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.

 

Top 10 Benefits of a Chiropractic Adjustment

Do you want to receive chiropractic care, and wonder whether your condition can be treated by a chiropractor? Then this blog will help you understand and know the various conditions that can be treated by a chiropractor. Chiropractic care is a safe and non-invasive form of healthcare that can treat various types of conditions. A chiropractor aims to improve neurological function for the whole body.

 

Chiropractic Treatment

Chiropractic treatment is widely known for treating neck and back pain but it might be surprising to learn that many people visit a chiropractor to get relief from headaches, arthritis, and other conditions. Chiropractors treat disorders related to the musculoskeletal system and focus on treating the condition. The basic premise is that the spine is the center of health and wellness, pain and inflammation in other parts of the body can occur when the spine is out of alignment. Regular chiropractic care reduces pain, less tension, and increases movement. It is accomplished through safe and natural practices that encourage the brain and the body to communicate with one another properly.

Chiropractic treatments focus on a variety of non-invasive methods to help the body heal itself, rather than relying on medications or surgery.

Chiropractors mainly use manual therapy to treat a variety of health conditions. The goal of chiropractic care is to help people feel better and live a more active life, without the side effects of medication and surgery. The most common chiropractic therapy is chiropractic adjustment also known as spinal manipulation. The purpose of an adjustment is to restore joint mobility by manually manipulating the joints to alleviate pain and muscle tightness. Chiropractic treatments include other techniques like massage, including deep tissue massage to help with muscle knots in the back, ice therapy, heat therapy, cold laser therapy, ice or heat therapy, exercises, etc.

Chiropractors are experts in treating conditions that affect the joints, muscles, spine, and nervous system. They take careful assessment and evaluation, review the symptoms and medical history, and possibly recommend taking an X-ray, to diagnose and treat a range of issues and illnesses that compromise health and quality of life. Chiropractors are highly trained medical professionals who work with people of all age groups to manage pain and improve function. The chiropractor recommends a customized treatment plan to help alleviate the symptoms.

A treatment plan may include one or more adjustments, additional chiropractic therapies, and healthy lifestyle habits. They may suggest exercises that can be performed by the patient on his own time to help his body heal. These may include exercises that increase flexibility and range of motion to help improve posture and strengthen muscles.

Chiropractic treatments are not only effective in treating neck pain and back pain but have also been found to be effective in treating various conditions, few of them are mentioned below:

·        Joint Pain, chiropractors can help alleviate pain in the joints, particularly the shoulders, hips, and knees.

·        Soft Tissue injuries such as Whiplash,  Sprains, and Strains also often benefit from chiropractic treatment. Helps to relieve pain and stiffness in the neck, back, or joints, related to soft tissue injuries. Chiropractors conduct a comprehensive assessment of the pain and symptoms and provide specific adjustments along with prescribing exercises to manage pain and prevent a recurrence.

·        Spinal Pain, chiropractic treatments can offer relief in a few sessions and sometimes immediately by spinal manipulation. Chiropractors assess the underlying factors that contribute to pain and often prescribe rehabilitative exercises to keep the patient well long after the treatments are complete.

·        Arthritis, Frozen Shoulder, Osteoarthritis, and even Ligament and Tendon strains may benefit from chiropractic treatment to restore pain-free movement in the joints.

·        Sciatica, chiropractors can help to alleviate pain with adjustments of the sacroiliac joint while also prescribing exercises to strengthen muscles in the core and around the low back to prevent further aggravation.

·        Headaches, Tension Headaches associated with poor posture, stress, and even underlying injuries. Chiropractor thoroughly evaluates tension headaches to better understand their cause so they can offer the most effective treatments. They may recommend skeletal manipulations of the neck, shoulders, or spine along with daily stretches and strengthening exercises to address the headaches.

·        Migraine is another common type of headache that often benefits from chiropractic treatment. A growing body of research supports chiropractic care in reducing the frequency, duration, and intensity of migraine pain while also helping individuals reduce their reliance on heavy medications.

·        Fibromyalgia, common symptoms include jaw pain, headaches, tingling and numbness in the hands and feet, stiff joints and muscles, and widespread pain. Chiropractic treatment can help restore the balance of the skeletal structure, and reduce the frequency of the symptoms. They can also help with pain management and improve sleep quality.

