Principles of Exercises in

Physiotherapy
Principles of Exercises in
Physiotherapy

C Sivaram BPT MSPT

Director, Physiotherapy
Institute of Technology and Sciences
Murad Nagar, Ghaziabad
Uttar Pradesh, India

Foreword
SS Rau

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Principles of Exercises in Physiotherapy

© 2009, C Sivaram

All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any
means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.

This book has been published in good faith that the material provided by author is original. Every effort is made to ensure
accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of
any dispute, all legal matters to be settled under Delhi jurisdiction only.

First Edition: 2009

ISBN 978-81-8448-616-2
Typeset at JPBMP typesetting unit
Printed at
 To

My parents
for their encouragement
To my wife
for her support
To my teachers
for their guidance
To my students
for their inquisitiveness...
 Foreword

Principles of Exercises in Physiotherapy written by C Sivaram, I am convinced, will serve primarily as a

textbook for the students of physiotherapy. Sivaram has endeavoured, and in my opinion succeeded
in making the text enlightening. The main strength of the book is that it explains as far as possible the
current state of knowledge that is needed by the students of today.
The book’s contents have been divided into separate sections and covers topics from anatomy and
physiology to mobilisation of joints. The pictorial and diagrammatic approach makes understanding
easy and the book attractive.
I am sure after reading the chapters, therapists will be encouraged. This book shall serve as a quick
guide for postgraduate students and clinical therapists as well.

SS Rau
Assistant Professor and
Head of Department, Physiotherapy
National Institute for the Orthopaedically Handicapped
Kolkata, India
 Preface

Exercises have emerged as a very potent therapeutic tool in the treatment and prevention of medical
ailments. Management of most of the diseases in the modern world is in some way or the other linked
to exercises. They form an integral part of the prescription of contemporary practice. However, scientific
knowledge regarding the anatomical and physiological principles involved in their execution are
seldom not understood.
Principles of Exercises in Physiotherapy is an effort to bridge the gap between theory and practice of
exercise therapy. It intends to lay a strong foundation on which to build the reasoning for a therapeutic
approach in rehabilitation.
The chapters have been arranged in such a way that the student would find it easy to understand
as he/she progresses through the subject. Each Unit provides understanding of a new concept.
Though the book is intended primarily for the Undergraduate students, it would appeal to the
Postgraduates as well. Special emphasis has been made to elaborate on topics which are generally
difficult to understand. Recent advances in research in the field have also been taken into account
while writing this book.
Any suggestions from teachers and students will be highly appreciated.

C Sivaram
 Acknowledgements

This book would not have been possible without the inspiration I have drawn from my teachers who
have shaped my knowledge throughout my career.
First of all, I would like to thank Shri SS Rau, Assistant Professor, Department of Physiotherapy,
National Institute for the Orthopaedically Handicapped, Kolkata, for being a guiding light in my life.
The seeds to come up in this profession were sown by his untiring efforts to chisel out my mistakes.
I would like to acknowledge with thanks Dr Jaspal Singh Sandhu, Dean and Head, Faculty of
Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar for the immense
contribution in the shaping of my professional career.
Without the support of my colleagues M Thangaraj and Stuti Sehgal, many of the pictures included
in this book would not have taken shape. I appreciate the care shown by them to scrutinize the text of
the book as well.
My friend Roshan Lal Meena with whom I had originally shared the idea of this book, has been a
constant persuasive force to complete this work.
I would like to acknowledge the patience shown by my models Sohan Pal Singh, Sumanto Ghosh
and Nishant Tyagi in this endeavor.
Last but not the least, I would like to thank the entire team at Jaypee Brothers Medical Publishers
(P) Ltd, New Delhi especially Shri Jitendar P Vij (Chairman and Managing Director), Mr Tarun Duneja
(Director-Publishing), Mr KK Raman (Production Manager), Mr Subrato Adhikary (Author
Coordinator), Mr Sanjay (Graphic Designer), Mr Khirod (Proof Reader), Mrs Kamlesh Bisht (DTP
Operator) for their unmatchable contribution in bringing this book to present shape.
 Contents

