Regardless of the type of therapeutic exercise interventions in a patient’s exercise program, safety is a fundamental consideration in every aspect of the program whether the exercises are performed independently or under a therapist’s supervision. Patient safety, of course, is paramount; nonetheless, the safety of the therapist must also be considered, particularly when the therapist is directly involved in the application of an exercise procedure or a manual therapy technique.

Many factors can influence a patient’s safety during exercise. Prior to engaging in exercise, a patient’s health history and current health status must be explored. A patient unaccustomed to physical exertion may be at risk for the occurrence of an adverse effect from exercise associated with a known or an undiagnosed health condition. Medications can adversely affect a patient’s balance and coordination during exercise or cardiopulmonary response to exercise. Therefore, risk factors must be identified and weighed carefully before an exercise program is initiated. Medical clearance from a patient’s physician may be indicated before beginning an exercise program.

The environment in which exercises are performed also affects patient safety. Adequate space and a proper support surface for exercise are necessary prerequisites for patient safety. If exercise equipment is used in the clinical setting or at home, to ensure patient safety the equipment must be well maintained and in good working condition, must fit the patient, and must be applied and used properly.

Specific to each exercise in a program, the accuracy with which a patient performs an exercise affects safety, including proper posture or alignment of the body, execution of the correct movement patterns, and performing each exercise with the appropriate intensity, speed, and duration. A patient must be informed of the signs of fatigue, the relationship of fatigue to the risk of injury, and the importance of rest for recovery during and after an exercise routine. When a patient is being directly supervised in a clinical or home setting while learning an exercise program, the therapist can control these variables. However, when a patient is carrying out an exercise program independently at home or at a community fitness facility, patient safety is enhanced and the risk of injury or re-injury is minimized by effective exercise instruction and patient education.

As mentioned, therapist safety is also a consideration to avoid work-related injury. For example, when a therapist is using manual resistance during an exercise designed to improve a patient’s strength or is applying a stretch force manually to improve a patient’s range of motion, the therapist must incorporate principles of proper body mechanics and joint protection into these manual techniques to minimize his or her own risk of injury.

Precautions, contraindications, and safety considerations are addressed for the management of specific pathologies, impairments, and functional limitations and for the use and progression of specific therapeutic exercise interventions.

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