The number of chiropractic sessions required depends on the condition and how quickly the body responds to treatment. Chiropractors treat the patient so that he/she gets an individualized level of care that helps improve their health and mental state quickly and successfully in as few sessions as possible.

Stroke and Cold Weather: How decrease in Temperature increases the risk of Ischemic Stroke?

Incidences of stroke have been found to have possible associations with certain weather conditions. Daily temperature variations and higher humidity were associated with increased stroke rates. Colder average annual temperatures are associated with stroke. An average daily temperature change of 5 degrees Fahrenheit is associated with about a 6 percent increase in stroke risk. In this blog, we will discuss how stroke is associated with cold weather and how we can prevent it.

 

Winter season is a cause for various health ailments, as we head towards winter it has been seen that the drop in temperature is responsible for a rise in several health-related problems, among which stroke is one of the critical challenges.  During the winter months the chances of getting a stroke increase.

Stroke is a unique health condition that can occur because of blockage, causing paralysis, or can even burst which leads to bleeding. If a stroke occurs in the right side of the brain, the left side of the body will be affected, causing paralysis on the left side of the body, speech or language problems, slow, cautious behavior, memory loss, etc.

Studies have proved that there are more stroke cases during extremely cold conditions. The risk of getting a stroke attack increases by 80% particularly when the temperature dips below 15 degrees Celsius. One of the main reasons that can attribute to this is, that during the cold seasons the blood vessels constrict, which leads to an increase in blood pressure, which means that the blood has to be pumped harder to travel around the body, making it one of the major factors for the onset of stroke.

Another reason may be due to the various changes in the chemical balance that occur in the body during the winter season. These include cholesterol levels and some other factors that increase the chances of clotting. Also, changes in physical activity which usually decreases during winter as well as weight gain can play a role. These are probably the reasons why the number of stroke cases goes up during winter.

Winter can lead some people to develop depression, which has been linked to an increased risk of stroke.

The incidence of stroke is significantly increased in winter, especially when the temperature drops sharply in a cold period. Though the pathogenesis of ischemic stroke remains unclear, one of the causes may involve a cold-induced increase in blood pressure, hypercoagulation, and fibrinolysis.

 

Ways to Control the risk of Stroke in Winter:

To prevent the chances of stroke and other cardiovascular events, it is strongly recommended:

• To regularly monitor blood pressure during the changing weather. And even with mild changes or a rise in blood pressure, one needs to immediately consult the doctor who can prescribe an adjustment in the medications.
• Avoid sudden exposure to harsh cold weather.
• Maintain the recommended levels of regular physical activity.
• Avoid sudden changes in diet.
• Avoid stress.
• Avoid unhealthy drinking and eating too much.
• Avoid being less active in winter,
• Avoid developing depression,
• Wear warm clothing when going outside.
• Quit smoking.
• Do more exercise if overweight.
• Simply staying indoors or ensuring ample heating when it's especially cold outside.

During the average winter temperature of <13°C, the risk factors, etiology, coagulation factors, and degree of neurological impairment of patients with ischemic stroke are found to be significantly different from patients with ischemic stroke during warmer temperatures thus it is advised to keep warm and avoid sudden exposure to severe cold temperatures as the risk of stroke remains for many days after the exposure.

 

Top 10 Exercises for Pediatric Patients after Cardiac Surgery

Physiotherapy plays an important part in the recovery process of pediatric patients after cardiac surgery. After cardiac surgery, the child needs to start the exercises as soon as possible. Before cardiac surgery, pediatric patients are given some exercises by the physiotherapist to prepare them for the surgery. These exercises are required to be done after surgery to help them recover and to keep their lungs clear, well-expanded, and free of mucus. Physiotherapy treatment focuses on general mobility and chest care. It is essential to consult a physiotherapist before cardiac surgery. As he guides and teaches exercises that should be practiced before and after the surgery. This blog is designed to mention a few exercises that will help pediatric patients to recover after cardiac surgery.

 

Exercise strategy

A physiotherapist is a health professional who is trained to prevent, identify, and correct movement problems. Pediatric patients should start doing the exercises as soon as possible while in the hospital. The posture is frequently checked during the day to make sure the child sits or stands straight and does not lean forward or to the side.

• Sit in a chair with feet on the floor.
• Sit or stand up straight, with the shoulders pulled back and down.
• Shoulders should be stacked above the hips and should not be arching the back.

