Therapeutic exercise : foundations and techniques /
Kisner, Carolyn.
Therapeutic exercise : foundations and techniques / Carolyn Kisner, Lynn Allen Colby. - 5th edition - Philadelphia : F.A. Davis, c2007. - xxvii, 928 p. : ill. ; 29 cm.
Includes bibliographical references and index.
Contents
Contents
Part I: General Concepts 1
Chapter 1: Therapeutic Exercise: Foundational Concepts 1
Therapeutic Exercise: Impact on Physical Function 2
Definition of Therapeutic Exercise 2
Aspects of Physical Function: Definition of Key Terms 2
Types of Therapeutic Exercise Intervention 3
Exercise Safety 3
Process and Models of Disablement 4
The Disablement Process 4
Models of Disablement 4
Use of Disablement Models and Classifications in Physical Therapy 5
Patient Management and Clinical Decision Making: An Interactive Relationship 11
Clinical Decision Making 11
Evidence-Based Practice 11
A Patient Management Model 12
Strategies for Effective Exercise and Task-Specific Instruction 24
Preparation for Exercise Instruction 24
Concepts of Motor Learning: A Foundation of Exercise and Task-Specific
Instruction 24
Adherence to Exercise 31
Independent Learning Activities 33
Chapter 2: Prevention, Health, and Wellness 37
Karen Holtgrefe, DHS, PT, OCS
Role of Physical Therapy in Healthy People 2010 37
Identifying Risk Factors 38
Determining Readiness to Change 38
Developing and Implementing a Program 40
Case Example: Exercise and Osteoporosis 40
Additional Considerations for Developing Prevention, Health, and Wellness
Programs 41
Independent Learning Activities 42
Part II: Applied Science of Exercise and Techniques 43
Chapter 3: Range of Motion 43
Types of ROM Exercises 44
Indications and Goals for ROM 44
Passive ROM 44
Active and Active-Assistive ROM 44
Limitations of ROM Exercises 45
Limitations of Passive Motion 45
Limitations of Active ROM 45
Precautions and Contraindications to ROM Exercises 45
Principles and Procedures for Applying ROM Techniques 45
Examination, Evaluation, and Treatment Planning 45
Patient Preparation 46
Application of Techniques 46
Application of PROM 46
Application of AROM 46
ROM Techniques 46
Upper Extremity 47
Lower Extremity 52
Cervical Spine 55
Lumbar Spine 55
Combined Patterns of Motion 56
Self-Assisted ROM 56
Self-Assistance 57
Wand (T-Bar) Exercises 59
Wall Climbing 60
Overhead Pulleys 60
Skate Board/Powder Board 61
Reciprocal Exercise Unit 61
Continuous Passive Motion 61
Benefits of CPM 61
General Guidelines for CPM 62
ROM Through Functional Patterns 62
Independent Learning Activities 63
Chapter 4: Stretching for Impaired Mobility 65
Definitions of Terms Related to Mobility and Stretching 66
Flexibility 66
Hypomobility 66
Contracture 66
Types of Contracture 67
Interventions to Increase Mobility of Soft Tissues 68
Selective Stretching 69
Overstretching and Hypermobility 69
Properties of Soft Tissue-Response to Immobilization and Stretch 69
Mechanical Properties of Contractile Tissue 70
Neurophysiological Properties of Contractile Tissue 72
Mechanical Properties of Noncontractile Soft Tissue 73
Determinants, Types, and Effects of Stretching Interventions 77
Alignment and Stabilization 77
Intensity of Stretch 79
Duration of Stretch 79
Speed of Stretch 81
Frequency of Stretch 81
Mode of Stretch 82
Proprioceptive Neuromuscular Facilitation Stretching Techniques 85
Integration of Function into Stretching 87
Procedural Guidelines for Application of Stretching Interventions 88
Examination and Evaluation of the Patient 88
Preparation for Stretching 89
Application of Manual Stretching Procedures 89
After Stretching 90
Precautions for Stretching 90
General Precautions 90
Special Precautions for Mass-Market Flexibility Programs 91
Adjuncts to Stretching Interventions 92
Relaxation Training 92
Heat 92
Massage 93
Biofeedback 93
Joint Traction or Oscillation 93
Manual Stretching Techniques in Anatomical Planes of Motion 94
Upper Extremity Stretching 94
Lower Extremity Stretching 99
Independent Learning Activities 104
Chapter 5: Peripheral Joint Mobilization 109
Definitions of Terms 110
Mobilization/Manipulation 110
Self-Mobilization (Auto-mobilization) 110
Mobilization with Movement 110
Physiological Movements 110
Accessory Movements 110
Thrust 110
Manipulation Under Anesthesia 110
Muscle Energy 110
Basic Concepts of Joint Motion: Arthrokinematics 110
Joint Shapes 110
Types of Motion 111
Passive-Angular Stretching Versus Joint-Glide Stretching 113
Other Accessory Motions That Affect the Joint 113
Effects of Joint Motion 114
Indications for Joint Mobilization 114
Pain, Muscle Guarding, and Spasm 114
Reversible Joint Hypomobility 114
Positional Faults/Subluxations 114
Progressive Limitation 114
Functional Immobility 114
Limitations of Joint Mobilization Techniques 115
Contraindications and Precautions 115
Hypermobility 115
Joint Effusion 115
Inflammation 115
Conditions Requiring Special Precautions for Stretching 115
Procedures for Applying Passive Joint Mobilization Techniques 116
Examination and Evaluation 116
Grades or Dosages of Movement 116
Positioning and Stabilization 117
Treatment Force and Direction of Movement 118
Initiation and Progression of Treatment 118
Speed, Rhythm, and Duration of Movements 119
Patient Response 119
Total Program 119
Mobilization with Movement: Principles of Application 120
Principles of MWM in Clinical Practice 120
Pain as the Guide 120
Techniques 120
Theoretical Framework 121
Peripheral Joint Mobilization Techniques 121
Shoulder Girdle Complex 121
Elbow and Forearm Complex 127
Wrist Complex 131
Hand and Finger Joints 133
Hip Joint 135
Knee and Leg 137
Ankle and Foot Joints 141
Independent Learning Activities 145
Chapter 6: Resistance Exercise for Impaired Muscle Performance 147
Muscle Performance and Resistance Exercise-Definitions and Guiding Principles 148
Strength 149
Power 149
Endurance 149
Overload Principle 150
SAID Principle 150
Reversibility Principle 150
Skeletal Muscle Function and Adaptation to Resistance Exercise 151
Factors that Influence Tension Generation in Normal Skeletal Muscle 151
Physiological Adaptations to Resistance Exercise 157
Determinants of Resistance Exercise 159
Alignment and Stabilization 160
Intensity 161
Volume 162
Exercise Order 163
Frequency 163
Duration 163
Rest Interval (Recovery Period) 164
Mode of Exercise 164
Velocity of Exercise 165
Periodization 166
Integration of Function 166
Types of Resistance Exercise 167
Manual and Mechanical Resistance Exercise 167
Isometric Exercise (Static Exercise) 168
Dynamic Exercise-Concentric and Eccentric 170
Dynamic Exercise-Constant and Variable Resistance 172
Isokinetic Exercise 172
Open-Chain and Closed-Chain Exercise 174
General Principles of Resistance Training 180
Examination and Evaluation 180
Preparation for Resistance Exercises 181
Application of Resistance Exercises 181
Precautions for Resistance Exercise 182
Valsalva Maneuver 182
Substitute Motions 183
Overtraining and Overwork 183
Exercise-Induced Muscle Soreness 184
Pathological Fracture 185
Contraindications to Resistance Exercise 185
Pain 186
Inflammation 186
Severe Cardiopulmonary Disease 186
Manual Resistance Exercise 186
Definition and Use 186
Guidelines and Special Considerations 187
Techniques-General Background 188
Upper Extremity 188
Lower Extremity 192
Proprioceptive Neuromuscular Facilitation-Principles and Techniques 195
Diagonal Patterns 196
Basic Procedures with PNF Patterns 196
Upper Extremity Diagonal Patterns 197
Lower Extremity Diagonal Patterns 200
Specific Techniques with PNF 202
Mechanical Resistance Exercise 203
Use in Rehabilitation 204
Use in Conditioning Programs 204
Special Considerations for Children and Older Adults 204
Selected Resistance Training Regimens 206
Progressive Resistance Exercise 206
Circuit Weight Training 207
Plyometric Training-Stretch-Shortening Drills 208
Isokinetic Regimens 210
Equipment for Resistance Training 212
Free Weights and Simple Weight-Pulley Systems 213
Variable Resistance Machines 215
Elastic Resistance Bands and Tubing 216
Equipment for Closed-Chain Training 219
Reciprocal Exercise Equipment 220
Equipment for Dynamic Stabilization Training 221
Isokinetic Testing and Training Equipment 222
Independent Learning Activities 223
Chapter 7: Principles of Aerobic Exercise 231
Karen Holtgrefe, DHS, PT, OCS
Terri M. Glenn, PhD, PT
Key Terms and Concepts 232
Fitness 232
Maximum Oxygen Consumption 232
Endurance 232
Aerobic Exercise Training (Conditioning) 232
Adaptation 232
Myocardial Oxygen Consumption 232
Deconditioning 233
Energy Systems, Energy Expenditure, and Efficiency 233
Functional Implications 234
Energy Expenditure 234
Efficiency 234
Physiological Response to Aerobic Exercise 235
Cardiovascular Response to Exercise 235
Respiratory Response to Exercise 235
Responses Providing Additional Oxygen to Muscle 236
Testing as a Basis for Exercise Programs 236
Fitness Testing of Healthy Subjects 236
Stress Testing for Convalescing Individuals and Individuals at Risk 236
Multistage Testing 237
Determinants of an Exercise Program 237
Intensity 237
Duration 239
Frequency 239
Mode 239
Reversibility Principle 240
Exercise Program 240
Warm-Up Period 240
Aerobic Exercise Period 240
Cool-Down Period 241
Application 241
Physiological Changes that Occur With Training 241
Cardiovascular Changes 241
Respiratory Changes 242
Metabolic Changes 243
Other System Changes 243
Application of Principles of an Aerobic Conditioning Program for the Patient With
Coronary Disease 243
Inpatient Phase (Phase I) 243
Outpatient Phase (Phase II) 243
Outpatient Program (Phase III) 244
Special Considerations 244
Adaptive Changes 244
Applications of Aerobic Training for the Deconditioned Individual and the Patient with
Chronic Illness 245
Adaptations for Disabilities, Functional Limitations, and Deconditioning 245
Impairments, Goals, and Plan of Care 245
Age Differences 246
Children 246
Young Adults 247
Older Adults 248
Independent Learning Activities 248
Chapter 8: Exercise for Impaired Balance 251
Anne D. Kloos, PT, PhD, NCS
Deborah Givens Heiss, PT, PhD, DPT, OCS
Background and Concepts 251
Balance: Key Terms and Definitions 251
Balance Control 252
Sensory Systems and Balance Control 253
Motor Strategies for Balance Control 254
Balance Control Under Varying Conditions 256
Impaired Balance 258
Sensory Input Impairments 258
Sensorimotor Integration 259
Biomechanical and Motor Output Deficits 259
Deficits with Aging 259
Deficits from Medications 260
Management of Impaired Balance 260
