Active Movements: Classification, Muscle Work & 20 MCQs

Active Movements: Principles & Classification

💡 Core Concept: Active Movement is any movement performed or controlled by the voluntary action of the patient's own muscles. It is the opposite of Passive Movement (where the therapist does 100% of the work).

1. Classification of Active Movements

Active movements are classified based on the amount of assistance or resistance applied.

Type	External Force	Indication (MMT Grade)	Goal
1. Active Assisted	Patient + External Help	Grade 1 to 2+ (Weak)	Maintain ROM, educate movement pattern, early strengthening.
2. Free Active	Patient + Gravity only	Grade 3 (Fair)	Maintain tone, physiological function, coordination.
3. Resisted	Patient vs Resistance	Grade 4 to 5 (Strong)	Hypertrophy (size), Power, Endurance.

1. Active Assisted Exercise

• Definition: The patient performs the movement to the limit of their ability, and external assistance completes the range.
• Types of Assistance:
  • Manual: Therapist's hand (most common).
  • Mechanical: Pulleys, suspension therapy, finger ladder, skate board.
  • Self-Assisted: Using the stronger limb to help the weaker one (e.g., clasping hands for shoulder flexion).
• Key Rule: The assistance must be just enough to complete the movement but not so much that the muscle stops working.

2. Free Active Exercise

• Definition: Movement performed by the patient's own muscles against gravity, without any external aid or resistance other than the weight of the limb.
• Characteristics: Can be performed anywhere (home exercise program). Requires full anti-gravity strength.

3. Resisted Exercise

• Definition: Movement performed against an external force (Manual or Mechanical).
• Overload Principle: To increase strength, a muscle must be loaded beyond its normal capacity.
• Types of Resistance: Weights (dumbbells), Springs/Therabands, Water (Hydrotherapy), Manual Resistance (PNF).

2. Types of Muscle Work (Contraction)

A. Isotonic (Dynamic) Contraction

Length of the muscle changes while tension remains relatively constant. "Iso" = same, "Tonic" = tension.

• Concentric (Shortening):
  • Muscle shortens while generating force.
  • Origins and insertions move closer together.
  • Used for acceleration (lifting the weight).
  • Example: Biceps during the "up" phase of a curl.
• Eccentric (Lengthening):
  • Muscle lengthens while under tension.
  • Origins and insertions move apart.
  • Used for deceleration/control (lowering the weight against gravity).
  • Example: Biceps during the "down" phase of a curl.
  • Note: Generates more force than concentric but causes more DOMS (muscle soreness).

B. Isometric (Static) Contraction

Length of the muscle remains constant. "Iso" = same, "Metric" = length.

• No joint movement occurs.
• Used for stabilization and when joint motion is painful or contraindicated (e.g., acute arthritis, casted fracture).
• Work Done = 0 (Physics: Work = Force x Distance).

3. Effects & Uses of Active Movement

• Musculoskeletal: Maintains physiological elasticity, joint range, and muscle power. prevents atrophy/adhesions.
• Circulatory: "Muscle Pump" action aids venous return and lymphatic drainage (reduces edema).
• Nervous: Improves coordination, proprioception, and motor learning.
• Bone: Wolff's Law – stress on bone increases bone density (prevents osteoporosis).

⚠️ Contraindications

• Acute Inflammation/Infection: Active movement can spread infection.
• Recent MI (Myocardial Infarction): Careful monitoring required; heavy resistance is contraindicated (Valsalva maneuver risk).
• Unhealed Fracture: If movement causes shear force at the fracture site.
• Ankylosis: Do not force movement in a fused joint.

🏆 AIIMS "Golden Points"

• Assisted-Resisted Exercise: A unique category where muscles are strong in part of the range (Resistance given) and weak in another part (Assistance given).
• Eccentric Strength: Eccentric strength is generally 20-30% higher than concentric strength.
• Coordination: Free active exercises are the best starting point for training coordination (repetition creates engrams).

📝 20 High-Yield MCQs

Test your knowledge for AIIMS/JIPMER.

Q1. Which type of exercise is indicated for a muscle with MMT Grade 2 (Poor)?

A. Active Assisted B. Free Active C. Resisted D. Passive

Rationale: Grade 2 means the muscle can move the limb with gravity eliminated but not against gravity. Active assistance helps complete the range or support the limb.

Q2. During the lowering phase of a bicep curl, the Biceps brachii undergoes which type of contraction?

A. Concentric B. Eccentric C. Isometric D. Isokinetic

Rationale: The muscle is lengthening while controlling the descent of the weight against gravity. This is eccentric work.

Q3. Which type of muscle work produces the greatest amount of tension/force?

A. Concentric B. Eccentric C. Isometric D. All are equal

Rationale: Eccentric contractions can generate higher force levels than isometric or concentric contractions due to the contribution of passive elastic elements in the muscle.

Q4. Free Active Exercises are primarily used to:

A. Increase muscle bulk (Hypertrophy) B. Maintain joint range and muscle tone C. Break adhesions D. Test maximal strength

Rationale: Free active exercises use only the weight of the limb (gravity). This is usually insufficient for hypertrophy (which needs overload) but excellent for maintaining mobility and tone.

