7 - Therapeutic Exercise Flashcards
What is therapeutic exercise?
The prescription of physical activity that involves the client undertaking voluntary muscle contractions and/or movement with the aim of
- Relieving symptoms
- Improving function
- Improving, retaining or slowing deterioration of health
What are three examples of muscle performance exercises?
Strength, power and endurance training
True or false: stretching techniques are a type of therapeutic exercise
True
What are some examples of therapeutic exercise?
Muscle performance exercises Stretching techniques Joint mobilization procedures Neuromuscular control, inhibition and facilitation techniques Posture awareness training Task specific functional training
What should you consider before you prescribe an exercise?
What tissue you are targeting (ex. muscle fibers, scar tissue, peripheral nerve, CNS)
Is the tissue damaged, if so what stage of healing is it in?
What other structures would be affected by this exercise?
What are some exercise goals?
Increase or improve: ROM Strength Endurance Core stability Peripheral joint stability Motor patterning
True or false: ROM/flexibility exercises should not be done when motion is disruptive to the healing process?
True
What is a contraindication versus a precaution?
Contraindication, you should not do something as it will not help, it may even hinder the recovery process
Precaution, be cautious, take it slow
What are some situations in which you would do PROM?
To maintain the integrity during the healing process
When someone can’t or is not supposed to actively move the segment
To regain or recover motor impairment to maintain ROM
To avoid negative effects of immobilization
What are some goals of PROM?
To reduce the complications the occur with immobilization:
- maintain joint and connective tissue mobility
- minimize effects of contracture formation
- maintain elasticity of muscle
- assist circulation and vascular dynamics
- enhance synovial movement
- decrease or inhibit pain
- assist healing process
- maintain patient awareness of movement
What is Continuous Passive Motion?
A CPM machine performs passive motion by a mechanical device that moves through joint ROM slowly and continuously.
- Prevents adhesions and contractures
- stimulates healing of tendons and ligaments
- enhances healing of incisions
- increases synovial fluid lubrication of joint
- faster return of ROM
- decreases post-op pain
When would you use AROM
If there is no inflammation or contraindications to active motion
- whenever the patient is able to contract the muscles actively and move the segment with or without assistance
- aerobic conditioning
- above and below regions of immobilized segments
What are some goals of AROM
Maintain elasticity and contractility of the muscles
Provide sensory feedback (AROM>PROM)
Provide stimulus for bone and joint tissue integrity
Increase circulation to prevent thrombus formation
Develop coordination and motor skills for functional activities
When would you use AAROM?
When patient is unable to move joint through desired range (muscle weakness)
To aid in the healing process
What are some limitations to PROM?
Consciousness challenges true passive ROM
Does not prevent muscle atrophy
Does not improve strength and endurance
Limited assisted circulation
What are some limitations of AROM and AAROM?
Does not maintain or increase strength in strong muscles
Does not develop skill or coordination except in movement patterns used
What way are you moving if you are moving against gravity?
Away from the ground
What way are you moving if you are moving with gravity?
Towards the ground
What way are you moving if you have gravity eliminated?
Parallel with the ground
True or false: movements against gravity may require less assistance than movements with gravity eliminated?
False, they may require more assistance
True or false: movements toward gravity may require assistance to support antagonist muscles?
True
What is hypomobility
A decrease mobility or restricted motion at a joint/joints
What is a contracture?
Adaptive shortening of tissues significantly resisting stretch and limiting ROM
What is hypermobility?
detrimental joint instability if muscular control of joint is unable to maintain joint stability and functional position during activities
What is a myostatic contracture?
No pathology, musculotendinous unit has adaptively shortened, can be resolved with stretching
What is a pseudomyostatic contracture?
where there is hypertonicity/spasm/rigidity, muscle spasm or guarding can be resolved with neuromuscular inhibition techniques
What is an arthrogenic contracture?
An intra-articular pathology (ex. adhesions, joint effusion, osteophyte formation)
What is a periarticular contracture
Connective tissue crossing or attaching to joint or capsule lose mobility restricting normal arthrokinematics
What is a fibrotic or irreversible contracture?
Potential to stretch fibrotic tissue but difficult to achieve optimal length, increased duration reduces gains (ex. immobilization)
What is manual/passive/assisted stretching?
When there is end range stretch force applied by manual contact or mechanical device. Can be sustained or intermittent
What is a self stretch?
Performed independently by patient
Goal to elongate hypomobile soft tissue
What are muscle energy techniques?
Voluntary muscle contraction by patient, precise controlled direction and intensity against counter forces
Example: Post Isometric Relaxation: automatic state of muscle relaxation for a brief latent period after muscle contraction
What is soft tissue mobilization?
When the therapist uses their hands to manipulate the tissue.
It is to improve extensibility of any soft tissue
Sustained manual pressure
Can also manipulate the connective tissue that binds soft tissue
True or false: normal movements need free gliding of the dural neural and vascular tissues?
True
True or false: increased tension on nerve tissue by adhesions can lead to pain or neurological symptoms
True
What are three types of neuromuscular facilitation?
Hold Relax
Agonist Contraction
Hold Relax with Agonist Contraction
What is the hold relax technique?
typical stretch technique. isometric contraction followed by relaxation and further stretch. Build tension slowly to avoid stretch reflex
What is the agonist contraction technique?
Contract the agonist to inhibit antagonist to further stretch the antagonist
What is the hold relax with agonist contraction technique?
Combination of all of them
What are the general concepts/principles of stretching?
Stretch after activity
Helps maintain length/ROM
To decrease hypomobility
For chronic fibrotic contractures
What are the clinical considerations for stretching a patient?
Warm the tissue to be stretched
Stabilize one bony attachment and move the other
Know the actions of the muscle and stretch in the opposite direction
Sensation should be tolerable discomfort
Hold for 15-30 seconds and repeat 3 times
What are the 5W’s plus ___
Who, What, When, Where, Why, and How
What to consider about the “who”
Age Weight bering status Joint irritibility Co-morbidities Patient goals
What to consider about the “what”
What is the name of the exercise
What tissue is being affected
What should the patient expect to feel during and after the exercise
What to consider about the “where”
Where should the exercise be performed
Where should the patient feel the stress
What to consider about the “when”
When and how often should the exercise be performed
What to consider about the “why”
A patient who understands the purpose of the exercise will be more motivated and compliant
What to consider about the “how”
Demonstrate the proper performance Have patient perform exercise while you observe Encourage what is performed correctly Correct what is not right Repeat the reps, sets, duration etc.