Examination and Evaluation of Impaired Balance 260
Balance Training 261
Health and Environmental Factors 265
Evidence-Based Balance Exercise Programs 265
Tai Chi for Balance Training 266
Independent Learning Activities 269
Chapter 9: Aquatic Exercise 273
Robert Schrepfer, MS, PT
BACKGROUND AND PRINCIPLES FOR AQUATIC EXERCISE 273
Definition of Aquatic Exercise 273
Goals and Indications for Aquatic Exercise 274
Precautions and Contraindications to Aquatic Exercise 274
Precautions 274
Contraindications 274
Properties of Water 274
Physical Properties of Water 274
Hydromechanics 275
Thermodynamics 275
Center of Buoyancy 276
Aquatic Temperature and Therapeutic Exercise 276
Temperature Regulation 276
Mobility and Functional Control Exercise 276
Aerobic Conditioning 277
Special Equipment for Aquatic Exercise 277
Collars, Rings, Belts, and Vests 277
Swim Bars 278
Gloves, Hand Paddles, and Hydro-tone(r) Balls 278
Fins and Hydro-tone(r) Boots 278
Kickboards 278
EXERCISE INTERVENTIONS USING AN AQUATIC ENVIRONMENT 279
Stretching Exercises 279
Manual Stretching Techniques 279
Self-Stretching with Aquatic Equipment 282
Strengthening Exercises 283
Manual Resistance Exercises 283
Independent Strengthening Exercises 287
Aerobic Conditioning 290
Treatment Interventions 290
Physiological Response to Deep-Water Walking/Running 290
Proper Form for Deep-Water Running 290
Exercise Monitoring 291
Equipment Selection 291
Independent Learning Activities 291
Part III: Principles of Intervention 295
Chapter 10: Soft Tissue Injury, Repair, and Management 295
Soft Tissue Lesions 295
Examples of Soft Tissue Lesions-Musculoskeletal Disorders 295
Clinical Conditions Resulting from Trauma or Pathology 296
Severity of Tissue Injury 297
Irritability of Tissue: Stages of Inflammation and Repair 297
Management During the Acute Stage 298
Tissue Response-Inflammation 298
Management Guidelines-Protection Phase 298
Management During the Subacute Stage 300
Tissue Response-Repair and Healing 300
Management Guidelines-Controlled Motion Phase 300
Management During the Chronic Stage 302
Tissue Response-Maturation and Remodeling 302
Management Guidelines-Return to Function Phase 303
Cumulative Trauma-Chronic Recurring Pain 305
Tissue Response-Chronic Inflammation 305
Etiology of Chronic Inflammation Leading to Prolonged or Recurring Pain 305
Contributing Factors 305
Management Guidelines-Chronic Inflammation 306
Independent Learning Activities 307
Chapter 11: Joint, Connective Tissue, and Bone Disorders and Management 309
Arthritis-Arthrosis 309
Clinical Signs and Symptoms 309
Rheumatoid Arthritis 310
Osteoarthritis-Degenerative Joint Disease 314
Fibromyalgia and Myofascial Pain Syndrome 316
Fibromyalgia 316
Myofascial Pain Syndrome 318
Osteoporosis 318
Risk Factors 318
Prevention of Osteoporosis 319
Recommendations for Exercise 320
Exercise Precautions and Contraindications 320
Fractures-Post-traumatic Immobilization 320
Risk Factors 322
Bone Healing Following a Fracture 322
Principles of Management-Period of Immobilization 323
Postimmobilization Period 323
Independent Learning Activities 325
Chapter 12: Surgical Interventions and Postoperative Management 329
Indications for Surgical Intervention 329
Guidelines for Preoperative and Postoperative Management 329
Considerations for Preoperative Management 330
Considerations for Postoperative Management 331
Potential Postoperative Complications 334
Overview of Common Orthopedic Surgeries and Postoperative Management 335
Surgical Approaches-Open, Arthroscopic, and Arthroscopically Assisted
Procedures 335
Use of Tissue Grafts 336
Repair, Reattachment, Reconstruction, Stabilization, or Transfer of Soft
Tissues 336
Release, Lengthening, or Decompression of Soft Tissues 339
Joint Procedures 339
Extra-articular Bony Procedures 343
Independent Learning Activities 345
Chapter 13: Peripheral Nerve Disorders and Management 349
Review of Peripheral Nerve Structure 350
Nerve Structure 350
Nervous System Mobility Characteristics 350
Common Sites of Injury to Peripheral Nerves 351
IMPAIRED NERVE FUNCTION 363
Nerve Injury and Recovery 363
Mechanisms of Nerve Injury 363
Classification of Nerve Injuries 364
Recovery of Nerve Injuries 365
Management Guidelines-Recovery from Nerve Injury 365
Neural Tension Disorders 366
Symptoms and Signs of Nerve Mobility Impairment 367
Causes of Symptoms 367
Principles of Management 367
Neural Testing and Mobilization Techniques for the Upper Quadrant 367
Neural Testing and Mobilization Techniques for the Lower Quadrant 368
Prevention 370
MUSCULOSKELETAL DIAGNOSES INVOLVING IMPAIRED NERVE
FUNCTION 370
Thoracic Outlet Syndrome 370
Related Diagnoses 370
Etiology of Symptoms 371
Location of Compression or Entrapment and Tests of Provocation 371
Common Impairments in TOS 372
Common Functional Limitations/Disabilities 372
Nonoperative Management of TOS 373
Carpal Tunnel Syndrome 373
Etiology of Symptoms 374
Tests of Provocation 374
Common Impairments 374
Common Functional Limitations/Disabilities 375
Nonoperative Management of CTS 375
Surgical Intervention and Postoperative Management 376
Compression in Tunnel of Guyon 377
Etiology of Symptoms 377
Tests of Provocation 377
Common Impairments 377
Common Functional Limitations/Disabilities 377
Nonoperative Management 378
Surgical Release and Postoperative Management 378
Complex Regional Pain Syndrome: Reflex Sympathetic Dystrophy and Causalgia 378
Related Diagnoses and Symptoms 378
Etiology and Symptoms 378
Three Stages of CRPS Type I (RSD) 378
Common Impairments 379
Management 379
Independent Learning Activities 381
Part IV: Exercise Interventions by Body Region 383
Chapter 14: The Spine and Posture: Structure, Function, Postural Impairments,
and Management Guidelines 383
POSTURE AND BIOMECHANICAL INFLUENCES 384
Alignment 384
Curves of the Spine 384
Postural Alignment 384
Stability 385
Postural Stability in the Spine 385
Effects of Limb Motion on Spinal Stability 392
Effects of Breathing on Posture and Stability 392
IMPAIRED POSTURE 393
Etiology of Pain 393
Effect of Mechanical Stress 393
Effect of Impaired Postural Support from Trunk Muscles 393
Effect of Impaired Muscle Endurance 394
Pain Syndromes Related to Impaired Posture 394
Common Faulty Postures: Characteristics and Impairments 394
Pelvic and Lumbar Region 394
Cervical and Thoracic Region 395
Frontal Plane Deviations from Lower Extremity Asymmetries 397
MANAGEMENT OF IMPAIRED POSTURE 398
General Management Guidelines 398
Postural Alignment: Proprioception and Control 398
Relationship of Impaired Posture and Pain 400
Joint, Muscle, and Connective Tissue Mobility Impairments 400
Impaired Muscle Performance 401
Body Mechanics 401
Stress Provoking Postures and Activities: Relief and Prevention 401
Stress Management/Relaxation 401
Healthy Exercise Habits 402
Tension Headache/Cervical Headache 403
Causes 403
Presenting Signs and Symptoms 403
General Management Guidelines 403
Independent Learning Activities 404
Chapter 15: The Spine: Impairments, Diagnoses, and Management
Guidelines 407
Review of the Structure and Function of the Spine 408
Functional Components of the Spine 408
Motions of the Spinal Column 408
Structure and Function of Intervertebral Disks 409
Intervertebral Foramina 409
Inert Structures: Influence on Movement and Stability 410
Neuromuscular Function: Dynamic Stabilization 410
SPINAL PATHOLOGIES AND IMPAIRED SPINAL FUNCTION 410
Pathology of the Intervertebral Disk 410
Injury and Degeneration of the Disk 410
Disk Pathologies and Related Conditions 412
Signs and Symptoms of Disk Lesions and Fluid Stasis 412
Pathomechanical Relationships of the Intervertebral Disk and Facet Joints 414
Three-Joint Complex 414
Related Pathologies 414
Pathology of the Zygapophyseal (Facet) Joints 415
Facet Joint Characteristics 415
Common Diagnoses and Impairments from Facet Joint Pathologies 415
Pathology of Muscle and Soft Tissue Injuries: Strains, Tears, and Contusions 416
General Symptoms from Trauma 416
Common Sites of Lumbar Strain 416
Common Sites of Cervical Strain 416
Postural Strain 416
Emotional Stress 417
Functional Limitations/Disabilities 417
Pathomechanics of Spinal Instability 417
Neutral Zone 417
Instability 417
MANAGEMENT GUIDELINES BASED ON IMPAIRMENTS 418
Principles of Management for the Spine 418
Examination and Evaluation 418
General Guidelines for Managing Acute Spinal Problems: Protection
Phase 420
General Guidelines for Managing Subacute Spinal Problems: Controlled
Motion Phase 421
General Guidelines for Managing Chronic Spinal Problems: Return to
Function Phase 423
Management Guidelines-Non-Weight-Bearing Bias 424
Management of Acute Symptoms 424
Progression 424
Management Guidelines-Extension Bias 424
Principles of Management 424
Indications, Precautions, and Contraindications for Interventions-
Extension Approach 425
Techniques Using an Extension Approach in the Lumbar Spine 425
Techniques to Manage a Disk Lesion in the Cervical Spine 428
Management Guidelines-Flexion Bias 429
Principles of Management 429
Indications and Contraindications for Intervention-Flexion Approach 429
Techniques Utilizing a Flexion Approach 429
Management Guidelines-Stabilization 430
Identification of Clinical Instability 430
Principles of Management 431
Management Guidelines-Mobilization 431
Management-Lumbar Spine 431
Management-Cervical Spine 432
Management Guidelines-Soft Tissue Injuries 432
Management During the Acute Stage: Protection Phase 432
Management in the Subacute and Chronic Stages of Healing: Controlled
Motion and Return to Function Phases 433
Management Guidelines-Temporomandibular Joint Dysfunction 433
Signs and Symptoms 433
Etiology of Symptoms 433
Principles of Management 434
Independent Learning Activities 435
Chapter 16: The Spine: Exercise Interventions 439
BASIC CONCEPTS OF SPINAL MANAGEMENT WITH EXERCISE 440
Fundamental Interventions 440
Patient Education 440
General Exercise Guidelines 441
Kinesthetic Awareness 441
Mobility/Flexibility 441
Muscle Performance 441
Cardiopulmonary Endurance 441
Functional Activities 442
KINESTHETIC AWARENESS 443
Elements of Kinesthetic Training-Fundamental Techniques 443
Position of Symptom Relief 443
Effects of Movement on the Spine 443
Integration of Kinesthetic Training With Stabilization Exercises and Fundamental
Body Mechanics 443
Progression to Active and Habitual Control of Posture 443
MOBILITY/FLEXIBILITY 444
Cervical and Upper Thoracic Region-Stretching Techniques 444
