Exercise

Therapeutic Exercises
Range of Motion Exercises
Gait Retraining
Manual Techniques

Soft Tissue Mobilization

Joint Mobilization
Spinal Mobilization Therapy
Modalities

TENS (Transcutaneous Electrical Nerve Stimulation)

IFC (Inferential Current Therapy)
Laser Light Therapy
Hydrotherapy
Cold Packs
Hot Packs
Iontophoresis
Mobility Aids
Cervical/Lumbar Traction
Compression Therapy
Chest Physiotherapy
Cardiovascular Conditioning

exercises

Therapeutic exercises refers to a wide range of physical activities that focuses on restoring and maintaining
strength, endurance, flexiblity, stability and balance. The goal of therapeutic exercises is to return an injured
patient to a fully functioning, pain-free state.

A physical therapist begins by conducting a thorough evaluation of an individual's physical capabilities through both a medical history and
physical assessment. The physical therapist then uses his/her knowledge to shape a treatment care plan containing a slowly-progressing
exercise program that is appropriate to each individual's needs. The physical therapist monitors progress, assists with some physical
movements and continuously modifies the plan as the client recovers.
The first objective of therapeutic exercise is to help the body reduce pain and inflammation. Once this is achieved, the exercise program
focuses on regaining range of motion and rebuilding muscle strength and endurance. Exercises that may be included in a therapeutic
program include:
Strengthening exercises, usually performed with heavy resistance and fewer repetitions.
Endurance exercises that engage large muscle groups over a longer period of time.
Flexibility exercises achieved through stretching and movement.
Balance and coordination exercises that focus on maintaining an individual's center of gravity.

\\Range of motion refers to the distance and direction a joint moves between a flexed (bent) position and an
extended (stretched) position. It also refers to therapeutic exercises designed to increase this distance in a joint's
movement.

A number of health issues contribute to restricted range of motion, including:

Problems with body mechanics

Swelling
Inflammation
Muscle spasms

Infection
Disease, such as arthritis
Range of motion is also one of the dimensions used in Functional Capacity Evaluations to measure and determine joint flexibility.
There are three types of range of motion exercises:
Passive Range of Motion (PROM): With PROM, the client applies no effort to move the joint, which is moved through a variety of stretching
exercises by a physical therapist or with the help of equipment.
Active Assisted Range of Motion (AAROM): With AAROM, the client uses the muscles around a weak joint to complete stretching exercises
with the help of a physical therapist or equipment.
Active Range of Motion (AROM): With AROM, the client performs stretching exercises, moving the muscles around a weak joint without any
aid.

Gait retraining is a method used to prevent and rehabilitate injuries to the leg, knee or hip that occur from walking
or running. The goal of this technique is to correct body mechanics for a better stride and to lessen stress on the
joints and soft tissue. It is most commonly used to reduce joint wear and tear for runners and to help older adults
recover from falls or stroke.

During gait retraining, sensors placed on the legs convey real-time, three-dimensional images to a computer where gait problems can be
identified. The client uses the 3-D imagery to practice and learn corrected body mechanics to prevent future injury. Gait retraining is often
coupled with strengthening and stretching exercises in order to overcome muscular imbalances.

Manual therapy

Soft tissue in the human body is made up of muscles, ligaments, tendons and fascia. The soft tissue supports
joint action. After a trauma, soft tissue can shorten, restricting the natural movement of a joint. Inflammation
causes soft tissue thickening, which can also impede joint function.

Soft tissue manipulation is a manual technique used to reduce pain, relax muscles, increase range of motion and restore strength. It is also
used to treat adhesions, which may form within the soft tissue as a result of trauma, surgery, immobilization or repetitive strain.
Soft tissue mobilization breaks down adhesions and stimulates tissue regeneration.
With this treatment, the physical therapist gently moves a joint through its natural motion, stretching the soft tissue, releasing tension from the
muscles and improving blood circulation. The physical therapist slowly adds force to this movement until the deep tissue is reached and
released.

Joints are points in the body where two bones meet. They are surrounded by soft tissue, which is susceptible to
injury or disease. Joint mobilization is a physical therapy technique designed to relieve pain and muscle spasms,
release tension and improve flexibility in a joint. By increasing the clients awareness of the correct position and
movement of a joint and simulating smooth joint function, joint mobilization improves range of motion and mobility.

Using small, passive movements, a physical therapist manually moves a joint, gently working it through a natural level of resistance. These
motions stretch and strengthen the tissue surrounding the bone, which helps reduce pain and increase range of motion.
Every joint is classified on a five grade scale for range of motion. Grades I and II are used predominantly to reduce pain and stiffness.
Grades III through V are used primarily to increase mobility and joint play.
Joint mobilization should not be confused with joint manipulation, a similar manual technique for strengthening joints. With joint manipulation,
the physical therapist applies a forceful thrust to the joint movement, which stretches the tissue and restores joint play.

