Therapeutic Exercise: Definition and Components

Definition of Therapeutic Exercise

• Therapeutic exercise systematically and purposefully uses bodily movements, postures, and physical activities.
• The goals are to prevent impairments, improve physical function, reduce health risks, and optimize overall well-being for patients or clients.

Individualized Exercise Programs

• Physical therapists design therapeutic exercise programs tailored to each patient's unique needs.

Components of Physical Function

• Physical function involves performing activities independently at home, work, or in daily life (ADL).
• Integration and connection between physical, psychological, and social functions are necessary.

Requirements for Physical Function

• Balance: Needed to align body segments against gravity, maintaining the body's center of mass within its base of support, requiring equilibrium via sensory-motor interaction.
• Cardiopulmonary fitness: Needed for low-intensity, repetitive movements over time, such as walking, jogging, cycling, or swimming.
• Coordination: The correct timing and sequence of muscle firing with appropriate intensity is needed for muscular contraction.
• Flexibility: Freely moving without restriction and returning to a neutral position depends on this.
• Mobility: The ability of body structures or segments to move without limitation is required to achieve desired movement.
• Muscle performance: Producing tension and physical work, requiring strength, power, and endurance
• Neuromuscular control: Coordinated, balanced movement through interaction of sensory and motor systems
• Stability: Maintains proper body alignment during static and dynamic positions.
• Impairment of body systems can limit an individual’s ability to participate in daily activities.

Types of Therapeutic Exercise Interventions

• Selection of therapeutic exercise techniques relies on a therapist's determination of the underlying causes of a patient's impairments, limitations, or disability.

Exercise Type Examples

• Aerobic exercises
• Muscle performance exercises for strength, power, and endurance
• Stretching exercises
• Neuromuscular control, inhibition, and facilitation techniques
• Postural control exercises
• Balance exercises
• Relaxation exercises
• Breathing exercises
• Joint mobilization exercises

Exercise Safety Considerations

• Supervision by a physical therapist is needed during exercise.
• Safety factors involve patient history, medication, the environment, comfortable positions, correct posture, and prompt reporting of fatigue or pain to avoid injury.

Impairments

• Changes in physiological, anatomical, and psychological functions reflect a person's health status.
• Pathological conditions lead to signs and symptoms, reflecting abnormalities.
• Primary impairment is the initial problem, while secondary impairments are complications arising from untreated conditions.

Types of Impairments

• Musculoskeletal impairments involve muscle weakness, tightness, pain, or faulty posture.
• Neuromuscular impairments involve pain, hypotonia, incoordination, or impaired balance.
• Cardiovascular impairments involve poor circulation or decreased cardiopulmonary endurance.
• Dermatological impairments involve scars.

Patient Management Model

• A physical therapist needs a treatment plan through systematic steps to help the patient reach the highest function.
• Examination needed includes history, observation, palpation, and special tests.
• Collection and evaluation of data is needed.
• Diagnosis is needed.

Plan of Treatment

• Short-term goals
• Long-term goals
• Intervention

General Aims of Therapeutic Exercises

• Increase Range of Motion (ROM), circulation, muscle strength, and respiratory capacity.
• Reduce pain and edema.
• Restore joint flexibility.
• Improve self-confidence.
• Improve body function

Range of Motion (ROM)

• ROM is the extent a joint can move in a direction.
• Active ROM: The subject does it themselves.
• Passive ROM: An external force or an examiner move the joint.

Types of Movements

• Abduction: Moving away from the center
• Adduction: Moving toward the midline of the body
• Flexion: Moving the limb anterior or posterior plane
• Extension: Opposite to flex.
• Rotation: Turning the body segment around longitudinal axis
• Circumduction: Circular movement.
• Elevation and Depression: Movement in superior and inferior direction in sagittal plane
• Protraction and retraction: Moving the body part anteriorly in a horizontal plane
• Gliding: Movement between two opposite surface bones
• Supination and pronation: rotation of the distal end of radius and ulna
• Opposition: Special movement to the thumb, enabling grasp
• Dorsiflexion and plantar flexion: Movement of the foot