Techniques to Increase Thoracic Extension 444
Techniques to Increase Axial Extension (Cervical Retraction)-Scalene Muscle
Stretch 445
Techniques to Increase Upper Cervical Flexion-Short Suboccipital Muscle
Stretch 445
Techniques to Increase Scapular and Humeral Muscle Flexibility 446
Traction as a Stretching Technique 446
Other Techniques for Increasing Mobility 447
Mid and Lower Thoracic and Lumbar Regions-Stretching Techniques 447
Techniques to Increase Lumbar Flexion 447
Techniques to Increase Lumbar Extension 448
Techniques to Increase Lateral Flexibility in the Spine 448
Techniques to Increase Hip Muscle Flexibility 450
Traction as a Stretching Technique 450
MUSCLE PERFORMANCE: STABILIZATION, MUSCLE ENDURANCE, AND
STRENGTH TRAINING 451
Stabilization Training-Fundamental Techniques and Progressions 451
Guidelines for Stabilization Training 451
Deep Stabilizing (Core) Muscle Activation and Training 452
Global Muscle Stabilization Exercises 456
Isometric and Dynamic Exercises 465
Exercises for the Cervical Region 466
Exercises for the Thoracic and Lumbar Regions 467
CARDIOPULMONARY ENDURANCE 472
Common Aerobic Exercises and Effects on the Spine 472
Cycling 472
Walking and Running 473
Stair Climbing 473
Cross-Country Skiing and Ski Machines 473
Swimming 473
Upper Body Ergometry Machines 473
Step Aerobics and Aerobic Dancing 473
"Latest Popular Craze" 473
FUNCTIONAL ACTIVITIES 473
Early Functional Training-Fundamental Techniques 474
Preparation for Functional Activities-Basic Exercise Techniques 474
Weight-Bearing Exercises 474
Transitional Stabilization Exercises 476
Body Mechanics and Environmental Adaptations 476
Principles of Body Mechanics-Instruction and Training 476
Environmental Adaptations 477
Intermediate to Advanced Exercise Techniques for Functional Training 477
Repetitive Lifting 477
Repetitive Reaching 478
Repetitive Pushing and Pulling 478
Rotation or Turning 478
Transitional Movements 478
Transfer of Training 478
Education for Prevention 478
Independent Learning Activities 479
Chapter 17: The Shoulder and Shoulder Girdle 481
STRUCTURE AND FUNCTION OF THE SHOULDER GIRDLE 482
Joints of the Shoulder Girdle Complex 482
Synovial Joints 482
Functional Articulations 484
Shoulder Girdle Function 486
Scapulohumeral Rhythm 486
Clavicular Elevation and Rotation With Humeral Motion 486
External Rotation of the Humerus With Full Elevation 487
Internal Rotation of the Humerus With Full Elevation 487
Elevation of the Humerus Through the Plane of the Scapula-Scaption 487
Deltoid-Short Rotator Cuff and Supraspinatus Mechanisms 487
Referred Pain and Nerve Injury 487
Common Sources of Referred Pain in the Shoulder Region 487
Nerve Disorders in the Shoulder Girdle Region 487
MANAGEMENT OF SHOULDER DISORDERS AND SURGERIES 488
Joint Hypomobility: Nonoperative Management 488
Glenohumeral Joint 488
Acromioclavicular and Sternoclavicular Joints 493
Glenohumeral Joint Surgery and Postoperative Management 494
Glenohumeral Arthroplasty 494
Arthrodesis of the Shoulder 501
Painful Shoulder Syndromes (Rotator Cuff Disease, Impingement Syndromes,
Shoulder Instabilities): Nonoperative Management 502
Related Pathologies and Etiology of Symptoms 502
Common Impairments 505
Common Functional Limitations/Disabilities 506
Management: Painful Shoulder Syndromes (Without Dislocation) 506
Painful Shoulder Syndromes: Surgery and Postoperative Management 508
Subacromial Decompression and Postoperative Management 508
Rotator Cuff Repair and Postoperative Management 511
Shoulder Dislocations: Nonoperative Management 518
Related Pathologies and Mechanisms of Injury 518
Common Impairments 519
Common Functional Limitations/Disabilities 519
Closed Reduction of Anterior Dislocation 519
Closed Reduction Posterior Dislocation 521
Shoulder Instabilities: Surgery and Postoperative Management 521
Glenohumeral Joint Stabilization Procedures and Postoperative
Management 521
Acromioclavicular and Sternoclavicular Joint Stabilization Procedures and
Postoperative Management 529
EXERCISE INTERVENTIONS FOR THE SHOULDER GIRDLE 529
Exercise Techniques During Acute and Early Subacute Stages of Tissue Healing 529
Early Motion of the Glenohumeral Joint 529
Early Motion of the Scapula 531
Early Neuromuscular Control 531
Exercise Techniques to Increase Flexibility and Range of Motion 531
Self-Stretching Techniques 531
Manual and Self-Stretching Exercises for Specific Muscles 533
Exercises to Develop and Improve Muscle Performance and Functional Control 536
Isometric Exercises 536
Stabilization Exercises 539
Dynamic Strengthening Exercises-Scapular Muscles 541
Dynamic Strengthening Exercises-Glenohumeral Muscles 545
Functional Activities 549
Independent Learning Activities 550
Chapter 18: The Elbow and Forearm Complex 557
STRUCTURE AND FUNCTION OF THE ELBOW AND FOREARM 558
Joints of the Elbow and Forearm 558
Elbow Joint Characteristics and Arthrokinematics 558
Forearm Joint Characteristics and Arthrokinematics 559
Muscle Function at the Elbow and Forearm 560
Primary Actions at the Elbow and Forearm 560
Relationship of Wrist and Hand Muscles to the Elbow 560
Referred Pain and Nerve Injury in the Elbow Region 560
Common Sources of Referred Pain into the Elbow Region 561
Nerve Disorders in the Elbow Region 561
MANAGEMENT OF ELBOW AND FOREARM DISORDERS AND
SURGERIES 561
Joint Hypomobility: Nonoperative Management 562
Related Pathologies and Etiology of Symptoms 562
Common Impairments 562
Common Functional Limitations/Disabilities 562
Joint Hypomobility: Management-Protection Phase 562
Joint Hypomobility: Management-Controlled Motion Phase 562
Joint Hypomobility: Management-Return to Function Phase 564
Joint Surgery and Postoperative Management 564
Excision of the Radial Head 565
Total Elbow Arthroplasty 567
Myositis Ossificans 574
Etiology of Symptoms 574
Management 574
Overuse Syndromes: Repetitive Trauma Syndromes 575
Related Pathologies 575
Etiology of Symptoms 575
Common Impairments 575
Common Functional Limitations/Disabilities 575
Nonoperative Management of Overuse Syndromes: Protection Phase 575
Nonoperative Management: Controlled Motion and Return to Function
Phases 576
EXERCISE INTERVENTIONS FOR THE ELBOW AND FOREARM 578
Exercise Techniques to Increase Flexibility and Range of Motion 578
Manual, Mechanical, and Self-Stretching Techniques 578
Self-Stretching Techniques-Muscles of the Medial and Lateral
Epicondyles 579
Exercises to Develop and Improve Muscle Performance and Functional Control 580
Isometric Exercises 580
Dynamic Strengthening and Endurance Exercises 580
Functional Exercises 583
Independent Learning Activities 585
Chapter 19: The Wrist and Hand 589
STRUCTURE AND FUNCTION OF THE WRIST AND HAND 590
Joints of the Wrist and Hand 590
Wrist Joint-Characteristics and Arthrokinematics 590
Hand Joints-Characteristics and Arthrokinematics 590
Hand Function 592
Muscles of the Wrist and Hand 592
Grips and Prehension Patterns 593
Major Nerves Subject to Pressure and Trauma at the Wrist and Hand 594
Nerve Disorders in the Wrist 594
Referred Pain and Sensory Patterns 594
MANAGEMENT OF WRIST AND HAND DISORDERS AND SURGERIES 594
Joint Hypomobility: Nonoperative Management 594
Common Joint Pathologies and Associated Impairments 594
Common Functional Limitations/Disabilities with Joint Pathologies 596
Joint Hypomobility: Management-Protection Phase 596
Joint Hypomobility: Management-Controlled Motion and Return to
Function Phases 597
Joint Surgery and Postoperative Management 599
Wrist Arthroplasty 600
Metacarpophalangeal Implant Arthroplasty 603
Proximal Interphalangeal Implant Arthroplasty 608
Carpometacarpal Arthroplasty of the Thumb 610
Tendon Rupture Associated with RA: Surgical and Postoperative
Management 613
Repetitive Trauma Syndromes/Overuse Syndromes 615
Tenosynovitis, Tendinitis 615
Traumatic Lesions in the Wrist and Hand 616
Simple Sprain: Nonoperative Management 616
Lacerated Flexor Tendons of the Hand: Surgical and Postoperative
Management 616
Lacerated Extensor Tendons of the Hand: Surgical and Postoperative
Management 625
EXERCISE INTERVENTIONS FOR THE WRIST AND HAND 631
Techniques for Musculotendinous Mobility 631
Tendon-Gliding and Tendon-Blocking Exercises 631
Scar Tissue Mobilization for Tendon Adhesions 633
Exercise Techniques to Increase Flexibility and Range of Motion 634
General Stretching Techniques 634
Stretching Techniques for the Intrinsic and Multijoint Muscles 635
Exercises to Develop and Improve Muscle Performance, Neuromuscular Control,
and Coordinated Movement 636
Techniques to Strengthen Muscles of the Wrist and Hand 636
Functional Activities 638
Independent Learning Activities 638
Chapter 20: The Hip 643
STRUCTURE AND FUNCTION OF THE HIP 644
Anatomical Characteristics of the Hip Region 644
Bony Structures 644
Hip Joint Characteristics and Arthrokinematics 644
Influence of the Hip Joint on Balance and Posture Control 645
Functional Relationships of the Hips and Pelvis 645
Pelvic Motions and Muscle Function 645
Pathomechanics in the Hip Region 647
The Hip and Gait 648
Hip Muscle Function During Gait 648
Effect of Musculoskeletal Impairments on Gait 648
Referred Pain and Nerve Injury 648
Major Nerves Subject to Injury or Entrapment 648
Common Sources of Referred Pain in the Hip and Buttock Region 648
MANAGEMENT OF HIP DISORDERS AND SURGERIES 649
Joint Hypomobility: Nonoperative Management 649
Related Pathologies and Etiology of Symptoms 649
Common Impairments 650
Common Functional Limitations/Disabilities 650
Management: Protection Phase 650
Management: Controlled Motion and Return to Function Phases 650
Joint Surgery and Postoperative Management 652
Total Hip Arthroplasty 652
Hemiarthroplasty of the Hip 663
Fractures of the Hip-Surgical and Postoperative Management 664
Hip Fracture-Incidence and Risk Factors 664
Sites and Types of Hip Fracture 664
Open Reduction and Internal Fixation of Hip Fracture 665
Painful Hip Syndromes/Overuse Syndromes: Nonoperative Management 671
Related Pathologies and Etiology of Symptoms 671
Common Impairments and Functional Limitations/Disabilities 671
Management: Protection Phase 671
Management: Controlled Motion Phase 671
Management: Return to Function Phase 672
EXERCISE INTERVENTIONS FOR THE HIP REGION 672
Exercise Techniques to Increase Flexibility and Range of Motion 672
Techniques to Stretch Range-Limiting Hip Structures 672
Techniques to Stretch Range-Limiting Two-Joint Muscles 674
Exercises to Develop and Improve Muscle Performance and Functional Control 676
