1. Therapeutic Exercise

2. Overview of rehab

3. Review Acute Inflammation Repair or Fibroplasia Maturation
Tissue Healing
Modalities
Acute Inflammation
Repair or Fibroplasia
Maturation
Wolff’s Law- tissues will adapt to stresses/tension applied to them
Pain control
Inflammation control
Facilitate ROM
Can be used during rehab program

4. Goals of Injury Rehabilitation
Pain Control
Regain/increase ROM and flexibility
Proprioception
Regain/increase strength and power
Regain/increase endurance
Return to functional and sports specific activity
Maintain conditioning of whole body!

5. Your Duties as a Clinician
Understand injury and subsequent healing phase and design appropriate exercise regimen
Have purpose for exercise choice
Provide direction and instructions
Correct/modify/adjust program as needed
Supervision
Professionalism and courtesy
Support and encourage patient

6. Early Therapy Stages

7. Terminology
AROM (active range of motion): patient performs motion by his/herself
PROM (passive range of motion): clinician moves patient through range of motion
AAROM (active assisted range of motion): combination of passive and active; patient performs what he/she can and clinician assists with rest of movement

8. Terminology Subjective measurement: an approximation, guess
Objective measurement: factual, exact measure
Goniometer: tool used by clinicians to measure a patient’s ROM; similar to a protractor in math

9. Pain Control Pain control is usually a component of modality usage
Psychological Techniques
Relaxation
Meditation
Visualization
Medications

10. Active Range of Motion May be done in conjunction with modality usage
Alphabet with toes/foot in cold whirlpool
Initially pain free ROM indicated

11. Passive ROM used When patient cannot move on his/her own
Maintain flexibility
Increase blood flow
Adhesions or scar tissue not allowing full ROM
Machine or therapist can provide ROM
CPM- continuous passive movement used with ACL or knee replacement surgery

12. Active Assisted ROM Increase flexibility Assist weak musculature
Perform a specific ROM pattern
Use gravity to increase ROM
Pendulums
Wall slides
Bicycle
Dowel

13. Measuring ROM Determines normal vs. abnormal ROM Goal setting
Can be completed both subjectively and objectively

14. Goniometer Maintain consistency!
Note position of patient during testing
Use same landmarks on lateral side of joint each time tested
Start at 0 degrees (anatomical position) then move through ROM to gain measurement
Compare bilaterally

15. Remember!
If a therapy session results in increased pain or a return of inflammation, the clinician may be progressing too aggressively. Feedback from patient determines speed of progression.

16. Muscle strength, endurance, and proprioception: Early stages

17. Terminology
PRE (progressive resistive exercise): exercises that become increasingly more difficult
RROM (resistive range of motion): some form of resistance is applied to the movement
Manual resistance: clinician physically resists range of motion

18. Terminology
SLR (straight leg raise): ROM performed at hip if there is a lower extremity injury that prevents knee ROM
Open kinetic chain exercises: when the foot or hand is mobile or off the ground
Closed kinetic chain exercises: when the foot or hand is fixed or on the ground
Neuromuscular control: ability for muscles to respond to environmental changes

19. Considerations
Protect healing tissue, but must provide some stress for proper healing (Wolff’s law)
PRE
Safe ROMs and planes of movement
Exercise choice
Maintain rest of body fitness to prevent atrophy

20. Strengthening Isometric vs. isotonic vs. isokinetic Easy progression:
Gravity resistance
Light weight or manual resistance
Tubing/bands

21. Endurance Pain-free ROM No undue stress to healing site Examples: Bike
UBE- upper body
ergometer
Rowing
Swimming
Elliptical
Treadmill

22. Proprioception Static balance exercises- tandem stance or one leg
Flat hard surface
Foam or mat surface
Add weights or movements to each
Static upper extremity exercises
Mirror movements between limbs
Closed kinetic chain stability on hand-
tandem and single arm

23. Muscle strength, endurance and proprioception: later stages

24. Terminology
Agility: ability to accelerate, decelerate, and change direction while maintaining balance and posture
Plyometric exercise: movements that involve speed, agility and power

25. Considerations Phase of tissue healing
Range of motion and planes of movement
Should have near-full or full ROM
Advance to multi-planar activity
Exercise choice
Multi-joint exercises
Specific supplemental exercises for injury site

26. Strengthening and Endurance
Increased resistance loads
Moving resistance with multiple joints
Weight room activity
Plyometrics

27. Strengthening and Proprioception
Plyometrics
Advanced static balance and dynamic balance exercises
Wobble boards
Adding distractions or other movements

28. What muscles is this exercise working?
What muscles is this exercise working?
When and why would one use this exercise?
Is this exercise proprioceptive? strengthening? endurance?

