercises so that the patient can do them themselves. The supervision or guidance of an experienced physiotherapist is essential for perfect movement.

Physiotherapy can help people of all ages stay fit and healthy. It is unique and treats a huge variety of conditions. For many people, physiotherapy has been a lifesaver as it helped them to improve their quality of life and mental, emotional, physical, and social functioning. If you are interested and require physiotherapy treatment and want to benefit from it, then don’t believe these myths and reach out to a local physiotherapy clinic today.

Quadriplegia |top 20 Mobility Exercises To Regain Strength And Function

We know that exercise is a vital component of overall health, both physical and mental. This is just also true for individuals suffering from quadriplegia. For quadriplegic patients' active movement is limited, therefore, it is necessary to find alternative ways to incorporate movement into their daily life. Movement can be incorporated with the help of an experienced physiotherapist, who can recommend exercises according to the patient's needs. Regular exercises can benefit quadriplegic patients in a variety of ways. Exercising helps maintain the range of motion and promotes circulation, bone density, and muscle mass. And also minimizes the additional complications of quadriplegia and thus increases the ability to participate in daily activities. This blog has been written to give you some idea about exercises that can be done for quadriplegic patients.
Quadriplegic patients with less severe and incomplete injury to their cervical spine can move their upper limbs. Whereas, those patients with more severe spine damage have to deal with total loss of upper limb function. The recovery of the quadriplegic patient relies on the nature of the injury. Mostly, patients with incomplete quadriplegia have a higher chance of recovering lost functions to some degree.
Passive range of motion exercises plays a significant role in quadriplegia recovery.  Passive range of motion exercises makes a big difference in the healing and recovery journey. The physiotherapy technique consists of assisted activities that stimulate nerve healing and increase muscle strength. Quadriplegic patients can practice passive range of motion exercises. This type of exercise requires no active muscle contraction, instead, a physiotherapist or a trained caregiver can facilitate the movements for the patients to make sure that the joints move through their full range of motion.
Doing regular exercises can improve digestive function and also reduces the risk of urinary tract infections or constipation. Exercising strengthens the breathing muscles, improves blood circulation, and also helps prevent secondary complications such as swelling, pressure sores, infections like pneumonia, etc.

Exercises can be recommended for patients with both incomplete and complete paralysis.  Discussed below are some examples of passive range of motion exercises used for quadriplegia recovery:

Neck rotation stretch
Neck exercises like neck rotation, tilting the head left to right, up and down strengthen and re-activate the neck muscles, shoulders, and upper back, and also helps release tension in the muscles, easing pain in most quadriplegic patients.

Piriformis stretch

• Increased hip flexibility can improve hip movements, and eases lower back pain, which is a common problem among patients with paralyzing injuries to their upper and lower limbs. Quadriplegic patients do this exercise, with the help of a physiotherapist.
• The therapist gently pushes one leg in while the patient grasps his knee for around 8 to 10 seconds.  

Doorway chest stretch

• Stretching the chest muscles can relieve pain in the upper neck or upper back. This exercise lengthens the pectoral muscles and strengthens other muscle groups that help in facilitating upper limb movement.
• The physiotherapist bends the elbow and positions the forearm against a doorway opening.
• Lunge forward to open up the chest and stretch the muscles 

Spine twists

• Spine or trunk rotation exercises improve lower back flexibility which can increase spine mobility and rotation.
• To rotate the trunk, the therapist needs to raise and bend the legs and push them gently toward the chest.
• After completing the movement, the patient should tilt his knees from one side to the other without moving his shoulder muscles.

Shoulder Flexion

• The patient's arm is relaxed by the side so that the palm is facing inward.
• The therapist raises the arm forward slowly, keeping the elbow straight, bringing it up so that the hand reaches up and the arm is as close to the ear as possible.

Shoulder Abduction

• The patient's arm is straight with the palm facing forward.
• The therapist slowly brings the arm and hand outward to the side, away from the patient's body.
• The patient's arm should be level with the shoulders or higher.
• Then, bring the arm back to the starting position.

Elbow Flexion and Extension

• The therapist bends the elbow so that the hand can touch the shoulder.
• Then extends it so that the arm is fully straight.

Forearm Rotation

• The therapist bends the elbows at 90° at the patient's sides with the back of the hands facing up.
• With one hand, hold just above the elbow, and with the other, flips the hand over so that the palm faces up.
• Forearm rotation can also be completed with the arms straight and positioned at the patient's sides.

