0 ‫بــ ِم ِ ٰٱَلهَّّلـ ٱّـَّلْحَرـ َٰم ِن ٱّـَّلِحَرـي ِم‬

‫ِ ْس‬
in the name of god,the Most Gracious,
the Most Merciful.

LECTURE NO 5
SUBJECT
kinesiology ii

Dr Syeda Abida Hussain Sherazi(PT)

MSAPT(DUHS)DPT(BMU)
MPPTA
Snr.Lecturer physical therapy UAJ&K
Resistance
A resisting force other than that provided by gravity
and friction may be provided by:
1. The physiotherapist .
2. The patient
3. Weights *
4. Weight and pulley circuits
5 Springs and other elastic struc
6. Substances which are malleable
7, Water
• 1 . Resistance by the Physiotherapist .
This is usually applied manually in the line of the movement.
Proprioceptive stimulation facilitates the patient’s efforts to
overcome the resistance
when the physiotherapist’s hand is placed on the surface of the skin
which is in the direction of the movement.
To prevent waste of effort and to ensure smooth controlled pressure
the physiotherapist’s stance must be in the line of the movement,
so that the thrusting action of the legs and the body weight are
utilised.
• Traction may be maintained
throughout the movement and
the resistance varied according to the variations in power in
different parts of the muscle’s range,
but it cannot be measured accurately or recorded .
2. Resistance by the Patient .
The patient can resist his own movements with the sound limb,
or by tensing the muscles antagonistic to those which attempt to
produce the movement,
or by using his own body weight.
• The latter method is probably more accurately classified as a free
exercise, but is included here as the quantity of resistance is
obviously much greater when,
as in this case, the muscles work with reversed origin and insertion to
move the trunk on the limbs.
• This type of resistance is convenient,
but tends to be unreliable as it cannot be measured or felt by the
physiotherapist and it requires careful instruction
and the co-operation
and understanding of the patient.
• Examples. From high sitting the Extensors of
one Knee can be resisted by the weight and
pressure of the other leg when the ankles are
crossed.
• The Flexors of the Elbow can be thrown into
strong contraction by bracing all the muscles of
the arm.
• The body can be pressed up from the floor by
the arms, if their strength is sufficient
3. Resistance by Weights.
The direct application of weights to the body forms a simple and effective
method of resisting active exercise.
The apparatus required is commonly sandbags, metal weights or a medicine
ball,
which can be applied by being held in the hand,
by attachment to a shoe, or to any other part, by suitable straps.
• When sandbags or metal weights are used,
a canvas bag may be strapped to the part and any number of units of weight
can be inserted to provide the required resistance.
• It is essential that the means of attachment should be comfortable and
efficient, but it need not be elaborate.
By this method, resistance must, of necessity, be given in the direction of
gravity;
its effect increases progressively if the weight is moved away from the
central axis of the body.
It is a convenient method and suitable for home practice after adequate
instruction has been given.
• Examples. Lifting a weight held in the hand or
attached to the foot or throwing a medicine
ball are common examples. Resistance by
weights is also commonly used for the
technique known as Heavy Resistance
Exercise.
• Heavy Resistance Exercise
• The use of Heavy Resistance Exercise for the
restoration of muscle power and volume after
injury was first described by de Lorme in 1945
• although this method of promoting muscular
development had been well known and used
by professional muscle builders for a very long
time.
• Metal weights, which constitute the resisting force,
are applied to the part of the body in question either
by means of a bar-bell held in the hand or hands, a
de Lorme metal boot or some similar device.
• The poundage is determined by testing the
repetition maximum (R.M.) for a given number of
repetitions.
• Lifting of the weight may involve either static
(isometric) or dynamic (isotonic) muscle work
according to the circumstances and the movement
is slow and controlled.
• Several ways of correlating the weight lifted and the
number of repetitions have been used.
• It appears that the regime most suitable and successful
in the treatment of an individual patient varies very
much with his age, temperament and the condition
from which he is suffering.
• It is essential that his instruction is precise and that his
efforts arc well supervised.
• The following schemes are in common use and form a
basis for experiment ;
they are all based on the test for a 10 R.M. and represent
a power programme.
• The endurance programme is based on the
use of relatively low resistance and high
repetition regime.
