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Practical Exercise Therapy PDF

485 Pages·1999·11.43 MB·English
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Page i Practical Exercise Therapy Fourth Edition Edited by Margaret Hollis MBE, MSc, FCSP, DipTP Formerly Principal, Bradford School of Physiotherapy and Phyl Fletcher-Cook MEd, MCSP, Cert Ed Senior Lecturer, Huddersfield University With contributions by Sheila S. Kitchen MSc, MSCP, DipTP Course Co-ordinator, Physiotherapy Group King's College, London Barbara Sanford DipPE (Lond. Univ.) Formerly Lecturer in Physical Education Bradford School of Physiotherapy The late Patricia J. Waddington BA (Hons), FCSP, DipTP Formerly Principal, School of Physiotherapy Manchester Royal Infirmary Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 1 of 1 3/14/2009 1:39 PM Page ii © 1976, 1981, 1988, 1999 by Blackwell Science Ltd Editorial Offices: Osney Mead, Oxford OX2 0EL 25 John Street, London WC1N 2BL 23 Ainslie Place, Edinburgh EH3 6AJ 350 Main Street, Malden MA 02148 5018, USA 54 University Street, Carlton Victoria 3053, Australia 10, rue Casimir Delavigne 75006 Paris, France Other Editorial Offices: Blackwell Wissenschafts-Verlag GmbH Kurfürstendamm 57 10707 Berlin, Germany Blackwell Science KK MG Kodenmacho Building 7-10 Kodenmacho Nihombashi Chuo-ku, Tokyo 104, Japan The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First published 1976 Reprinted 1997 Second edition 1981 Reprinted 1983, 1984, 1985, 1987 Third edition 1989 Reprinted 1990, 1992, 1994, 1997 Fourth Edition 1999 Set in Sabon 10 on 13.5 pt by Best-set Typesetter Ltd., Hong Kong Printed and bound in Great Britain at The Alden Press, Oxford The Blackwell Science logo is a trade mark of Blackwell Science Ltd, registered at the United Kingdom Trade Marks Registry DISTRIBUTORS Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 1 of 3 3/14/2009 1:39 PM Marston Book Services Ltd PO Box 269 Abingdon Oxon OX14 4YN (Orders: Tel: 01235 465500 Fax: 01235 465555) USA Blackwell Science, Inc. Commerce Place 350 Main Street Malden, MA 02148 5018 (Orders: Tel: 800 759 6102 781 388 8250 Fax: 781 388 8255) Canada Login Brothers Book Company 324 Saulteaux Crescent Winnipeg, Manitoba R3J 3T2 (Orders: Tel: 204 837-2987 Fax: 204 837-3116) Australia Blackwell Science Pty Ltd 54 University Street Carlton, Victoria 3053 (Orders: Tel: 03 9347 0300 Fax: 03 9347 5001) A catalogue record for this title is available from the British Library ISBN 0-632-04973-1 Library of Congress Cataloging-in-Publication Data Practical exercise therapy/edited by Margaret Hollis and Phyl Fletcher-Cook; with contributions by Sheila S. Kitchen, Barbara Sanford, the late Patricia J. Waddington. —4th ed. p. cm. Includes bibliographical references and index. ISBN 0-632-04973-1 1. Exercise therapy. I. Hollis, Margaret. II. Fletcher-Cook, Phyl. RM725.P73 1999 615.8'2—dc21 98-53120 CIP For further information on Blackwell Science, visit our website: www.blackwell-science.com Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 2 of 3 3/14/2009 1:39 PM Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 3 of 3 3/14/2009 1:39 PM Page iii Contents Preface v Acknowledgements vii 1 Introduction M. Hollis 1 2 Biomechanics M. Hollis & S.S. Kitchen 9 3 Fundamental and Derived Positions M. Hollis 47 4 Relaxation M. Hollis 58 5 Passive Movements M. Hollis 62 6 Respiratory Care – Basic Exercises Phyl Fletcher-Cook 76 7 Apparatus: Small, Soft and Large M. Hollis & B. Sanford 83 8 Suspension M. Hollis 96 9 Springs, Thera-Bands, Pulleys, Weights and Water M. Hollis 109 10 Re-education of Walking 134 Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 1 of 2 3/14/2009 1:31 PM M. Hollis 11 Examination, Assessment and Recording of Muscle Strength M. Hollis 145 12 Mobilization of Joints M. Hollis 159 13 Assessment of a Patient's Suitability for Group Treatment M. Hollis & B. Sanford 163 14 Group Exercise B. Sanford 165 15 Preparation of Group Activities B. Sanford 172 Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 2 of 2 3/14/2009 1:31 PM Page iv 16 Exercises for Infants and Children M. Hollis & B. Sanford 178 17 Special Regimes M. Hollis 183 18 Neurophysiology of Movement Phyl Fletcher-Cook 189 19 Proprioceptive Neuromuscular Facilitation (PNF) P. J. Waddington 202 20 PNF Arm Patterns P. J. Waddington 206 21 PNF Leg Patterns P. J. Waddington 220 22 PNF Head and Neck, Scapular, and Trunk Patterns P. J. Waddington 231 23 PNF Techniques P. J. Waddington 241 24 Functional Activities on Mats P. J. Waddington 248 25 Balance P. J. Waddington 260 26 Gait P. J. Waddington 269 Index 273 Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 