7 - Therapeutic Exercise Flashcards by Alyssa Milley

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

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What are three examples of muscle performance exercises?

Strength, power and endurance training

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True or false: stretching techniques are a type of therapeutic exercise

True

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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

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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?

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What are some exercise goals?

Increase or improve:
ROM
Strength
Endurance
Core stability
Peripheral joint stability
Motor patterning

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True or false: ROM/flexibility exercises should not be done when motion is disruptive to the healing process?

True

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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

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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

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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

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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

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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

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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

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When would you use AAROM?

When patient is unable to move joint through desired range (muscle weakness)
To aid in the healing process

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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

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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

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What way are you moving if you are moving against gravity?

Away from the ground

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What way are you moving if you are moving with gravity?

Towards the ground

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What way are you moving if you have gravity eliminated?

Parallel with the ground

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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. ```