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Therapeutic exercises
Dr. Afaf A.M Shaheen
Lecture 1
RHS 322
Out lines
 Introduction
 Approach
to patient evaluation and
program development (SOAP)
 Posture
Introduction to therapeutic
exercises


Physical therapy
Therapeutic exercises: is on of physical
therapy modalities
The ultimate goal of any therapeutic
exercise program is the achievement of
symptom-free movement and function.
In order to effectively administer
therapeutic exercise to patient the
therapist must:
1. know the basic principles and effects of the
treatment
2. Be able to do a functional evaluation of the
patient
3. Know the interrelationships between the
anatomy and kinesiology of the part
4. Have an understanding of the state of
disability and its potential rate of recovery,
complications, precautions, and
contraindications
Approach to patient evaluation
and program development
 Patient
care is a problem-solving process.
it is feed bake loop
Assess
needs
Develop
plan
Implement
plan
Evaluate
plan
Approach to patient evaluation and
program development. Cont.,
Assess needs
1) Subjective information (the case history)
A.


1.
2.
3.
4.
5.
Name , age, sex……….
Ask questions to get the patient to:
Describe how he perceives his symptoms. e.g
location, type, and nature of pain or symptom
Describe the behavior of the symptoms through a
24-hour period. e.g motions or positions cause and
influence the symptom
Briefly describe his general health, medications
being taken……………..
Describe the previous history of the condition.
Describe related history, such as any medical or
surgical intervention.
Approach to patient evaluation and
program development. Cont.,
Assess needs
2) Objective data (clinical evaluation)
a) Inspection (observation)
1. The ADL such as gait- patient ability to
stand, sit, or dress himself
2. Use of any assistive aids
3. Posture
4. Shape of body parts such as contour
changes, swelling, atrophy, hypertrophy,
and asymmetry
5. Appearance of the skin
A.
Approach to patient evaluation and
program development. Cont.,
A. Assess needs
2) Objective data (clinical evaluation)
b) function Functional tests include:
1. Active range of motion (AROM)
2. Passive range of motion (PROM)
3. Describe the end feel (normal –abnormal)
4. Manual muscle testing
5. Joint integrity tests
Approach to patient evaluation and
program development. Cont.,
A. Assess needs
2) Objective data (clinical evaluation)
c) Palpation
1. Skin and subcutaneous tissue, temperature,
2. Edema
3. Muscles, tendons, trigger point……
4. Joint (effusion, tenderness, changes in position or
shape)
5. Nerve and blood supply
d) Neurological tests
e) Additional tests
f) Cardiovascular status
Approach to patient evaluation and
program development. Cont.,
A. Assess needs
3) Assessment
Once the subjective and objective data
about patient are gathered:
 List the problem area
 Determine major versus minor problems
Approach to patient evaluation and
program development. Cont.,
B. Develop Plane
Goals or objectives of the treatment
Each goal should be operational zed to
include:
1. A measurable outcome
2. Specific conditions or tests
3. The time expected to accomplish the
goal
Long term-goals:
1. Are a final measurable outcome
expected at the end of the treatment
2. Are often described in functional terms
Short term goals:
1. Reflect the component skills needed to
obtain the long term goals
2. Are helpful in directing the decisionmaking process
 C.
Implement plan
 D. Evaluate plan
 E . Home care program
Goals of therapeutic exercises
 The
positive effects of therapeutic
exercises include the prevention of
dysfunction as well as the development,
improvement , restoration, or
maintenances of normal:
 Strength
 Endurance and cardiovascular fitness
 Mobility and flexibility
 Relaxation
 Coordination and skill
Definition of posture
 Postural development
 Common spinal deformities
 HIPS

What is posture?

Defined:
› “The position of the body at a given point
in time.” (Starkey)
› “A set of muscle contractions that place
the body in the necessary location from
which a movement is performed.”
(Enoka)
› “The situation or disposition of the several
parts of the body with respect to each
other for a particular purpose.” (Webster)
What is good posture?
 Ideal
posture serves as a
reference point.
 Ideal posture…
› Distributes gravitational stress for
balanced muscle function.
› Allows joints to move in their mid
range to minimize stress on
ligaments and articular surfaces.
› Effective for the individual’s
activities of daily living.
› Allows the individual to avoid
injury.

Birth
Entire spine concave
forward (flexed)
“Primary curves”
›
›


Thoracic spine
Sacrum
Developmental
(usually around 3 mos.)

