Therapeutic Exercise Health Article

Definition

Therapeutic exercise is a physical therapy intervention encompassing a broad range of activities designed to restore or improve musculoskeletal, cardiopulmonary and/or neurologic function.

Purpose

Some form of therapeutic exercise is indicated in almost every physical therapy case. Physical therapists may assist clients in designing therapeutic exercise programs to prevent injury or secondary impairments. In addition, physical therapists use therapeutic exercise as one component of patient care to improve functional ability and general well-being in those who are experiencing limitations or disability due to a disease, disorder, trauma, or surgery.

Precautions

Therapeutic exercise includes a broad spectrum of activities, from passive range of motion and breathing exercises to high-speed agility drills. Precautions, therefore, are specific to each individual depending upon his or her condition. The physical therapist must use his or her specialized knowledge to determine exercises that are appropriate for a patient or client's level of ability, age, endurance, severity of injury and/or stage of recovery. Outlined below, however, are a few examples of situations in which general precautions should be observed.

Post-operative

A progression of therapeutic exercise is usually more gradual in a patient recovering from surgery than in one who did not require surgery, especially in order to allow inflamed tissues to heal. In general, specific joint motions and weightbearing are often restricted. High-intensity stretching and resistance exercise is usually limited for at least six weeks to allow adequate healing time for muscles or tendons that have been repaired.

Osteoporosis

In osteoporosis, bone resorption has taken place at a much higher rate than bone formation, resulting in weakened osseous structures. The risk for pathologic fracture resulting from very minor stress is high. In patients with osteoporosis, low-impact weight-bearing and endurance exercise should be introduced. Caution should be taken when adding resistive exercises, and explosive or twisting movements should be avoided altogether.

Pregnancy

There are several high-risk conditions that are contraindications to exercise. These include: incompetent cervix, vaginal bleeding, placenta previa, preterm rupture of membranes, premature labor, and maternal heart disease, diabetes, or hypertension. Precautions need to be taken when women present with the following: multiple gestation, anemia, systemic infection, extreme fatigue, musculoskeletal pain, overheating, phlebitis, diastisis recti, or uterine contractions which last several hours after exercise. In these cases, women who participate in exercise should be monitored closely by both physician and therapist.

Resistance exercise

Resistance exercise is often a key part of a therapeutic exercise program; however, considerations must be made regarding risk factors. Resistive exercise should not be performed when there is muscle or joint inflammation, or when severe pain is present during or after exercise. Precautions should be taken with high-risk cardiovascular patients. All patients should be taught to avoid the Valsalva maneuver, excessive fatigue and over-work.

Joint mobilization

Joint mobilization techniques are often used to increase range of motion by passively distracting or gliding the joint surfaces. Gentle, small grade oscillatory movements may be used to inhibit pain and relax the patient; however, larger movements are contraindicated in the cases of hypermobility, joint effusion and inflammation. In addition, precautions should be taken when any of the following exist: malignancy, unhealed fracture, connective tissue or bone disease, total joint replacements, or weakened connective tissue (due to recent trauma, surgery, disuse, or medication).

Description

Therapeutic exercise can be an intervention used in a physical therapy plan of care or as part of a recommendation in client consultation. The physical therapist uses a thorough examination including subjective and objective data to assess each patient's specific needs. It is clear that an 80-year-old woman with osteoporosis with a history of fractures is going to require a much different program from a 20-year-old athlete who wants to return to sports following a knee injury.

The main goal of therapeutic exercise is to improve or maintain functional ability, including daily living skills, through the application of careful and gradual forces to the body. Often, this overall goal is achieved through the objectives of developing, improving, restoring or maintaining one or more of the following: strength, endurance, flexibility, stability, coordination and/or balance.

Strength

Strength in muscular tissue is improved through graded and deliberate overloading of the targeted muscle(s). When the main focus is strength, exercise is usually performed against heavy loads with relatively few repetitions. Physiologically, this training leads first to an increase in the number of motor units being fired, which increases force output. Gradually, the cross-sectional size of individual skeletal muscle fibers increases as well, which produces bulk and improves strength capacity.