1 of 2 3/14/2009 1:40 PM Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 2 of 2 3/14/2009 1:40 PM Page v Preface In revising this book I have been greatly assisted by my co-editor Phyl Fletcher-Cook who has written new chapters on basic techniques for respiratory care and the neurological basis of movement. Barbara Sanford has checked and revised the chapters on which she worked originally but, sadly, Pat Waddington died in 1997. She gave her blessing to any revision we might make. We have omitted some sections, notably some of the suspension and spring exercises, as these can now be achieved in the more readily available therapeutic pools, and also the exercises for babies. Much of the first edition of the book was based on our knowledge gained in practice both with patients and in teaching students, so we have omitted the original bibliography which mostly related to those parts of the book we have not altered. The two totally rewritten chapters each have their own references. It was not necessary to revise the mechanics chapter as these concepts are eternal truths, as are many of the concepts of movement and muscle action. The first edition became a 'latin primer' as I kept in mind that recovery of movement and re-education of muscle could only be achieved in a limited number of ways. The main principle that all students have to understand is that progression is of the patient, with the physiotherapist constantly adapting techniques to the new needs and demands of the patient. Machines need all the basic principles applied to their use and as more expensive forms of equipment become more freely available in the developed world, there is still great need for the under-developed world to be able to carry out exercise without modern gadgetry. In this fourth edition we have stuck to the principle of producing a basic teaching book so that in the different educational environments which prevail in some countries, students can still turn to simple explanations Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 1 of 1 3/14/2009 1:32 PM Page vi of the 'how' of 'therapeutic exercise'. We hope that future generations of students of all nationalities will find this a book from which they can practise physiotherapeutic skills with the lesser guidance that now prevails. Mr Peter Harrison AIMBI has again undertaken the photography and Janice Eccles has also again been able to type the manuscript. We thank them for their work. I would like to pay tribute to the contribution the late Pat Waddington made to the book and to thank Barbara Sanford for her continued willingness to check and revise. The staff at Blackwell Science continue to encourage me by wanting further editions of my books. I cannot help feeling there must be a swan song sometime soon and in finding Phyl Fletcher-Cook I feel I have assisted with continuity of the idea I first projected, of giving students a background knowledge based on sound principles of mechanics, anatomy and physiology. MARGARET HOLLIS MBE, MSc, FCSP, DIPTP BRADFORD AND PHYL FLETCHER-COOK MEd, MCSP, CERT ED BRADFORD Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 1 of 1 3/14/2009 1:41 PM Page vii Acknowledgements I am grateful to the following companies who lent photographs. Days Medical Aids of Bridgend for Figs 10.2, 10.3, 10.5 and 10.6 of their walking aids. Kirton Designs Ltd of Norwich for Fig. 7.1. Nomeq of Redditch for provision of their extensive bibliography and articles on isokinetics and for Figs 7.2, 7.3, 7.4, 7.5, 7.6, 7.7, 9.29 and 10.1. Portabell Keep Fit Systems Ltd for Fig. 9.38B. Rank Stanley Cox for Fig. 8.3 of the Guthrie Smith suspension frame and Fig. 9.32 of their Variweight boot. Fig. 9.3 is from the booklet issued by The Hygienic Corporation, to whom we are grateful. Table 11.2 is modified from Skinner A. T. & Thomson A. M. (1983) Duffield's Exercise in Water, 3rd edn, Baillière Tindall, London, with permission. Our photographers were Mrs V. Cruse of Pudsey, Mr P. Harrison AIMBI of Bradford and Mr R. E. S. Murray AIIP of Manchester to whom we owe our thanks for their patience and their expertise. To our students who, in learning from us, teach us so much Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 1 of 1 3/14/2009 1:32 PM Page 1 Chapter 1— Introduction M. Hollis The application of therapeutic exercise to a patient is a process which demands an initial examination of the patient's needs and a constant reassessment of the situation in the light of progress or retrogression. It also demands a knowledge of the condition from which the patient suffers, the potential recovery rate and complications