Active Assisted Exercise: Definition, Benefits, and Performance

What is an example of an active assisted exercise?

An active assisted exercise is a movement where the individual actively contracts their muscles to perform the exercise, but receives external assistance to complete the full range of motion or to overcome a sticking point. This assistance can come from a therapist, a partner, or a piece of equipment like a resistance band, pulley system, or a simple stick.

Understanding Active Assisted Exercise

Active assisted exercise represents a crucial phase in the continuum of movement rehabilitation and performance enhancement. It bridges the gap between passive range of motion (where external force entirely moves the limb) and active range of motion (where the individual's muscles perform the movement unassisted). The core principle is that the individual initiates and attempts to perform the movement through their own muscular effort, and external assistance is provided only to facilitate or extend that movement beyond what the individual could achieve independently.

The Role of Assistance

The "assistance" component is carefully managed to ensure the primary effort remains with the individual. This external aid can take various forms:

• Manual Assistance: A physical therapist, trainer, or partner gently guides the limb through the desired range of motion, providing just enough support to complete the movement.
• Mechanical Assistance: Tools such as a stick, dowel, towel, resistance band, or pulley systems can be used by the individual to assist their own movement. For example, using the stronger limb to assist the weaker one.
• Gravity-Assisted Movement: Positioning the body to allow gravity to assist the movement, often seen in early stages of rehabilitation (e.g., sliding a limb on a smooth surface).

The goal of this assistance is not to do the work for the individual, but rather to enable them to experience the full, pain-free range of motion, reinforce proper movement patterns, and gently challenge the muscles without overstressing them.

Key Benefits of Active Assisted Exercise

Active assisted exercises offer a multitude of benefits, making them invaluable in various contexts, from post-injury rehabilitation to improving athletic performance:

• Enhanced Range of Motion (ROM): By gently extending the movement beyond what is actively possible, these exercises can gradually increase joint flexibility and muscle length.
• Improved Motor Control and Neuromuscular Re-education: The active component helps to re-establish the brain-muscle connection, improving coordination and the ability to recruit specific muscles.
• Reduced Pain and Fear of Movement: The controlled assistance can make movements less daunting, helping individuals move past apprehension or a "fear of re-injury" cycle.
• Gentle Strength Development: While not primarily a strength-building modality, the active effort still provides a stimulus for muscle activation and endurance, especially in weakened muscles.
• Safe Progression: It allows for a gradual and controlled increase in demand, preparing the body for more challenging unassisted movements.
• Circulation and Tissue Healing: Movement helps promote blood flow, which is vital for tissue repair and reducing swelling.

Example: Active Assisted Shoulder Flexion with a Stick/Dowel

One of the most common and effective examples of an active assisted exercise, particularly in shoulder rehabilitation or for improving overhead mobility, is Active Assisted Shoulder Flexion using a Stick or Dowel.

Why this exercise?

This exercise is frequently prescribed for individuals recovering from shoulder injuries (e.g., rotator cuff repair, frozen shoulder), those with limited overhead range of motion, or as a warm-up drill to improve shoulder mobility. It allows the individual to actively engage their shoulder muscles while using the stick to gently guide and extend the movement, preventing compensation and overstressing the joint.

Muscles Involved:

• Primary Movers: Anterior deltoid, supraspinatus (for shoulder flexion).
• Synergists/Stabilizers: Middle deltoid, serratus anterior, upper and lower trapezius (for scapular stability and upward rotation).

Equipment Needed:

• A lightweight stick, dowel, broom handle, or PVC pipe (approximately 3-4 feet long).

How to Perform:

1. Starting Position:

   • Sit or stand tall with good posture, back straight, and shoulders relaxed.
   • Hold the stick with both hands, palms facing down, about shoulder-width apart. The hand on the affected side (the one you are assisting) should be closer to the center of the stick, while the unaffected hand is positioned towards the end to provide leverage.
   • Keep elbows slightly bent.