Wrist Flexion and Extension

• The therapist bends the patient's wrist so that the palm moves toward the inner arm and makes a 90° angle.
• Then, extends the wrist in the opposite direction.

Finger Flexion and Extension

• The therapist curls the patient's fingers inward towards the palm, creating a fist.
• Then extends them back so that they are straight.
• Keep the wrists neutral (straight) while doing this.

Finger O's

• The therapist touches the tip of the patient's each finger to the tip of the thumb.

Finger Abduction (Splits)

• The therapist separates the patient's two adjacent fingers by moving them away from each other.
• Then brings them back together.

Finger splits

• The therapist splits the fingers through the passive exercise that helps loosen up stiff joints and activate the hand and finger muscles. The physiotherapist does this movement by separating two adjacent fingers and putting them back in their resting position. 

Hip Rotation

• The therapist bends the patient's knee so that the thigh is perpendicular to the bed and there's a 90° angle at the knee.
• Then he rotates the patient's hip in the socket by holding the thigh just above the knee and moves the foot inward towards the opposite leg. Further, reverse the direction of rotation and move the foot outward, keeping the thigh perpendicular to the mat the whole time 

Hip Abduction

• The patient's legs should be straight. The therapist pulls one leg to the side away from the midline of the body and creates a separation between the feet until there's slight muscle resistance. Then, brings the feet back together.

Ankle Rotations

• The therapist puts one hand just above the patient's ankle to stabilize the leg and the other hand on the foot.
• Then moves the foot in a circular motion to stretch the ankle and calf.

Toe Flexion and Extension

• The therapist bends the toes of the patient towards the sole and brings them back out to neutral.
• Then extends them upward toward the shin to stretch the bottom of the foot.

Breathing Exercises

• The muscles of the abdomen and diaphragm are vital to performing breathing exercises depending on the level of injury, these muscles may be affected. Breathing function and overall respiratory health are also important for quadriplegic patients. Breathing exercises help maximize respiratory function.
• The patient takes a deep breath through the nose, trying to expand the chest and lungs. The patient holds this breath for 2-3 seconds and releases slowly through pursed lips.

Air stacking

• The patient sits upright or reclines slightly with the support behind his back. Then takes a deep breath in and holds, then breathes in more air and holds again. The patient then continues this exercise 4-5 times without exhaling and holds for 2-3 seconds, then exhales slowly to finish one cycle of the exercise.

Number Counting

• The patient takes a deep breath in, then releases the breath slowly while counting out loud. Then tries to gradually increase the number to reach to improve his breath control.

The above-mentioned exercises are designed in such a way that they are to be performed for the patient by the therapist or caretaker. As the patient continues practicing these exercises, he might find that he can actively do some of the movements. Then this is a sign of recovery and progress.

 

Paraplegia | Top 15 Mobility And Balance Exercises To Regain Strength And Function

Movement is the major requirement of the human body, but conditions like paraplegia, hemiplegia, tetraplegia, quadriplegia, etc. don't allow an individual to perform certain movements. Individuals suffering from such conditions should involve themselves in regular exercises and activities, to maintain cardiovascular and metabolic health. Individuals suffering from such conditions are more susceptible to high cholesterol, weight gain, and elevated blood sugar.  In today's blog, we will figure out the various exercises that can be done by paraplegic patients regardless of their condition. 

What is Paraplegia?

Paraplegia or Partial paralysis is a form of paralysis in which function is impeded from below the level of injury. Paraplegic patients have perfectly healthy legs but the problem resides in either their spinal cord or brain, which cannot send or receive signals from or to the lower body due to a disease or an injury.

Paraplegia symptoms can vary significantly from one person to person. A paraplegic is someone who is usually in a wheelchair as he cannot move his legs, and cannot feel anything below the level of injury. The patients cannot walk and can have a range of capabilities that may change over time, as their health evolves, physiotherapy helps them learn to work around their injuries.

An exercise routine can help protect an individual against various health issues and also improve overall health. Exercises lead to greater flexibility and increased energy levels and also helps strengthen the muscles and maximize function. Wheelchair exercises make the patient more flexible and also decrease pain.

