Resisted exercises

• Resistance exercise is a form of active exercise in

which a dynamic or static muscular contraction is
resisted by an outside force.
• The forces of resistance offered to the action of the
working muscles are artificially and systematically
increased to develop the power and endurance of the
muscles.
 Principles of resistance
• External force is applied to the body levers to oppose the
force of muscular contraction.
• Tension is increased within the muscle in response to
opposing force i.e. resistance and muscle respond by increase
in muscle power and hypertrophy.
• As increase in muscular development occurs in response to
the increase in intramuscular tension which is in direct
proportion to the application of the resistance.
 Resistance
Exercise

Isometri Isotonic Isokinetic

c
 Isometric Resisted Exercise

• Isometric resisted exercise is a static contraction of

muscle against external resistance without appreciable
change in its length or joint motion.
Advantage
• Isometric exercise is valuable when joint motion is
uncomfortable or contraindicated, during
immobilization.
• Isometric exercise is effective when weakness exist at a
specific point in the ROM.
• Easy to understand.
 Isotonic Resisted Exercise
• During isotonic contraction the resistive force which is
applied should sufficient to increase intramuscular
tension to maximum without interfering with the ability
of the muscles to produce co-ordinated movement.
• CONCENTRIC CONTRACTION occurs when active
muscle undergoes shortening while overcoming
external resistance.
• ECCENTRIC CONTRACTION occurs when active
muscle undergoes lengthening while being
overcoming an external resistance.
 Isokinetic Resistive Exercise

• Isokinetic exercise is a form of active exercise in which

a muscle or group of muscles contracts against a
controlled accommodating resistance which is moving at
a constant angular velocity.
• The isokinetic exercise are performed with a specialized
apparatus that provides variable resistance to a
movement, so that no matter how much effort is exerted,
the movement takes place at a constant speed.
– maximum resistance through the entire ROM.
 Advantage

• Ability to fully activate more muscle fiber for

longer period because the machine
accommodate the resistance according to the
changing ability throughout the ROM.

• The isokinetic device OPTION provides many

strengthening protocols to chose from
according to the patient condition and the
goal of exercise.
 Disadvantage

• The device is expensive

• Require trained personnel for setting up the
patient training program.
Manual Resistance Exercise

• Manual resistance
exercise is a type of
active resistive exercise
in which resistance is
provided by a therapist
or other professional.
 Uses of Manual Resistance Exercise

– Early stages of an exercise program.

– When the range of joint movement needs to be carefully

controlled.
 Advantages of Manual Resistance Exercise

– Easy,

– Inexpensive,

– Specific muscle can be exercised

 Disadvantages

– The amount of resistance:

• cannot be measured quantitatively.
• is limited by the strength of the therapist.
– Effort & time consuming.
Mechanical Resistance Exercise

• Mechanical resistance exercise

is a form of active exercise in
which resistance is applied
through the use of mechanical
apparatus.
 Advantages of Mechanical Resistance Exercise

• The amount of resistance can be:

– measured quantitatively

– progressed over time.

 Uses of Mechanical Resistance Exercise

• When amount of resistance needed is greater than the therapist

can apply manually
 Goals of Resistance Exercise
• The overall purpose of resistance exercise is
to:

Improve physical function.

 Specific goals

Goal of resistive exercise

of
resistance
exercise

Increase
Increase Increase
Muscular
Power Muscle volume
Endurance
 Principles of resistance

There are five factors which contribute to the development of muscular efficiency
which are following
1. Power
2. Endurance
3. Volume of muscle
4. Speed of contraction
5. Coordination
The power, endurance and volume are interlinked and can be build up by the use of
resistive exercises.
 Principles of resistance
Power:

• Power develops in response to the maximum force or resistance

which is consistent with the ability of the muscle to over come it, so
therefore the power can be enhanced when the muscle will work
against the progressively increasing resistance.
• During power development the main factor is resistance the method
used to promote the power is ‘’progressive resistance with low
repetition exercise’’.