2. Execution (Active Assisted Flexion):

   • Initiate Actively: Begin by actively trying to lift the stick straight up in front of you, using the muscles of the affected shoulder.
   • Apply Assistance: As you reach the limit of your active range of motion, use your unaffected arm to gently push the stick further overhead. The unaffected hand acts as a lever, guiding the stick and the affected arm upwards.
   • Maintain Control: Ensure the movement is smooth and controlled. Do not force the movement or push into sharp pain. The assistance should be just enough to gently extend the range, not to pull or yank the arm.
   • Focus on Form: Keep your core engaged and avoid shrugging your shoulders towards your ears or arching your lower back excessively as you raise the stick. The movement should primarily come from the shoulder joint.
   • Hold (Optional): At the top of the comfortable range, you can hold briefly for 1-2 seconds to allow for a gentle stretch.

3. Return:

   • Slowly and with control, lower the stick back down to the starting position, maintaining active control as much as possible with the affected arm.

4. Repetitions and Sets:

   • Perform 10-15 repetitions for 2-3 sets, or as recommended by a healthcare professional.
   • Focus on quality of movement over quantity.

Common Mistakes to Avoid:

• Over-relying on Assistance: The affected arm should always be actively attempting the movement. The assisting arm is a helper, not the primary mover.
• Compensatory Movements: Avoid shrugging the shoulders, arching the lower back, or tilting the torso to achieve a greater range of motion. This indicates that the movement is coming from other joints, not the target shoulder.
• Pushing into Pain: A gentle stretch or mild discomfort is acceptable, but sharp, shooting, or increasing pain is a sign to stop or reduce the range.
• Fast, Jerky Movements: Control is paramount. Slow and deliberate movements allow for better muscle activation and reduce the risk of injury.

Progression and Regression:

• Progression: As mobility improves, gradually decrease the amount of assistance provided by the unaffected arm. Eventually, aim to perform the movement purely actively (Active Range of Motion). You can also increase repetitions, sets, or the duration of the hold at the top.
• Regression: If the movement is too challenging, increase the amount of assistance provided, or reduce the range of motion to a pain-free limit. You might also perform the exercise lying on your back (supine position), which uses gravity to assist the initial part of the movement.

When to Use Active Assisted Exercise

Active assisted exercises are invaluable in several scenarios:

• Early-Stage Rehabilitation: After injury or surgery, when muscles are too weak or painful to move a joint through its full range independently.
• Restoring Range of Motion: For conditions like frozen shoulder, post-fracture stiffness, or chronic tightness where active ROM is limited.
• Neurological Conditions: To help re-educate movement patterns and strengthen weakened muscles in individuals with conditions like stroke or spinal cord injury.
• Warm-up: To gently prepare joints and muscles for more demanding exercises, particularly those requiring significant mobility.
• Overcoming Sticking Points: In strength training, to help an individual move past a point in an exercise where they typically fail, allowing them to experience the full movement.

Important Considerations and Safety

While generally safe, active assisted exercises require careful attention to detail:

• Listen to Your Body: Pain is a warning signal. Do not push through sharp or increasing pain.
• Proper Form is Paramount: Always prioritize correct technique over achieving a greater range of motion. Compensatory movements can lead to further injury or reinforce poor mechanics.
• Gradual Progression: Increase the range of motion and decrease assistance slowly and systematically.
• Consult a Professional: Especially after an injury or surgery, always consult with a physical therapist, kinesiologist, or qualified healthcare provider before starting any active assisted exercise program. They can assess your specific needs and guide your rehabilitation safely and effectively.

Conclusion

Active assisted exercises serve as a vital bridge in the journey from limited to full, functional movement. By strategically combining active muscular effort with external support, they enable individuals to safely explore and expand their range of motion, re-educate movement patterns, and build foundational strength. The active assisted shoulder flexion with a stick is a prime example of how this principle can be applied effectively to restore mobility and function, highlighting the nuanced and evidence-based approach central to exercise science and kinesiology.