Range of motion ( ROM / ROME ) is a basic technique used for the examination of movement and for initiating movement into a program of therapeutic intervention. Movement that is necessary to accomplish functional activities can be viewed, in its simplest form, as muscles or external forces moving bones in various patterns or ranges […]

Good clinical decision making is key to effective patient management. Physical therapists play a critical role in assessing neuromusculoskeletal problems. As more patients enter the medical system through the general practitioner, the patient is often referred to physical therapy without a clear diagnosis, especially those patients with musculoskeletal complaints. Physical […]

Application of Elastic Resistance
Selecting the appropriate grade of material. The thickness (stiffness) of the material affects the level of resistance. A heavier grade of elastic generates greater tension when stretched and therefore imparts a greater level of resistance. As already noted, corresponding levels of resistance have been published for the different grades of bands […]

Introduction
There seems to be an almost limitless selection of exercise equipment on the market that is designed for resistance training. The equipment ranges from simple to complex, compact to space-consuming, and inexpensive to expensive. An assortment of simple but versatile handheld and cuff weights or elastic resistance products is useful in clinical and home settings, […]

Application and Progression of Plyometric Training
Plyometric training is appropriate only in the later stage of rehabilitation of active individuals who must achieve a high level of physical performance in specific, high-demand activities.
Contraindications. Plyometrics should not be used if inflammation, pain, or significant joint instability is present.
Preparation for plyometrics. Prior to initiation of plyometric training, a […]

Introduction
For the past 50 to 60 years practitioners and researchers alike in rehabilitation and fitness settings have taken great interest in resistance exercise and functional training. As a result, many systems of exercise have been developed to improve muscle strength, power, and endurance. All of these systems are based on the overload principle, and most […]

Introduction
Mechanical resistance exercise is any form of exercise in which resistance (the exercise load) is applied by means of some type of exercise equipment. Frequently used terms that denote the use of mechanical resistance are resistance training, weight training, and strength training.
Mechanical resistance exercise is an integral component of rehabilitation and conditioning programs for individuals […]

Isokinetic exercise is a form of dynamic exercise in which the velocity of muscle shortening or lengthening and the angular limb velocity is predetermined and held constant by a rate-limiting device known as an isokinetic dynamometer. The term isokinetic refers to movement that occurs at an equal (constant) velocity. Unlike DCER exercise where a specific […]

UPPER EXTREMITY DIAGONAL PATTERNS

NOTE: All descriptions for hand placements are for the patient’s right (R) upper extremity. During each pattern tell the patient to watch the moving hand. Be sure that rotation shifts gradually from internal to external rotation (or vice versa) throughout the range. By mid-range, the arm should be in neutral rotation. Manual […]

I NTRODUCTION

Proprioceptive neuromuscular facilitation (PNF) is an approach to therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function. This widely used approach to exercise was developed during the 1940s and 1950s by the pioneering work of Kabat, Knott, […]

Manual resistance exercise is a form of active resistive exercise in which the resistance force is applied by the therapist to either a dynamic or a static muscular contraction.
• When joint motion is permissible, resistance is usually applied throughout the available ROM as the muscle contracts and shortens or lengthens under tension.
• Exercise is carried […]

Introduction
There are only a few instances when resistance exercises are contraindicated. Resistance training is most often contraindicated during periods of acute inflammation and with some acute diseases and disorders. By carefully selecting the appropriate mode of exercise (static vs. dynamic; weight-bearing vs. non-weight-bearing) and keeping the initial intensity of the exercise at a very low […]

Introduction
Regardless of the goals of a resistance exercise program and the types of exercises prescribed and implemented, the exercises must not only be effective but safe. The therapist’s interpretation of the examination’s findings determine the exercise prescription. Awareness of precautions maximizes patient safety. General precautions for resistance training are summarized below.
General Precautions During Resistance Training
• […]

Introduction
The principles of resistance training presented in this section apply to the use of both manual and mechanical resistance exercises for persons of all ages, but these principles are not “set in stone.” There are many instances when they may or should be modified based on the judgment of the therapist. Additional guidelines specific to […]

The most common system of resistance training used with dynamic exercise against constant or variable resistance is progressive resistance exercise (PRE). A later section of the chapter, which covers systems of training using mechanical resistance, addresses PRE.
Dynamic constant external resistance (DCER) exercise is a form of resistance training where a limb moves through a ROM […]

A dynamic muscle contraction causes joint movement and excursion of a body segment as the muscle contracts and shortens (concentric contraction) or lengthens under tension (eccentric contraction). The term concentric exercise refers to a form of dynamic muscle loading where tension in a muscle develops and physical shortening of the muscle occurs as an external […]

Isometric exercise is a static form of exercise in which a muscle contracts and produces force without an appreciable change in the length of the muscle and without visible joint motion. Although there is no mechanical work done (force × distance), a measurable amount of tension and force output are produced by the muscle. Sources […]

From a broad perspective a load can be applied to a contracting muscle in two ways: manually or mechanically.
Manual Resistance Exercise
Manual resistance exercise is a type of active-resistive exercise in which resistance is provided by a therapist or other health professional. A patient can be taught how to apply self-resistance to selected muscle groups. Although […]

Isokinetic exercise is a form of dynamic exercise in which the velocity of muscle shortening or lengthening and the angular limb velocity is predetermined and held constant by a rate-limiting device known as an isokinetic dynamometer. The term isokinetic refers to movement that occurs at an equal (constant) velocity. Unlike DCER exercise where a specific […]

An understanding of the disablement process as well as knowledge of the process of making informed clinical decisions based on evidence from the scientific literature are necessary foundations of comprehensive management of patients seeking and receiving physical therapy services. Provision of quality patient care involves the ability to make sound clinical judgments, solve problems that […]

This first major component of the disablement model refers to disruptions of the body’s homeostasis as the result of acute or chronic diseases, disorders, or conditions characterized by a set of abnormal findings (clusters of signs and symptoms) that are indicative of alterations or interruptions of structure or function of the […]

Continued from Patient-Client Management Model (Part 1)
Prognosis—the predicted optimal level of functional improvement within a time frame—will also help determine intervention strategies. Predicting the level of improvement guides the intensity, duration, and style of intervention. The combination of diagnosis and prognosis is used to justify physical therapy management. The prognosis for […]

The disablement model is distinctly different from the classic medical model, where the emphasis is on treating the specific diagnosis with pharmacology or surgery. The disablement model emphasizes the functional and health status of individuals, with intervention based on improving these aspects of the patient’s condition. The model has four […]