Discussed below are a few exercises that can help the patient to develop mobility and balance:

Side Leg Lifts

• Slip the front half of the foot into the loop of the leg lifter. Then, lie on the side so that the foot with the leg lifter is on top of the other leg.
• Pull the strap of the leg lifter gently so that the leg raises to the side. The patient should stop pulling when he starts feeling the body's natural resistance and then hold the position to stretch the inner thigh.
• Continue to lift and drop the leg 15 times, then turn to the other side and repeat with the other leg.

Knees to Chest

• Place the leg lifter on one foot and lie flat on the back. Use one hand to slowly pull the strap towards the upper body and the other hand to bend the knee as it moves up.
• When the knee reaches the torso, use the arms to hold it in place.
• Hold the position for several seconds and then slowly straighten the knee and bring the leg back down. 

Knee Extensions

• The patient places the foot into the leg lifter and then gently pulls so that the knee straightens out.
• Then, bring it back down.
• Do this exercise 15 times.
• Repeat the same exercise with the other leg.

Hamstring Stretch

• The patient sits on the floor with the front half of the foot inside the leg lifter.
• Pull the strap up the body so that the entire leg lifts off the ground. Pull until the patient reaches mild resistance, then hold for 10-15 seconds.

Ankle Rotations

• The patient sits with one leg bent to the side so that he can easily reach the foot. Use one hand to stabilize the ankle while the patient uses the other to move the foot in circles.
• Rotate clockwise direction and counterclockwise direction.

Ankle Pulls

• The patient sits on the floor and places the leg lifter on one foot.
• The legs should be straight and then slowly pull the strap towards the body so that the toes point towards the ceiling.
• Hold for 10-15 seconds and then repeat.

Seated Elliptical

• The patient uses a seated elliptical to help passively exercise the legs.
• The machine connects the arm and leg movements, so by swinging the arms back and forth, the patient promotes cycling motions in the legs.
• As the patient is seated, the legs will not be bearing any weight.

Seated Marches

• The patient is in a seated position, alternate lifting the knees as if the patient is marching. Bring the knees up as high as he can.
• This exercise develops the leg lifting motions necessary to walk again without bearing additional weight on the joints.

Hydrotherapy

• Hydrotherapy helps individuals with paraplegia relieve pressure from the legs by exercising in a pool. Buoyancy is the property of water that helps keep the body afloat and the patient feels light. Walking in a pool removes pressure from the joints and allows the patient to practice standing without bearing much body weight.

Heel Taps

• The patient lies down with his knees bent and feet flat on the ground.
• Gently tilt the torso to the side and tap the heel with the fingertips. Only the upper half of the body should be moving. Then, simultaneously tilt to the other side and repeat.

Sitting on a Stability Ball

• Sitting on a stability ball requires constant adjustment of the center of gravity (COG), which continuously engages the core muscles. With the help of a physiotherapist, sit on a stability ball, and substitute a stability ball for a chair a few times a day to improve balance. To avoid falling, lean the stability ball against a stable surface like the corner of 2 walls before getting on and off.

Stability Ball Crunches

• Once the patient can sit on a stability ball, make the patient lean back and perform crunches. Crunches on a stability ball help to reduce strain on the tailbone.

Knee Planks

• The patient lies on the stomach and gently gets on the knees and forearms, often called a quadruped position.
• The back should create a straight, downwards-sloping line from the shoulders to the knees.
• Hold for 20-30 seconds and repeat.

Gait training exercises: Weight-Bearing Treadmill Training

• Once the patient develops enough control and strength in their legs to bear weight, then exercises that help to develop their gait are recommended. Gait training is a type of exercise training that focuses on developing the ability to walk. These exercises for paraplegia include weight-bearing treadmill training and overground training.
• The patient is made to wear a harness for weight-bearing treadmill training, the harness controls the amount of weight that is placed on the legs, thus reducing the pressure on the joints. Paraplegic patients can focus on improving their walking form by gradually accustoming the legs to add weight until the patient can support the full body weight.

Gait training exercises: Overground Gait Training

• Paraplegic patients can improve their gait by gait training exercise that involves using equipment like parallel bars, walkers, and canes, to maintain balance. These assistive devices teach the patient, how to shift weight and maintain balance.

Muscle mass decreases due to paraplegia, causing muscle atrophy. To prevent or reduce muscle atrophy regular exercise is the most effective way to slow down muscle atrophy and improve blood circulation and metabolism.

