Calf Stringthe

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STRINGTHEXERCISEs

PROGAMEFOR

CALF

MUSCLE


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DONE BY:Zahra A. Al-Abd alhai

ID : 208012493

Ftimah A. Al-Khamis

ID : 208008394SOAP Note,,Subjective : a20 year old Saudi female ,she has right tibia shaft

fracture due to an accident , she had long leg plaster for six weeks ,now she has pain at the back of her Rt leg and difficult in walk.

Objective:

Mesomorph pt. Pt. came walk assisted by crutches with PWB on her Rt leg.There is calf muscle weak in affected leg.There is grade 1 tenderness in Rt calf muscle bulk.ROM : knee flexion : 130 / 140 ROM of all other

joints indorsiflexion : 15 / 20 both legs in all plane ofplantar flexion : 40 / 60 motion are within

normal

eversion : 15 / 20 ROM.inversion : 35 / 40

MT : Knee flexors are grade 3 / 5Plantar flexors are grade 2+ /5Grossly MP of Rt leg muscles are graded 3+ / 5 to 4+ / 5 ,

proximal stronger than distal.

assessment:

problem list:

1;pain at Rt calf muscle2;limitation in ROM in Rt ankle joint especially in planter flexion.


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3;weakness in knee / ankle plantar flexors ( especially in calf M(Short term goal:

1;reduce pain

2;increase ROM in Rt knee / ankle joints. 3;strength of calf muscles.Long term goal:

Patient will be able to walk full WB on Rt leg within 4 Wks.

Plane:

TREATMENT SCEDUAL:PT will see the px. 3 sessions per week , for next 5 weeks.

ttt : TENS ( 100 mA ) at Rt calf M , at 15 min for 4 sessions.Exercises program include : circulatory ex , ROM ex ,strength ex , endurance ex , stretch ex and balance ex.

EXERCISES PROGRAMNOTE;

DON'T hold breathing during contraction of any exercise..Take 2 sec as relax period between every 2 Repetition ,

and 5 minbetween set to another..

FIRST WEEK Ex's PROGRAME:

1st session:

Ex 1 : isometric static- ex , for calf & hamistring Ms group..

Pt in supine position with the kneeslightly flexed , put a pillow underthe ankle joint of an affected leg ,press on the pillow down by heel .

hold the contraction and count for 5


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sec , then relax and repeat the contraction and holding for 5times , do it for 2 sets.

Ex 2 : active assisted ROM ex , For ankle joint motions..

For plantar flexion and;

Pt prone with both knees straight , PTsupport the heel with the bottom of the

hand , other hand place on the dorsum offoot and tell to pt. try to move your foot

up, with assisted of PT at begin and endof ROM to complete the range , repeat at

6 times for 2 sets.

For ankle dorsiflexion;

as the same manner above , put the pt. in supine position ,repeat at 6 times for 2 sets.

For inversion & eversion;Pt supine with your knees straight , PT using the bottom

hand , place the thumb medial and the finger lateral to thejoint on either side of the heel , other hand place on the

dorsum of foot and tell to pt try to turn your foot inward andoutward , with assisted of PT at begin and end of ROM ,

repeat at 6 times for 2 sets.

Ex 3 : active free ROM ex for knee flexion..

While prone position with your knees straight, slowly bendyour knee by moving your foot toward your buttocks , thenstraighten to the starting position .. Repeat at 10 times for 2

sets.

2nd session:


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Do the Ex 1 , with 10 Rep , for 2 sets.

Do the Ex 2 , with 10 Rep , for 2 sets.

Progression of Ex 3 : active free ROM ex for knee flexion..While prone position with your knees straight, slowly bend your

knee , while the bending move your sole of the foot towardyour head , then straighten to the starting position .. Repeat at

10 times for 2 sets.

3rd session:

Do the Ex 1 , hold the contraction for 10 sec , with 10 Repand for 2 sets.

Do the progression of Ex 3 , Repeat at 15 times for 2 sets

AT THE BEGININNG OF 2nd WEEK:

Re-assessment:ROM:

knee flexion : 135 / 140

dorsiflexion : 18 / 20 plantar flexion : 45 / 60eversion : 18 / 20:inversion : 37 / 40

MPKnee flexors are grade 3+ / 5Plantar flexors are grade 3 / 5

SECOND WEAK Ex's PROGRAME


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1st session:

Ex 4 : active free ROM ex,

for plantar flexion..