Section 1: An Introduction to Physiotherapy

1. Meaning and Scope .................................................................................................................. 3
2. Physiotherapy—Definition, Scope and Nature of Work ................................................. 5
3. Physiotherapy—Branches, Education and History ........................................................... 7

Section 2: Basic Terminologies and Joint Motion

4. Muscle Anatomy and Physiology ....................................................................................... 13
5. Axes and Planes ....................................................................................................................... 30
6. Goniometry ............................................................................................................................... 34
7. Starting and Derived Positions ........................................................................................... 52

Section 3: Movements and Stretching

8. Range of Motion and Stretching ......................................................................................... 63
9. Movements ................................................................................................................................ 90
10. Passive Movements ............................................................................................................... 104

Section 4: Manual Muscle Testing and Strengthening Exercises

11. Principles of Manual Muscle Testing ............................................................................... 119
12. Manual Muscle Testing ....................................................................................................... 121
13. Strengthening Exercises ....................................................................................................... 205
14. Exercise and Delayed Onset Muscle Soreness ................................................................ 214
15. Hydrotherapy ......................................................................................................................... 226

Section 5: Massage
16. Massage—Techniques, Setting, Unconventional Types .............................................. 233
17. Therapeutic Massage: A Physiological Review .............................................................. 255
18. Physiotherapy of Lymphatic System ................................................................................ 266

Section 6: Biomechanical Modalities

19. Biomechanical Modalities ................................................................................................... 301
xii Principles of Exercises in Physiotherapy

Section 7: Exercises for Fitness

20. Physical Fitness ..................................................................................................................... 329
21. Yoga Asanas ............................................................................................................................ 372

Section 8: Mobilization
22. Joint Mobilization and Manipulation ............................................................................. 449

Section 9: Stress and Relaxation

23. Relaxation Exercises .............................................................................................................. 475

Section 10: Balance and Coordination

24. Ataxia ....................................................................................................................................... 495
25. Anatomy of Cerebellum ....................................................................................................... 498
26. Physiology of Cerebellum ................................................................................................... 501
27. Role of Cerebellum ............................................................................................................... 503
28. Etiology of Ataxia.................................................................................................................. 507
29. Pathophysiology of Cerebellar Ataxia.............................................................................. 510
30. Clinical Features of Cerebellar Ataxia ............................................................................. 512
31. Assessment and Examination ............................................................................................. 518
32. Investigations in Cerebellar Ataxia ................................................................................... 531
33. Treatment of Cerebellar Ataxia ........................................................................................... 533
34. Physiotherapy Treatment of Ataxia ................................................................................... 536
35. Frenkel’s Exercises ................................................................................................................. 542
36. Hydrotherapy in Ataxia ....................................................................................................... 547
37. Relaxation Exercises .............................................................................................................. 548
38. Vestibular Rehabilitation ................................................................................................... 549
39. Balance and Posture .............................................................................................................. 554
40. Biofeedback ............................................................................................................................ 557
41. Hand Exercises ....................................................................................................................... 559
42. Games ....................................................................................................................................... 561
43. Gait Training .......................................................................................................................... 562
44. Functional Electrical Stimulation ..................................................................................... 565
45. Cognitive Rehabilitation .................................................................................................... 566
46. Speech Therapy ..................................................................................................................... 568
47. Rehabilitative Methods ....................................................................................................... 569
48. Occupational Therapy .......................................................................................................... 573
49. Aids and Assistive Devices ................................................................................................. 576
 Contents xiii

Section 11: Proprioceptive Neuromuscular Facilitation

50. Applied Anatomy and Physiology for PNF .................................................................... 579
51. Neurophysiological Mechanisms in PNF ........................................................................ 586
52. Basic Procedures of Facilitation ......................................................................................... 590
53. Mass Movement Patterns in PNF ...................................................................................... 596
54. Basic Proprioceptive Neuromuscular Facilitation (PNF) Techniques ....................... 598
55. Neck Patterns ......................................................................................................................... 606
56. Trunk Patterns ....................................................................................................................... 611
57. Lower Extremity Patterns .................................................................................................... 616
58. Upper Extremity Patterns .................................................................................................... 634

Index .......................................................................................................................................... 653