Non-Weight-Bearing Exercises 676
Closed-Chain Weight-Bearing Exercises 678
Functional Training 681
Independent Learning Activities 682
Chapter 21: The Knee 687
STRUCTURE AND FUNCTION OF THE KNEE 688
Joints of the Knee Complex 688
Tibiofemoral Joint 688
Patellofemoral Joint 689
Patellar Function 689
Patellar Alignment 689
Patellar Compression 691
Muscle Function 691
Knee Extensor Muscle Function 691
Knee Flexor Muscle Function 692
Dynamic Stability of the Knee 692
The Knee and Gait 692
Muscle Control of the Knee During Gait 692
Hip and Ankle Impairments 692
Referred Pain and Nerve Injuries 693
Major Nerves Subject to Injury at the Knee 693
Common Sources of Referred Pain 693
MANAGEMENT OF KNEE DISORDERS AND SURGERIES 693
Joint Hypomobility: Nonoperative Management 693
Common Joint Pathologies and Associated Impairments 693
Common Functional Limitations/Disabilities 695
Joint Hypomobility: Management-Protection Phase 695
Joint Hypomobility: Management-Controlled Motion and Return to Function
Phases 695
Joint Surgery and Postoperative Management 698
Repair of Articular Cartilage Defects 698
Synovectomy 699
Total Knee Arthroplasty 702
Patellofemoral Dysfunction: Nonoperative Management 711
Related Patellofemoral Pathologies 711
Etiology of Symptoms 712
Common Impairments and Functional Limitations/Disabilities 712
Patellofemoral Symptoms: Management-Protection Phase 712
Patellofemoral Symptoms: Management-Controlled Motion and Return to
Function Phases 712
Patellofemoral and Extensor Mechanism Dysfunction: Surgical and Postoperative
Management 715
Lateral Retinacular Release 716
Proximal Realignment of the Extensor Mechanism 718
Distal Realignment of the Extensor Mechanism 721
Ligament Injuries: Nonoperative Management 722
Mechanisms of Injury 722
Ligament Injuries in the Female Athlete 722
Common Impairments and Functional Limitations/Disabilities 723
Ligament Injuries: Nonoperative Management 723
Ligament Injuries: Surgical and Postoperative Management 725
Background 725
Anterior Cruciate Ligament Reconstruction 726
Posterior Cruciate Ligament Reconstruction 735
Meniscal Tears: Nonoperative Management 737
Mechanisms of Injury 737
Common Impairments and Functional Limitations/Disabilities 737
Management 738
Meniscal Tears: Surgical and Postoperative Management 738
Meniscus Repair 738
Partial Meniscectomy 742
EXERCISE INTERVENTIONS FOR THE KNEE 742
Exercise Techniques to Increase Flexibility and Range of Motion 743
To Increase Knee Extension 743
To Increase Knee Flexion 743
Exercises to Develop and Improve Muscle Performance and Functional Control 744
Nonweight-Bearing Exercises 745
Closed-Chain Exercises 748
Techniques to Simulate Functional Activities 750
Independent Learning Activities 751
Chapter 22: The Ankle and Foot 759
STRUCTURE AND FUNCTION OF THE ANKLE AND FOOT 760
Structural Relationships and Motions 760
Anatomical Characteristics 760
Motions of the Foot and Ankle Defined 760
Leg, Ankle, and Foot Joint Characteristics and Arthrokinematics 761
Function of the Ankle and Foot 763
Structural Relationships 763
Muscle Function in the Ankle and Foot 763
The Ankle/Foot Complex and Gait 764
Function of the Ankle and Foot Joints During Gait 764
Muscle Control of the Ankle and Foot During Gait 764
Referred Pain and Nerve Injury 764
Major Nerves Subject to Pressure and Trauma 764
Common Sources of Segmental Sensory Reference in the Foot 765
MANAGEMENT OF FOOT AND ANKLE DISORDERS AND SURGERIES 765
Joint Hypomobility: Nonoperative Management 766
Common Joint Pathologies and Etiology of Symptoms 766
Common Impairments and Functional Limitations/Disabilities 766
Joint Hypomobility: Management-Protection Phase 767
Joint Hypomobility: Management-Controlled Motion and Return to
Function Phases 767
Joint Surgery and Postoperative Management 769
Total Ankle Arthroplasty 770
Arthrodesis at the Ankle and Foot 773
Overuse (Repetitive Trauma) Syndromes: Nonoperative Management 776
Related Pathologies and Etiology of Symptoms 776
Common Impairments and Functional Limitations/Disabilities 776
Overuse Syndromes: Management-Protection Phase 777
Overuse Syndromes: Management-Controlled Motion and Return to
Function Phases 777
Ligamentous Injuries: Nonoperative Management 777
Common Impairments and Functional Limitations/Disabilities 777
Management: Protection Phase 778
Management: Controlled Motion Phase 778
Management: Return to Function Phase 778
Traumatic Soft Tissue Injuries: Surgical and Postoperative Management 779
Repair of Complete Lateral Ligament Tears 779
Repair of a Ruptured Achilles Tendon 782
EXERCISE INTERVENTIONS FOR THE ANKLE AND FOOT 786
Exercise Techniques to Increase Flexibility and Range of Motion 786
Flexibility Exercises for the Ankle Region 786
Flexibility Exercises for Limited Mobility of the Toes 788
Stretching the Plantar Fascia of the Foot 788
Exercises to Develop and Improve Muscle Performance and Functional Control 788
Activities to Develop Dynamic Neuromuscular Control 788
Open-Chain Strengthening Exercises 789
Weight-Bearing Exercises for Strength, Balance, and Function 790
Independent Learning Activities 792
Part V: Special Areas of Therapeutic Exercise 797
Chapter 23: Women's Health: Obstetrics and Pelvic Floor 797
Barbara Settles Huge, BS, PT
OVERVIEW OF PREGNANCY, LABOR, AND RELATED CONDITIONS 798
Characteristics of Pregnancy and Labor 798
Pregnancy 798
Labor 798
Anatomical and Physiological Changes of Pregnancy 800
Weight Gain During Pregnancy 800
Changes in Organ Systems 800
Changes in Posture and Balance 801
Overview of Pelvic Floor Anatomy, Function and Dysfunction 801
Pelvic Floor Musculature 801
Effect of Childbirth on the Pelvic Floor 802
Classification of Pelvic Floor Dysfunction 803
Risk Factors for Dysfunction 803
Interventions for Pelvic Floor Impairments 804
Pregnancy-Induced Pathology 804
Diastasis Recti 804
Postural Back Pain 805
Sacroiliac/Pelvic Girdle Pain 806
Varicose Veins 806
Joint Laxity 807
Nerve Compression Syndromes 807
EXERCISE INTERVENTIONS FOR PREGNANCY, LABOR, AND RELATED
CONDITIONS 807
Physiological Effects of Aerobic Exercise During Pregnancy 807
Maternal Response to Aerobic Exercise 807
Fetal Response to Maternal Aerobic Exercise 808
Exercise for the Uncomplicated Pregnancy and Postpartum 808
Guidelines for Managing the Pregnant Woman 810
Recommendations for Fitness Exercise 811
Precautions and Contraindications to Exercise 811
Critical Areas of Emphasis and Selected Exercise Techniques 812
Pelvic Floor Awareness, Training and Strengthening 814
Relaxation and Breathing Exercises for Use During Labor 815
Unsafe Postures and Exercises During Pregnancy 816
Exercise Critical to the Postpartum Period 817
Cesarean Childbirth 817
Significance to Physical Therapists 817
Suggested Activities for the Patient Following a Cesarean Section 818
High-Risk Pregnancy 819
High-Risk Conditions 819
Management Guidelines and Precautions for High-Risk Pregnancies 820
Independent Learning Activities 821
Chapter 24: Management of Vascular Disorders of the Extremities 825
Disorders of the Arterial System 825
Types of Arterial Disorders 825
Clinical Manifestations of Peripheral Arterial Disorders 826
Examination and Evaluation of Arterial Sufficiency 827
Management of Acute Arterial Occlusion 828
Management of Chronic Arterial Insufficiency 829
Special Considerations in a Graded Exercise Program for Patients with Chronic
Arterial Insufficiency 830
Disorders of the Venous System 831
Types of Venous Disorders 831
Clinical Manifestations of Venous Disorders 831
Examination and Evaluation of Venous Sufficiency 832
Prevention of Deep Vein Thrombosis and Thrombophlebitis 833
Management of Deep Vein Thrombosis and Thrombophlebitis 833
Management of Chronic Venous Insufficiency and Varicose Veins 833
Disorders of the Lymphatic System 834
Conditions Leading to Insufficiency of the Lymphatic System 835
Clinical Manifestations of Lymphatic Disorders 835
Examination and Evaluation of Lymphatic Function 836
Prevention of Lymphedema 836
Management of Lymphedema 836
Breast Cancer-Related Lymphatic Dysfunction 838
Background 838
Surgical Procedures 838
Impairments and Complications Related to Breast Cancer Treatment 839
Guidelines for Management After Breast Cancer Surgery 840
Exercises for the Management of Lymphedema 842
Background and Rationale 842
Components of Exercise Regimens for Management of Lymphedema 842
Guidelines for Lymphatic Drainage Exercises 843
Selected Exercises for Lymphatic Drainage: Upper and Lower Extremity
Sequences 843
Independent Learning Activities 847
Chapter 25: Management of Pulmonary Conditions 851
Review of Respiratory Structure and Function 852
Thorax and Chest Wall: Structure and Function 852
Muscles of Ventilation 852
Mechanics of Ventilation 853
Anatomy and Function of the Respiratory Tracts 854
The Lungs and Pleurae 855
Lung Volumes and Capacities 856
Examination 856
Components of the Examination 857
Breathing Exercises and Ventilatory Training 861
Guidelines for Teaching Breathing Exercises 861
Diaphragmatic Breathing 862
Segmental Breathing 863
Pursed-Lip Breathing 864
Preventing and Relieving Episodes of Dyspnea 865
Positive Expiratory Pressure Breathing 865
Respiratory Resistance Training 866
Glossopharyngeal Breathing 866
Exercises to Mobilize the Chest 867
Specific Techniques 867
Coughing 868
The Normal Cough Pump 868
Factors that Decrease the Effectiveness of the Cough Mechanism and Cough
Pump 868
Teaching an Effective Cough 868
Additional Techniques to Facilitate a Cough and Improve Airway Clearance 869
Suctioning: Alternative to Coughing 870
Postural Drainage 870
Manual Techniques Used With Postural Drainage Therapy 870
Postural Drainage Positions 872
Guidelines for Implementing Postural Drainage 873
Modified Postural Drainage 874
Home Program of Postural Drainage 874
Management of Patients with Chronic Obstructive Pulmonary Disease 874
Types of Obstructive Pulmonary Disorders 875
Pathological Changes in the Pulmonary System 875
Impairments and Impact on Function 875
Management Guidelines: COPD 875
Management of Patients with Restrictive Pulmonary Disorders 875
Acute and Chronic Causes of Restrictive Pulmonary Disorders 877
Pathological Changes in the Pulmonary System 877
Management Guidelines: Post-Thoracic Surgery 877
Independent Learning Activities 880
Appendix A Systematic Musculoskeletal Examination Guidelines
9780803615847 0803615841
Exercise therapy--Handbooks, manuals, etc.
Exercise Therapy--methods.
