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Therapeutic Exercise: Foundations and Techiniques, 5th Edition

by Carolyn Kisner, Lynn Colby

Publisher: F. A. Davis Company

Copyright Year: 2007

Publishing Date: 2007/04/17

eText ISBN-10: 0-8036-1926-X

eText ISBN-13: 978-0-8036-1926-5

Print ISBN-10: 0-8036-1584-1

Print ISBN-13: 978-0-8036-1584-7

Course: Occupational Therapy, Physical Therapy, Athletic Training

Pages: 932

eTextbook $35.00

(360 day subscription)

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Table of Contents | Description

Instructor Resources | Student Resources

ABOUT THIS TITLE - TABLE OF CONTENTS

Acknowledgments, ix

Contributors, xi

Part I. General Concepts, 1

Chapter 1. Therapeutic Exercise: Foundational Concepts, 1

THERAPEUTIC EXERCISE: IMPACT ON PHYSICAL FUNCTION, 2

Definition of Therapeutic Exercise, 2

Aspects of Physical Function: Definition of Key Terms, 2

Types of Therapeutic Exercise Intervention, 3

Exercise Safety, 3

PROCESS AND MODELS OF DISABLEMENT, 4

The Disablement Process, 4

Models of Disablement, 4

Use of Disablement Models and Classifications in Physical Therapy, 5

PATIENT MANAGEMENT AND CLINICAL DECISION MAKING: AN INTERACTIVE RELATIONSHIP, 11

Clinical Decision Making, 11

Evidence-Based Practice, 11

A Patient Management Model, 12

STRATEGIES FOR EFFECTIVE EXERCISE AND TASK-SPECIFIC INSTRUCTION, 24

Preparation for Exercise Instruction, 24

Concepts of Motor Learning: A Foundation of Exercise and Task-Specific Instruction, 24

Adherence to Exercise, 31

INDEPENDENT LEARNING ACTIVITIES, 33

Chapter 2. Prevention, Health, and Wellness, 37

ROLE OF PHYSICAL THERAPY IN HEALTHY PEOPLE 2010, 37

Identifying Risk Factors, 38

Determining Readiness to Change, 38

Developing and Implementing a Program, 40

Case Example: Exercise and Osteoporosis, 40

Additional Considerations for Developing Prevention, Health, and Wellness Programs, 41