›
›
›
Secondary curves
Cervical spine
Lumbar spine
 Factors affecting posture
› Bony contours
› Laxity of ligamentous structures
› Fascial & musculotendinous tightness
› Muscle tonus
› Pelvic angle
› Joint position & mobility

Causes of poor posture
› Positional factors
 Appearance of increased
height (social stigma)
 Muscle
imbalances/contractures
 Pain
 Respiratory conditions
› Typically can be managed
conservatively through
therapeutic ex &
education

Causes of poor posture
› Structural factors
 Congenital anomalies
 Developmental problems
 Trauma
 Disease
› Not typically easily
managed
Example: Total Spinal Posture

Ideal
1. Head sits straight on
shoulders
 nose in-line c/
manubrium,
xiphoid, umbilicus
 Earlobes in-line
with acromion
process
2. Shoulders and
clavicles level are
equal
3. normal appearance
of Shoulders
4. Arms equidistant from
trunk
5. Normal spinal curves
6.
7.
8.
9.
10.
11.
12.
13.
Iliac crests, ASIS’s &
PSIS’s .
ASIS sit lower than PSIS
Gluteal folds and knee
joints even
Patellae point forward
No Genu conditions
noted
Heads of fibula and all
malleoli level
Achilles tendons &
heels appear to be
straight
Evident arches
Good Spinal Posture
What is bad posture?

Any position that
deviates from “good
posture”
› Static
 Standing
 Sitting
 Sleeping
› Dynamic
 Running
 Throwing, etc.

Correct posture
› “Position in which
minimum stress is placed
on each joint.”

Faulty posture
› Any position that
increases stress on joints

Lordosis
› Excessive anterior
curvature of the spine
› Exaggeration of
normal curves in the
cervical & lumbar
spines

Lordosis causes:
›
›
›
›
›
›
›
›
Postural deformity
Lax muscles (esp. abs)
Heavy abdomen
Compensatory
mechanisms
Hip flexion contracture
Spondylolisthesis
Congential problems
Fashion (high heels)

Swayback deformity
 Increased pelvic
inclination (40)
 Typically includes
kyphosis

Kyphosis
› Excessive posterior
curvature of the spine




Round back
Humpback/gibbus
Flat back
Dowager’s Hump

Scoliosis
› Nonstructural
 “Functional”
 May be related to
leg length
discrepancy
› Structural
 Lacks normal
flexibility
 Asymmetric
movements
Commonly Seen Postural
Deviations
 Shoulder/Scapula
› FSP
› Winging Scapula
 Head
› FHP
and C-Spine
HIPS
History
Inspection
Palpation
Special (Functional)
Tests
Relevant History

Identify factors that
influence posture
› Overuse
› Neurological
Problems
› Pain
› Lack of
awareness
› Ms weakness/
Imbalance
Hypermobile Jts
Hypomobile Jts
ST Flexibility
Bony
Abnormality
› Leg Length Disc.
›
›
›
›
Inspection

Use of a plumb line
› Anatomical reference
› 3 views
 Lateral (sagittal
plane movements)
 Anterior (frontal/
transverse plane
movements)
 Posterior (frontal/
transverse plane
movements)
 Body
type
› Ectomorph
› Mesomorph
› Endomorph
Lateral View

Look for:
› @ ankle?
› @ knee?
› @ hip?
› @ shoulder?
› @ neck?
› @ head?
Anterior view

Anterior view
› Head straight on
›
›
›
›
›
›
›
›
›
›
shoulders
Shoulders level
Clavicles/AC joints
Sternum & ribs
Waist angles & arm
positions
Carrying angles
Iliac crests
ASIS
Patellae
Knees
Fibular heads
Malleoli level
Arches
Foot rotation
Bowing of bones
Diastematomyelia (hairy
patches)
› Pigmented lesions
›
›
›
›
›
 Café au lait spots
Posterior View

Look for:
› @ heel?
› @ pelvis?
› @ lumbar spine?
› @ scapulae?
› @ neck?
› @ head?
Palpation

In assessment position (i.e., standing), palpate:
› Laterally
 ASIS vs. PSIS
› Anteriorly
 Patellae
 Iliac Crests
 ASIS heights
 Lateral Malleolar heights
 Fibular Head heights
 Shoulder heights
Posteriorly
PSIS
positions
Spinal alignment
Scapular positions
Functional Tests
Slump Test
 Romberg
 Tandem walking
 Others designed to:

› Rule out bony restrictions
› Rule out soft tissue
restrictions
› Assess muscular length
 ROM
 Resting muscle length
Other Technology




Video Analysis
3D Motion Analysis
REBA
Sway Measurement
Tools
› Force Plate
› Biodex Stability System
› NeuroCom