WB 541 K617t 2007
Therapeutic exercise : foundations and techniques / Carolyn Kisner, Lynn Allen Colby. - 5th edition - Philadelphia : F.A. Davis, c2007. - xxvii, 928 p. : ill. ; 29 cm.
Includes bibliographical references and index.
Contents
Contents
Part I: General Concepts 1
Chapter 1: Therapeutic Exercise: Foundational Concepts 1
Therapeutic Exercise: Impact on Physical Function 2
Definition of Therapeutic Exercise 2
Aspects of Physical Function: Definition of Key Terms 2
Types of Therapeutic Exercise Intervention 3
Exercise Safety 3
Process and Models of Disablement 4
The Disablement Process 4
Models of Disablement 4
Use of Disablement Models and Classifications in Physical Therapy 5
Patient Management and Clinical Decision Making: An Interactive Relationship 11
Clinical Decision Making 11
Evidence-Based Practice 11
A Patient Management Model 12
Strategies for Effective Exercise and Task-Specific Instruction 24
Preparation for Exercise Instruction 24
Concepts of Motor Learning: A Foundation of Exercise and Task-Specific
Instruction 24
Adherence to Exercise 31
Independent Learning Activities 33
Chapter 2: Prevention, Health, and Wellness 37
Karen Holtgrefe, DHS, PT, OCS
Role of Physical Therapy in Healthy People 2010 37
Identifying Risk Factors 38
Determining Readiness to Change 38
Developing and Implementing a Program 40
Case Example: Exercise and Osteoporosis 40
Additional Considerations for Developing Prevention, Health, and Wellness
Programs 41
Independent Learning Activities 42
Part II: Applied Science of Exercise and Techniques 43
Chapter 3: Range of Motion 43
Types of ROM Exercises 44
Indications and Goals for ROM 44
Passive ROM 44
Active and Active-Assistive ROM 44
Limitations of ROM Exercises 45
Limitations of Passive Motion 45
Limitations of Active ROM 45
Precautions and Contraindications to ROM Exercises 45
Principles and Procedures for Applying ROM Techniques 45
Examination, Evaluation, and Treatment Planning 45
Patient Preparation 46
Application of Techniques 46
Application of PROM 46
Application of AROM 46
ROM Techniques 46
Upper Extremity 47
Lower Extremity 52
Cervical Spine 55
Lumbar Spine 55
Combined Patterns of Motion 56
Self-Assisted ROM 56
Self-Assistance 57
Wand (T-Bar) Exercises 59
Wall Climbing 60
Overhead Pulleys 60
Skate Board/Powder Board 61
Reciprocal Exercise Unit 61
Continuous Passive Motion 61
Benefits of CPM 61
General Guidelines for CPM 62
ROM Through Functional Patterns 62
Independent Learning Activities 63
Chapter 4: Stretching for Impaired Mobility 65
Definitions of Terms Related to Mobility and Stretching 66
Flexibility 66
Hypomobility 66
Contracture 66
Types of Contracture 67
Interventions to Increase Mobility of Soft Tissues 68
Selective Stretching 69
Overstretching and Hypermobility 69
Properties of Soft Tissue-Response to Immobilization and Stretch 69
Mechanical Properties of Contractile Tissue 70
Neurophysiological Properties of Contractile Tissue 72
Mechanical Properties of Noncontractile Soft Tissue 73
Determinants, Types, and Effects of Stretching Interventions 77
Alignment and Stabilization 77
Intensity of Stretch 79
Duration of Stretch 79
Speed of Stretch 81
Frequency of Stretch 81
Mode of Stretch 82
Proprioceptive Neuromuscular Facilitation Stretching Techniques 85
Integration of Function into Stretching 87
Procedural Guidelines for Application of Stretching Interventions 88
Examination and Evaluation of the Patient 88
Preparation for Stretching 89
Application of Manual Stretching Procedures 89
After Stretching 90
Precautions for Stretching 90
General Precautions 90
Special Precautions for Mass-Market Flexibility Programs 91
Adjuncts to Stretching Interventions 92
Relaxation Training 92
Heat 92
Massage 93
Biofeedback 93
Joint Traction or Oscillation 93
Manual Stretching Techniques in Anatomical Planes of Motion 94
Upper Extremity Stretching 94
Lower Extremity Stretching 99
Independent Learning Activities 104
Chapter 5: Peripheral Joint Mobilization 109
Definitions of Terms 110
Mobilization/Manipulation 110
Self-Mobilization (Auto-mobilization) 110
Mobilization with Movement 110
Physiological Movements 110
Accessory Movements 110
Thrust 110
Manipulation Under Anesthesia 110
Muscle Energy 110
Basic Concepts of Joint Motion: Arthrokinematics 110
Joint Shapes 110
Types of Motion 111
Passive-Angular Stretching Versus Joint-Glide Stretching 113
Other Accessory Motions That Affect the Joint 113
Effects of Joint Motion 114
Indications for Joint Mobilization 114
Pain, Muscle Guarding, and Spasm 114
Reversible Joint Hypomobility 114
Positional Faults/Subluxations 114
Progressive Limitation 114
Functional Immobility 114
Limitations of Joint Mobilization Techniques 115
Contraindications and Precautions 115
Hypermobility 115
Joint Effusion 115
Inflammation 115
Conditions Requiring Special Precautions for Stretching 115
Procedures for Applying Passive Joint Mobilization Techniques 116
Examination and Evaluation 116
Grades or Dosages of Movement 116
Positioning and Stabilization 117
Treatment Force and Direction of Movement 118
Initiation and Progression of Treatment 118
Speed, Rhythm, and Duration of Movements 119
Patient Response 119
Total Program 119
Mobilization with Movement: Principles of Application 120
Principles of MWM in Clinical Practice 120
Pain as the Guide 120
Techniques 120
Theoretical Framework 121
Peripheral Joint Mobilization Techniques 121
Shoulder Girdle Complex 121
Elbow and Forearm Complex 127
Wrist Complex 131
Hand and Finger Joints 133
Hip Joint 135
Knee and Leg 137
Ankle and Foot Joints 141
Independent Learning Activities 145
Chapter 6: Resistance Exercise for Impaired Muscle Performance 147
Muscle Performance and Resistance Exercise-Definitions and Guiding Principles 148
Strength 149
Power 149
Endurance 149
Overload Principle 150
SAID Principle 150
Reversibility Principle 150
Skeletal Muscle Function and Adaptation to Resistance Exercise 151
Factors that Influence Tension Generation in Normal Skeletal Muscle 151
Physiological Adaptations to Resistance Exercise 157
Determinants of Resistance Exercise 159
Alignment and Stabilization 160
Intensity 161
Volume 162
Exercise Order 163
Frequency 163
Duration 163
Rest Interval (Recovery Period) 164
Mode of Exercise 164
Velocity of Exercise 165
Periodization 166
Integration of Function 166
Types of Resistance Exercise 167
Manual and Mechanical Resistance Exercise 167
Isometric Exercise (Static Exercise) 168
Dynamic Exercise-Concentric and Eccentric 170
Dynamic Exercise-Constant and Variable Resistance 172
Isokinetic Exercise 172
Open-Chain and Closed-Chain Exercise 174
General Principles of Resistance Training 180
Examination and Evaluation 180
Preparation for Resistance Exercises 181
Application of Resistance Exercises 181
Precautions for Resistance Exercise 182
Valsalva Maneuver 182
Substitute Motions 183
Overtraining and Overwork 183
Exercise-Induced Muscle Soreness 184
Pathological Fracture 185
Contraindications to Resistance Exercise 185
Pain 186
Inflammation 186
Severe Cardiopulmonary Disease 186
Manual Resistance Exercise 186
Definition and Use 186
Guidelines and Special Considerations 187
Techniques-General Background 188
Upper Extremity 188
Lower Extremity 192
Proprioceptive Neuromuscular Facilitation-Principles and Techniques 195
Diagonal Patterns 196
Basic Procedures with PNF Patterns 196
Upper Extremity Diagonal Patterns 197
Lower Extremity Diagonal Patterns 200
Specific Techniques with PNF 202
Mechanical Resistance Exercise 203
Use in Rehabilitation 204
Use in Conditioning Programs 204
Special Considerations for Children and Older Adults 204
Selected Resistance Training Regimens 206
Progressive Resistance Exercise 206
Circuit Weight Training 207
Plyometric Training-Stretch-Shortening Drills 208
Isokinetic Regimens 210
Equipment for Resistance Training 212
Free Weights and Simple Weight-Pulley Systems 213
Variable Resistance Machines 215
Elastic Resistance Bands and Tubing 216
Equipment for Closed-Chain Training 219
Reciprocal Exercise Equipment 220
Equipment for Dynamic Stabilization Training 221
Isokinetic Testing and Training Equipment 222
Independent Learning Activities 223
Chapter 7: Principles of Aerobic Exercise 231
Karen Holtgrefe, DHS, PT, OCS
Terri M. Glenn, PhD, PT
Key Terms and Concepts 232
Fitness 232
Maximum Oxygen Consumption 232
Endurance 232
Aerobic Exercise Training (Conditioning) 232
Adaptation 232
Myocardial Oxygen Consumption 232
Deconditioning 233
Energy Systems, Energy Expenditure, and Efficiency 233
Functional Implications 234
Energy Expenditure 234
Efficiency 234
Physiological Response to Aerobic Exercise 235
Cardiovascular Response to Exercise 235
Respiratory Response to Exercise 235
Responses Providing Additional Oxygen to Muscle 236
Testing as a Basis for Exercise Programs 236
Fitness Testing of Healthy Subjects 236
Stress Testing for Convalescing Individuals and Individuals at Risk 236
Multistage Testing 237
Determinants of an Exercise Program 237
Intensity 237
Duration 239
Frequency 239
Mode 239
Reversibility Principle 240
Exercise Program 240
Warm-Up Period 240
Aerobic Exercise Period 240
Cool-Down Period 241
Application 241
Physiological Changes that Occur With Training 241
Cardiovascular Changes 241
Respiratory Changes 242
Metabolic Changes 243
Other System Changes 243
Application of Principles of an Aerobic Conditioning Program for the Patient With
Coronary Disease 243
Inpatient Phase (Phase I) 243
Outpatient Phase (Phase II) 243
Outpatient Program (Phase III) 244
Special Considerations 244
Adaptive Changes 244
Applications of Aerobic Training for the Deconditioned Individual and the Patient with
Chronic Illness 245
Adaptations for Disabilities, Functional Limitations, and Deconditioning 245
Impairments, Goals, and Plan of Care 245
Age Differences 246
Children 246
Young Adults 247
Older Adults 248
Independent Learning Activities 248
Chapter 8: Exercise for Impaired Balance 251
Anne D. Kloos, PT, PhD, NCS
Deborah Givens Heiss, PT, PhD, DPT, OCS
Background and Concepts 251
Balance: Key Terms and Definitions 251
Balance Control 252
Sensory Systems and Balance Control 253
Motor Strategies for Balance Control 254
Balance Control Under Varying Conditions 256
Impaired Balance 258
Sensory Input Impairments 258
Sensorimotor Integration 259
Biomechanical and Motor Output Deficits 259
Deficits with Aging 259
Deficits from Medications 260
Management of Impaired Balance 260
Examination and Evaluation of Impaired Balance 260
