Chapter 16: Therapeutic Exercise in Rehabilitation

Question 1

What effect does immobilization have on muscles, joint lubrication, ligament, bone & cardiorespiratory?

Answer 1

Muscle: loss of muscle mass (especially Type 1), less atrophy if immob in lengthened/neutral
Joint Lubrication: decreases normal lubrication, degeneration
Ligament/Bone: weaken, collagen fiber breakdown, full remodel takes 12+ months
Cardiorespiratory system: resting HR increases by ½ beat/minute each day of immobilization, stroke volume/max O2 uptake/vital capacity decrease

Question 2

What are some of the major components of the rehabilitation program?

Answer 2

Minimize swelling, control pain, reestablish NM control, establish/enhance core stability, regain/improve ROM, restore/increase muscular strength/endurance, regain balance/postural control, maintain cardiorespiratory endurance, functional progression

Question 3

What are accessory motions? 3 examples?

Answer 3

Voluntary movement, Spin, Roll, and Glide

Question 4

How should training progress isotonic/isometric/isokinetic/plyometric exercises?

Answer 4

Isometric, isotonic (concentric/eccentric) isokinetic, plyometric

Question 5

What does DAPRE stand for? How does it work?

Answer 5

Daily Adjustable Progressive Resistance Exercises. takes advantage of the fact that strength can be redeveloped much more quickly than it was developed initially.
1 set - 1/2 of working weight with 10 reps
2 set - 3/4 of working weight with 6 reps
3 set - full working weight with max reps
4 set - adjusted weight with max reps (determined by next table)

0-2 reps: decrease 5-10 lbs and perform set over keep the same for next day
3-4 reps: decrease 0-5 lbs and increase 5-10 lbs the next day
5-7 reps: keep the same and increase 5-15 lbs the next day
8-12 reps: increase 5-10 lbs and increase 10-20 lbs the next day
13+ reps: increase 10-15 lbs

Question 6

What is the relationship between kinesthesia, proprioception, and neuromuscular control?

Answer 6

Kinesthesia: the ability to detect movement
Proprioception: ability to determine the position of a joint in space
Neuromuscular Control: produces coordinated movement, relies on CNS to interpret/integrate

Question 7

What are the types of joint mechanoreceptors?

Answer 7

Ruffini’s Corpuscles: sensitive to touch, tension, heat, most active in end range of motion
Pacinian: in the skin, respond to deep pressure
Merkel’s: in the skin, respond to deep pressure, but more slowly than Pacinian
Meissner’s: in the skin, activated by light touch
Free Nerve Endings: sensitive to extreme mechanical/thermal/chemical energy, respond to pain/damage

Question 8

What are the types of muscle mechanoreceptors?

Answer 8

Muscle spindles: located in the muscle, sensitive to changes in the length of the muscle
Golgi Tendon Organs: found at musculotendinous junction, sensitive to change in muscle tension

Question 9

What are functional progressions?

Answer 9

A program that incorporates sport-specific skills into the rehab program

Question 10

What are some functional tests?

Answer 10

Single leg hop test, DAPRE, figure 8

Question 11

What are the phases of rehab?

Answer 11

Preop, 1) Acute Inflammatory response, 2) fibroblastic repair, 3) maturation-remodeling

Question 12

What are some criteria for RTP?

Answer 12

Later stage of healing, pain disappeared or functional, swelling has decreased, ROM, strength, NM control, cardiorespiratory endurance, sport-specific demands, functional testing, bracing/padding, Predisposition to injury, psych factors, athlete education

Question 13

What is open/closed kinetic chain?

Answer 13

Open kinetic chain is when the foot or hand is off the ground (not making contact)
Closed kinetic chain is when the foot or hand is on the ground (making contact)

Question 14

What is core stabilization?

Answer 14

A program designed to help an individual gain strength, NM control, power, and mm endurance

Question 15

What are some of the concepts that apply to aquatic exercise?