• Heavy resistance exercise can be used in
principle for the development of most muscle
groups but it is at present more often used for
the Knee Extensors than any other group.
 4. Resistance by Weight and Pulley Circuits.
The use of a rope and pulley allows the force exerted by a weight to
act in any direction ,
therefore the muscles need not be required to work against the
resistance of both gravity and the weight.
The effect of gravity can be counterbalanced if the movement takes
place in a horizontal plane.
This provides a useful method of arranging resistance for weak
muscles when the limb is heavy.
• Example. In sitting the resistance of gravity to the Knee
Extensors is approximately 10 lbs.
• If these muscles are unable to straighten the knee against
this resistance,
• they may still be able to perform the exercise adequately
when, in side lying, the leg is supported horizontally and a
resistance of, perhaps, 8 lbs. is applied.
• As the angle of pull of the rope by which it is applied,
and therefore the resistance itself,
must vary during the course of a movement,
• a resistance can be offered to the muscles which matches the
variation of their power in different parts of the range more
accurately than
that supplied by means of a weight applied directly to the part or
by a spring.
• Assuming that a particular muscle group is most
powerful in mid range it is there that the resistance is
applied at right angles.
• Both the power of the muscles and the force of the
resistance will diminish on either side of this point.
• To ensure relaxation and lack of strain on the joints
between movements a relaxation stop is incorporated on
the circuit by means of a clip or knot which prevents the
rope from passing the pulley, or by arranging for the
weight to be supported at the end of the movement.
• Psycho logically, it is of the greatest importance for the
patient to be able to see the weight moving as the result
of his work and to know and record the poundage lifted.
5.Resistance by Springs and Other Elastic Substances.
The resisting force of a spring increases progressively
as it is stretched or compressed according to the type
of spring used.
Although convenient to arrange, the use of springs for
resisting muscular contraction must be regarded as a
somewhat crude method as it is virtually impossible to
match their resistance to the capacity of the muscles
with regard to both power and range of movement.
When springs are used the speed of movement must
be carefully controlled by the muscles both in
contraction and during controlled relaxation as the
accumulated energy in an extended spring makes its
natural speed of recoil very great.
Other extensible materials such as rubber elastic of
various widths and thicknesses behave in a manner
similar to that of springs, but they are not so durable.
The elastic properties of Sorbo rubber are apparent on
pressure, and rubber sponges, Dunlopillo and rubber
balls afford varying resistances which are particularly
useful in developing the gripping muscles of the
hand.
6. Resistance by Substances which are Malleable.
Substances such as putty, clay, some kinds of wax,
Plasticine and wet sand can be moulded into different
shapes. The resistance they offer to this change in form is
variable and can be used both for strengthening and for
mobilising the hands.
7. Resistance by Water. The resistance offered by water
increases with the speed and the surface area of the part
moved. 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.
Methods of Assessment
Neuromuscular efficiency must be tested before treatment and at specific intervals in
order to assess progress and the efficacy of the treatment. A variety of methods may
be used, but in every case it is
important that the test should be standardised as far as possible, i.e. it should be
carried out by the same physiotherapist under conditions which are as nearly similar
as possible to those of the previous test. Results must be accurately recorded. The
following examples of testing methods are in common use
1. Electrical Tests These may be carried out by the doctor with the use of the
electromyograph or by means of the strength-duration curve. They are particularly
valuable for diagnostic purposes.
2. The Oxford Classification:This is the standard most universally employed. 0. No
contraction.1. Flicker of contraction. 2. Weak. Small movement with gravity
counterbalanced. 3. Fair. Movement against gravity. 4. Good. Movement against
gravity and some resistance. 5. Normal.
3. Circumference Measurement ,This test relies on the fact that there is a relationship
between the development of power and that of hypertrophy. A tape measure made
from some inextensible material is used to measure the circumference of the limb at
a predetermined level. Experiment on normal limbs indicates that this method is
unreliable even in experienced hands; it is still, however, much used.
4. Static Power Test The power of static or isometric contraction may be recorded by means
of a spring balance capable of registering up to 50 or 100 lbs. The extensibility of the spring
within this type of balance is virtually negligible and it can be arranged in such a way that
contraction of the muscle group can take place at any predetermined point within its range.