Spinal mobililization is a therapy technique used to treat back and neck pain and stiffness. The bones in the back,
known asvertebrae, are surrounded by small muscles, which can get tight as a result of trauma, injury or disease.
This can lead to pain, stiffness and restricted range of motion for activities of daily living.

Spinal mobilization gently stretches the muscles between the vertebrae, temporarily relieving pain and encouraging healing. A physical
therapist slowly and gently stretches each vertebrae through a series of controlled movements that relax the muscles and open up the space
between the vertebrae.

compression therapy

Compression therapy is used to reduce swelling and improve circulation in the legs, most commonly post surgery. Normally, leg
movement, such as walking, stimulates regular contraction and relaxation of the calf muscles to help circulate blood from the
lower extremeties up to the heart. Periods of immobility, such as surgical recovery, prevent the blood from circulating to the heart
and can lead to blood clots.

Compression garments, such as socks or stockings, help prevent blood from pooling in the legs, which improves circulation. The garments
are designed to apply differing amounts of pressure onto various points in the leg and foot.
In the hospital, a
pneumatic compression device
is often used to maintain adequate blood circulation in the legs. In these cases, leg garments are hooked up to a mechanical device, which
automatically applies and releases pressure to the legs, ensuring proper blood circulation.

Chest physiotherapy

Chest physiotherapy involves a number of physical techniques to help remove excess mucus from respiratory passages and
improve breathing. The goal is to help patients breathe more freely and get more oxygen through the blood stream into all parts of
the body.

Normally, mucus helps lubricate the lungs. But infection, trauma or illness can create excess mucus that needs to be cleared for better
breathing. This treatment method is applied by physical therapists or respiratory therapists and is often part of the treatment plan for people
with:

Artificial ventilation
Asthma
Bronchitis
Chronic Obstructive Pulmonary Disease (COPD)
Cerebral Palsy
Cystic Fibrosis
Fractured ribs
Head or neck injury
Heart attack
Pneumonia
Post operative
Tuberculosis
Typically, chest physiotherapy is done several times a day in either a sitting up or lying down position. There are six different techniques:
Postural Drainage: This technique uses gravity as an aid to draining secretions by optimizing the position of the body to clear mucus.
Chest Percussion: Also known as cupping or clapping, this technique involves the rhythmic striking or hitting of the chest, back and below the
arms to loosen up thick mucus and force it from the small airways to the large airways, where it can be expelled.
Controlled Coughing: This technique helps break down thick mucus and then helps expel the mucus.
Deep Breathing: This technique improves the distribution of air throughout the body by expanding lung tissue.

Turning: Like postural drainage, this technique uses the natural force of gravity to help loosen and move mucus from the lungs. It involves
turning a patient from side to side to expand the lungs and promote drainage.
Vibration: This technique is performed simultaneously with a patient doing deep breathing exercises. Gentle vibrations are applied to the
chest either manually (hands-only) or mechanically to help break up lung secretions.

Coughing and Deep Breathing

Coughing and deep breathing are techniques used to help clear the respiratory system of secretions. The goal of coughing and deep
breathing is to increase lung capacity and expand the airways after a period of inactivity or anesthesia. The combination of voluntary
coughing and deep breathing helps loosen and clear mucus from the large and small air passages and prevents lung infections all of which
make breathing easier. Coughing and deep breathing are best accomplished in a sitting or standing position.

Cardiovascular conditioning

Cardiovascular conditioning improves circulation and strengthens the heart, lungs and blood vessels. It builds endurance and
strength for the heart muscle, whether a person is well or recovering from a disease or injury. Exercise conditions the heart to
work more efficiently, which helps prevent heart attacks or other heart ailments. It also increases oxygen to the blood, strengthens
the heart and lungs, improves energy levels, burns calories and reduces cholesterol.
Like all muscles, the heart needs a steady program of exercise to help keep it fit. Moderate aerobic activity for at least 30 minutes
six days a week is recommended for adults and 60 minutes of moderate aerobic activity each day is recommended for children.
To be aerobic, you must achieve a certain level of intensity in your workout, known as the target heart rate. To calculate your
target heart rate, simply complete the following formula:
220 Your Current Age = Maximal Heart Rate
Maximal Heart Rate x 65% = Target Heart Rate
In addition to aerobic activity, your physical therapist will likely recommend a series of strengthening exercises.