10 Easy Home Exercises To Reduce Your Belly Fat

Are you looking for ways to shed the layer of belly fat that sits just under your skin? Then you need to exercise regularly. Though losing abdominal fat is tough but isn't impossible. A proper training schedule can shed stubborn pounds and get you in shape once and for all. This blog will discuss some exercises that help burn belly fat. With old age, there is an increase in belly fat along the waistline. This is because muscle mass decreases with age as fat increases. Belly fat can make a person feel self-conscious or can cause difficulty fitting into their favorite attire.

Excessive fat belly also has some associated health risks therefore stress should be laid to try to control belly fat. There are 3 types of belly fat:

• Subcutaneous,
• Intramuscular, and
• Visceral.
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• Visceral fat is the type of fat that is between the organs and is known as belly fat. Even if a person has normal weight and Body mass index (BMI), excessive visceral belly fat can lead to a variety of health problems, like:

• Heart diseases.
• Breathing problems.
• Type 2 diabetes.
• High blood pressure.
• High cholesterol.
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• There are many exercises, but not all create an equal banishing effect on belly fat. Also, physical activity should be incorporated into your daily routine as it is a great way to burn off unwanted belly fat.
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• Here are some fat-burning Exercises for belly fat that you can try to help you slim down your waistline:
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• Medicine Ball Crunch:
• Place the ball on the chest, and hold it with both hands.
• Lie down, and bend your knees.
• Lift the torso off the floor so that it's perpendicular to the floor.
• Roll backward almost 45 degrees, return to sitting upright, and exhale through the pursed lips.
• Repeat 20 times. 
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• Hanging Leg Raise
• Suspend the body in the hanging position on a pull-up bar, with the hands at about shoulder width.
• Keep the knees straight and relaxed, and pull the legs up towards the chest as far as possible without locking or hyperextending them.
• Pause for a moment, and lower slowly to the starting position by bending at the knees till they touch the floor.
• Repeat the movement 30 times. 
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• Russian Twist
• Sit on the floor, bend the legs keep the feet flat on the floor.
• Place the hands behind, and interlace fingers so that the palms are facing outwards. Lift the elbows off the floor by squeezing the shoulder blades together. That should raise the torso slightly off the ground, keep the abdominals tight, and don't arch the lower back.
• Extended the arms at 90 degrees from the shoulders while holding onto something sturdy like a rack of weights. Make sure to raise the legs off the ground while doing so.
• Twist the torso to the left side as far as possible without moving the hips or buttocks up from the ground. Keep them parallel to the surface beneath them while keeping the arms straight and pointing towards the ceiling throughout the movement.
• Pause for 2 secs once the rotation is done before returning to the starting position where the knees were crossed over each other earlier in the exercise (keeping hands interlaced behind the back with arms lifted above the head).
• Repeat 8- 12 times.
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• Burpees with pushups
• Stand with the arms by the sides and feet shoulder-width apart.
• Squat down, and place the hands on the floor about one foot in front of the body.
• Kick both feet back so that the person is in a push-up position, with knees on the floor and hands under the shoulders.
• Lower into a push-up till the chest is almost touching the ground.
• Straighten both legs quickly so that they're extended behind while simultaneously swinging the arms forward between the legs to perform one push up
• Reverse the direction by pulling up so that both feet land under the hips again after ending the push-up with the chest above the hands.
• Stand up straight again and repeat.
• Do the exercises continuously for 20 seconds. 
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• Abdominal Crunches
• The person lies on the back with the knees bent, hip-width apart.
• Place the hands behind the head with the elbows open wide. 
• Take a deep breath and engage the core muscles (upper and lower abdominal muscles) as the person lifts the torso including the shoulders while keeping the head back without pulling on the neck. 
• Do 20 repetitions.
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• Bicycle Abdominal Exercise
• While still on the back, continue to keep the hands behind the head.
• Bring the knees into the chest then straighten one leg while turning the upper body toward the opposite bent knee. 
• Alternate with the right and left legs until the person performs 20 repetitions – 10 on each side. 
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• Plank
• Turn over on the front and place the elbows underneath the shoulders. 
• Flex the feet and lift the entire body so it is parallel to the floor. 
• Hold for 60 seconds. 
• Work up to 1, 2, and 5 minutes. 
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• Walk or Run
• Walking or running are effective exercises, these not only reduce belly fat, but also lower the risk of chronic diseases such as cancer, Type 2 Diabetes, or high cholesterol.  A person can burn 100 calories per mile, depending on the weight, just by running. Start slow and work the way up to 30 to 40 minutes every day. 
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• Leg Lifts
• The person lies in the back with the palms facing down tucked just underneath the hips so that the hands are peaking out.
• Engage the core muscles and lift the hips and legs keeping them straight. 
• Perform 10 – 12 repetitions. 
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• Push-Ups
• If any of the exercises listed above do not appeal to you or want another option, you can perform push-ups. 
• Begin by bending over and walking the hands forward to a downward-facing dog position with the hands shoulder-width apart and hips pointing to the ceiling. 
• Slowly lower down to the plank position and hold for 3 seconds before dropping the hips to the floor and lifting the chest to the sky. 
• Go back to the plank position and lift the hips to the downward-facing dog position. 
• Repeat 10 times. 
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• An individual should do at least 30 minutes of moderate exercise per day, without overtraining and pushing themselves too hard. As, sometimes due to overtraining, the body can produce too much cortisol (a stress hormone, associated with belly fat), so overtraining may make it more difficult to burn off belly fat. Therefore, just moderate regular exercise is recommended.

