Physiotherapy Exercises: Balance, Range of Motion and Strengthening

Whether you are seeing a physiotherapist for help in regaining leg strength after a hip replacement or to build up some aerobic capacity after heart surgery, your visit will have one commonality: physiotherapy exercises will be involved. After all, physiotherapy can be defined as a treatment method that focuses on the science of movement and helps people to restore, maintain and maximize their physical strength, function, motion and overall well-being. It’s all about learning to make the proper moves.

Although each patient’s physiotherapy program is unique and tailored to the nature of their physical issues, there are three types of physiotherapy exercises commonly included in rehabilitation programs:

• Balance
• Range of Motion
• Strengthening

Physiotherapy can explore both static and dynamic balance. Static balance refers to control of your stationary body, while dynamic balance refers to the control you have over your body while it’s moving. Deep core stability and hip and leg muscle control are essential for good balance.

Without good static balance, you may be prone to falls and their unpleasant consequences: fractures. As people age, their bones are more fragile and hips and pelvises are more vulnerable.

When your dynamic balance is impaired, you end up with poor muscle and joint control that can lead to instability-related conditions such as back pain, sciatica, hip pain, bursitis or knee pain. Poor dynamic balance also affects your sporting pursuits, because you are not working from a stable platform.

Balance exercises work to improve both balance and proprioception, or awareness of joint position. They help you to adjust and maintain as your centre of gravity shifts. Five minutes a day of balance exercises is a good start, and your exercises should not cause symptoms or increase them.

Possible balance exercises include:

• Single Leg Balance: Stand on one leg with arms extended and attempt to maintain your balance for a minute.
• Single Leg Pillow Balance: Stand on one leg on a pillow with arms extended, maintaining your balance for a minute.
• Heel-Toe Walk: Slowly walk in a straight line, carefully placing one foot down and bringing the other foot in front, touching the heel of the front foot to the toe of the rear foot.

Range of motion refers to the movement of a joint from its fully flexed position to its fully extended position. Although each joint has a normal range of motion, the amount of joint movement varies from person to person.

There are three types of range of motion exercises: passive, active-assistive and active.

• Passive range of motion exercises: As you remain still, the physiotherapist will move your limb along the joint range; it is often done if you are unable to move a limb yourself.
• Active-assistance exercises: Although the patient can move the limb, the physiotherapist helps complete the motion along the joint range or until the point that pain kicks in.
• Active exercises: The patient performs the movement without any assistance from the physiotherapist.

Here is a sample of range of motion exercises for various body parts:

• Neck: Head tilts, forward and back: Bow your head gently and try to touch your chin to your chest. Now, move your head back to the starting position. Next, tilt your head back as far as possible so you are looking at the ceiling; return your head to the starting position.
• Shoulder: Shoulder rotation: Raise your shoulders up toward your ears, as if you were shrugging. Lower them to the starting position, and relax. Pull your shoulders back. Then relax them again. Roll your shoulders forward in a smooth circle; reverse direction and roll your shoulders smoothly backward.
• Legs: Leg lifts: Lie on your back and raise your leg so that it is 15 to 31 centimetres off the floor. Hold for 30 seconds. Return to the floor. Repeat.

Strengthening exercises are done to ensure that your muscles have normal strength, in order to prevent future injury. In situations where your muscles have not moved for a while due to injury, strengthening is essential.

Exercises to increase muscle strength fall somewhere in type between the high repetitions and low resistance of endurance training programs and the fewer repetitions and high weight load of the programs designed to increase muscle size.

Here is a sample of strengthening exercises for core stability:

• Transverse Abdominus: This muscle is a key stabilizing muscle in the abdomen. Lie on your back and slowly draw the section of your abdomen situated below your belly button upwards and inwards away from the line of your belt and breathe normally. Keep your rib cage relaxed and not elevated. Practise holding this muscle at 20 to 30 per cent of a maximum contraction for 10 seconds; repeat 10 times.
• Plank or Prone Hold: Lie down on your stomach. Prop yourself up on your elbows and toes and hold for as long as possible.

Ideally, you should see a physiotherapist for an exercise program that is tailored to your needs. Remember, physiotherapy exercises can be preventive as well as rehabilitative.