The breastbone takes approximately three months to heal. Therefore, to prevent stress on the breastbone the child should avoid pushing through his/her arms. He/she is advised to put his/her hands on the knees and shuffle the bottom when getting out of bed or a chair for the next three months.

 

Chest care

Chest physiotherapy begins on the first day after the surgery. Discomfort or pain from the chest wound can stop the child from taking a deep breath in and coughing. For the first few days, the child may not be as mobile as he/she would normally be and so he/she can't breathe deeply. If the child is taught deep breathing exercises before the surgery, then it is easier to remember these exercises afterward.

 

Breathing exercise:

The physiotherapist will teach the child how to practice deep breathing.

• The child is made to sit upright with hands placed over the sides of the chest.
• Then, asked to slowly take a deep breath through the nose.
• Hold this breath in for one to two seconds and then breathe the air out slowly through the mouth.
• Repeat 5 times.
• Then huff 5 times.

To do a huff take a breath (medium-sized) then force the air out quickly through an open mouth.

Coughing:

• Take a deep breath in and have a good strong cough, supporting the chest wound with a small pillow.
• Take normal relaxed breaths after coughing.
• Young children can practice deep breathing by blowing bubbles.
• Older children can practice deep breathing using a device called an incentive spirometer.

After surgery, once the child is awake and breathing on their own, it is important to start doing the exercises.

 

Chin tucks:

Prevent forward chin posture, to encourage good posture, as forward chin posture can cause neck discomfort.

• Sit in a good posture.
• Sit up tall, drawing the shoulder blades towards the center of the spine.
• While holding this posture, focus on bringing the chin back so the neck is long.
• Hold this position for 5-10 seconds to feel the stretch and repeat 5-10 times.

Initially, some gentle arm and leg exercises should be done to prevent stiffness, help circulation, and then progress to walking

 

Shoulder shrugs:

From the first day after the surgery, exercising should be encouraged.

• The patient is sitting in a chair or standing.
• Gently bring both shoulders up and down.
• Repeat five to ten times.

 

Shoulder rolls:

Improve shoulder movement while maintaining neck posture.

• Sit in a good posture.
• Slowly and gently roll the shoulders in circles forward and backward.
• Relax and repeat 5-10 times.

 

Arm raise:

The exercise goes like this:

• Sit in a good posture.
• Sit up tall, and draw the shoulder blades towards the center of the spine.
• Lift one arm so that the elbow is beside the ear and then lower the arm.
• Repeat 5-10 times. Repeat with the other arm.
• Raise both arms straight forward over the head.
• Then bring both arms back and down.
• Repeat five to ten times.

 

Trunk side flexion:

Reduce stiffness that can happen with a side incision.

• Sit in a good posture.
• Lift the arm straight up on the incision.
• Bend away from the incision so that it feels a stretch.
• Breathe, in, then breathe out.
• Return to the starting position and repeat 5-10 times.

 

Gentle heel slides:

These exercises are taught to help keep the muscles strong and promote circulation.

• The patient lies on the bed with the legs well supported.
• Bend both knees and straighten the legs alternatively.
• Repeat 10 times.

 

Ankle movements:

The exercise goes like this:

• The patient lies on the bed or sits in a chair.
• Draw a circle shape with the feet from ankles, in one direction.
• Repeat in the other direction.
• Repeat 10 times in each direction.
• Bring the ankles up towards the body.
• Then bring them down toward the floor.
• Repeat 10 times with each ankle.

Quadriceps sets:

The exercise goes like this:

• The patient lies on the bed with legs straight.
• Tighten the thigh muscles on the front of the legs.
• Press the back of the knee into the bed and pull the toes towards the body. 

Quadriceps arc:

The exercise goes like this:

• The patient lies on the bed with legs straight.
• Tighten the thigh muscles.
• Lift the leg from the bed to a small height.
• Hold for 2 seconds, then slowly bring it down
• Repeat ten times with each leg. 

From day two onwards following the surgery, begin to progress the mobility under the guidance of an experienced physiotherapist. After heart surgery, the child may have been unable to exercise for some time, so the increase in an activity needs to be done gradually, to build up his/her fitness slowly. Your physiotherapist may also recommend an exercise bike or pedals, to improve the patient's fitness by increasing the length of time on the bike rather than the resistance. At three months after the surgery, the child should be able to do everything that he/she did before the surgery.