INDEPENDENT LEARNING ACTIVITIES, 42

Part II. Applied Science of Exercise and Techniques, 43

Chapter 3. Range of Motion, 43

TYPES OF ROM EXERCISES, 44

INDICATIONS AND GOALS FOR ROM, 44

Passive ROM, 44

Active and Active-Assistive ROM, 44

LIMITATIONS OF ROM EXERCISES, 45

Limitations of Passive Motion, 45

Limitations of Active ROM, 45

PRECAUTIONS AND CONTRAINDICATIONS TO ROM EXERCISES, 45

PRINCIPLES AND PROCEDURES FOR APPLYING ROM TECHNIQUES, 45

Examination, Evaluation, and Treatment Planning, 45

Patient Preparation, 46

Application of Techniques, 46

Application of PROM, 46

Application of AROM, 46

ROM TECHNIQUES, 46

Upper Extremity, 47

Lower Extremity, 52

Cervical Spine, 55

Lumbar Spine, 55

Combined Patterns of Motion, 56

SELF-ASSISTED ROM, 56

Self-Assistance, 57

Wand (T-Bar) Exercises, 59

Wall Climbing, 60

Overhead Pulleys, 60

Skate Board/Powder Board, 61

Reciprocal Exercise Unit, 61

CONTINUOUS PASSIVE MOTION, 61

Benefits of CPM, 61

General Guidelines for CPM, 62

ROM THROUGH FUNCTIONAL PATTERNS, 62

INDEPENDENT LEARNING ACTIVITIES, 63

Chapter 4. Stretching for Impaired Mobility, 65

DEFINITIONS OF TERMS RELATED TO MOBILITY AND STRETCHING, 66

Flexibility, 66

Hypomobility, 66

Contracture, 66

Types of Contracture, 67

Interventions to Increase Mobility of Soft Tissues, 68

Selective Stretching, 69

Overstretching and Hypermobility, 69

PROPERTIES OF SOFT TISSUE–RESPONSE TO IMMOBILIZATION AND STRETCH, 69

Mechanical Properties of Contractile Tissue, 70

Neurophysiological Properties of Contractile Tissue, 72

Mechanical Properties of Noncontractile Soft Tissue, 73

DETERMINANTS, TYPES, AND EFFECTS OF STRETCHING INTERVENTIONS, 77

Alignment and Stabilization, 77

Intensity of Stretch, 79

Duration of Stretch, 79

Speed of Stretch, 81

Frequency of Stretch, 81

Mode of Stretch, 82

Proprioceptive Neuromuscular Facilitation Stretching Techniques, 85

Integration of Function into Stretching, 87

PROCEDURAL GUIDELINES FOR APPLICATION OF STRETCHING INTERVENTIONS, 88

Examination and Evaluation of the Patient, 88

Preparation for Stretching, 89

Application of Manual Stretching Procedures, 89

After Stretching, 90

PRECAUTIONS FOR STRETCHING, 90

General Precautions, 90

Special Precautions for Mass-Market Flexibility Programs, 91

ADJUNCTS TO STRETCHING INTERVENTIONS, 92

Relaxation Training, 92

Biofeedback, 93

Joint Traction or Oscillation, 93

MANUAL STRETCHING TECHNIQUES IN ANATOMICAL PLANES OF MOTION, 94

Upper Extremity Stretching, 94

Lower Extremity Stretching, 99

INDEPENDENT LEARNING ACTIVITIES, 104

Chapter 5. Peripheral Joint Mobilization, 109

DEFINITIONS OF TERMS, 110

Mobilization/Manipulation, 110

Self-Mobilization (Auto-mobilization), 110

Mobilization with Movement, 110

Physiological Movements, 110

Accessory Movements, 110

Manipulation Under Anesthesia, 110

Muscle Energy, 110

BASIC CONCEPTS OF JOINT MOTION: ARTHROKINEMATICS, 110

Joint Shapes, 110

Types of Motion, 111

