Introduction to
Therapeutic Exercises
DR. Mohamed Seyam PhD. PT.
Assistant Professor of Physical Therapy
Module Title: Therapeutic Exercises-1
Module ID: PHT 224
Prerequisite (Co-requisite) : PHT 226
Level: 4
Credit Hours: 3 (1+2+0)
Module Description
Introduction of therapeutic exercises,
Methods of use and application,
Different types of passive and active movements,
The types of muscle effort,
Ways of strengthening the muscle group or individually,
Flexibility exercises,
Practical training of students to apply different types of
exercises
Module Aims
Basic principles, indications, and precautions to be considered when performing
different forms of exercises.
Applying on one of his/her colleagues the different types of movements and
exercises used in muscle re-education for any parts of the body.
Able to express in writing and demonstration the different steps to be used in the
progressive strengthening of any muscle group of the human body, specification
made on the use of gravity, the patient and therapist starting positions, the therapist
grasps.
The type of muscle contraction used and the procedures of application or assistance
or manual resistance.
Learning Outcomes
Integrate scientific knowledge in performing therapeutic interventions.
Recognize physics and basic principles used in ROM in physical therapy
Recognize the human movements and define the concepts of functional
excursion, active and passive insufficiency
Describe procedure to apply different techniques of mobilisation .
Analyze the human movement and concepts of rhythm, starting
position, co-ordination and progression in therapeutic exercises .
Utilize the concepts of progression by adopting various positions and
techniques in therapy ( Same as before)
Introduction to Therapeutic Exercise
Definition of Therapeutic Exercise,
Impact on Physical Function,
Types of Therapeutic Exercise Intervention,
Exercise Safety,
Process and Models of Disablement,
Use of Disablement Models and Classifications in Physical Therapy.
Definition of Therapeutic Exercise
Therapeutic exercise is the systematic, planned
performance of body movements, postures, or physical
activities intended to provide a patient/client with the
means to:
•Remediate or prevent impairments
•Improve, restore, or enhance physical function
•Prevent or reduce health-related risk factors
•Optimize overall health status, fitness, or sense of well-being
Balance. The ability to align body segments against gravity to maintain or
move the body (center of mass) within the available base of support without
falling; the ability to move the body in equilibrium with gravity via
interaction of the sensory and motor systems.
Cardiopulmonary fitness. The ability to perform low intensity, repetitive,
total body movements (walking, jogging, cycling, swimming) over an
extended period of time; a synonymous term is cardiopulmonary
endurance.
Coordination. The correct timing and sequencing of muscle firing combined
with the appropriate intensity of muscular contraction leading to the
effective initiation, guiding, and grading of movement. It is the basis of
smooth, accurate, efficient movement and occurs at a conscious or
automatic level.
Flexibility. The ability to move freely, without restriction; used
interchangeably with mobility.
Mobility. The ability of structures or segments of the body to
move or be moved in order to allow the occurrence of range of
motion (ROM) for functional activities (functional ROM). Passive
mobility is dependent on soft tissue (contractile and no
contractile) extensibility; in addition, active mobility requires
neuromuscular activation.
Muscle performance. The capacity of muscle to produce tension
and do physical work. Muscle performance encompasses
strength, power, and muscular endurance.
Neuromuscular control. Interaction of the sensory and motor
systems that enables synergists, agonists and antagonists, as well
as stabilizers and neutralizers to anticipate or
Therapeutic Exercise Interventions
1. Aerobic conditioning and reconditioning
2. Muscle performance exercises: strength, power, and endurance training
3. Stretching techniques including muscle-lengthening procedures and joint
mobilization techniques
4. Neuromuscular control, inhibition, and facilitation techniques and posture
awareness training
5. Postural control, body mechanics, and stabilization exercises
6. Balance exercises and agility training
7. Relaxation exercises
8. Breathing exercises and ventilatory muscle training
9. Task-specific functional training
Exercises safety for both patient and therapist.
Factors affecting patient safety:
1. Patient’s health history.
2. Medication.
3. Medical clearance.
4. Environment.
5. Equipment.
6. Accuracy in application of ex’s.
7. Fatigue.
8. Patient education.
Exercise Safety
Safety is a fundamental consideration in every aspect of the
program whether the exercises are performed independently or
under a therapist’s supervision.
Therapist safety is 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.
factors of safety during exercise.
1. patient unused to physical exertion
2. Medications can adversely affect a patient’s balance and coordination
during exercise or cardiopulmonary response to exercise.
3. The environment in which exercises are performed. Adequate space
and a proper support surface for exercise are necessary prerequisites
for patient safety.
4. 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.
5. proper posture or alignment of the body, execution of the correct
movement patterns, and performing each exercise with the
appropriate intensity, speed, and duration.
The Disablement Process
Disablement is a term that refers to the impact(s) and
functional consequences of acute or chronic conditions, such
as disease, injury, and congenital or developmental
abnormalities,
Physical therapists most commonly provide care and services
to people with physical disability.
Social, emotional, and cognitive disablement can affect
physical function and vice versa and, therefore, should not be
disregarded or dismissed.
Models of Disablement
Several models that descripe the process of disablement have been proposed
over the past 40 years. The first two schema developed were
 the Nagi mode and
the International Classification of Impairments, Disabilities, and Handicaps
(ICIDH) model for the World Health Organization (WHO).
The ICIDH model was revised after its original publication, with adjustments
made in the descriptions of the classification criteria of the model based on
input from health-care practitioners as they became familiar with the original
model.
The National Center for Medical Rehabilitation Research (NCMRR)
integrated components of the Nagi model with the original ICIDH model to
develop its own model.
 The NCMRR model added interactions of individual risk factors, including
physical and social factors, to the disablement process.
Anatomical Movements
Flexion: movement in a sagittal plane, that decreases the angle of the joint, that decreases the
angle of the joint& bring two bones together. e.g., bending the knee, bending forward at hip.
Extension: movement that increases the angle between two bones. e.g., straightening the knee or
elbow.
Rotation: is a movement of a bone around its longitudinal axis, e.g. shaking your head no.
Abduction: is a movement of a limb away from the midline(generally on the frontal plan or median
plane) e.g., movements of fingers & toe.
Adduction: is the movement of a limb towards the body midline.
Circumduction: is the combination of flexion, extension, abduction and adduction, e.g, ball &
socket joint.
Dorsiflexion movement in the ankle join where the top of the foot is moved up "life toes" foot is
flexed
Plantarflexion movement of the ankle so that the top of the foot is moved downward "point toes"
foot is extended
Movements
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Flexion
Extension
Hyperextension
Adduction
Abduction
Prontaion
Supination
Retraction
Protraction
Elevation
Depression
Rotation
Circumduction
External Rotation
Internal Rotation
Inversion
Eversion
Dorsiflexion
Plantarflexion
Radial Deviation
Ulnar Deviation
Opposition
Interactions of Skeletal Muscles in the Body:
Prime mover:
A muscle that is chiefly responsible for a particular movement
Antagonist:
A muscle that opposes the action of a prime mover
Synergist:
A muscle that prevents unwanted movements in an intermediate joint where the
another muscle crosses that joint. To prevent unwanted movements and stabilizes the
intermediate joints.
Fixator:
A muscle that contracts isometrically, to stabilize the origin of the prime mover so
that it can act efficiently