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Isometric exercises

Bentuk latihan statik Adalah latiahn dimana kontraksi otot tidak
menimbulkan perubahan panjang otot dan tampa menimbulkan
gerakan sendi.
Static contraction menimbulkan ketenggangan otot yang dihasilkan
oleh kekuatan kontraksi .
-Selama isometric contraction, kekuatan otot akan meningkat bila
beban dipertahankan minimal 6 detik.
-in order to develop strength throughout the ROM, resistance must
be applied in several positions.
-The amount of tension produced during the isometric contraction is
directly affected by the length of the muscle of the time of
contraction. Therefore the amount of resistance also must be vary at
different points in the range.
-Resistance can be applied either manually or mechanically.
Examples of Isometric regimens
Brief maximal isometric exercise: in which the patient
performs a singles isometric contraction is held for 5
to 6 seconds.
Brief repetitive isometric exercise: in which the patient
performs five to ten brief maximum isometric
contraction against resistance.
Multiple isometric exercise: in which the patient
performs the isometric exercise against resistance
applied every 10 degrees in the ROM and hold for 10
seconds. This type of exercise improve muscle
strength through the ROM
Equipment used with isometric
1-Free weights and pully system
2-Isokinetic devices
3-Lifting a weight that provides resistance
greater than the force of the muscle
4-when the patient performs the exercise
against fixed objects( pushing a wall)
1-Determine the point in the ROM at which the muscle
contraction is to occur and set the patient up
2-Appropriate stabilization is need to avoid substitution
3-Instruct the patient to contract the muscle, hold a
least 6 seconds, then relax and repeat
4-Have the patient carry out the exercise at several
points in the ROM
5-Make sure that the patient exhales while exerting his
maximum isometric exercise
Movement performed within the
unrestricted ROM controlled by the voluntary
contraction of the muscle.
Classification of Active Movement
1- Active assisted exercise: In which assistance is provided
by an outside force, either manual or mechanical when
muscle strength is inadequate to complete the motion.
2- Active free exercise: In which the voluntary contraction
of the muscle can perform full ROM against gravity.
3- Active resisted exercise: In which the voluntary
contraction of the muscle is resisted by an outside
• The principles of assistance:
1-When the voluntary contraction of the muscle is insufficient to produce
2- An external force may be added to complete range.
3- This external force must be applied in the direction of the muscle
4-The magnitude of this assisting force must be sufficient only to augment
the muscular action but not allowed to act as a substitute for it.
5-As the muscular power is increasing,
the assistance given must be decreased
Technique of Assisted Exercise

The assisting force is applied only to

augment the maximum effort and not to act
as a substitute force.
1- Starting position: stability of the body is
important to ensure that the patient’s
attention is concentrated on the pattern of
the movement and the effort required to
perform it.
Technique of Assisted Exercise
2-Pattern of movement: this can be
explained to the patient by performing it
passively or actively on the sound limb.
3-Fixation: fixation of the proximal part of
the prime movers improves their
efficiency. Avoid trick movements to
occur by proper fixation.
Technique of Assisted Exercise
4- Support: the moved part should be supported to
reduce the load on the muscle. Manual support
is more effective since it can be provided in any
plane suitable for the movement and adjusted in
each successive part of the range.
5-Traction: preliminary stretching of the weak muscle
provides a powerful stimulus to contraction because
it stimulate the muscle spindle( Myotatic reflex)
which helps in the initiation of movement.
Technique of Assisted Exercise
6- The antagonistic muscle: a proper starting
position should be selected to reduce the tension
in the antagonistic muscles, e.g. a position in
which the knee flexed is suitable for assisted
dorsiflexion of the foot.
7- The assistance force: the force used in assisting
the action of the muscle must be applied in the
direction of the movement by the PT hands.
Technique of Assisted Exercise
8- The character of the movement: movement is
performed smoothly and its efficiency depends on
the speed of contraction.
9- Repetitions: repetition of the movement depends
on the condition of the
10-The cooperation of patient: this is essential during
this type of exercise. The patient should be
encouraged to exert maximum effort.
Effects and uses of assisted exercise
1-When the patient has weak musculature( poor to fair minus muscle test grade). Active assisted exercises is used to provide enough assistance to strength the
weak muscle.
2-Maintain physiologic elasticity and contractility of the muscles which will gain strength and hypertrophy.
3-provide sensory feedback from the contracting muscle to be used in early stages of neuromuscular re-education.