Passive-Angular Stretching Versus Joint-Glide Stretching, 113

Other Accessory Motions that Affect the Joint, 113

Effects of Joint Motion, 114

INDICATIONS FOR JOINT MOBILIZATION, 114

Pain, Muscle Guarding, and Spasm, 114

Reversible Joint Hypomobility, 114

Positional Faults/Subluxations, 114

Progressive Limitation, 114

Functional Immobility, 114

LIMITATIONS OF JOINT MOBILIZATION TECHNIQUES, 115

CONTRAINDICATIONS AND PRECAUTIONS, 115

Hypermobility, 115

Joint Effusion, 115

Inflammation, 115

Conditions Requiring Special Precautions for Stretching, 115

PROCEDURES FOR APPLYING PASSIVE JOINT MOBILIZATION TECHNIQUES, 116

Examination and Evaluation, 116

Grades or Dosages of Movement, 116

Positioning and Stabilization, 117

Treatment Force and Direction of Movement, 118

Initiation and Progression of Treatment, 118

Speed, Rhythm, and Duration of Movements, 119

Patient Response, 119

Total Program, 119

MOBILIZATION WITH MOVEMENT: PRINCIPLES OF APPLICATION, 120

Principles of MWM in Clinical Practice, 120

Pain as the Guide, 120

Techniques, 120

Theoretical Framework, 121

PERIPHERAL JOINT MOBILIZATION TECHNIQUES, 121

Shoulder Girdle Complex, 121

Elbow and Forearm Complex, 127

Wrist Complex, 131

Hand and Finger Joints, 133

Knee and Leg, 137

Ankle and Foot Joints, 141

INDEPENDENT LEARNING ACTIVITIES, 145

Chapter 6. Resistance Exercise for Impaired Muscle Performance, 147

MUSCLE PERFORMANCE AND RESISTANCE EXERCISE–DEFINITIONS AND GUIDING PRINCIPLES, 148

Overload Principle, 150

SAID Principle, 150

Reversibility Principle, 150

SKELETAL MUSCLE FUNCTION AND ADAPTATION TO RESISTANCE EXERCISE, 151

Factors that Influence Tension Generation in Normal Skeletal Muscle, 151

Physiological Adaptations to Resistance Exercise, 157

DETERMINANTS OF RESISTANCE EXERCISE, 159

Alignment and Stabilization, 160

Exercise Order, 163

Rest Interval (Recovery Period), 164

Mode of Exercise, 164

Velocity of Exercise, 165

Periodization, 166

Integration of Function, 166

TYPES OF RESISTANCE EXERCISE, 167

Manual and Mechanical Resistance Exercise, 167

Isometric Exercise (Static Exercise), 168

Dynamic Exercise–Concentric and Eccentric, 170

Dynamic Exercise–Constant and Variable Resistance, 172

Isokinetic Exercise, 172

Open-Chain and Closed-Chain Exercise, 174

GENERAL PRINCIPLES OF RESISTANCE TRAINING, 180

Examination and Evaluation, 180

Preparation for Resistance Exercises, 181

Application of Resistance Exercises, 181

PRECAUTIONS FOR RESISTANCE EXERCISE, 182

Valsalva Maneuver, 182

Substitute Motions, 183

Overtraining and Overwork, 183

Exercise-Induced Muscle Soreness, 184

Pathological Fracture, 185

CONTRAINDICATIONS TO RESISTANCE EXERCISE, 185

Inflammation, 186

Severe Cardiopulmonary Disease, 186

MANUAL RESISTANCE EXERCISE, 186

Definition and Use, 186

Guidelines and Special Considerations, 187

Techniques–General Background, 188

Upper Extremity, 188

Lower Extremity, 192

PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION–PRINCIPLES AND TECHNIQUES, 195

