3) Auto Assisted Exercises
These exercises can be either passive or active assisted, as described
above and occur when the external force is applied by the individual rather than by the physiotherapist
1. Active Exercises
Also known as free active exercises, these are activities in which the
movement is produced solely by use of the individual's voluntary muscle action. They can be used as either strengthening for grade 2 and above on the Oxford scale , or to mobilize structures - as in the case with dynamic stretching exercises.
A clinically useful feature of active exercises is that they can be performed without the use of equipment, so they can be practiced anywhere and can easily form the basis of a home exercise programme .
2. Stretching Exercises
Stretching exercises if performed appropriately may be a simple yet very effective form of treatment. For example, in the elderly a loss of hip extension during walking implies the presence of functionally significant hip flexor tightness and predisposes individuals to falls and subsequent femoral neck fractures. Overcoming hip tightness with specific stretching exercises is therefore worthy of investigation as a simple intervention to improve walking performance and fall prevention in the elderly.
Stretching exercises are performed with the target structure towards a lengthened position. The stretching exercise will involve further movement in that direction, so as to further lengthen the structure. Collagen fibres realign rapidly as a result of stretching forces and become aligned (and therefore
stronger) in the direction of the stretching force . The limiting factors to further movement, such as the degree of pain experienced , will govern the extent to which any further movement is possible. Stretches are commonly used to increase range of movement by mobilizing restrictions within soft tissue (e . g. scar tissue), and are
specifically used in the lengthening of tight muscles.
The time at which stretching is commenced after an injury needs careful consideration , After any soft - tissue injury the length of the immobilization depends on the grade of injury and must be optimized so that the scar can bear the pulling forces operating on it without re - rupture. Mobilization of soft tissues by stretching will aid resorption of the connective tissue scar and recapillarization of the damaged area.
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