Balance Training 261
Health and Environmental Factors 265
Evidence-Based Balance Exercise Programs 265
Tai Chi for Balance Training 266
Independent Learning Activities 269
Chapter 9: Aquatic Exercise 273
Robert Schrepfer, MS, PT
BACKGROUND AND PRINCIPLES FOR AQUATIC EXERCISE 273
Definition of Aquatic Exercise 273
Goals and Indications for Aquatic Exercise 274
Precautions and Contraindications to Aquatic Exercise 274
Precautions 274
Contraindications 274
Properties of Water 274
Physical Properties of Water 274
Hydromechanics 275
Thermodynamics 275
Center of Buoyancy 276
Aquatic Temperature and Therapeutic Exercise 276
Temperature Regulation 276
Mobility and Functional Control Exercise 276
Aerobic Conditioning 277
Special Equipment for Aquatic Exercise 277
Collars, Rings, Belts, and Vests 277
Swim Bars 278
Gloves, Hand Paddles, and Hydro-tone(r) Balls 278
Fins and Hydro-tone(r) Boots 278
Kickboards 278
EXERCISE INTERVENTIONS USING AN AQUATIC ENVIRONMENT 279
Stretching Exercises 279
Manual Stretching Techniques 279
Self-Stretching with Aquatic Equipment 282
Strengthening Exercises 283
Manual Resistance Exercises 283
Independent Strengthening Exercises 287
Aerobic Conditioning 290
Treatment Interventions 290
Physiological Response to Deep-Water Walking/Running 290
Proper Form for Deep-Water Running 290
Exercise Monitoring 291
Equipment Selection 291
Independent Learning Activities 291
Part III: Principles of Intervention 295
Chapter 10: Soft Tissue Injury, Repair, and Management 295
Soft Tissue Lesions 295
Examples of Soft Tissue Lesions-Musculoskeletal Disorders 295
Clinical Conditions Resulting from Trauma or Pathology 296
Severity of Tissue Injury 297
Irritability of Tissue: Stages of Inflammation and Repair 297
Management During the Acute Stage 298
Tissue Response-Inflammation 298
Management Guidelines-Protection Phase 298
Management During the Subacute Stage 300
Tissue Response-Repair and Healing 300
Management Guidelines-Controlled Motion Phase 300
Management During the Chronic Stage 302
Tissue Response-Maturation and Remodeling 302
Management Guidelines-Return to Function Phase 303
Cumulative Trauma-Chronic Recurring Pain 305
Tissue Response-Chronic Inflammation 305
Etiology of Chronic Inflammation Leading to Prolonged or Recurring Pain 305
Contributing Factors 305
Management Guidelines-Chronic Inflammation 306
Independent Learning Activities 307
Chapter 11: Joint, Connective Tissue, and Bone Disorders and Management 309
Arthritis-Arthrosis 309
Clinical Signs and Symptoms 309
Rheumatoid Arthritis 310
Osteoarthritis-Degenerative Joint Disease 314
Fibromyalgia and Myofascial Pain Syndrome 316
Fibromyalgia 316
Myofascial Pain Syndrome 318
Osteoporosis 318
Risk Factors 318
Prevention of Osteoporosis 319
Recommendations for Exercise 320
Exercise Precautions and Contraindications 320
Fractures-Post-traumatic Immobilization 320
Risk Factors 322
Bone Healing Following a Fracture 322
Principles of Management-Period of Immobilization 323
Postimmobilization Period 323
Independent Learning Activities 325
Chapter 12: Surgical Interventions and Postoperative Management 329
Indications for Surgical Intervention 329
Guidelines for Preoperative and Postoperative Management 329
Considerations for Preoperative Management 330
Considerations for Postoperative Management 331
Potential Postoperative Complications 334
Overview of Common Orthopedic Surgeries and Postoperative Management 335
Surgical Approaches-Open, Arthroscopic, and Arthroscopically Assisted
Procedures 335
Use of Tissue Grafts 336
Repair, Reattachment, Reconstruction, Stabilization, or Transfer of Soft
Tissues 336
Release, Lengthening, or Decompression of Soft Tissues 339
Joint Procedures 339
Extra-articular Bony Procedures 343
Independent Learning Activities 345
Chapter 13: Peripheral Nerve Disorders and Management 349
Review of Peripheral Nerve Structure 350
Nerve Structure 350
Nervous System Mobility Characteristics 350
Common Sites of Injury to Peripheral Nerves 351
IMPAIRED NERVE FUNCTION 363
Nerve Injury and Recovery 363
Mechanisms of Nerve Injury 363
Classification of Nerve Injuries 364
Recovery of Nerve Injuries 365
Management Guidelines-Recovery from Nerve Injury 365
Neural Tension Disorders 366
Symptoms and Signs of Nerve Mobility Impairment 367
Causes of Symptoms 367
Principles of Management 367
Neural Testing and Mobilization Techniques for the Upper Quadrant 367
Neural Testing and Mobilization Techniques for the Lower Quadrant 368
Prevention 370
MUSCULOSKELETAL DIAGNOSES INVOLVING IMPAIRED NERVE
FUNCTION 370
Thoracic Outlet Syndrome 370
Related Diagnoses 370
Etiology of Symptoms 371
Location of Compression or Entrapment and Tests of Provocation 371
Common Impairments in TOS 372
Common Functional Limitations/Disabilities 372
Nonoperative Management of TOS 373
Carpal Tunnel Syndrome 373
Etiology of Symptoms 374
Tests of Provocation 374
Common Impairments 374
Common Functional Limitations/Disabilities 375
Nonoperative Management of CTS 375
Surgical Intervention and Postoperative Management 376
Compression in Tunnel of Guyon 377
Etiology of Symptoms 377
Tests of Provocation 377
Common Impairments 377
Common Functional Limitations/Disabilities 377
Nonoperative Management 378
Surgical Release and Postoperative Management 378
Complex Regional Pain Syndrome: Reflex Sympathetic Dystrophy and Causalgia 378
Related Diagnoses and Symptoms 378
Etiology and Symptoms 378
Three Stages of CRPS Type I (RSD) 378
Common Impairments 379
Management 379
Independent Learning Activities 381
Part IV: Exercise Interventions by Body Region 383
Chapter 14: The Spine and Posture: Structure, Function, Postural Impairments,
and Management Guidelines 383
POSTURE AND BIOMECHANICAL INFLUENCES 384
Alignment 384
Curves of the Spine 384
Postural Alignment 384
Stability 385
Postural Stability in the Spine 385
Effects of Limb Motion on Spinal Stability 392
Effects of Breathing on Posture and Stability 392
IMPAIRED POSTURE 393
Etiology of Pain 393
Effect of Mechanical Stress 393
Effect of Impaired Postural Support from Trunk Muscles 393
Effect of Impaired Muscle Endurance 394
Pain Syndromes Related to Impaired Posture 394
Common Faulty Postures: Characteristics and Impairments 394
Pelvic and Lumbar Region 394
Cervical and Thoracic Region 395
Frontal Plane Deviations from Lower Extremity Asymmetries 397
MANAGEMENT OF IMPAIRED POSTURE 398
General Management Guidelines 398
Postural Alignment: Proprioception and Control 398
Relationship of Impaired Posture and Pain 400
Joint, Muscle, and Connective Tissue Mobility Impairments 400
Impaired Muscle Performance 401
Body Mechanics 401
Stress Provoking Postures and Activities: Relief and Prevention 401
Stress Management/Relaxation 401
Healthy Exercise Habits 402
Tension Headache/Cervical Headache 403
Causes 403
Presenting Signs and Symptoms 403
General Management Guidelines 403
Independent Learning Activities 404
Chapter 15: The Spine: Impairments, Diagnoses, and Management
Guidelines 407
Review of the Structure and Function of the Spine 408
Functional Components of the Spine 408
Motions of the Spinal Column 408
Structure and Function of Intervertebral Disks 409
Intervertebral Foramina 409
Inert Structures: Influence on Movement and Stability 410
Neuromuscular Function: Dynamic Stabilization 410
SPINAL PATHOLOGIES AND IMPAIRED SPINAL FUNCTION 410
Pathology of the Intervertebral Disk 410
Injury and Degeneration of the Disk 410
Disk Pathologies and Related Conditions 412
Signs and Symptoms of Disk Lesions and Fluid Stasis 412
Pathomechanical Relationships of the Intervertebral Disk and Facet Joints 414
Three-Joint Complex 414
Related Pathologies 414
Pathology of the Zygapophyseal (Facet) Joints 415
Facet Joint Characteristics 415
Common Diagnoses and Impairments from Facet Joint Pathologies 415
Pathology of Muscle and Soft Tissue Injuries: Strains, Tears, and Contusions 416
General Symptoms from Trauma 416
Common Sites of Lumbar Strain 416
Common Sites of Cervical Strain 416
Postural Strain 416
Emotional Stress 417
Functional Limitations/Disabilities 417
Pathomechanics of Spinal Instability 417
Neutral Zone 417
Instability 417
MANAGEMENT GUIDELINES BASED ON IMPAIRMENTS 418
Principles of Management for the Spine 418
Examination and Evaluation 418
General Guidelines for Managing Acute Spinal Problems: Protection
Phase 420
General Guidelines for Managing Subacute Spinal Problems: Controlled
Motion Phase 421
General Guidelines for Managing Chronic Spinal Problems: Return to
Function Phase 423
Management Guidelines-Non-Weight-Bearing Bias 424
Management of Acute Symptoms 424
Progression 424
Management Guidelines-Extension Bias 424
Principles of Management 424
Indications, Precautions, and Contraindications for Interventions-
Extension Approach 425
Techniques Using an Extension Approach in the Lumbar Spine 425
Techniques to Manage a Disk Lesion in the Cervical Spine 428
Management Guidelines-Flexion Bias 429
Principles of Management 429
Indications and Contraindications for Intervention-Flexion Approach 429
Techniques Utilizing a Flexion Approach 429
Management Guidelines-Stabilization 430
Identification of Clinical Instability 430
Principles of Management 431
Management Guidelines-Mobilization 431
Management-Lumbar Spine 431
Management-Cervical Spine 432
Management Guidelines-Soft Tissue Injuries 432
Management During the Acute Stage: Protection Phase 432
Management in the Subacute and Chronic Stages of Healing: Controlled
Motion and Return to Function Phases 433
Management Guidelines-Temporomandibular Joint Dysfunction 433
Signs and Symptoms 433
Etiology of Symptoms 433
Principles of Management 434
Independent Learning Activities 435
Chapter 16: The Spine: Exercise Interventions 439
BASIC CONCEPTS OF SPINAL MANAGEMENT WITH EXERCISE 440
Fundamental Interventions 440
Patient Education 440
General Exercise Guidelines 441
Kinesthetic Awareness 441
Mobility/Flexibility 441
Muscle Performance 441
Cardiopulmonary Endurance 441
Functional Activities 442
KINESTHETIC AWARENESS 443
Elements of Kinesthetic Training-Fundamental Techniques 443
Position of Symptom Relief 443
Effects of Movement on the Spine 443
Integration of Kinesthetic Training With Stabilization Exercises and Fundamental
Body Mechanics 443
Progression to Active and Habitual Control of Posture 443
MOBILITY/FLEXIBILITY 444
Cervical and Upper Thoracic Region-Stretching Techniques 444
Techniques to Increase Thoracic Extension 444