 

Top 20 Exercises After Spinal Injury To Improve Range Of Motion

After spinal cord injury, survivors may struggle with movement, coordination, or other worse effects. To restore strength and function, exercises are recommended. Exercises help to move the joints through their full range of motion, this prevents stiffness and promotes circulation in the paralyzed or weakened areas of the body thus promoting function and recovery. This blog will explore some of the most effective exercises for spinal cord injury that help rebuild strength and flexibility. But before doing these exercises you should check with your physiotherapist before adding these new exercises to your regimen to make sure they are safe for you.

Spinal Cord Injury Rehabilitation
The level of the spinal cord injury is an important factor to consider when designing a treatment plan or rehabilitation program because it determines which functions are affected, such as high-level injuries, as cervical spine injury can result in weakness or paralysis in both the arms and legs.
Movement is affected by the level of spinal cord injury, whereas lower-level spinal cord injuries may not affect arm function. For example, patients with C1-C4 complete spinal cord injury may affect hand function, whereas those with C8-T1 injury may have full wrist and hand control.

Exercises:
Exercises should match the ability level. If the patient is unable to perform a particular exercise actively, then should try active-assisted or passively with the help of a family member or caregiver. With time and a lot of repetition and practice, the patient can progress toward doing the exercises more independently.
Every spinal cord injury has different functional outcomes, most spinal cord injury patients can perform passive range of motion exercises. These exercises do not require the patient to exert their energy, a physiotherapist or caregiver moves the patient’s body. Patients who have more control of their movements should try to perform the range of motion exercises on their own.
Passive range of motion exercises should be done at least once daily to minimize tightness in the joints and stimulate the nervous system. With more consistent practice mobility and endurance also improves. These exercises reduce muscle atrophy and increase circulation. After spinal cord injury, core exercises are also essential because they help stabilize the trunk for better balance and posture.

Mentioned below are the various examples of passive range of motion exercises that can be done by the patient with the help of a therapist.

Deep Breathing:
For deep, diaphragmatic breathing, the patient should be able to see and feel his abdomen rise with his inhales and fall with his exhales. This is the easiest to practice:
The patient lies on his back with his hand on his belly so that he can feel it moving.
Focus on taking slow, deep breaths will help strengthen the core and increase oxygen intake to optimize body functions.

• Shoulder Flexion:
• The patient’s arm should relax by the side.
• The therapist raises the arm of the patient out in front, reaching as high as possible without pain.
• Prevent the shoulder from shrugging upward and keep the rest of the body aligned.
• Then the therapist can support the arm as it comes back down to the side and repeat.
  
