MUSCULAR
WEAKNESS AND AND
LOSS OF POWER
DR. NEETU RANI
DHIMAN
(RESEARCH ASSOCIATE),
PHD. (PHYSIOTHERAPY),
MPT (NEUROLOGY), BPT
MRC- MEDICAL RESEARCH COUNCIL
‣ loss of movement
‣ Instability of joint
‣ muscular imbalance (loss of coordinated movement)
‣ To recover:
‣ they must be protected
‣ re-education
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CAUSES OF WEAKNESS OR LOSS OF MUSCLE POWER
‣ As contraction is the only means by which muscle
power can be maintained or increased, any lesion or
habit which prevents or limits contraction will result in
loss of power and muscle wasting.
‣ Complete loss of power is known as paralysis, partial
loss as paresis, or a muscle may be merely weak or sub-
normal.
TEXT
LESIONS AFFECTING THE MOTOR NERVES
1. Paralysis: due to loss of conduction impulse
2. Temporary if neuropraxia or recovery from
poliomyelitis
3. Permanent if axonotmesis or neurotmesis
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LESIONS AFFECTING THE MUSCLE
TISSUE
1. Degeneration (MD)
2. Ischemia (VIC)
3. Extensive scar tissue may replace contractile tissue as
the result of deep flesh injuries.
TEXT
DISUSE OF NORMAL NERVE AND MUSCLE TISSUE
▸ Pain
▸ Splintage/immobility
▸ Unwillingness
▸ Some Diseases: RA
▸ Functional cause:
▸ Muscles don’t function
TEXT
PREVENTION OF WASTING
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FLACCID PARALYSIS
▸ No nerve supply
▸ Muscles are limp, hypotonic
▸ Solution:
▸ Improving the blood supply to the area by doing
passive movement
▸ Electrical stimulation of muscle fibres
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SPASTIC PARALYSIS
▸ UMN destroyed
▸ No control from higher centers
▸ Muscles are tense, hypertonic and incapable of
voluntary contraction or relaxation.
▸ Solution:
▸ Stretching
▸ Relaxation technique
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PRIMARY LESIONS OF MUSCLE TISSUE
▸ LIGHT EXERCISE IF POSSIBLE
▸ MAKING THE BEST USE OF FIBRES WHICH ARE STILL IN
ACTION
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DISUSE ATROPHY
▸ Frequent voluntary contraction in any possible range
▸ Five minutes in every hour with maximum effort
▸ Faradism
▸ Convincing the patient in either way (necessity,
comparison)
‣ The wasting in rheumatoid arthritis, some of which is due
to disuse, is combated by active contraction as soon and
as often as the condition will allow.
TEXT
STRENGTHENING METHODS
▸ Contraction that too active if possible
▸ Working with full capacity against ever-increasing resistance/
maximum
▸ Increase in strength and hypertrophy occur in response to
tension in the muscles created by the opposition of contraction.
▸ Resistance Strength/power (but according to muscle
power)- should be gradual
▸ So power assessment is necessary at the beginning
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PRINCIPLES OF PRELIMINARY TREATMENT AND
EARLY RE-EDUCATION OF FLACCID MUSCLE
1. The Affected Muscles must be protected from prolonged
Over- stretching by adequate Support and Splintage
▸Normal muscles protect themselves from overstretching
by stretch reflex
▸? About flaccid muscles: can be overstretched beyond
their physiological limit. Eg. Foot Drop
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2. The Circulation to the Area must be maintained to ensure Adequate
Nutrition to the Paralysed Muscles by such means as Heat, Massage,
and Movement of Neighbouring Joints unaffected by the Paralysis
▸ Paralysis leads to cold and blue area, indicating poor
circulation
▸ To supply oxygen and nutrition
▸ For local venous return
▸ By intermittent pressure exerted on vessels by muscle
contraction and joint movement
TEXT
3. The Mobility of Joints and the Extensibility of the Muscles
which pass across them must be maintained by Full-range Passive
Movements
▸ The fibrous tissue like muscle fascia, ligaments
undergo adaptive shortening due to immobilization
▸ Full ROM passively-necessary to avoid this
▸ Once or twice every hour
TEXT
4. Remembrance of the Pattern of Movement must be
stimulated and kept alive by Passive Movement while Active
Movement is impossible
‣ Movement is associated in the brain with numerous
sensory impulses from the joints, muscle, skin and eyes.