Techniques to Increase Axial Extension (Cervical Retraction)-Scalene Muscle
Stretch 445
Techniques to Increase Upper Cervical Flexion-Short Suboccipital Muscle
Stretch 445
Techniques to Increase Scapular and Humeral Muscle Flexibility 446
Traction as a Stretching Technique 446
Other Techniques for Increasing Mobility 447
Mid and Lower Thoracic and Lumbar Regions-Stretching Techniques 447
Techniques to Increase Lumbar Flexion 447
Techniques to Increase Lumbar Extension 448
Techniques to Increase Lateral Flexibility in the Spine 448
Techniques to Increase Hip Muscle Flexibility 450
Traction as a Stretching Technique 450
MUSCLE PERFORMANCE: STABILIZATION, MUSCLE ENDURANCE, AND
STRENGTH TRAINING 451
Stabilization Training-Fundamental Techniques and Progressions 451
Guidelines for Stabilization Training 451
Deep Stabilizing (Core) Muscle Activation and Training 452
Global Muscle Stabilization Exercises 456
Isometric and Dynamic Exercises 465
Exercises for the Cervical Region 466
Exercises for the Thoracic and Lumbar Regions 467
CARDIOPULMONARY ENDURANCE 472
Common Aerobic Exercises and Effects on the Spine 472
Cycling 472
Walking and Running 473
Stair Climbing 473
Cross-Country Skiing and Ski Machines 473
Swimming 473
Upper Body Ergometry Machines 473
Step Aerobics and Aerobic Dancing 473
"Latest Popular Craze" 473
FUNCTIONAL ACTIVITIES 473
Early Functional Training-Fundamental Techniques 474
Preparation for Functional Activities-Basic Exercise Techniques 474
Weight-Bearing Exercises 474
Transitional Stabilization Exercises 476
Body Mechanics and Environmental Adaptations 476
Principles of Body Mechanics-Instruction and Training 476
Environmental Adaptations 477
Intermediate to Advanced Exercise Techniques for Functional Training 477
Repetitive Lifting 477
Repetitive Reaching 478
Repetitive Pushing and Pulling 478
Rotation or Turning 478
Transitional Movements 478
Transfer of Training 478
Education for Prevention 478
Independent Learning Activities 479
Chapter 17: The Shoulder and Shoulder Girdle 481
STRUCTURE AND FUNCTION OF THE SHOULDER GIRDLE 482
Joints of the Shoulder Girdle Complex 482
Synovial Joints 482
Functional Articulations 484
Shoulder Girdle Function 486
Scapulohumeral Rhythm 486
Clavicular Elevation and Rotation With Humeral Motion 486
External Rotation of the Humerus With Full Elevation 487
Internal Rotation of the Humerus With Full Elevation 487
Elevation of the Humerus Through the Plane of the Scapula-Scaption 487
Deltoid-Short Rotator Cuff and Supraspinatus Mechanisms 487
Referred Pain and Nerve Injury 487
Common Sources of Referred Pain in the Shoulder Region 487
Nerve Disorders in the Shoulder Girdle Region 487
MANAGEMENT OF SHOULDER DISORDERS AND SURGERIES 488
Joint Hypomobility: Nonoperative Management 488
Glenohumeral Joint 488
Acromioclavicular and Sternoclavicular Joints 493
Glenohumeral Joint Surgery and Postoperative Management 494
Glenohumeral Arthroplasty 494
Arthrodesis of the Shoulder 501
Painful Shoulder Syndromes (Rotator Cuff Disease, Impingement Syndromes,
Shoulder Instabilities): Nonoperative Management 502
Related Pathologies and Etiology of Symptoms 502
Common Impairments 505
Common Functional Limitations/Disabilities 506
Management: Painful Shoulder Syndromes (Without Dislocation) 506
Painful Shoulder Syndromes: Surgery and Postoperative Management 508
Subacromial Decompression and Postoperative Management 508
Rotator Cuff Repair and Postoperative Management 511
Shoulder Dislocations: Nonoperative Management 518
Related Pathologies and Mechanisms of Injury 518
Common Impairments 519
Common Functional Limitations/Disabilities 519
Closed Reduction of Anterior Dislocation 519
Closed Reduction Posterior Dislocation 521
Shoulder Instabilities: Surgery and Postoperative Management 521
Glenohumeral Joint Stabilization Procedures and Postoperative
Management 521
Acromioclavicular and Sternoclavicular Joint Stabilization Procedures and
Postoperative Management 529
EXERCISE INTERVENTIONS FOR THE SHOULDER GIRDLE 529
Exercise Techniques During Acute and Early Subacute Stages of Tissue Healing 529
Early Motion of the Glenohumeral Joint 529
Early Motion of the Scapula 531
Early Neuromuscular Control 531
Exercise Techniques to Increase Flexibility and Range of Motion 531
Self-Stretching Techniques 531
Manual and Self-Stretching Exercises for Specific Muscles 533
Exercises to Develop and Improve Muscle Performance and Functional Control 536
Isometric Exercises 536
Stabilization Exercises 539
Dynamic Strengthening Exercises-Scapular Muscles 541
Dynamic Strengthening Exercises-Glenohumeral Muscles 545
Functional Activities 549
Independent Learning Activities 550
Chapter 18: The Elbow and Forearm Complex 557
STRUCTURE AND FUNCTION OF THE ELBOW AND FOREARM 558
Joints of the Elbow and Forearm 558
Elbow Joint Characteristics and Arthrokinematics 558
Forearm Joint Characteristics and Arthrokinematics 559
Muscle Function at the Elbow and Forearm 560
Primary Actions at the Elbow and Forearm 560
Relationship of Wrist and Hand Muscles to the Elbow 560
Referred Pain and Nerve Injury in the Elbow Region 560
Common Sources of Referred Pain into the Elbow Region 561
Nerve Disorders in the Elbow Region 561
MANAGEMENT OF ELBOW AND FOREARM DISORDERS AND
SURGERIES 561
Joint Hypomobility: Nonoperative Management 562
Related Pathologies and Etiology of Symptoms 562
Common Impairments 562
Common Functional Limitations/Disabilities 562
Joint Hypomobility: Management-Protection Phase 562
Joint Hypomobility: Management-Controlled Motion Phase 562
Joint Hypomobility: Management-Return to Function Phase 564
Joint Surgery and Postoperative Management 564
Excision of the Radial Head 565
Total Elbow Arthroplasty 567
Myositis Ossificans 574
Etiology of Symptoms 574
Management 574
Overuse Syndromes: Repetitive Trauma Syndromes 575
Related Pathologies 575
Etiology of Symptoms 575
Common Impairments 575
Common Functional Limitations/Disabilities 575
Nonoperative Management of Overuse Syndromes: Protection Phase 575
Nonoperative Management: Controlled Motion and Return to Function
Phases 576
EXERCISE INTERVENTIONS FOR THE ELBOW AND FOREARM 578
Exercise Techniques to Increase Flexibility and Range of Motion 578
Manual, Mechanical, and Self-Stretching Techniques 578
Self-Stretching Techniques-Muscles of the Medial and Lateral
Epicondyles 579
Exercises to Develop and Improve Muscle Performance and Functional Control 580
Isometric Exercises 580
Dynamic Strengthening and Endurance Exercises 580
Functional Exercises 583
Independent Learning Activities 585
Chapter 19: The Wrist and Hand 589
STRUCTURE AND FUNCTION OF THE WRIST AND HAND 590
Joints of the Wrist and Hand 590
Wrist Joint-Characteristics and Arthrokinematics 590
Hand Joints-Characteristics and Arthrokinematics 590
Hand Function 592
Muscles of the Wrist and Hand 592
Grips and Prehension Patterns 593
Major Nerves Subject to Pressure and Trauma at the Wrist and Hand 594
Nerve Disorders in the Wrist 594
Referred Pain and Sensory Patterns 594
MANAGEMENT OF WRIST AND HAND DISORDERS AND SURGERIES 594
Joint Hypomobility: Nonoperative Management 594
Common Joint Pathologies and Associated Impairments 594
Common Functional Limitations/Disabilities with Joint Pathologies 596
Joint Hypomobility: Management-Protection Phase 596
Joint Hypomobility: Management-Controlled Motion and Return to
Function Phases 597
Joint Surgery and Postoperative Management 599
Wrist Arthroplasty 600
Metacarpophalangeal Implant Arthroplasty 603
Proximal Interphalangeal Implant Arthroplasty 608
Carpometacarpal Arthroplasty of the Thumb 610
Tendon Rupture Associated with RA: Surgical and Postoperative
Management 613
Repetitive Trauma Syndromes/Overuse Syndromes 615
Tenosynovitis, Tendinitis 615
Traumatic Lesions in the Wrist and Hand 616
Simple Sprain: Nonoperative Management 616
Lacerated Flexor Tendons of the Hand: Surgical and Postoperative
Management 616
Lacerated Extensor Tendons of the Hand: Surgical and Postoperative
Management 625
EXERCISE INTERVENTIONS FOR THE WRIST AND HAND 631
Techniques for Musculotendinous Mobility 631
Tendon-Gliding and Tendon-Blocking Exercises 631
Scar Tissue Mobilization for Tendon Adhesions 633
Exercise Techniques to Increase Flexibility and Range of Motion 634
General Stretching Techniques 634
Stretching Techniques for the Intrinsic and Multijoint Muscles 635
Exercises to Develop and Improve Muscle Performance, Neuromuscular Control,
and Coordinated Movement 636
Techniques to Strengthen Muscles of the Wrist and Hand 636
Functional Activities 638
Independent Learning Activities 638
Chapter 20: The Hip 643
STRUCTURE AND FUNCTION OF THE HIP 644
Anatomical Characteristics of the Hip Region 644
Bony Structures 644
Hip Joint Characteristics and Arthrokinematics 644
Influence of the Hip Joint on Balance and Posture Control 645
Functional Relationships of the Hips and Pelvis 645
Pelvic Motions and Muscle Function 645
Pathomechanics in the Hip Region 647
The Hip and Gait 648
Hip Muscle Function During Gait 648
Effect of Musculoskeletal Impairments on Gait 648
Referred Pain and Nerve Injury 648
Major Nerves Subject to Injury or Entrapment 648
Common Sources of Referred Pain in the Hip and Buttock Region 648
MANAGEMENT OF HIP DISORDERS AND SURGERIES 649
Joint Hypomobility: Nonoperative Management 649
Related Pathologies and Etiology of Symptoms 649
Common Impairments 650
Common Functional Limitations/Disabilities 650
Management: Protection Phase 650
Management: Controlled Motion and Return to Function Phases 650
Joint Surgery and Postoperative Management 652
Total Hip Arthroplasty 652
Hemiarthroplasty of the Hip 663
Fractures of the Hip-Surgical and Postoperative Management 664
Hip Fracture-Incidence and Risk Factors 664
Sites and Types of Hip Fracture 664
Open Reduction and Internal Fixation of Hip Fracture 665
Painful Hip Syndromes/Overuse Syndromes: Nonoperative Management 671
Related Pathologies and Etiology of Symptoms 671
Common Impairments and Functional Limitations/Disabilities 671
Management: Protection Phase 671
Management: Controlled Motion Phase 671
Management: Return to Function Phase 672
EXERCISE INTERVENTIONS FOR THE HIP REGION 672
Exercise Techniques to Increase Flexibility and Range of Motion 672
Techniques to Stretch Range-Limiting Hip Structures 672
Techniques to Stretch Range-Limiting Two-Joint Muscles 674
Exercises to Develop and Improve Muscle Performance and Functional Control 676
Non-Weight-Bearing Exercises 676