Record can be made of the maximum poundage recorded or of the average poundage re
poundage recorded as the result of three efforts made at one-minute intervals.
5. Dynamic Power Test This is a method devised by de Lorme and Watkins as a basis for
progressive Heavy Resistance Exercise. The maximum weight which can be lifted once only
through a prescribed range is called the One Repetition Maximum (1 R.M.) and the
maximum weight which can be lifted ten times at natural speed without rest between lifts
is the Ten Repetition Maximum (10 R.M.). Experience in estimating the approximate weight
which can be lifted is essential to avoid fatigue which results from continued trial and error
and which rapidly reduces the poundage which can be lifted.
6. Endurance Test Endurance may be calculated by recording the drop in the maximal power
of the muscles when their effort of contraction is repeated at given intervals for a specific
period of time.
7. Functional Assessment
This involves a series of tests designed to estimate the patient’s ability to perform the activities of daily
living (A.D.L.). Such activities may be grouped under headings, e.g. mobility, personal care,
household or garden jobs, work, recreational and social activities.
Progression As the power of the muscle increases, the tension produced by a resistance which is
constant will diminish, therefore, to maintain the stimulus of tension, the resistance must be
increased proportionately as
the power of the muscle develops. There are four main methods of increasing resistance to muscle
action. Each method may be usM singly or in combination with any
other method:
1. Increase in poundage or weight of the resisting force.
2. Increase in leverage of the resisting force.
3. Alteration in the speed of movement.
4. Increase in the duration of the exercise.
• 1. Increase in Poundage or Weight. For example: it is
found that a muscle group, able to achieve full-range
contraction against a weight of 3 lbs. when it is applied at
a specific point, can contract at a specific speed and for a
specific duration. As the muscle power increases, the
weight is increased proportionately to 4 lbs., 5 lbs. or 6
lbs., while the other conditions remain constant. The
actual amount of the increase is variable according to the
particular muscle group, its rate of progress to recovery
and the frequency at which an increase is made.
2. Increase in Leverage. The total resistance offered by a given weight depends on the position of
its point of application in relation to the fulcrum. (Moment of Force = Weight X Perpendicular
Distance from the fulcrum.) The greater the perpendicular distance o1 the point of
application from the fulcrum, i.e. the joint at which movement takes place, the greater the
resistance offered by the weight. Example. A manual resistance, which is relatively constant,
given to the Shoulder Abductors with the arm straight, is much greater when applied at the
wrist than at the elbow
3. Alteration in the Speed of Movement . Muscular contraction is most efficient when it takes
place at an optimum or natural speed. This speed varies according to the form and structure
of the muscles concerned, the resistance, and the individual. Increase or decrease in this
natural speed of contraction increases the effect of the resistance when the muscle works
concentrically, but when it works eccentrically, the slower the movement the greater the
effect of the resistance, i.e. concentric work is easiest at natural speed, eccentric work at high
speeds. For example: it is easier to climb a steep hill at your own speed than at one dictated
by a companion who may prefer to go faster or slower than you do, but it is easier to come
down rapidly.
4. Increase in the Duration. As muscles warm up to their
task of overcoming a resistance, they become more
efficient and therefore the effect of the resistance
decreases and the exercise seems easier. If, however, it is
continued a sufficient number of times, fatigue reduces
the efficiency of the muscles and the resistance
therefore appears greater. For example: sawing a log of
wood may seem to become easier as you warm up to it,
but it becomes hard work by the end of an hour.
• Effects and Uses of Resisted Exercises
(0 Muscle power can only be maintained or increased by contraction, and
in these exercises the working muscles are strengthened and
hypertrophied in response to the tension created in them by the
resistance.
Their power and endurance is increased. Resisted exercises are used to
build up weak muscles and so to restore the balance of muscle power
which is essential for stability and co-ordinated movement. When all
the muscles are weak, power and function are improved.
(2) The blood flow to the working muscles is increased in proportion to
tHt amount of work they are called upon to do thus providing the
materials for repair and hypertrophy. Although the flow is impeded
during the actual contraction, the amount of blood contained in the
muscles immediately after contraction may be as much as ten times as
great during strenuous exercise as the amount contained during rest.
