The document summarizes strengthening exercises for lower limb muscles. It begins by defining muscle strength and the need to progressively overload muscles through exercise. It then outlines indications for strengthening including curative, preventive, preparative and recreational reasons. The document describes assessing muscle strength and selecting an appropriate resistance. It provides examples of exercises categorized by muscle groups of the lower limb and activities to target each group. Finally, it discusses techniques for re-educating weak or paralyzed muscles in a graded manner from passive to active resistance training.

1. Strengthening of lower limbs
Presented by :
AMULYA BODKE
BPT 4TH YR,
Apollo college of
Physiotherapy, Jubilee
Hills, Hyderabad.

2. What is
strength? Muscle strength is a broad term
that refers to the ability of
contractile tissue to produce
tension and a resultant force
based on the demands placed on
the muscle . More specifically,
muscle strength is the greatest
measurable force that can be
exerted by a muscle or muscle
group to overcome resistance
during a single maximum effort.

4. The art of training or strengthening
muscles lies in creating the
conditions under which they are
called upon to work to full capacity
against an ever increasing
resistance.

5. INDICATIONS :
1. CURATIVE : Muscle – weakness or paralysis
Bone – to increase density
Aerobic system – improves aerobic capacity
Other connective tissues – improves pliability .
2. PREVENTIVE : To preserve muscle power in all conditions where
muscle weakness is anticipated / to live a healthy life with high levels of fitness.
3. PREPARATIVE : To prepare for some specific activity where the adaptations of
resistance exercise will be useful, ex. – training for arm muscles of a boxer will prepare
him for a better performance.
4. RECREATIVE : Various forms of resistance training is used as sports & recreation
activity.

6.  At the beginning of the treatment, assessment of the
strength of the muscles is essential.
A suitable resistance is then selected, which includes
consideration of the poundage of the resisting force, the
leverage, the speed, the duration of the movement.
 As treatment continues, progression of one or all of these factors
is made as muscle strength develops.
 Account must be taken of all work the muscles in question are
called upon to do, whether it be exercises in the physiotherapy
dept. ,occupational therapy, specific home exercises, work or
ordinary activities of everyday life.

7. Technique of re-educating muscles
grade wise :
Muscles with severe paralysis or weakness are evaluated by MMT and re-
educated from grade-0 to grade-5 as follows :
Grade 0
PASSIVE MOVEMENTS
FACILITATORY TECHNIQUES SUCH AS
JOINT APPROXIMATION OR WEIGHT
BEARING
QUICK STRETCHING , FAST ICING ,
HACKING , IRRADIATION TECHNIQUES
RE-EDUCATION
BOARDS
INTERRUPTED DIRECT
CURRENTS FOR
DENERVATED
MUSCLESFARADIC AND HVG CURRENTS FOR
INNERVATED MUSCLES

8. SUSPENSION
THERAPY
HYDROTHERAPY
ASSISTED EXERCISES
PNF TECHNIQUES

9. GRADE
2 TO 3
ACTIVE ASSISTED EXERCISES
ACTIVE EXERCISES
ACTIVE EXERCISES ELIMINATING
GRAVITY USING SUSPENSION
THERAPY
HYDROTHERAPY AND PULLEYS

10. GRADE
3 TO 4
PROGRESSIVE RESISTED
EXERCISES
SAND BAGS
WEIGHT CUFFS
FUNCTIONAL EXERCISES
MANUAL RESISTANCE
EXERCISES
DUMBBELLS STARTING WITH
LOW WEIGHT
THERABANDS

11. GRADE
4 TO 5
ALL ABOVE EXERCISES
INCREASING RESISTANCE
GRADUALLY
MANUAL RESISTED EXERCISES
WITH INCREASING LEVERAGE,
WEIGHT , NUMBER OF
REPETITIONS
INCREASING MECHANICAL
WEIGHTS

12. Overload principle
If muscle performance is to improve, a load that exceeds the metabolic
capacity of the muscle must be applied; that is, the muscle must be
challenged to perform at a level greater than that to which it is
accustomed . If the demands remain constant after the muscle has
adapted, the level of muscle performance can be maintained but not
increased.

13.  Increase in strength and hypertrophy occur
in response to an increase in intra muscular
tension set up by the factors which oppose
their contraction.
 It is, therefore, essential that these opposing
factors, which constitute the resistance, must
be increased as the strength of the muscles
improves.

14.  An increase in resistance which is too rapid
results in overloading, which prevents
contraction and may damage the muscles.
 Underloading will not increase strength, but
may be sufficient to prevent wasting of muscles.