Endurance:
• Is the quality which develops in response to repetitive contraction so
in this case the principle followed would be ‘’low resistance with
high repetition exercise’’.
 Principles of resistance
Volume:
• Is observed or measured as an indicator of
hypertrophy, this usually develops in proportion to the
power.
Skill in estimating the capacity of the muscle at every
stage of treatment and matching it with the correct
amount of resistance is the key note to success in the
use of resisted exercises.
 VERIATION OF POWER

• Muscles which are capable of producing a

considerable range of joint movement are
not equally powerful in all parts of range.
• Greatest strength—fully extended
• Force diminish.----as they shorten
• Most powerful in the part of range in which
muscle is habitually used.
 Techniques

• Starting position
• Pattern of movement
• Stabilisation
• Traction
• The Resistive Force
• Character of Movement
• Repetition
• Co.-operation of patient
A resistance force is that which is provided
other than the gravity and friction.
It may be by following means
1. The Physiotherapist
2. The patient
3. The weights
4. Weight and pulley circuits
5. Spring and other elastic structures
6. Substance which are malleable
7. Water
 Resistance by the
Physiotherapist
It is applied manually. Physiotherapists hand
is used to apply the resistance. This may
vary in different part of range according to
the power of the muscle.
 Resistance by the Patient
Patient can resist his movement by his own
sound limb, or by his own body weight.
Examples:
High sitting and resisting extension of knee
by his own sound limb.
Press ups.
 RESISTANCE BY WEIGHT
Direct application of force on the body forms a
simple and effective method.
Apparatus used for this are
 Sand bags
 Metal weights
 Medicinal ball i.e. held in the hand
Attachment should be comfortable and efficient.
Resistance by weights is also known as PRE
(Progressive resistance exercises)
 PROGRESSIVE RESISTANCE
EXERCISES PRE
Progressive resistance exercise is a dynamic
resistance training in which a constant external
load is applied to the contracting muscle by some
mechanical means and incrementally increased.
The RM is used as the basis of progression in the
resistance.
Multiple sets are used in a session, which may
consist of 2-3 sets of 6-12repititions of 6-12 RM
Common variants are DeLorme, Oxford and
McQueen method.
 REPETITION MAXIMUM
RM is a method of quantifying exercise
intensity, Given by Delorme
Definition:
A repetition maximum is defined as the
greatest amount of weight a muscle can
move through the available ROM in a
specific no of times.
1 RM FOR A MUSCLE
It is the maximum weight (resistance) with which
the muscle can contract through full/ available
ROM for one time. The muscle will be unable to
perform the repetition for a second time .

10 RM FOR A MUSCLE
It is the maximum weight (resistance) with which
the muscle can contract through full/ available
ROM for 10 times. The muscle will be unable to
perform an 11th repetition .
Resistance by Pulley circuits
The use of rope and pulley allows the force
to exerted by a weight to act in any direction.
So muscle is not required to work against
both gravity and the weight.
The effect of gravity can be counter
balanced when work is done in horizontal
plane. This is helpful for the weak muscle
when the limb is heavy.
• Assuming that a particular muscle is
powerful in mid range so the resistance is
applied at right angle. Both the power and
the resistance will diminish on either side
of the point.
• Psychologically it is important for the
patient that he is able to see the weight
moving across
 Different method of application of
resistance
• Resistance by weight and pulley circuit:
 Resistance by springs and other
elastic substances

• Resisting force of spring increases

progressively as the spring can be compressed
and stretched according to the type of spring
used.
• When springs are used the speed of the
movement must be carefully controlled by
muscle both in contraction and controlled
relaxation as accumulated energy in the
stretched spring make natural recoil very great .
Resistance by springs and
other elastic substances
 RESISTANCE BY MALLEABLE
SUBSTANCES
Substances such as, clay, some kind of
waxes, plasticine and wet sand bags can be
molded into different shapes.