which may arise. In addition the therapist must constantly bear in mind the anatomy of the part being treated and of the whole body; the physiological reactions of the body to all exercise and the particular exercise she is applying at the moment; and the underlying mechanical principles associated with the exercise and/or techniques applied. Therapeutic exercise is also influenced by a psychological reaction in which the patient may or may not wish to get better. If he wishes to improve he may be overeager to please and do too much or perform badly and in haste. If he does not wish to improve it may be because he is afraid. He may be in pain and fear more pain, he may be afraid his illness or accident may recur, or he may have a fundamental fear of the whole field of medicine and hospitals in particular. This barrier must be overcome and a rapport established between patient and therapist so that the therapist may initiate the proceedings which will eventually lead to the patient achieving his maximum independent potential. To this end a few simple but important rules should be followed by the therapist. First, each patient should be known by name and greeted and welcomed at each treatment session. Secondly, fear of more pain can be overcome by working and teaching on parts which are not painful. Each action should be taught on the soundest or least painful part, then on the afflicted part gradually working towards the part he most dreads having treated. In this way he will not only be reassured but there will probably be less pain due to facilitation of inhibition. As he relaxes he will relax his protective painful spasm and so have less discomfort. Thirdly, his activities must always be harnessed to a goal which is within his potential of achievement. This has two uses: it is a goal for which he can strive and a matter for congratulation when achieved. The objective can be reset each day or each week or with no regularity at all, but it is most important that the early goal is remarked upon when achieved as then the patient will gain confidence in his therapist as well as in himself. It is said that initially patients have a 'love–hate' relationship with their therapists. This may be so as the therapist may have to insist on the patient performing an uncomfortable manoeuvre and he will not be grateful for it until some time has elapsed. Examples of this situation arise when a patient Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 1 of 1 3/14/2009 1:34 PM Page 2 with an ineffective cough must be persuaded to cough more effectively to void his chest secretions in spite of the pain of his abdominal incision; and when patients have to contract the quadriceps muscle group following knee surgery. In both these cases patients freely admit later on that they hated the therapist at the time, but are grateful now that they were persuaded to do their therapeutic exercise. Therapists who work in this climate become accustomed to this attitude from their patients and learn to use all their manual and psychological skills for the improvement of the patient. With the patient who has a long-term problem, short-distance goal setting is even more important, and knowledge of the medical history of the patient, his social background and his home and work environment will be necessary to determine the sequence of the goals to be achieved. Personal independence should usually be aimed for initially. This may be toileting, personal care and dressing, feeding or ability to get about. Some go hand in hand. It is no use being able to undress and dress in the toilet if there is no possibility of physically getting there. It is essential that the therapist gradually withdraws what she does for the patient so that eventually he does every task for himself. If this goal cannot be achieved then it is important to recognize that substitution must occur, e.g. if independent walking is unsafe and not improving, the patient must come to terms with the appropriate walking aid. Recognizing the moment when no further progress is being made is as important as the first assessment of a patient. Failure to recognize this fact leads to false hopes on the part of the patient and his family and a waste of the resources of the therapist, the tools of her work and the patient's time and effort. Physical Definitions of Muscle Performance Force The force output of a muscle, usually called its strength, is that which develops tension in the contracting muscle so that it contracts to produce work. Work is defined as the action of a force over a specific distance in space. In the human body it refers to the