Therapeutic Exercise Techniques and Principles

The Kinetic Chain

A concept that describes the interconnectedness of body segments and how movement in one segment affects others.

Open kinetic chain

A type of exercise where the distal segment of the limb is free to move in space.

bicep curls, leg extension

Closed kinetic chain

A type of exercise where the distal segment of the limb is fixed and cannot move.

squats, pushups

properties of water

buyancy and specific gravity

hydrostatic pressure

viscosity

fluid dynamics

effect of depth of immersion on weight bearing

Buoyancy

The upward force exerted by a fluid that opposes the weight of an object immersed in it.

buoyancy assisted

Movement toward the surface of the water

buoyancy supported

perpendicular to surface

buoyancy resisted

directly opposing upward thrust

archimedes principle

the buoyant force on an object is equal to the weight of the fluid displaced by the object

depends on specific gravity

<1 float

>1 sink

Specific Gravity

The ratio of the density of a substance to the density of a reference substance, typically water.

Hydrostatic Pressure

The pressure exerted by a fluid at equilibrium due to the force of gravity.

Pascal's law

A principle stating that pressure applied to a confined fluid is transmitted undiminished in all directions.

liquid putting equal pressure on all surfaces

helps with swelling

at 4 feet, the force from hydrostatic pressure is 89.6, slightly lower than systolic pressure

Viscosity

friction b/w individual molecules in liquid

speed vs resistance

high = high

low=low

Fluid Dynamics

The study of the behavior of fluids in motion.

laminar flow

smooth, streamline flow

turbulent flow

added turbulence

modify resistance

speed of movement

alter frontal surface (resistance)

flow of water (resistance)

what mofemnts used in water

concentric

Effect of Depth of Immersion on Weight Bearing

The phenomenon where the deeper an individual is submerged, the less weight they bear due to buoyancy.

easier on joints

maintain CV health while injured

structures and factors contributing to limitations in rom

joint capsule tightness

ligamentous adhesions

muscular spasms

muscular tightness

myofascial tightness

pain

joint effusion

bony blocks

connective tissue and stretching

at least 6. seconds

tupically 10-15 sec

increase temp, decrease resistance

increase extensibility

between 102 and 110 inceased elasticity

reciprocal inhibition

The simultaneous contraction of one muscle and the relaxation of its antagonist to allow movement to take place

Golgi Tendon Organs

Sensory receptors located at the junction of muscles and tendons that monitor tension.

autogenic inhibition

Muscle Spindles

Sensory receptors located within muscles that detect changes in muscle length.

Ballistic stretching

A type of stretching that involves bouncing movements to push the body beyond its normal range of motion.

effective for flexibility

not safe

Static stretching

A type of stretching where a muscle is lengthened and held in that position for a period of time.

safest

PNF stretching

Proprioceptive Neuromuscular Facilitation, a stretching technique that involves both stretching and contracting the muscle group being targeted.

effective

takes clinician and patient

takes time

contraindications to stretching

limitation of joint motion by a bony block

recent fracture

evidence of an acute inflammatory or infectious process in or around joints

sharp, acute pain with joint movement or muscle elongation

hematome or other indications of tissue trauma

contractures or sortened soft tissues providing sincreased joint stability in lieu of normal structural stability or muscle strength

contractures or shortened soft tissues forming basis

Contract-Relax

A PNF stretching technique where the muscle is contracted before being relaxed and stretched.

Hold-Relax

A PNF stretching technique where the muscle is held in a stretched position before being relaxed.

Slow Reversal Hold-Relax

A PNF technique that combines contraction and relaxation with a slow reversal of movement.

upper extremity D1 flexion

flexion, adduction, external rotation

putting on seatbelt with opposite hand

upper extremity D1 extension

extension, abduction, internal rotaiton

putting on seatbelt with opposite hand

upper extremity D2 flexion

flexion, abduction, external rotation

putting on seatbelt with same hand

upper extremity D2 extiesion

extrnsion, adduction, internal rotation

putting on seatbelt with same hand

D1 lower extremity flexion

flexion, adduction, ext rotation

lower extremity d1 extension

extension, abduction, int roations

lower extremity d2 flexion

flexion, abduction, ext rotation

lower extremity d2 extension

exetension adduction, int rotation

indications of joint mobilizations

facilitate healing

reduce disability

relieve pain

restore full rom

stretching vs mobilization

tight muscle vs tight joint capsule

effective at end of motion vs. any point

limited to one direction vs any direction

increase pain with increased rom vs decreased pain with increased rom

long lever arm vs short lever arm safer

roll

multiple surfaces come into contact with multiple surfaces

spin

multiple surfaces cone into contact with one surface

glide

one surface hitting multiple surfaces

restrictions in motion

capsular

noncapsular - ligamentous adhesions, internal derangement, extraarticular limitations

capsular end feel

normal

firm; forcing shoulder into full external roation

bony end feel

normal

abrupt; moving into elbow into full extension

soft tissue end feel

normal

soft; flexing the normal knee or elbow approximation

muscular end feel

normal

rubbery; tension of tight hamstrings

adhesion and scarring endfeel

abnormal

sudden; sharp arrest in one direction

muscle spasm end feel

abnormal

rebound; usually accoumpanies pain felt at end of restriction

loose end feel

abnormal

ligamentous lacity; a hypermobile joint

boggy end feel

abnormal

soft, mushy; joint effusion

internal derangment end feel

abnormal

springy; mechanical block such as a torn meniscus

empty end feel

abnormal

no resistance to motion

contraindications to mobility

premature stressing of surgical sutures

vascular disease

hypermobility

advanced osteoarthritis

acute inflammation

neurologic signs

infection

congenital bone deformation

fractures

osteoporosis

malignancy

rheumatoid arthritis

spondylosis/spondylisthesis

paget diease

veterbral artery insufficiency

spinal cord instability

precautions to mobility

unexplained pain

onset of new symptoms

joint ankylosis

protective muscle spasm

scoliosis

pregnancy

maitland grade 1

A small amplitude movement at the beginning of the rom that is used when pain and spasm limit movement early in the range of motion

decrease pain

maitland grade 2

large amplitude movement within the midrange of motion that is used when slowly increasing pain restricts movement halfway into range

decrease pain

mailand grade 3

large amplitude movement up to the pathologic limit of rom that is used when pain and resistance as a result of spasm, inert tissue tension, or tissue compression limit movement near end of range

increase mobility

maitland grade 4

small amplitutde movement at the very end of the rom that is used when resistance limits moevement in the absense of pain and spasm

incrase mobilitiy

maitland grade 5

not typically used because it is manipulation

small amplitude, quick thrust delivered at the end of rom that is usally accompanied by a popping sound

when mvoving joint

ossilations of 1-3 seconds for 30 sec

small-amplitude and can incresae to large

concave stations, covex mobilized

convex opposite the restriction

convex stationaty, concave mobilized

concave in same direction

mulligan technique

mobilation with movement (MWM)

sustained natural apophyseal glides (SNAG)

use bands or belts and mobilze while someone is moving

other techniques

muscle energy

myofascial release

IASTM

strain/counterstrain

positional relase therapy

active release therayp

biofeedback