16.  Re-education may be regarded as a continuous
process which begins, while the muscles are still
paralyzed, in the form of an attempted initiation of
contraction, and extends until maximum function is
achieved.
 Once the power of contraction has been regained,
the muscles are strengthened progressively until
maximum function is obtained.

17. The affected muscles must be strengthened progressively by
resisted exercises, which are specific for the group to which
the muscles belong.
a. RANGE – The range of movement is increased.
b. TYPE OF MUSCLE WORK – concentric, eccentric and static muscle work are
elicited.
c. RESISTANCE – The resistance is increased by:
- Increasing the poundage of the resistance ;
- Increasing the leverage of the resistance .
d. SPEED – increase or decrease in the speed of movement is a progression for
concentric work. Decrease in speed is a progression for eccentric work. Lengthening of the
contraction period is a progression for static holding.
e. DURATION – Increase in number of times an exercise is performed or decrease in
the rest period between each series of exercises, or a combination of both according to
circumstances, makes more work for the muscles.

18. TYPES OF EXERCISES USED TO
STRENGTHEN MUSCLES AND
RESTORE FUNCTION

19. FREE
EXERCISES
ASSISTED-RESISTED
EXERCISES
RESISTED EXERCISES PNF
REPEATED
CONTRACTIONS,
SLOW REVERSALS ,
RHYTHMIC
STABILIZATIONS.

20. Concentric muscle contraction
Eccentric muscle contraction
Isometric exercise is a static form of
exercise in which a muscle contracts and
produces force without an appreciable
change in the length of the muscle and
without visible joint motion

21. Muscle setting exercises
Stabilization exercises
Multiple angle isometrics

22. Dynamic exercises
A dynamic muscle
contraction causes joint
movement and excursion
of a body segment as the
muscle contracts and
shortens (concentric
contraction) or lengthens
under tension (eccentric
contraction).

23. During concentric and eccentric exercise,
resistance can be applied in several ways:
 constant resistance, such as body weight,
 a free weight,
 a simple weight pulley system;
 a weight machine that provides variable
resistance
 an isokinetic device that controls the velocity
of limb movement.

25. PHYSIOLOGICAL CHANGES &
BENEFITS FROM
STRENGTHENING EXERCISES

29. Intrinsic foot muscles

30. Toe
abduction

31. •Tibialis anterior
•Extensor digitorum
longus
•Extensor hallucis
longus
•Fibularis / Peroneus
tertius

32. ACTIVITIES :
1. Walking
2. Walking uphill
3. Climbing
4. Bicycling with pedal straps
5. Long jump

33. The plantar flexors
1.Gastrocnemius
2.Soleus
3.plantaris

34. ACTIVITIES:
1. Walking
2. Running
3. Jumping
4. Balance walk
5. Cycling

36. The Invertors :
1.Tibialis
anterior
2.Tibialis
posterior

37. ACTIVITIES :
1.Walking
2.Running
3.Balancing on
uneven surface
4.Kicking a football

38. THE EVERTORS :
1.Peroneus longus
2.Peroneus brevis

39. Toe standing , balance on
surface which slopes
downwards or medial
wards

40. THE KNEE EXTENSORS :
QUADRICEPS
1.Rectus femoris
2. Vastus lateralis
3. Vastus medialis
4. Vastus intermedius
5. Sartorius
6. Articularis genu

44. THE KNEE FLEXORS :
HAMSTRINGS / BACK OF THIGH
MUSCLES :
1. SEMITENDINOSUS
2. SEMIMEMBRANOSUS
3. BICEPS FEMORIS
4. ADDUCTOR MAGNUS (
HAMSTRINGS PART )

47. ACTIVITIES :

48. THE HIP EXTENSORS
:
1. GLUTUES MAXIMUS
2.HAMSTRINGS

50. ACTIVITIES :

52. THE HIP FLEXORS :
1.PSOAS MAJOR
2.ILIACUS
assisted by
3. QUADRICEPS

56. ACTIVITIES :

57. THE HIP ABDUCTORS :
1.GLUTEUS MEDIUS
2.GLUTEUS
MINIMUS
3.TENSOR FASICAE
LATA

60. ACTIVITIES :

61. THE HIP ADDUCTORS :
1. ADDUCTOR BREVIS
2.ADDUCTOR LONGUS
3.ADDUCTOR
MAGNUS
4.PECTINEUS
5.GRACILIS

64. ACTIVITES :