‣ In the absence of voluntary movement, stimulation of
these sensory impulses by passive movement reminds
the brain of the pattern of movement,
‣ in preparation for the time when the motor pathway will
be intact.
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5. The Power and Use of Normal Muscles in the Area must be
maintained as far as possible by Active Exercise
‣ Unless the limb is flail (all muscles paralysed) all
possible activity is encouraged, provided overstretching
of the paralysed muscles is prevented.
‣ Thus wasting from disuse is prevented and circulation to
the part is improved.
TEXT
6. Contraction of the Affected Muscles must be discovered and
encouraged at the Earliest Possible Moment by creating the Ideal
Conditions under which Minimal Contraction will take place
▸ Warmth: improves quality of contraction
▸ Stabilisation: manually
▸ Resistance: should be cancelled (gravity also)
▸ Range of muscle work: Middle range (most efficient)
▸ Type of muscle work: concentric first and the concentric
▸ Stretching: mild and short; stimulate contraction
TEXT
▸ Effort: Conscious effort and remembrance of the pattern
of movement must be made by the patient.
▸ Fatigue: No more than a flicker of contraction can be
expected at first. A decrease in the quality of the
contraction indicates fatigue.
▸
Example.
TEXT The Preliminary Treatment in the case of injury to the Circumflex Nerve
causing flaccid paralysis of Deltoid and resulting in the loss of the power of
abduction at the shoulder joint, might be carried out as follows:
‣ Support is given by an abduction splint, or a muff and sling.
‣ The circulation to the area is improved by warming the limb by immersion in a
whirlpool bath, or by giving the treatment under a radiant heat lamp.
‣ The mobility of the joints and extensibility of the muscles are maintained by two
full-range passive movements, given with the shoulder girdle fixed.
‣ Remembrance of the pattern of movement is stimulated by passive elevation of the
arm, during which the patient actively elevates the other arm.
‣ The power of the normal muscles is maintained by active exercise for the hand,
elbow, and shoulder girdle, while the shoulder is supported in abduction.
‣ The contraction of the Abductors is attempted in recumbency with the shoulder
girdle fixed, and the arm flexed at the elbow and supported in a degree of lateral
rotation.
‣ Support for the upper arm is horizontal and may be given by a well-polished and
powdered re- education board, sling suspension, water, or the physiotherapist’s
hands.
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SUBSEQUENT TREATMENT TO INCREASE MUSCULAR
▸ Active exercises started
▸ Resisted exercise follows: antigravity, increase wight.
▸ Range increased
▸ Both concentric and eccentric
▸ Speed
▸ Duration
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FULL FUNCTION OF THE AFFECTED MUSCLES AS MEMBERS
OF THE TEAMS OF MUSCLES WHICH WORK TO PRODUCE
SKILLED AND CO-ORDINATED MOVEMENT, MUST BE
RESTORED BY FREE ACTIVITIES NATURAL AND SKILLED
MOVEMENTS
‣ Progression of these exercises follows on lines similar
to those stated above for resisted exercises.
‣ Pendular movements requiring relatively little power
are used at first to assist in the restoration of muscle
balance, progressing to slow sustained or rapid
movements requiring more power.
‣ Small-range movements in which many joints must be
controlled are the most highly skilled.
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TYPES OF EXERCISES USED TO STRENGTHEN MUSCLES
▸ Assisted
▸ active/free
▸ Resisted
▸ Activities
▸ Measurement: by muscle girth and
resistance or ADLs