Closed-Chain Weight-Bearing Exercises 678
Functional Training 681
Independent Learning Activities 682
Chapter 21: The Knee 687
STRUCTURE AND FUNCTION OF THE KNEE 688
Joints of the Knee Complex 688
Tibiofemoral Joint 688
Patellofemoral Joint 689
Patellar Function 689
Patellar Alignment 689
Patellar Compression 691
Muscle Function 691
Knee Extensor Muscle Function 691
Knee Flexor Muscle Function 692
Dynamic Stability of the Knee 692
The Knee and Gait 692
Muscle Control of the Knee During Gait 692
Hip and Ankle Impairments 692
Referred Pain and Nerve Injuries 693
Major Nerves Subject to Injury at the Knee 693
Common Sources of Referred Pain 693
MANAGEMENT OF KNEE DISORDERS AND SURGERIES 693
Joint Hypomobility: Nonoperative Management 693
Common Joint Pathologies and Associated Impairments 693
Common Functional Limitations/Disabilities 695
Joint Hypomobility: Management-Protection Phase 695
Joint Hypomobility: Management-Controlled Motion and Return to Function
Phases 695
Joint Surgery and Postoperative Management 698
Repair of Articular Cartilage Defects 698
Synovectomy 699
Total Knee Arthroplasty 702
Patellofemoral Dysfunction: Nonoperative Management 711
Related Patellofemoral Pathologies 711
Etiology of Symptoms 712
Common Impairments and Functional Limitations/Disabilities 712
Patellofemoral Symptoms: Management-Protection Phase 712
Patellofemoral Symptoms: Management-Controlled Motion and Return to
Function Phases 712
Patellofemoral and Extensor Mechanism Dysfunction: Surgical and Postoperative
Management 715
Lateral Retinacular Release 716
Proximal Realignment of the Extensor Mechanism 718
Distal Realignment of the Extensor Mechanism 721
Ligament Injuries: Nonoperative Management 722
Mechanisms of Injury 722
Ligament Injuries in the Female Athlete 722
Common Impairments and Functional Limitations/Disabilities 723
Ligament Injuries: Nonoperative Management 723
Ligament Injuries: Surgical and Postoperative Management 725
Background 725
Anterior Cruciate Ligament Reconstruction 726
Posterior Cruciate Ligament Reconstruction 735
Meniscal Tears: Nonoperative Management 737
Mechanisms of Injury 737
Common Impairments and Functional Limitations/Disabilities 737
Management 738
Meniscal Tears: Surgical and Postoperative Management 738
Meniscus Repair 738
Partial Meniscectomy 742
EXERCISE INTERVENTIONS FOR THE KNEE 742
Exercise Techniques to Increase Flexibility and Range of Motion 743
To Increase Knee Extension 743
To Increase Knee Flexion 743
Exercises to Develop and Improve Muscle Performance and Functional Control 744
Nonweight-Bearing Exercises 745
Closed-Chain Exercises 748
Techniques to Simulate Functional Activities 750
Independent Learning Activities 751
Chapter 22: The Ankle and Foot 759
STRUCTURE AND FUNCTION OF THE ANKLE AND FOOT 760
Structural Relationships and Motions 760
Anatomical Characteristics 760
Motions of the Foot and Ankle Defined 760
Leg, Ankle, and Foot Joint Characteristics and Arthrokinematics 761
Function of the Ankle and Foot 763
Structural Relationships 763
Muscle Function in the Ankle and Foot 763
The Ankle/Foot Complex and Gait 764
Function of the Ankle and Foot Joints During Gait 764
Muscle Control of the Ankle and Foot During Gait 764
Referred Pain and Nerve Injury 764
Major Nerves Subject to Pressure and Trauma 764
Common Sources of Segmental Sensory Reference in the Foot 765
MANAGEMENT OF FOOT AND ANKLE DISORDERS AND SURGERIES 765
Joint Hypomobility: Nonoperative Management 766
Common Joint Pathologies and Etiology of Symptoms 766
Common Impairments and Functional Limitations/Disabilities 766
Joint Hypomobility: Management-Protection Phase 767
Joint Hypomobility: Management-Controlled Motion and Return to
Function Phases 767
Joint Surgery and Postoperative Management 769
Total Ankle Arthroplasty 770
Arthrodesis at the Ankle and Foot 773
Overuse (Repetitive Trauma) Syndromes: Nonoperative Management 776
Related Pathologies and Etiology of Symptoms 776
Common Impairments and Functional Limitations/Disabilities 776
Overuse Syndromes: Management-Protection Phase 777
Overuse Syndromes: Management-Controlled Motion and Return to
Function Phases 777
Ligamentous Injuries: Nonoperative Management 777
Common Impairments and Functional Limitations/Disabilities 777
Management: Protection Phase 778
Management: Controlled Motion Phase 778
Management: Return to Function Phase 778
Traumatic Soft Tissue Injuries: Surgical and Postoperative Management 779
Repair of Complete Lateral Ligament Tears 779
Repair of a Ruptured Achilles Tendon 782
EXERCISE INTERVENTIONS FOR THE ANKLE AND FOOT 786
Exercise Techniques to Increase Flexibility and Range of Motion 786
Flexibility Exercises for the Ankle Region 786
Flexibility Exercises for Limited Mobility of the Toes 788
Stretching the Plantar Fascia of the Foot 788
Exercises to Develop and Improve Muscle Performance and Functional Control 788
Activities to Develop Dynamic Neuromuscular Control 788
Open-Chain Strengthening Exercises 789
Weight-Bearing Exercises for Strength, Balance, and Function 790
Independent Learning Activities 792
Part V: Special Areas of Therapeutic Exercise 797
Chapter 23: Women's Health: Obstetrics and Pelvic Floor 797
Barbara Settles Huge, BS, PT
OVERVIEW OF PREGNANCY, LABOR, AND RELATED CONDITIONS 798
Characteristics of Pregnancy and Labor 798
Pregnancy 798
Labor 798
Anatomical and Physiological Changes of Pregnancy 800
Weight Gain During Pregnancy 800
Changes in Organ Systems 800
Changes in Posture and Balance 801
Overview of Pelvic Floor Anatomy, Function and Dysfunction 801
Pelvic Floor Musculature 801
Effect of Childbirth on the Pelvic Floor 802
Classification of Pelvic Floor Dysfunction 803
Risk Factors for Dysfunction 803
Interventions for Pelvic Floor Impairments 804
Pregnancy-Induced Pathology 804
Diastasis Recti 804
Postural Back Pain 805
Sacroiliac/Pelvic Girdle Pain 806
Varicose Veins 806
Joint Laxity 807
Nerve Compression Syndromes 807
EXERCISE INTERVENTIONS FOR PREGNANCY, LABOR, AND RELATED
CONDITIONS 807
Physiological Effects of Aerobic Exercise During Pregnancy 807
Maternal Response to Aerobic Exercise 807
Fetal Response to Maternal Aerobic Exercise 808
Exercise for the Uncomplicated Pregnancy and Postpartum 808
Guidelines for Managing the Pregnant Woman 810
Recommendations for Fitness Exercise 811
Precautions and Contraindications to Exercise 811
Critical Areas of Emphasis and Selected Exercise Techniques 812
Pelvic Floor Awareness, Training and Strengthening 814
Relaxation and Breathing Exercises for Use During Labor 815
Unsafe Postures and Exercises During Pregnancy 816
Exercise Critical to the Postpartum Period 817
Cesarean Childbirth 817
Significance to Physical Therapists 817
Suggested Activities for the Patient Following a Cesarean Section 818
High-Risk Pregnancy 819
High-Risk Conditions 819
Management Guidelines and Precautions for High-Risk Pregnancies 820
Independent Learning Activities 821
Chapter 24: Management of Vascular Disorders of the Extremities 825
Disorders of the Arterial System 825
Types of Arterial Disorders 825
Clinical Manifestations of Peripheral Arterial Disorders 826
Examination and Evaluation of Arterial Sufficiency 827
Management of Acute Arterial Occlusion 828
Management of Chronic Arterial Insufficiency 829
Special Considerations in a Graded Exercise Program for Patients with Chronic
Arterial Insufficiency 830
Disorders of the Venous System 831
Types of Venous Disorders 831
Clinical Manifestations of Venous Disorders 831
Examination and Evaluation of Venous Sufficiency 832
Prevention of Deep Vein Thrombosis and Thrombophlebitis 833
Management of Deep Vein Thrombosis and Thrombophlebitis 833
Management of Chronic Venous Insufficiency and Varicose Veins 833
Disorders of the Lymphatic System 834
Conditions Leading to Insufficiency of the Lymphatic System 835
Clinical Manifestations of Lymphatic Disorders 835
Examination and Evaluation of Lymphatic Function 836
Prevention of Lymphedema 836
Management of Lymphedema 836
Breast Cancer-Related Lymphatic Dysfunction 838
Background 838
Surgical Procedures 838
Impairments and Complications Related to Breast Cancer Treatment 839
Guidelines for Management After Breast Cancer Surgery 840
Exercises for the Management of Lymphedema 842
Background and Rationale 842
Components of Exercise Regimens for Management of Lymphedema 842
Guidelines for Lymphatic Drainage Exercises 843
Selected Exercises for Lymphatic Drainage: Upper and Lower Extremity
Sequences 843
Independent Learning Activities 847
Chapter 25: Management of Pulmonary Conditions 851
Review of Respiratory Structure and Function 852
Thorax and Chest Wall: Structure and Function 852
Muscles of Ventilation 852
Mechanics of Ventilation 853
Anatomy and Function of the Respiratory Tracts 854
The Lungs and Pleurae 855
Lung Volumes and Capacities 856
Examination 856
Components of the Examination 857
Breathing Exercises and Ventilatory Training 861
Guidelines for Teaching Breathing Exercises 861
Diaphragmatic Breathing 862
Segmental Breathing 863
Pursed-Lip Breathing 864
Preventing and Relieving Episodes of Dyspnea 865
Positive Expiratory Pressure Breathing 865
Respiratory Resistance Training 866
Glossopharyngeal Breathing 866
Exercises to Mobilize the Chest 867
Specific Techniques 867
Coughing 868
The Normal Cough Pump 868
Factors that Decrease the Effectiveness of the Cough Mechanism and Cough
Pump 868
Teaching an Effective Cough 868
Additional Techniques to Facilitate a Cough and Improve Airway Clearance 869
Suctioning: Alternative to Coughing 870
Postural Drainage 870
Manual Techniques Used With Postural Drainage Therapy 870
Postural Drainage Positions 872
Guidelines for Implementing Postural Drainage 873
Modified Postural Drainage 874
Home Program of Postural Drainage 874
Management of Patients with Chronic Obstructive Pulmonary Disease 874
Types of Obstructive Pulmonary Disorders 875
Pathological Changes in the Pulmonary System 875
Impairments and Impact on Function 875
Management Guidelines: COPD 875
Management of Patients with Restrictive Pulmonary Disorders 875
Acute and Chronic Causes of Restrictive Pulmonary Disorders 877
Pathological Changes in the Pulmonary System 877
Management Guidelines: Post-Thoracic Surgery 877
Independent Learning Activities 880
Appendix A Systematic Musculoskeletal Examination Guidelines
9780803615847 0803615841
Exercise therapy--Handbooks, manuals, etc.
Exercise Therapy--methods.
WB 541 K617t 2007