Therapeutic Exercise Foundations

Therapeutic Exercise Foundational Concepts

• Therapeutic exercise involves systematically planned bodily movements, postures, or physical activities to improve a patient's physical function and overall well-being. This may include remediation or prevention of impairments as well as optimizing health status, fitness, or sense of well-being.

Topics

• Definition of therapeutic exercise
• Components of physical function
• Types of therapeutic exercise
• Introduction to range of motion exercise

Definition of Therapeutic Exercise

• Therapeutic exercise is the systematic, planned performance of bodily movements, postures, or physical activities intended to provide a patient with the means to:
  • Remediate or prevent impairments
  • Improve, restore, or enhance physical function
  • Prevent or reduce health-related risk factors
  • Optimize overall health status, fitness, or sense of well-being

Components of Physical Function

• Balance/Postural Equilibrium
• Muscle Performance
• Cardiopulmonary Endurance
• Stability
• Neuromuscular Control/Coordination
• Mobility/Flexibility

Balance

• The ability to align body segments against gravity to maintain or move the body within an available base of support without falling. This depends on the sensory and motor systems working together.
• Key elements include postural control, postural stability, and equilibrium.

Flexibility

• The ability to move freely without restriction.

Mobility

• The ability of body structures or segments to move or be moved to allow range of motion (ROM) for functional activities.
• Passive mobility relies on soft tissue extensibility, while active mobility requires neuromuscular activation.

Muscle Performance

• The capacity of muscles to produce tension and perform physical work, including strength, power, and muscular endurance.

Neuromuscular Control

• The interaction between the sensory and motor systems. This enables synergists, agonists, and antagonists, as well as stabilizers and neutralizers, to respond appropriately to proprioceptive and kinesthetic information. This allows coordinated movement.

Coordination

• The correct timing and sequencing of muscle firing combined with appropriate intensity of muscular contraction.
• This results in effective initiation, guiding, and grading of movement
• Coordination is the basis for smooth, accurate, and efficient movement and can occur consciously or automatically.

Cardiopulmonary Fitness

• The ability to perform moderate-intensity repetitive total body movements over an extended period of time. Examples include walking, jogging, cycling, and swimming.

Stability

• The ability of the neuromuscular system to hold a body segment in a stationary position or control a stable base during movement, through synergistic muscle groups.
• Joint stability is the maintenance of proper bony alignment of joint partners.

Types of Therapeutic Exercise Interventions

• Aerobic conditioning and reconditioning
• Muscle performance exercises (strength, power, and endurance)
• Stretching techniques (muscle-lengthening and joint mobilization/manipulation)
• Neuromuscular control (inhibition, facilitation, and posture awareness)
• Postural control, body mechanics, and stabilization exercises
• Balance exercises and agility training
• Relaxation exercises
• Breathing exercises and ventilatory muscle training
• Task-specific functional training

Range of Motion (ROM) Exercise

Definitions

• Range of motion (ROM) is the angle through which a joint moves from anatomical position to its extreme limit in a particular direction. It is measured in degrees.

• The complete ROM of a joint can be broken into thirds(inner, middle, and outer ranges).

• Example: The difference in angle at the elbow in a fully extended position versus a maximum flexed position is its ROM for flexion.

• Range of motion is an essential technique to examine and begin developing a program of intervention for movement. Measures are usually taken with a goniometer and recorded in degrees.

Movement in Sagittal Plane

• Movements in the sagittal plane, including flexion and extension, are demonstrated with examples of different joints.

Towards or away from midline

• Abduction and Adduction are movements in the frontal plane and are illustrated with examples of shoulder and hip joints.

Internal/External Rotation

• Internal and external rotation are illustrated as movements in the horizontal plane.

Patient Management Model

• The model describes a comprehensive process for patient management, including referrals/consultations, prognosis and plan of care, diagnosis, evaluation, intervention, and re-examination. The cycle emphasizes communication, coordination, and documentation.