Answer 15

Buoyancy and water resistance, exercise environment can be varied for each person: Assistive/supportive/resistive

Question 16

What are the 5 PNF strengthening techniques?

Answer 16

1) Rhythmic Initiation: passive then active assistive movement, active through agonist pattern, within first day after the injury
2) Repeated Contraction: for general weakness or point weakeness, moves isotonically against max resistance of ATC until fatigue, then stretch
3) Slow Reversal: move through complete ROM against max resistance, reverse to agonist/ant
4) Slow-Reversal-Hold: moves isotonically against agonist muscles and then with isometric contraction
5) Rhythmic Stabilization: sometric contraction of the agonsits followed by isometric contraction of antagonists

Question 17

What are the 3 PNF Stretching techniques?

Answer 17

1) Contract-Relax: body part is passively moved until resistance, patient conracts the antagonistic muscle isotonically, then relaxes
2) Hold-Relax: body part is moved to resistance and holds with isometric contraction, then relaxes and restretched
3) Slow-Reversal-Hold-Relax: body part moves to resistance and isometrically contracts then contracts agonist as body part is moved to another ROM

Question 18

What are D1/D2 PNF Patterns?

Answer 18

Shoulder: D1 into flexion (to opposite ear), D1 into extension, D2 into flexion (opposite hip), D2 into extension
Hip: D1 into flexion (& add, foot to opp knee), D1 into etension (& abd), D2 into flexion (direct adduction to abd with hip flexion), D2 into extension

Question 19

What movements should occur first, proximal or distal?

Answer 19

Proximal

Question 20

What are muscle energy techniques?

Answer 20

(MET), manually applied stretching techniques that use neurophysiology to relax overactive muscles and/or stretch chronically shortened muscles. Variation of PNF…patient provides the corrective intrinsic forces & controls the intensity of muscular contractions while ATC controls precision and localization

Question 21

What are the 5 grades of Joint Mobilizations?

Answer 21

Grade 1: small amplitude glides at beginning of ROM, used when pain/spasm limit movement
Grade 2: large amplitude glides in midrange, when spasm limits movement with quick oscillation
Grade 3: large amplitude glides up to pathological ROM limit, when pain/resistance from spasm/inert tissue tension/tissue compression limit movement near end ROM
Grade 4: small amplitude glide at end ROM, when resistance limits movement w/o pain/spasm
Grade 5: small amplitude, quick thrust at end ROM that usually has popping sound (manipulation)
used when minimal resistance limits end ROM, velocity is important factor

Question 22

What are the grades used for, what can ATCs perform?

Answer 22

Grades 1-2: pain, Grades 3-4: stiffness, ATCs can do Grades 1-4, NOT Grade 5

Question 23

What is the concave-convex rule?

Answer 23

When concave surface is stationary and convex is moving, the glide should be in the opposite direction of the bone movement. When convex is stationary and concave moves, the glide should be in the same direction as bone movement.

Question 24

What is myofascial release?

Answer 24

A group of techniques used to relieve soft tissue from abnormally tight fascia, form of stretching… soft tissue mobilization (graston, etc)

Question 25

What is strain-counterstrain?

Answer 25

Approach to decrease muscle tension and guarding to normalize muscle function. Passive technique that puts body in greatest comfort position

Question 26

What is a tender point? Point of comfort? How long should it be held?

Answer 26

Tender points correspond to areas of dysfunction (tense/tender/edema)
Position of ease is when muscle is shortened, held for 90 seconds

Question 27

What is Positional Release Technique?

Answer 27

Based on strain/counterstrain, find greatest point of relaxation, the tender point maintained by palpating a finger at subthreshold pressure as the patient is placed passively in a position that reduces that tension

Question 28

What is Active Release Technique?

Answer 28

AKA Soft-tissue mobilization, used to disrupt adhesions, deep-tissue technique, locate adhesion and palpate with pressure, then actively move body part so it moves from shortened to elongated position. Repeat 3-5 times per treatment session