While prone position with yourknee straight , move your foot upthen return back slowly . do it 10

Rep for 2 sets.For dorsiflexion & eversion &

inversion,,Sit on a chair with both feet on the

ground , slowly move your foot upand return to starting position ,then move it inward and outward ,

repeat at 10 times for 2 sets.

Ex 5 : active free ROM ex , for kneeflexion..

From standing position , Hold table with one

hand and Slowly bend your knee , so foot liftsup behind you , hold the position for 2 sec thenSlowly lower your foot back down. repeat at 10

times for 2 sets.

Ex 6 : Multiple angle isometricex,

for plantar flexion.. pt. in prone lying position withboth knees straight and feet out

the edge , by the therapist's handstabilize the leg above ankle joint ,

and by other hand grasp the footthen ask the pt. to lift her foot up ( about 20 of plantarflexion ) & hold while the therapist push the foot down ,

count at 5 sec , repeat at 6 times .

Then repeat the ex with patient's


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foot actively lifted up about 40 ( then about 60 ) , for 6 Rep. Do the ex for 1 set.

for knee flexion

..

pt. prone and by therapist's forearm stabilize the pelvis ,other hand resisted motion above the ankle while the pt.

bends her knee for 30 of flexion ( then for 60 / after thatfor 90 ) , and ask the pt. to push against therapist

resistance and hold . Repeat at 10 times for 1 set.

2nd session:

Ex 7 : static ex , for ankle plantarflexion..

Pt. sit in a chair with both feet on theground , pushing down through the toes ,raise your heel off the ground , hold this

position for 6 sec , then slowly return back .repeat at 10 times for 2 sets.

Do the Ex 5 , BUT hold the table withone finger , repeat at 15 times for 2 sets.

Do the Ex 6 : Multiple angle isometric ex,for plantar flexion .. do it at 10 Rep for 1 set.for knee flexion .. do it at 10 Rep for 1 set.

3rd session:

Do the Ex 7 : WHEN you hold raising heel position count of10 sec , do it at 10 Rep for 2 sets.

Ex 8 : active resisted manual- ex ,for knee flexion..

From prone lying position , with bothknees straight bend an affected kneewhile the therapist applied moderate to


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maximum resistance on the above ankle joint , then Slowlylower your foot back down , repeat at 10 times for 2 sets.

Do the Ex 6 : Multiple angle isometric ex,for plantar flexion .. do it at 10 Rep for 2 - 3 sets.for knee flexion .. do it at 10 Rep for 2 - 3 sets.

AT THE BEGININNING OF 3rd WEEK:

Re-assessment:ROM:

Full ROM for all Rt leg joints in all plans of motion.

MP : Knee flexors are grade 4 / 5Plantar flexors are grade 3+ /5

THIRD WEAK Ex's PROGRAME

1st session:

Ex 9 ; self stretching ex , for calf muscle..can be done using a towel or a sheet ,

Hold the ends of the towel, and loopthe middle around your toes , Keep

your knee straight with your toespointing up , Pull the towel ends,

pulling your toes towards your body ,hold this position for 20 sec , repeat at

4 times for 2 set.

Ex 10 : active self-resisted ex , forplantar flexion..

By a resistance band around your foot , andyour foot and ankle held up towards your

head. Slowly move your foot down againstthe resistance band and comfortable

tightening your calf muscle . Slowly return

back to the starting position , repeat 10times for 2 sets.


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Ex 11 : active resisted mechanical- ex ,for knee flexion..

Pt. in prone lying position and put 1 Kgweight above ankle of an exercised leg , askthe pt. to bend her knee at 90 for 10 Rep at

2 sets.

2nd session:

Ex 12 ; stretching ex , for calf muscle andhamistring..

Pt. standing with one leg on a chair and toesmove toward the body , then move trunk

forward , hold this position for 20 sec , repeat itat 3 times for 2 sets.

Ex 13 : active resisted ex,From supine position , therapist stabilize the lower leg by

one hand and by other apply resistance tothe plantar surface of the foot at the

metatarsals to resist plantar flexion , askthe pt. to move her foot against therapist's

hand , repeat at 6 Rep for 2 sets.Therapist apply resistance to the dorsum

of the foot just above the toes to resistdorsiflexion , ask the pt. to move her footagainst therapist's hand , repeat at 6 Rep

for 2 sets.Therapist apply resistance to the medial

aspect of the first metatarsal to resistinversion and to the lateral aspect of the

fifth metatarsal to resist eversion , ask thept. to move her foot against therapist's

hand , repeat at 6 Rep for 2 sets.