  Elbow Flexion
• The arm should be relaxed and the hand facing the side.
• The therapist should gently bend the elbow, rotating the forearm so that the hand turns toward the shoulder.
• Bend the elbow without pain. Then relax the arm and repeat.
• The patient is also made to perform elbow extension, supination, and pronation.
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• Knee Extension
• The patient should be sitting.
• The therapist slowly moves the patient’s leg upwards until his knee is nearly straight.
• Gently bring the legs back down into the starting position, and repeat.
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• Ankle Dorsiflexion
• The patient is seated on a chair or by the bedside.
• The therapist raises the patient’s toes up toward the calf, then relaxes back to a neutral position.
• Again, stop if the patient feels any pain.
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• Ankle Pumps
• The patient sits on a chair or lies down on his back.
• The therapist points the patient’s toes down so that the ankle is extended.
• Then raise the feet upwards towards the knees to flex the ankles.
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• Knees to Chest
• The patient lies on the bed.
• The therapist places the patient’s hand on the upper leg just above the knee and asks the patient to bend the knee with the opposite foot so that it reaches toward his chest.
• Then bring his foot down and straighten the knee.
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• Straight Leg Lifts
• The patient lies down with the legs straightened.
• The therapist lifts the patient’s leg without bending at the knees.
• When the leg is high so that the patient feels the stretch, hold for a few seconds.
• The therapist then brings the leg back down and alternates with the other leg.
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• Seated Marching
• The patient sits at the edge of the seat with both feet on the ground.
• Then the therapist alternately lifts the knees one at a time.
• This leg exercise allows the patient to practice movements used while walking without added pressure on their joints.
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• Arm Circles
• The therapist puts the patient’s arms out to the side so that body makes a “T” shape.
• Then the therapist moves the arms in a circular motion going forward and backward.
• The therapist can alternate between making large circular motions or smaller ones.
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• Making O’s and Fists
• The therapist can use the patient’s one or both hands.
• The therapist assists the patient in alternate tapping the tips of each finger to the thumb.
• After touching each finger, the therapist can also assist in closing the hand into a fist.
• The patient holds a few seconds or as long as he can and straightens the fingers back out.
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• Wrist Extension
• The therapist holds the patient’s arm out in front of him with the palm facing down.
• Then asks the patient to hold with the other hand to grab the palm and pull it back up. 
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• Separating Fingers
• The patient lies the hand flat on a tabletop or wall.
• Then the therapist assists him by spreading the fingers apart and bringing them back together
  
  Back Extensor Isometric Hold
• The patient is made to sit at the edge of the seat and lean back against the chair.
• Hold for a few seconds or as long as he can and use his core muscles to sit up straight again.
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• Seated Trunk Flexion
• The patient sits in a chair.
• The therapist assists him in slowly leaning forward as far as he can comfortably.
• The patient tries reaching his hands to the floor.
• Then the therapist assists him to use his back muscles to slowly sit back up.
• If the patient has trouble with his sitting balance, be sure that the therapist is nearby to spot the patient during this exercise.
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• Trunk Rotation
• The patient lies down.
• The therapist can bend his knees and place the patient’s feet flat on the floor.
• Try to keep the shoulders and upper body firmly on the floor.
• Tighten the abdominal muscles and relax the knees down toward the floor on one side of the body, then the other.
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• Supine Twist:
• The patient lies on the back with the knees bent and feet flat on the bed.
• The therapist assists by slowly letting the patient’s knees fall to one side, without moving his shoulders.
• Bring them back to the center, and then twist to the other side.
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• Crunches:
• The patient lies on the floor or on the bed with feet about shoulder-width apart.
• The therapist slowly assists the patient to lift the upper body forward and lowers it gradually back down.
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• Seated Side Crunch:
• The patient is seated, and the therapist helps to tilt the patient’s upper body to one side and hold for 5 seconds.
• Then return back to the center and repeat to the other side without moving the lower body.
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• Figure 8s:
• The patient sits at the edge of the seat.
• The therapist slowly moves the torso in a figure 8 motion.
• Moves the patient clockwise and anti-clockwise after every 3 rotations.
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• Kneeling Planks:
• The patient lies with his hands and knees on the floor.
• The therapist helps the patient adjust the body so there’s a straight downward slope from the head to the knees.
• The patient holds this position for 20 seconds.
• In case it is too difficult, bend the patient’s arms at the elbows and transfer the weight onto the forearms for greater stability.

As the patient begins to recover and is able to do these exercises with less help from the therapist, then he can continue doing these exercises actively with breaks in between. Further, performing the exercises on his own without help can increase his endurance and strength, and difficulty can be increased by adding  resistance by using weights, a stability ball, increasing repetitions, etc.

 

Range of Motion Exercises: Active, Passive and Assisted

Range of motion is very essential for the normal functioning of our body parts. Range of motion refers to how far one can move or stretch a joint. It is the distance and direction, the joint moves between a bent position and an extended position. This range of motion is restricted in various health problems like inflammation, injury, disease, muscle cramps, ligament strain, etc. The limitation differs from person to person. In this blog, we will throw some light on the various types of range of motion exercises that can be recommended by your physiotherapist to regain the movement and functionality of the affected joint. The physiotherapist designs therapeutic exercises to increase the range of motion and flexibility of the involved joint.