Q5. According to the Overload Principle, to increase strength, the load must be:

A. Greater than the normal capacity of the muscle B. Equal to the normal capacity C. Less than the normal capacity D. Zero

Rationale: Adaptation (strengthening) only occurs when the system is stressed beyond its current capacity (Overload).

Q6. Which of the following is a form of Mechanical Assistance for exercise?

A. Therapist's hand B. Finger Ladder / Pulley C. Dumbbell D. Gravity

Rationale: Pulleys, suspension frames, skateboards, and finger ladders are mechanical devices used to assist weak muscles in moving a limb.

Q7. Wolff's Law states that:

A. Nerves regenerate if the sheath is intact B. Bone adapts and strengthens in response to stress/load C. Muscle fibers split with training D. Ligaments become lax with heat

Rationale: Wolff's law explains why weight-bearing active exercises are crucial for preventing osteoporosis and strengthening bones.

Q8. Isometric exercises are most indicated when:

A. The goal is to increase range of motion B. Joint movement is painful or contraindicated (e.g., inside a cast) C. The goal is to improve coordination D. The patient has full strength

Rationale: Isometric (Static) exercises maintain muscle strength without moving the joint, making them safe for acute inflammation or immobilized limbs.

Q9. Self-Assisted exercise is commonly used for:

A. Shoulder ROM in Hemiplegia (using the sound hand) B. Quad strengthening in paraplegia C. Testing reflexes D. Balance training

Rationale: A classic example is a stroke patient clasping their hands together and using the strong arm to lift the weak/paralyzed arm overhead.

Q10. Which exercise type aids venous return via the "Muscle Pump" mechanism?

A. Isotonic (Rhythmic) Contractions B. Isometric Contractions C. Passive movements D. Stretching

Rationale: The rhythmic contraction and relaxation of muscles (Isotonic) squeezes veins, pushing blood back to the heart. Isometric holds can actually impede blood flow temporarily.

Q11. What is the definition of "Work" in physics terms during exercise?

A. Force × Distance B. Force / Time C. Mass × Acceleration D. Velocity × Time

Rationale: Work is done when a force moves an object over a distance. In isometric exercise, Distance = 0, so Work = 0.

Q12. Suspension Therapy allows for which type of movement?

A. Gravity Eliminated / Assisted B. Resisted against gravity C. Isometric only D. Passive only

Rationale: By suspending the limb, gravity is counterbalanced (eliminated), allowing very weak muscles (Grade 2) to move the limb freely (Axial suspension).

Q13. Which of the following creates "DOMS" (Delayed Onset Muscle Soreness) most frequently?

A. Concentric exercise B. Eccentric exercise C. Isometric exercise D. Stretching

Rationale: Eccentric loading causes micro-trauma to the Z-lines of the muscle sarcomere, leading to the inflammatory response felt as DOMS 24-48 hours later.

Q14. When standing up from a sitting position, the Quadriceps perform a:

A. Concentric contraction B. Eccentric contraction C. Isometric contraction D. Passive movement

Rationale: The quads shorten to extend the knee and lift the body weight against gravity (Going UP = Concentric). Sitting down slowly would be Eccentric.

Q15. Valsalva Maneuver (holding breath) is a risk mainly associated with:

A. Active Assisted exercise B. Heavy Resisted / Isometric exercise C. Passive exercise D. Stretching

Rationale: During heavy effort, patients often hold their breath, increasing intrathoracic pressure and BP. This is dangerous for cardiac patients.

Q16. A key principle of "Re-education" of a muscle is to:

A. Eliminate gravity initially B. Use maximum resistance immediately C. Use passive movements only D. Use rapid movements

Rationale: Re-education usually starts with weak muscles. Eliminating gravity (Free active assisted or suspension) allows the patient to initiate the correct motor pattern without fatigue.

Q17. Which is an example of an "Open Kinetic Chain" exercise?

A. Squat B. Seated Knee Extension (Kicking) C. Push-up D. Lunge

Rationale: In Open Chain exercises, the distal segment (foot/hand) is free to move. In Closed Chain (Squat, Push-up), the distal segment is fixed.

Q18. Active exercise is contraindicated in:

A. Paralysis B. Acute Myocardial Infarction (Day 1) C. Osteoporosis D. COPD

Rationale: Immediately after a heart attack, resting the heart is the priority. Any active muscle work increases oxygen demand on the heart.

Q19. Proprioceptive Neuromuscular Facilitation (PNF) uses which type of resistance?

A. Manual Resistance B. Weight machine C. Sandbags D. Springs

Rationale: PNF relies on the therapist's manual contact to provide resistance, sensory cues, and diagonal patterns of movement.

Q20. "Trick Movements" occur when:

A. The patient is strong B. Substitution by stronger muscles compensates for weak ones C. The joint is fused D. Reflexes are hyperactive

Rationale: Trick movements (Compensation) happen when the prime mover is weak (e.g., using lateral trunk flexion (Quadratus Lumborum) to hike the hip instead of using Hip Flexors).