Ex 14 : active resisted mechanical- ex ,

for knee flexion..


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Pt. in standing position and hold a table or a chair by bothehand , and put 1 Kg weight above ankle of an exercised leg ,

ask the pt. to bend her knee at 90 for 10 Rep at 2 sets.

3rd session:

Ex 15 : static - stretching ex , for calfmuscle..

-From standing position with leg stepbackward , and support both hand against a

chair ( or wall ) , Ask pt. to move her trunktoward the chair , maintain this position for

20 sec , 5 Rep , 1 set.

Do the Ex 14 : with 2 kg , at 10 Rep for 2sets.

Ex 16 : Calf Raises on a Leg Press Machine,,Sitting in a leg press machine and extendyour legs straight out . move your feet tothe leg press platform so that the balls of

your feet are firmly at the edge of theplatform. Then, let your heels move flex soyour calf are in a stretched position. Exhaleand raise onto your toes while keeping your

knees straight. Hold for a brief second at thetop and then slowly return to the starting position . Do it for 10

Rep for 2 sets.

AT THE BEGININNING OF 4th WEAK:

Re-assessment:Knee flexors 4+ / 5Plantar flexors 4 / 5

FOURTH WEAK Ex's PROGRAME


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1st session:

Do the Ex 15 : with 5 Rep , 2 sets.

Ex 17 : strength & endurance ex , both knee /ankle joints,,

STATIONARY BICYCLE , Adjust your bike seat so thatwhen sitting on the seat, your leg is slightly bent

when the pedal is at its lowest point .Beginpedaling slowly with little resistance. Perform for 5

min.

Ex 18 : isometric ex , for calf muscle..Begin this exercise standing at a bench or chair forbalance , facing forwards and slowly move up onto

your toes , raising your heels as far as possible ,maintain this position for 6 sec . Then slowly lower

back down , repeat at 10 times for 2sets.

2nd session:

Ex 19 : PNF stretch technique,,start from standing position , raise the heel up and hold this

position for 15 sec ,, Then return bake , and take few secondfor relax . Then push against the wall for 20 sec . Perform 5 Rep

for 1 sets.

Do the Ex 17 : strength & endurance ex , both knee / anklejoints ,, Do it with moderate resistance , for 5 min.

Ex 20 : isometric ex , for calf muscle..

Standing with your heels dropped belowthe level of a step as demonstrated.Ensure you have something to hold

onto for balance. Slowly move up ontoyour toes, raising your heels as far as


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possible and maintain this position for 6 sec . Then slowly lowerback down. Perform 10 Rep for 2 sets.

3rd session:

Do the Ex 19 : PNF stretch technique ,, Perform 5 Rep for 2sets.

Do the Ex17: strength & endurance ex , both knee / anklejoints ,, Do it with moderate resistance , for 5 min.

Ex 20 : isometric ex , for calf muscle..standing on one leg with your heels dropped

below the level of a step. hold something onto( eg. Chair ) for balance. Slowly move up onto

your toes , maintain this position for 6 sec . Thenslowly lower back down. Perform 10 Rep for 2

sets.

AT THE BEGININNING OF 5th WEAK,,Re-assessment:

Plantar flexors 4+ / 5

This weak for maintenance muscle power . So , do theseexercises as you can;

PNF stretch technique,,

start from standing position , raise the heel up and hold thisposition for 15 sec ,, Then return bake , and take few secondfor relax . Then push against the wall for 20 sec . Perform 5 Rep

for 1 sets.

strength & endurance ex , both knee / anklejoints,,

STATIONARY BICYCLE , Adjust your bike seat so thatwhen sitting on the seat, your leg is slightly bent

when the pedal is at its lowest point .Begin pedaling


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slowly with moderate to maximum resistance. Perform for 5min.

isometric ex , for calf muscle..standing on one leg and holding a weight , with yourheels dropped below the level of a step , hold

something onto ( eg. Chair ) for balance. Slowlymove up onto your toes , maintain this position for 6sec . Then slowly lower back down. Perform 10 Rep

for 2 sets.

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