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Therapeutic Exercise
Date Revised 10/8/03
Therapeutic Exercise
Therapeutic exercise is specifically concerned with maximizing body function after an injury.
In contrast, conditioning is geared toward improving normal function and maintenance of well
being, and is global and more general in nature than therapeutic exercise. Some specific
indications for the use of therapeutic exercise include:
CONTRAINDICATIONS
1. Joint effusion
2. When motion is disruptive to healing process (acute tears, fractures, surgery,
dislocations)
3. Muscular inflammation
4. Fever / active infection (systemic or local)
PRECAUTIONS
GENERAL COMMENTS
Basic components of therapeutic exercise (in order of proper therapeutic sequence) include
flexibility and range of motion, strength and muscular endurance and proprioception and
coordination. It is necessary to establish a workable range of motion prior to introducing
strengthening components.
Generally, it is best to improve strength through the existing range of motion, however small,
while still focusing on increasing the range. Range of motion is the most limiting factor and the
restoration of normal range should continue to be a primary goal throughout the rehabilitation
process. Therapeutic exercise is applied a minimum of 3 to 5 times a week depending upon
desired therapeutic outcome.
Stage 2: Subacute
• Passive congestion, repair.
• 2 to 4 days up to 14 to 21 days post injury.
1. Passive Range of Motion as indicated.
2. Active Range of Motion as indicated.
3. Manual Resistance Exercise.
a. Clinicians may provide resistance manually while the patient actively moves through a
pain-free range of motion.
b. Resistance should not cause joint or muscle pain.
c. Patient performs 5 to 10 repetitions of the exercise at every motion involved in joint
movement.
Stage 3: Chronic
• Repair and regeneration.
• 14 to 21 days to 12 weeks.
1. Externally resisted active exercise: increased emphasis on balance, coordination,
proprioception, and kinesthetic awareness.
2. Resistance is provided by dumbbells, elastic tubing, exercise equipment, or even patient's
own body weight or the weight of a limb.
3. Exercise is performed through a pain-free range of motion.
4. Patient must be able to perform 8 to 10 repetitions of the exercise with no assistance and
using the lightest available resistance (this is for patient safety, and to avoid soreness and
difficulty).
5. Patient performs one set of the exercise and gradually works up to approximately three sets of
8 to 15 repetitions for each exercise.
6. When patient can successfully complete 3 sets of the exercise with proper technique, and no
pain then resistance can be increased.
7. Progress toward more functional activities and closed kinetic chain activities and plyometrics
if indicated.
Reassessment
During re-evaluation or reassessment, quantitative measures should be retaken in accordance
with those measures taken during the initial evaluation; manual muscle testing, range of motion
measures, girth measures, etc.
Measurement of Recovery
1. Strength near equal to uninvolved limb or pre-injured state.
2. Range of motion near equal to uninvolved limb or pre-injured state.
3. Functional power and endurance is normal.
4. Restoration of functional balance and proprioceptive sense.
5. Symmetrical girth measurements.
6. Ability to perform sport/job specific skills.
7. Reassessment shows at least a 90% return to normal capacity of all functions necessary for
daily activities.
References Consulted
Houglum, Peggy A., Therapeutic Exercise for Athletic Injuries, Athletic Training Education
Series, Human Kinetics. 2001.
Kisner, Carolyn; Colby, Lynn Allen, Therapeutic Exercise, Foundations and Techniques,
F.A. Davis. 1996.