The range of motion exercises refers to the activity that is aimed to improve the movement of the joint. The movement of the joints is influenced by many structures like the bone surfaces within the joint, ligaments, joint capsules, tendons, and muscles acting on the joint. The range of motion exercise is the capability of the joint to go through its complete spectrum of motion.

The range of motion therapy is beneficial in recovery as well as healing from soft tissue and joint lesions, maintaining existing joint as well as soft tissue mobility, minimizing the effects of contracture, increasing synovial movement, and helping in Neuro-muscular re-education.

Regaining the range of motion in the joint is one of the first phases of injury rehabilitation, as well as an individual, can avoid injury and maintain well-being if he is aware of the range of motion exercises (ROM). ‌

The physiotherapist assesses the range and quality of the motion. The treatment plan involves many kinds of range of motion exercises. Among these, the most useful and common exercises are those which increase as well as facilitate a range of motion(ROM). ROM is used by physiotherapists to describe how much motion the patient makes with the joint or the part of the body. When the range of motion is affected, the patient finds it difficult to move the particular body part comfortably around the joint.

The ROM may be affected because of different causes like pulled muscles, sprained joints due to an accident or a sports injury, post-surgical, as well as the general lack of exercise, which may also result in a reduction in the range of motion. The ROM exercises target these injured areas. There are mainly three basic kinds of range of motion exercises for restoring and correcting the range of motion. These types of exercises are designed to treat the kind of problem the patient has and to assist him to rebuild strength as well as the range of motion without doing further damage. Depending on the injury, the patient is asked to do one or a combination of these various types of exercises:

• Passive range of motion.
• Active-assisted range of motion.
• Active range of motion.

 

Passive Range of Motion (PROM)

This is the space in which the part of the body is moved with the help of someone or something creating the movement, such as a physiotherapist or equipment. The patient does not engage himself i.e., the patient makes no effort to move the joint. PROM exercises are beneficial when a situation such as an accident has left the patient bedridden or wheelchair-bound or paralyzed. If the patient cannot move, the physiotherapist will move the patient's muscles and bend his joints for him daily. The physiotherapist may even teach the patient's family members how to help him.

 

Assisted Active Range of Motion (AAROM)

This is the movement that occurs when someone helps the patient to do the movement. For example, an individual sits on a chair and lifts one leg in front of him as far as he can. Another person who may be a therapist or any helper can help the patient stretch his leg more than he would be able to if the leg is flexed by the patient alone by his muscles. The patient uses the muscles around the weak joint to complete stretching exercises with the help of a physiotherapist or equipment. Stretching a little beyond the limit is good for increasing the range of motion. But pushing too far may lead to a muscle tear or damage to a joint, while doing active assisted movement no one should push the patient to the point of pain.

 

Active Range of Motion (AROM)

This is the space in which the part of the body is moved by using the muscles and the effort is made by the individual himself without outside help. With AROM, the patient performs stretching exercises, moving the muscles around the weak joint without any aid. For example, lifting the leg above the hip to stretch the muscles happens within the active range of motion. The active range of motion is performed by holding movements or stretches for at least 30 seconds. By doing this, the strength of the muscles is built needed for a particular movement. The patient is made to do a variety of range-of-motion exercises that challenge his entire body and not a single muscle group alone. AROM exercises, strengthen the muscles when actively engaged in movement. This is good for overall health and improves mobility over time. ‌Range-of-motion exercises are done to maintain mobility and flexibility. In case of stiffness, mobility decreases, and in such cases range of motion, exercises may help regain the lost mobility. For example, if the patient's knee was injured, he must have stopped moving his knee during the immobilization period. Once the knee heals and is ready to bear weight, the patient finds it hard to move. That's because the knee has lost its range of motion due to the lack of use. The patient may bend and extend the knee but does not move to the full range of motion. The physiotherapist can apply pressure to the knee to move it just a little more than the body allows. This stretches the muscle and joints, thus increasing the range of motion.‌ Care should be taken to keep in mind that no range of motion exercise should cause pain also, while using a passive or active range of motion, stretching beyond the limit may cause damage. The patient should listen to his body and stop when he reaches the limit.

The range of motion is the measurement of the motion around a body part or a specific joint. There are established ranges that are considered normal for various joints in a body. For the joint to have a full range of motion, it must have good flexibility and each joint has its level of flexibility, expressed in the degrees.