USE: This can be used for both

strengthening and mobilization of hand
 RESISTANCE BY WATER
Resistance increase as the speed and
surface area is increased.
When the movement is vertical buoyancy
adds to the resistance on the way down
and cancels out much of the resistance on
the way up.
It is also called as HYDROTHERAPY.
 PROGRESSION
As the power of muscle increase the
resistance must be increased
proportionally.
There are four main methods to increase
the resistance to muscle.
1. Increase the weight or poundage
2. Increase in leverage
3. Alteration in the speed of movement
4. Increase in the duration of exercise
 INCREASE IN POUNDAGE OR WEIGHT

As the muscle power increases the weight is

increased proportionally.
The actual amount of the increase is
variable according to particular muscle
group, its rate of progression and the
frequency at which an increase is made.
Increase in power α increase in resistance
 INCREASE IN LEVERAGE
Total resistance depend upon the point of
application in relation to the fulcrum.
Moment of force= weight × perpendicular
distance.
Applying resistance at wrist is more as
compared to elbow in shoulder abduction.
 ALTERATION IN SPEED OF
MOVEMENT:
• Efficient contraction when performed at natural or
optimal speed.
• Increase or decrease in the natural speed of
movement increase the effect of resistance when
muscle work concentrically
• But when performed eccentrically the slower the
movement greater the effect of resistance.
• Concentric work is easier when performed at
natural speed, eccentric work is easier when
performed at high speed. i.e. climbing uphill and
coming
 INCREASE IN DURATION
• As the muscle warm up to overcome the
resistance they become more efficient and
effect of resistance decrease and exercise
seems easier.
• Fatigue reduces the efficiency of the
muscle so resistance increase
 EFFECT AND USES OF RESISTED
EXERCISES
• MUSCLE POWER: Resisted exercise is
used to build up weak muscle and restore
muscle power for stability and coordinated
movement.
• BLOOD FLOW: It increase in response to
amount of work done. Blood flow increase
10 times in strenuous activity. blood flow
cause oxygen and nutrients to the muscle.
• BLOOD PRESSURE: resisted exercises
cause increase in blood pressure.
• Heat: heat produced during activity cause
stimulation of heat regulation center which
result in vasodilation. Skin appear moist,
pink indicating heat lost from the surface.
The degree of moisture depends largely
on temperature, humidity and movement
of atmosphere.
 INVOLUNTARY MOVEMENTS

REFLAX MOVEMENT:
It is the motor response to sensory stimulus.

The reflex movements are protective in nature.

They become usually habitual or autonomic.

 REFLEX ARC
• It is the pathway of impulse that give rise
to the stimulus. It consist of two neurons
• AFFERENT NEURONS - - from sensory
receptor organ to CNS
• EFFERENT NEURONS - - from CNS to
effector organ i.e. muscle.
• Reflex activity can be stimulated and used
to improve or facilitate movement or to
maintain posture.
 A simplified reflex arc

stimulus
 A simplified reflex arc

stimulus

receptor
 A simplified reflex arc

stimulus
sensory neurone
receptor
 A simplified reflex arc

stimulus
sensory neurone
receptor

spinal
cord of
central
nervous
system
 A simplified reflex arc

stimulus
sensory neurone
receptor

spinal
relay cord of
neurone central
nervous
system
 A simplified reflex arc

stimulus
sensory neurone
receptor

spinal
relay cord of
neurone central
nervous
system

motor neurone
 A simplified reflex arc

stimulus
sensory neurone
receptor

spinal
relay cord of
neurone central
nervous
system
effector

motor neurone
 THE STRETCH REFLEX
 This is spinal reflex activated by stretching
of the muscle.
 When an innervated muscle is stretched it
respond by contraction and developing
tension to counteract the stretching force.
 Contraction of the muscle by stretch reflex
is accompanied by the reciprocal inhibition
of the antagonistic muscle.
 THE RIGHTING REFLEX
These are series of reflexes concerned with
maintenance and restoration of equilibrium.
Pushing the patient cause the series of
mass movements to restore the balance.
 THE POSTURAL REFLEX
The erect posture is maintained by the
complex series of reflexes collectively
known as postural reflexes.
 EFFECT AND USES
INITIATION OF REFLEX MOVEMENT: it
provide activity of NM mechanism when
voluntary effort is ineffective. i.e. in flaccid
paralysis and brain damage.
NORMAL JOINT MOBILITY: joint
mobility and muscle extensibility is
maintained when the spastic paralysis
make voluntary movements impossible.
 EFFECT AND USES
CIRCULATION IMPROVEMENT: it is
improved by the contraction of muscle and
movement of joint.
RELAXATION OF THE SPASTIC
MUSCLE: it is achieved by reciprocal
inhibition.
POSTURAL REFLEXES: this is basis for
the postural reeducation.
Thanks