Therapeutic Exercises

Be honest: is active exercise the best kind of exercise?

sure is! you want your client to be using their own power

What are some goals of therapeutic exercise?

To develop or restore muscular strength, endurance, or flexibility

To improve neuromuscular coordination

To increase cardiovascular efficiency

Target health and performance factors

Rehabilitative vs habilitation exercise?

rehabilitative: restoration of function lose due to injury, disease, or behavioral traits

habilitative: acquisition of age-appropriate skills and functions

T or F: immobilization decreases joint mobility and tendon gliding

true

how do we fix it? movement!

T or F: scars can bind gliding structures together and reduce mobility

True

T or F: edema does not contribute to decreased tissue gliding

False, chronic edema is like filling a body part with glue

How can the "stress" of movement benefit gliding structures?

Enhances normal orientation of fibrils, preventing cross links

Increases tendon and ligament strength

Can influence collagen formation to maintain or restore tissue gliding and motion in joint

What are some ways to increase/decrease exercise dosage?

Intensity/force (how much you're contracting the muscle, how hard to passively stretch joint)

Duration (how long force is sustained)

Frequency (how many reps? how many sessions?)

What kind of exercise should you do in the inflammatory stage?

none!! rest the tissue instead

What kind of exercise should you do in the fibroplasia stage?

low, gentle force, few repetitions

performed in pain-free range

gradually increase as tensile strength increases

why? stimulates collagen production

What kind of exercise should you do in the maturation stage?

low load, prolonged duration

mild, prolonged at end range of joint motion

exercise to stretch tissues and create changes

focus on reducing stiffness and increasing tendon excursion

What is tenodesis?

the synergistic coupling of wrist extension with finger flexion and wrist flexion with finger extension

shows soft tissues are normal

T or F: the fingers should extend before the wrist does

False

the fingers should not be leading wrist extension, this usually indicates substitution due to weak extrinsic extensors I think

What are treatment goals you could see with therapeutic exercises?

Manage pain

Improve posture

Increase motion

Increase endurance

Increase strength

Restore function

What is passive exercise?

Exercise performed by a person by manual or mechanical means; no voluntary muscle contraction occurs

What are some benefits of passive exercise?

maintains joint/soft tissue mobility

edema control (usually in combination with massage)

increases circulation

increases synovial fluid

pain management

When would you do passive exercise with a client?

pain with active movement

weakness

need to maximize ROM

joint replacement

contracture management (for both soft tissue and bony)

paralysis

spasticity

T or F: passive exercise maintains muscle mass

FALSE, they're not even contracting the muscle............

What are precautions to consider with passive stretching?

Mobilizing unprotected joints

Causing additional trauma

Stretching the wrong joint

Osteoporosis (bones could fracture)

Edematous tissues are more susceptible to injury

For passive stretching, where in the ROM should you be stretching in order to lengthen soft tissues?

at end range

For passive stretching force should be ________, ___________, and ____________

slow, gentle, sustained

T or F: stretching can elongate contractile and non-contractile tissues

True

Joint contractures require __________________ before stretch (to determine ________)

joint mobilization

end feel

How do you avoid joint compression during stretch?

do joint distraction (opening joint) before

T or F: 2nd - 5th CMC joints are immobile

False!

2nd and 3rd are immobile

4th and 5th have 10-20 deg of flexion

Exercise to increase palmar arches?

Place thumb in palm and fingers on dorsum of hand, roll metacarpals around thumb

How to passively stretch forearm pronation and supination?

Stabilize humerus

Apply rotational force to distal forearm

Do this with elbow flexed and elbow extended

When passively stretching forearm, why should you stretch with elbow flexed and extended?

Pronation limitation can be caused by bicep tightness

(biceps assist with supination)

What is contract-relax technique and what does it do?

Isometric contraction of tight muscle before passive lengthening can give you more stretch

ex. make fist before stretching flexors

Stretching technique for intrinsic muscles of the hand?

PIP/DIP in flexion, MCP gently stretched into extension

How to stretch extrinsic extensors? How to stretch extrinsic flexors?

exercises you did before playing in band

Indications for active exercise?