4-provide stimulus for bone integrity, so the range
of effective joint movement may be increased.
5-The repetitive assisted exercises on the correct
pattern learn the patient to control the
movement by himself, so helping in training co-
6-Confidence of the patient in his ability to move
and helping to co-operate.
Contra-indications of assisted

1-Acute tears and fracture.

2-Greater swelling ,fever and redness.
3-Immediatlly followed myocardial infarction.
4-If active assisted exercises induced pain during
Active Free Exercise
• Free exercises are those which are performed
by the patient’s own muscular efforts without
the assistance or resistance of any external
force other than gravity. And classified into:
1-Localized: to strengthen muscle group.
2-General: to use many muscles all over the
Uses of Active Free Exercise
• This type of exercise can be used to obtain the
1-Relaxation: can be induced by exercises which
are rhythmical or pendulum( swinging) in
Uses of Active Free Exercise
2- Joint mobility: the normal range of joint motion is
maintained by exercises performed in full range.
3- Muscle power and tone: the power and endurance of
the working muscles are maintained or increased in
response to the tension developed in them. Tension is
greater when the exercise is performed at a speed
slower and long duration of exercise
Uses of Active Free Exercise
4- co-ordination: is improved by the repetition
of exercise. As the pattern of movement is
established the conduction of impulses
along the neuromuscular pathways.
5- Confidence: the achievements of
coordinated and efficient movement assure
the patient of his ability to maintain and
control of his movements, and new
6-Circulatory and respiratory cooperation:
during prolonged exercise, the depth of
respiration is increased leading to the
production of heat and increasing
Technique of active free exercise
• The starting position is selected and taught with
care to ensure the maximum postural efficiency
as a basis for movement.
• Instruction is given to gain interest and
cooperation of the patient.
• The speed at which the exercise is done depends
on the effect required.
• The duration of the exercise depends very largely
on the patient’s capacity without reaching
Examples of Active Free Exercises
Examples of Active Free Exercises
Examples of Active Free Exercises
Examples of Active Free Exercises
Examples of Active Free Exercises
Examples of Active Free Exercises
Active Resisted Exercise
Resisted exercise is a technique
based on applying resistance (an
outside force which may be manual or
mechanical) to muscle during dynamic
or static contraction to increase the
contractile force (strength) and muscle
size (hypertrophy). In isometric and
isotonic contraction the resistance
must be sufficient to increase the
intra-muscular tension.
Several options are
available for resistance
training, including:
• free weights (like
dumbbells, pulleys, springs).
• weight machines.
• Water
• Body weight of patient.
• The physical therapist.
Factors Contribute Muscular Efficiency
• There are five factors which contribute to the
development of muscular efficiency:
1- Speed of contraction
2- coordination
3- Power
4- Endurance
5- volume.
• The last three factors can be built up by use of
resistive exercises.
Factors Contribute Muscular Efficiency
– Power: can be increased when you
training muscle against progressive
resistance (increase overload).
– Endurance: high repetition and low
intensity resistive exercise can develop
– Volume: increasing the power and
strength will lead to increase the muscle

Physiological and mechanical principles of muscle

strength and range of motion
• During muscle contraction through wide
range of movement the tension or
strength are not equally powerful in all
parts of their range. Physiologically;
muscle exert their greatest strength in
their outer range and as they shorten
their force diminishes.
Effect and uses of resisted exercise
1- Strengthening the muscles due to increase
tension through gradual overload of
resistance of a muscle or muscle group.
2- Increase muscle endurance through low
intensity repetitive exercise over a prolonged
period of time without fatigue.
3- Increase coordination.
4- Increase muscle cross section (hypertrophy).
5- Increase blood flow of the working muscle.
6-Increase the power.
• When applying resistance, 4 basic rules should be
1- The resistance must be given smoothly from the beginning
to the end of range.
2- The direction of resistance force must be opposite to the
direction of the movement.
3- It should be diminish gradually from the beginning to the
end of movement.
4- don’t forget to give enough period of relaxation to avoid