29. What muscles is this exercise working?
When and why would one use this exercise?
Is this exercise proprioceptive? strengthening? endurance?

30. What muscles is this exercise working?
When and why would one use this exercise?
Is this exercise proprioceptive? strengthening? endurance?

31. Functional Training and Sport Specific rehabilitation

32. Terminology
ADL (activities of daily living): procedures or things that must be accomplished daily in order to properly function
Functional Training: training the body for activities that must be performed in daily life
Motor learning: practice and experience increases skilled movements

33. Terminology
Specificity: the theory that training should be relevant to what the desired results should be
SAID principle: (specific adaptations to imposed demands) body will adapt to demands placed upon it

34. ADLs
What are some movements that a person must be capable of doing in order to function on his/her own?

35. Functional Training
Requires smooth, coordinated movements across multiple planes
In training, exercises must be able to transfer over to the desired movements at desired speed
Components of the movement can be isolated, but goal is multi-joint coordination
Repetition of movement is important for motor learning

36. http://www. guardian. co
What types of functional exercises would each of these professionals have to do to effectively and safely perform their jobs?
Be prepared to share

37. Sports Specific Training
Factors that must be considered:
Movements required
Endurance, strength and agility needed
Surface, facility or environment
Equipment
Rules of sport
Gradual progression back to full competition

38. Therapy and Unique Populations

39. Therapy Issues Sensory deficits Verbal communication problems
Attention disorders
Spastic muscles/lack of muscle control
Diminished mental function
Chronic pain

40. Therapy Options: Aquatic Therapy
Increased buoyancy
Resistance and compression from water
Decreased stress on joints
Variety of exercises without equipment

41. Yoga Therapy Works strength, endurance and flexibility
Can customize for pain and injury through sequencing of poses
Can modify routine as pain decreases and strength increases

42. Interactive Video Gaming Systems
Can be done in privacy of home or socially
Hand-eye coordination
Some balance, agility and coordination needed

43. Equine Therapy Animals make good companions
Non-judgmental
Work on communication skills
Work on muscle tone, flexibility, and coordination

44. Fitness concerns for the geriatric populations

45. Benefits for Geriatric Populations
Increase calorie use (decrease weight)
Increase in cardiovascular fitness and strength
Decrease blood pressure
Decrease chance of stroke, some cancers, osteoporosis, and cardiovascular disease
Decrease psychological stress
Improve sleep and digestion

46. Therapeutic Benefits Heart attack patients
Diabetics (improves insulin response)
Decrease back pain by increasing strength
Arthritis patients (strong muscles= less joint pain)
Depression (improved self confidence)
Improves neurocognitive function
Decreases loss of muscle mass

47. Considerations Patient beginning health and fitness level
Modify workout based on injury/illness
Balance issues
Previous exercise experience
Medications

48. Clinician can control injury prevention
Ensure proper warm-up and cool down
Control lifting speed
Monitor for proper technique
Keep workout area uncluttered
Consider balance concerns:
Machines vs. free weights
Body weight or exercise bands
Seated or lying vs. standing
Stable vs. unstable surfaces

49. Geriatric Conditioning Guidelines
Strength program 2-3 times/week
Controlled speeds of repetitions
Beginners: more reps and less load
Provide clear explanation of lift/move
Demonstrate lift/move
Demonstrate breathing technique
Careful supervision with positive reinforcement

50. How can we modify this exercise for improved geriatric safety?

51. Cardiovascular Training
2-5 days/week for minutes
Workout intensity: 60-90% max HR
Medications may affect HR
Talk test- if they can say short-medium sentences during workout, they are at good pace

52. Clinician must enforce participant compliance with:
Increased fluid intake
Proper nutrition
Adequate rest and sleep
Proper hygiene
Approval of exercise regimen with physician
Communicate concerns to clinician