Knowing what therapeutic exercise is
Knowing what therapeutic exercise is
By Dr. Daniel Rocha DN LMT CPT CNS
Many require physical therapy but do not understand what this entails. Let us go over the different types of therapeutic exercise designed to rehabilitate any injuries you are having.
1. Manual Resistance Exercise
Manual resistance exercise is resistance that is provided by a therapist or patient themselves. The amount of resistance cannot be measured quantitatively, meaning that no actual number is applied. This technique is used when a muscle is weak and needs to be strengthened, or it can only overcome moderate resistance. It is also used when the range of joint movements needs to be controlled.
A simple example is doing a bicep curl, having a therapist or patient put pressure on the hand as they curl to contract the biceps.
2. Mechanical Resistance Exercise
Mechanical resistance exercise is when the resistance is applied through the use of equipment or mechanical apparatus. The amount of resistance can be measured quantitatively and incrementally progressed over time. This means we can use actual weight and see if each week the patient gets stronger. It is useful when the patient has progressed from manual resistance.
Another simple example is the use of a cable machine for biceps curl. We can keep track that one week 10lbs was used then next week 15lbs etc.
3. A dynamic muscle contraction causes joint movement and focuses on concentric and eccentric muscle actions. Concentric exercise refers to the dynamic muscle loading by physical shortening the muscle. An example is lifting a weight, and your biceps bulge. The eccentric exercise is the dynamic loading of a muscle by physically lengthening the muscle as it attempts to control the load. An example is when finishing the biceps curl and you lower the weight in a controlled manner, feeling the muscle stretch.
4. Isokinetic Exercise
Isokinetic exercise is a dynamic exercise where the velocity of muscle shortening or lengthening and the angular limb velocity is predetermined and held constant by a rate-limiting device known as an isokinetic dynamometer. Isokinetic refers to movement that occurs at an equal and constant velocity. The force encountered by the muscle depends on the extent of force applied to the equipment.
Isokinetic exercise can be explained when an individual is putting in maximum effort during each repetition of an exercise, the contracting muscle produces maximum force output, consistent with the muscle’s tension capabilities at all portions in the range of movement. The use of isokinetic training is integrated into the later stages of rehabilitation.
A great example is in Rocky IV, how the Russians trained Drago. His leg was strapped to a chair and each rep was at maximum effort through the whole range of motion.
5.) Open-Chain / Closed-Chain Exercises
Open-chain exercises involve motions in which the distal segment, such as the hand or foot, is free to move in space, without causing concurrent motions at adjacent joints. Limb movement occurs distal to the moving joint, and muscle activation occurs in the muscles that cross the moving joint. For example, during knee flexion in an open-chain exercise, the action of the hamstrings is independent of the recruitment of other hip or ankle musculature. The patient is holding onto a chair, keeping their body upright and stable. They use only the hamstring to bend at the knee, contracting the hamstrings.
Closed-Chain Exercises
Closed-chain exercises typically are performed in weight-bearing positions. They involve motions where the body moves on a distal segment that is fixed or stabilized on a support surface. Movement at one joint causes simultaneous motions at distal as well as proximal joints in a relatively predictable manner. For example, when performing a squat and then returning to an erect position, or standing position, the knees flex and extend, and the hips and ankles move in conjunction with the squat. Examples in the upper extremities or upper body include press-ups from a chair and wall push-offs. Other examples in the lower extremities or lower body include lunges and step-up or step-down exercises.
The idea is to utilize a strong surface, wall, floor, chair, etc, and perform a compound or multi-joint exercise. Squats utilize the knees, hips, and ankles for example.
I hope this article helps and allows you to choose a physical therapist who is best suited to help you accomplish your rehabilitation goals. In the meantime, message me with any questions or let me get you scheduled for a Naprapathic treatment.
Kisner, C., & Colby, L. A. (2013). Therapeutic exercise: Foundations and techniques. Philadelphia: F.A. Davis.