Half-lying Sitting

Foot-rolling.

Half-lying Foot-rolling (Passive) (Fig. 57). - Gymnast's position and placing of foot similar to Foot-bending-stretching. With one hand the leg is fixed just above the heel; the other hand grasps the foot from the plantar side at the metacarpophalangeal joints and carries it round in as large circles as possible fifteen to twenty times each way. The movement is completed either by a passive flexion with overstretching or by an active Foot-bending-stretching against resistance. Foot-rolling can of course be done actively (without resistance).

If the movement is quite double 2 Foot-roll, the gymnast places himself in front of the patient, as in 2 Foot-bending-stretching, or it may be done by two gymnasts. (N.B. - Both feet must be rolled at the same time inwards or outwards (not one in, the other out).) Sitting Foot-rolling. - Is done actively by the patient, without resistance. Heels supported on the ground.

Foot-rolling takes place chiefly in the astragalo-tibial and astra galo-calcaneo-scaphoid joints, but also in the other joints of the foot and in the hip joint more or less.

Effects And Uses

Passive Foot-rolling loosens the joints and increases their mobility, and increases circulation in the foot (by alternate lengthening and shortening of the vessels). It is used, therefore, in treatment of all kinds of stiffness in the joints of the foot, in treatment of heart disease, and in coldness of feet and legs. In active Foot-rolling all the muscles of the leg are brought into action, and its effects are therefore almost the same as the effects of active Foot-bending-stretching.

Fig. 57.

Movements in the Knee Joint.

Half-lying Wing-half-sitting Sit-lying Forward-lying Knee-bending and -stretching.

Half-lying Knee-bending and -stretching (Fig. 58). - The gymnast sits at the side of the patient and places the patient's leg over his own knee so that the knee can be freely bent. The gymnast's one hand fixes the thigh at the knee; the other gives resistance above the ankle to stretching, just above or at the heel to bending. Patient bends and stretches the knee; resisted by the gymnast four to six times. The movement is completed by gentle passive over-stretching with slight shaking. Usually given in this way, but can be given so that the muscles work concentrically and eccentrically. May also be given as a passive movement (Knee-pumping). The grasp is then either above the ankle or on the lower part of the leg just above the malleoli.

Wing - Half - Sitting Knee - Bending And -Stretching

Is carried out in the same way as the previous exercise, but the gymnast stands at the side of the patient, whose thigh rests on the apparatus (boom or high plinth).

Sit-lying 2 (Double) Knee-bending and -stretching (Fig. 59). - The gymnast fixes the patient's knees with one hand, while with the other he gives resistance at the feet.

Forward-Lying 2 Knee - Bending And -Stretching

The gymnast stands at the side of the patient and fixes his thighs with one hand just over the knees, while with the other he resists at the feet. Movement takes place in the knee joint.

The working muscles are: -

In bending, muscles at back of thigh (Semi-tendinosus, Semi-membranosus, and Biceps Femoris, and, to a certain extent, also Gastrocnemius).

In stretching, muscles in front of thigh (Quadriceps Femoris). Special Effects and Uses. - (a) Repleting to thigh muscles, and, according to Major Brandt, also slightly repleting to pelvis. (b) Depleting from head and upper part of body. Used specially after massage of thigh or knee joint, and in general gymnastic treatment as a good leg exercise, which can be easily modified to suit the patient's strength.

Fig. 58.

Fig. 59.

The Effects Of The Various Starting Positions

Half-lying position makes the effect of the movement as pure as possible, while the strength can be modified as required.

Half-sitting is somewhat harder, partly because a good deal of muscle action is necessary to maintain the position, partly because the origin and insertion of Rectus Femoris approach one another, so that the power of the muscle is diminished and stretching is more difficult.

Sit-lying facilitates stretching because the origin and insertion of Rectus Femoris are separated, and so the power of the muscle is increased. Because the movement is always (or usually) done double in this position, its depleting effect from the head is greater. Used really only for children (uncomfortable for older patients).

Forward-lying position likewise is only used for children. Comfortable for gymnast; saves time.

Passive Knee-Bending And -Stretching Or Knee-Pumping

Loosens the joints and helps circulation. Used for stiffness in the joint and in paralyses to maintain mobility in the joint.

Movements in the Hip Joint.

A. Exercises with Work chiefly for Flexors. All these movements give work also to the abdominal muscles, but because the leg is the part moved they are called Leg movements.

Reach-grasp-standing Wing-standing Alternate Knee-raising.

Without altering the position of the body the legs are lifted alternately as high as possible by flexion in the hip joint, while the knee is passively flexed and extended by the weight of the leg. The knee is carried in the plane of the foot from the starting position. The leg ought always to be perpendicular and the foot plantar flexed when it does not rest on the ground. The movement is repeated ten to twenty times. Beginners as a rule use Reach-grasp-standing position.

The working muscles are: -

(a) For performing the movement itself, flexors of the hip joint (concentrically and eccentrically).

(b) For fixing the origin of these on the pelvis, the abdominal muscles and the extensors of the supporting leg (statically).

(c) To fix the origin of the abdominal muscles, the inspiratory muscles, but not the diaphragm (statically).

(d) To prevent the body falling forward, the back muscles (statically).

Effects And Uses

(a) Because the muscle action is so complicated the exercise is good for the nervous system and innervation; this effect is increased by the balancing required for the movement. On this account it can be used in treating disturbances of innervation, e.g., chorea, diseases of the spinal cord, etc.

(b) As the abdominal muscles are used it aids peristalsis, but at the same time it impedes respiration, so that it should not be used for weak patients.

(c) Finally, the movement may be used as a strong combined leg and abdominal exercise in gymnastic training.