Postoperative rehabilitation is often a lengthy process. Given the limited number of justifiable therapy sessions available for postoperative management, it is highly unlikely for a therapist to have direct, ongoing contact with a patient through all phases of a rehabilitation program. Consequently, the key to successful postoperative outcomes is effective self-management that includes therapist-directed perioperative […]

Postoperative pain because of disruption of soft tissue
Postoperative swelling
Potential circulatory and pulmonary complications
Joint stiffness or limitation of motion because of injury to soft tissue and necessary postoperative immobilization
Muscle atrophy because of immobilization
Loss of strength for functional activities
Limitation of weight bearing
Potential loss of strength and mobility in unoperated joints
Time-Based and Criterion-Based Progression
Time frames for each phase […]

Every individually designed postoperative rehabilitation program must be based on initial and ongoing examinations of a patient. In addition to the components of a preoperative examination noted previously in this section, an assessment of integumentary integrity is important after surgery. The incision should be inspected before and after each exercise session to identify any evidence […]

Although surgical intervention can correct or reduce adverse effects and impairments (e.g., pain, deformity, instability) associated with musculoskeletal pathology, a carefully planned and progressed rehabilitation program is essential for a patient to achieve optimal functional outcomes after surgery. In an ideal situation, rehabilitation begins with patient education before surgery and continues after surgery with direct […]

The following impairments and complications may occur in association with treatment of breast cancer. Many of these problems are interrelated and must be considered jointly when a comprehensive postoperative rehabilitation program is developed for the patient.
Postoperative Pain
Incisional pain. A transverse incision across the chest wall is made to remove the breast tissue and underlying fascia […]

Breast cancer-related dysfunction of the lymphatic system and subsequent lymphedema of the upper extremity is a somewhat common and potentially serious complication of the treatment for breast cancer. It is estimated that 15% to 20% or as many as one in four patients with invasive breast cancer develop upper extremity lymphedema during or sometime after […]

Lymphedema
Location. When lymphedema develops, it is most often apparent in the distal extremities, particularly over the dorsum of the foot or hand. The term dependent edema describes the accumulation of fluids in the peripheral aspects of the limbs, particularly when the distal segments are lower than the heart. In contrast, lymphedema also can manifest more […]

Impairments
Dull ache or pain usually in the calf
Tenderness, warmth, and swelling with palpation
Prevention of Deep Vein Thrombosis and Thrombophlebitis
Every effort should be made to prevent the occurrence of a DVT and subsequent thrombophlebitis, particularly in patients at risk. The following interventions are implemented to reduce the risk of a DVT.
· Prophylactic use of anticoagulant therapy […]

Vascular disorders causing insufficient circulation to the extremities, can result in significant physical impairments and subsequent loss of function of either the upper or lower extremities. Disturbances of structure or function of the circulatory systems are broadly classified as acute or chronic peripheral vascular disease (PVD) and can be caused by a number of underlying […]

• Length of incison: ≤ 10 cm, depending on the location of the approach and the size of the patient.
• Most if not all muscles and tendons left intact
• Single-incision or two-incision approach
• Single incision: usually posterior or anterior, or occasionally lateral.
• Two-incision: approach: two 4- to 5-cm incisions, one anterior for insertion of acetabular […]

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 […]

There are numerous sources from which to obtain information on training for endurance in athletes and healthy young people and for individuals with coronary heart disease. Information or emphasis on endurance training and the improvement of fitness in the individual who has other types of chronic disease or disability is beginning to emerge. Using the […]

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, […]

General Background
The manual resistance exercise techniques described in this section are for the upper and lower extremities, performed concentrically in the anatomical planes of motion. The direction of limb movement would be the opposite if manual resistance were applied to an eccentric contraction. The exercises described are performed in non-weight-bearing positions and involve movements to […]

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 […]

The types of exercise selected for a resistance training program are contingent on many factors, including the cause and extent of primary and secondary impairments. Deficits in muscle performance, the stage of tissue healing, the condition of joints and their tolerance to compression and movement, the general abilities (physical and cognitive) of the patient, the […]