Maintain joint mobility

Increase synovial fluid

Pain management

Produce tendon glide

Maintain elasticity/contractility of muscles

Stimulus for bone integrity

Edema control

T or F: in order to maintain mobility, active exercises must be performed through full available ROM

True

T or F: you should prescribe exercises to areas that aren't directly affected by injury

True!

Areas like the neck, shoulder, elbow, forearm, and wrist can become tight after hand disuse)

T or F: to restore mobility, active exercises should involve quick movements

False

What are blocking exercises?

Direct force to stiff joint by isolating

Used for force transmission

What is active-assistive exercise?

Type of active motion where an outside force assists a joint to complete movement

What is the rationale for resistive exercise after immobilization?

Immobilization leads to muscle atrophy

Atrophy leads to decreased muscle strength

Weak muscles are ineffective to mobilize stiff joints

Resistance increases strength

Strengthening will increase the exertion the patient is able to place on stiff joints and restricted tendons

What are the colors of theraband/digiflex in order from lightest to heaviest resistance?

Yellow

Red

Green

Blue

Black

Are resistance exercises used to strengthen muscle groups or individual muscles?

muscle groups

Synergistic finger _______ and wrist ________ is important to increase grip strength

flexion, extension

Is a cylindrical or spherical grip used more often in functional activities?

Cylindrical

What kind of exercise is best for scar remodeling?

resistive exercise

low load, long duration force at end range leads to lengthening in scarred tissues

_______ __________ provides proximal pull on tendon adhesions

muscle contraction (resistive exercise)

In order to increase strength, you need to promote ___________ muscle contractions

sustained (during resistive exercise)

How should you mobilize adhesions?

Do an activity where flexor muscles are contracting and providing tension on adhesions

ex. hammer, clothespin, screwdriver

What is tendon gliding?

The need for tendons to glide in relation to surrounding structures

How can OT's help resolve tendon glide in scarred & adherent tendons?

Lengthen adhesions proximally and distally

proximal glide (at origin): requires strength (do active contractions)

Distal glide: passive stretching or use or orthotic

Which is better for tendon glide: active or passive motion?

Active!

Think cooked spaghetti noodle in straw for passive

How do you facilitate tendon glide in the FDP?

DIP flexion, PIP extension

How do you facilitate tendon glide in FDS?

PIP flexion with MCP extension

What hand position has the maximum glide between FDS and FDP?

hook fist

What hand position has maximum glide of FDP? Which has maximum glide of FDS?

FDP: composite flexion (picture)

FDS: flat fist

What hand position has maximum glide of FPL?

Thumb MCP and IP flexion

What is Place-and-Hold exercise? When would you use it?

Active-assistive to end range, then ask client to sustain position without holding it

Helpful when PROM > AROM

How do you facilitate maximum excursion of flexors? of extensors?

Flexors: full finger & wrist extension

Extensors: full finger & wrist flexion

How to facilitate tendon glide in FDP? in FDS?

FDP: hold PIP, flex DIP

FDS: hold all but one finger in MCP extension, flex the one finger at PIP

Extensor lag

full passive extension but incomplete active extension

What kind of adhesion is indicated when MCP's can't extend fully?

EDC (extensor digitorum communis)

What is the motion used to get full excursion of EDC?

PIP + DIP flexion (hook), then MCP extension

What issues could cause lag at PIP or DIP joints?

adhesions at complex extensor hood

Involvement of EDC, lumbricals, &/or interossei

Look over slides 51-53 for extensor info

Protected ROM

place repaired structures in protected position

What type of exercises provide the least amount of stress on an injured body part?

Place-and-hold exercises

___________ facilitates stretch of connective tissue prior to exercises

heat

T or F: Allowing muscles to cool in the lengthened position can allow permanent change

True

Buddy strap

provides PROM, can prevent deformity

Dynamic components can provide ____________

Static progressive devices for sustained ___________________

dynamic: resistance

Static: end range mobilization

Continuous passive motion (CPM)

More effective at preventing than correcting limits (8 hours a day)

Neuromuscular electrical stimulation (NMES)

Muscle re-education, increases muscle strength, and/or increases stress exerted on adhesions

Home exercise programs (HEPs)

- Needs patient cooperation

- Should not be painful

Use ___________, ______________ when stretching

low load, long duration

What is restorative glide?

flexion of individual fingers one at a time while keeping other fingers extended