This increase in the blood flow to the muscles continues for some time
after exercise, bringing oxygen and nutrition to the part and assisting
the removal of metabolic products..
(3) A general rise in blood pressure frequently anticipates exercise and may be
increased by the mental effort required to perform these exercises correctly.
(4) Heat, which i& produced as the result of strenuous muscular activity,
stimulates the heat-regulating centre causing vaso-dilatation in the skin. This
follows a constriction of these vessels which occurs in the first place to
compensate for the increase in the blood flow to the muscles.
If there has been sufficient exercise, the skin feels warm and possibly moist
and appears pink, indicating that heat is being lost from the surface to
balance the gain from muscle activity and so keep the body temperature
within normal limits.
The degree of moisture depends largely on the temperature, humidity and
movement of theatmosphere
ACTIVE EXERCISE (Involuntary Movement)
a. Reflex Movement
Reflex movements, which are always involuntary, occur in response to
sensory stimulation, which is transferred to the muscles without the
knowledge of the cerebral cortex, as the co-ordinating centre is situated
at some lower level of the central nervous system.
The essential constituents of the pathway by which the impulses travel are
theoretically, in the simplest form, Knowledge of the movement only
reaches consciousness after the muscular contraction has been initiated.
• Flexor Reflexes Reflexes which arise from painful
stimuli are mostly flexor in character, their
purpose being to protect the body from harm,
e.g. the withdrawal of a hand on touching a hot
iron, or of a foot on stepping on a nail.
• Extensor Reflexes These are weaker than the
flexor reflexes, and easily give way to them if
pain is experienced. They are most easily
demonstrated in the leg, where they involve the
use of the anti-gravity muscles and are elicited
by firm pressure on the foot when the kg is
bent.
• The Myotatic or Stretch Reflex This reflex is also
protective in character and is demonstrated by a sudden
and usually unexpected stretch on a muscle or its tendon,
e.g. the knee jerk. This contraction, which results from the
stretching of a muscle, is a device to protect it and the
underlying tissues from injury.
• Many instances of this contraction, which occurs in
response to passive stretching, are met in the application
of exercise therapy. It may be a response to be
encouraged or to be avoided, according to the
circumstances.
• Conditioned Reflexes This type of reflex is not inborn, but
is developed with the co-operation of the cerebral
cortex. A particular response to a particular stimulus may
be initiated by the cerebral cortex so often that it
eventually becomes unconscious or habitual. Examples
of this are the ability to walk or to ride a bicycle, which
are both activities which were achieved with much
conscious effort, but once learnt become conditioned
reflexes requiring no conscious effort. Thus the higher
centres are set free to concentrate on other things, such
as the traffic or the scenery.
• The Postural Reflex This is an extremely
complicated series of reflexes, some of which
are inborn and some conditioned . In the
healthy body reflexes always run true to form,
although many can be inhibited voluntarily, if
the higher centres are informed in time.
Failure to elicit a response, or an alteration in
the nature of the response, to a given stimulus
is of diagnostic significance in some diseases.
b. Associated Movements: A movement which occurs
involuntarily and accompanies another movement which is
usually voluntary may be called an associated movement.
These movements probably arise as the result ofspreading of
the impulses discharged to promote the initial movement.
Examples
(i) Stimulation of the involuntary musculature of the
alimentary tract is associated with that of the voluntary
musculature of the abdominal wall.
(it) The muscles of the pelvic floor may contract when the Hip
Extensors and Adductors are strongly innervated.
(«V) Muscle groups which habitually work together tend to contract when one of
their number is thrown into action. This association in this case is usually of
fixator or synergic origin.
(iv) Corresponding muscles on the opposite side of the Tsody tend to contract in
unison, or reciprocally, when those of one side are stimulated, as in the case of
muscles on either side of the face or of the muscles of the lep used in walking.
(r>) Intense concentration on the performance of one movement may lead to the
production of an apparently useless movement such as biting the lips or
frowning.
(vi) Pathologically, movements such as those of tremor frequently accompany
specific voluntary movements.In some cases association between movements
can be utilised, as for instance in obtaining contraction of the muscles of the
pelvic floor, and exercises in which both limbs are involved are frequently
beneficial when the function of one is impaired.
• Thanks