product of muscular force exerted through a specific range of movement. Power refers to a rate of doing work. In muscle action it is the output of the muscles at specific speeds of contraction. Endurance is the capacity to contract muscles at a specific rate (power) for a specific interval of time. Muscles require to be able to do work at varying tempos and to maintain the work for a period of time; failure to be able to produce satisfactory strength of muscle leads to weakness in one or more of the roles in which muscles play their part in normal activities. The roles of muscles are dealt with later in this chapter. Any failure of strength can lead to joint malfunction as well as functional incapacity in any of the daily activities to which the human body is subject during normal living. Types of Muscle Work There are two main ways in which a muscle may work naturally. It may contract and produce no movement, called isometric contraction, or it may produce movement during contraction, called isotonic contraction. Both these types of contraction may be used therapeutically, but a third type of muscle action Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 1 of 1 3/14/2009 1:35 PM Page 3 may be applied to muscles to strengthen them. This uses isokinetic or accommodative resistance to achieve isotonic contractions (see Chapter 9). Isotonic Contraction When a muscle works isotonically it contracts and the part of the body to which it is attached will move. There are two types of isotonic contraction. Isotonic Shortening. When a muscle performs a contraction and its two attachments are approximating to one another, the contraction is known as an isotonic shortening, e.g. when the arm is raised from the side and the abductors of the shoulder contract, the contraction is one of isotonic shortening. Isotonic Lengthening When the attachments of a muscle move slowly away from one another and the muscle allows this movement to occur in a controlled manner, the muscle action is one of isotonic lengthening, e.g. when the body is in the upright position and the arm is lowered from abduction to adduction, the abductors of the shoulder will control the movement and these abductors will be acting in isotonic lengthening. Isotonic shortening can take place under any circumstances, i.e. whenever movement takes place in which the attachments of a muscle approximate, the muscle work will be isotonic shortening. Isotonic lengthening, however, may only be brought about if an outside force is applied to the component which is to be moved and the body part is slowly moved so that the attachments of the muscle are moved away from one another. Gravity may be the outside force which pulls body components towards the earth as in lowering the arm from the abducted position to the side, or in sitting on the edge of a table lowering the outstretched leg to a right angle at the knee. However, under many other circumstances, in order to work a muscle in isotonic lengthening it is necessary for the therapist to be the outside force. The command given is 'resist slightly whilst I move your leg', or arm as the case may be, to a new position. The patient offers slight resistance, the therapist applies pressure which is greater than the resistance offered by the patient and is on the surface which is on the same aspect as the muscles which are required to be worked in isotonic lengthening. For example, if a patient is in side lying and the quadriceps are to be worked, the leg will be arranged straight at the knee, one hand will be placed as a stabilizing hand on the thigh and to palpate the quadriceps. The other hand will be placed on the anterior aspect of the leg and the command will be given 'resist slightly while I bend your leg'. The patient resists, the therapist bends the leg and the quadriceps will be worked in isotonic lengthening. Many other examples of isotonic shortening and isotonic lengthening can be found and therapists should attempt to work out the single movements of each of the joints of the body with and without resistance so that they are able to identify isotonic shortening and isotonic lengthening. When therapists can identify these two types of muscle work they should then try to apply the range of muscle work as described below. Isometric Contraction When a muscle works isometrically it shortens its muscular length and slightly lengthens its non-contractile components and in doing so no movement occurs at any of the joints over Document http://www.netlibrary.com.lp.hscl.ufl.edu/nlreader/nlreader.dll?bookid=... 1 of 1 3/14/2009 1:36 PM

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