Diagonal Patterns, 196

Basic Procedures with PNF Patterns, 196

Upper Extremity Diagonal Patterns, 197

Lower Extremity Diagonal Patterns, 200

Specific Techniques with PNF, 202

MECHANICAL RESISTANCE EXERCISE, 203

Use in Rehabilitation, 204

Use in Conditioning Programs, 204

Special Considerations for Children and Older Adults, 204

SELECTED RESISTANCE TRAINING REGIMENS, 206

Progressive Resistance Exercise, 206

Circuit Weight Training, 207

Plyometric Training–Stretch-Shortening Drills, 208

Isokinetic Regimens, 210

EQUIPMENT FOR RESISTANCE TRAINING, 212

Free Weights and Simple Weight-Pulley Systems, 213

Variable Resistance Machines, 215

Elastic Resistance Bands and Tubing, 216

Equipment for Closed-Chain Training, 219

Reciprocal Exercise Equipment, 220

Equipment for Dynamic Stabilization Training, 221

Isokinetic Testing and Training Equipment, 222

INDEPENDENT LEARNING ACTIVITIES, 223

Chapter 7. Principles of Aerobic Exercise, 231

KEY TERMS AND CONCEPTS, 232

Maximum Oxygen Consumption, 232

Aerobic Exercise Training (Conditioning), 232

Adaptation, 232

Myocardial Oxygen Consumption, 232

Deconditioning, 233

Energy Systems, Energy Expenditure, and Efficiency, 233

Functional Implications, 234

Energy Expenditure, 234

Efficiency, 234

PHYSIOLOGICAL RESPONSE TO AEROBIC EXERCISE, 235

Cardiovascular Response to Exercise, 235

Respiratory Response to Exercise, 235

Responses Providing Additional Oxygen to Muscle, 236

TESTING AS A BASIS FOR EXERCISE PROGRAMS, 236

Fitness Testing of Healthy Subjects, 236

Stress Testing for Convalescing Individuals and Individuals at Risk, 236

Multistage Testing, 237

DETERMINANTS OF AN EXERCISE PROGRAM, 237

Reversibility Principle, 240

EXERCISE PROGRAM, 240

Warm-Up Period, 240

Aerobic Exercise Period, 240

Cool-Down Period, 241

Application, 241

PHYSIOLOGICAL CHANGES THAT OCCUR WITH TRAINING, 241

Cardiovascular Changes, 241

Respiratory Changes, 242

Metabolic Changes, 242

Other System Changes, 243

APPLICATION OF PRINCIPLES OF AN AEROBIC CONDITIONING PROGRAM FOR THE PATIENT WITH CORONARY DISEASE, 243

Inpatient Phase (Phase I), 243

Outpatient Phase (Phase II), 243

Outpatient Program (Phase III), 244

Special Considerations, 244

Adaptive Changes, 244

APPLICATIONS OF AEROBIC TRAINING FOR THE DECONDITIONED INDIVIDUAL AND THE PATIENT WITH CHRONIC ILLNESS, 245

Adaptations for Disabilities, Functional Limitations, and Deconditioning, 245

Impairments, Goals, and Plan of Care, 245

AGE DIFFERENCES, 246

Young Adults, 247

Older Adults, 248

INDEPENDENT LEARNING ACTIVITIES, 248

Chapter 8. Exercise for Impaired Balance, 251

BACKGROUND AND CONCEPTS, 251

Balance: Key Terms and Definitions, 251

Balance Control, 252

Sensory Systems and Balance Control, 253

Motor Strategies for Balance Control, 254

Balance Control Under Varying Conditions, 256

IMPAIRED BALANCE, 258

Sensory Input Impairments, 258

Sensorimotor Integration, 259

Biomechanical and Motor Output Deficits, 259

Deficits with Aging, 259

Deficits from Medications, 260

MANAGEMENT OF IMPAIRED BALANCE, 260

Examination and Evaluation of Impaired Balance, 260

Balance Training, 261

Health and Environmental Factors, 265

Evidence-Based Balance Exercise Programs, 265

Tai Chi for Balance Training, 266

INDEPENDENT LEARNING ACTIVITIES, 269

Chapter 9. Aquatic Exercise, 273

BACKGROUND AND PRINCIPLES FOR AQUATIC EXERCISE, 273

DEFINITION OF AQUATIC EXERCISE, 273

GOALS AND INDICATIONS FOR AQUATIC EXERCISE, 274

PRECAUTIONS AND CONTRAINDICATIONS TO AQUATIC EXERCISE, 274

Precautions, 274

Contraindications, 274

PROPERTIES OF WATER, 274

Physical Properties of Water, 274

Hydromechanics, 275

Thermodynamics, 275

Center of Buoyancy, 276

AQUATIC TEMPERATURE AND THERAPEUTIC EXERCISE, 276

Temperature Regulation, 276

Mobility and Functional Control Exercise, 276

Aerobic Conditioning, 277

SPECIAL EQUIPMENT FOR AQUATIC EXERCISE, 277

Collars, Rings, Belts, and Vests, 277

Gloves, Hand Paddles, and Hydro-tone® Balls, 278

Fins and Hydro-tone® Boots, 278

Kickboards, 278

EXERCISE INTERVENTIONS USING AN AQUATIC ENVIRONMENT, 279

STRETCHING EXERCISES, 279

Manual Stretching Techniques, 279

Self-Stretching with Aquatic Equipment, 282

STRENGTHENING EXERCISES, 283

Manual Resistance Exercises, 283

Independent Strengthening Exercises, 287

AEROBIC CONDITIONING, 290

Treatment Interventions, 290

Physiological Response to Deep-Water Walking/Running, 290

Proper Form for Deep-Water Running, 290

Exercise Monitoring, 291

Equipment Selection, 291

INDEPENDENT LEARNING ACTIVITIES, 291

Part III. Principles of Intervention, 295

Chapter 10. Soft Tissue Injury, Repair, and Management, 295

SOFT TISSUE LESIONS, 295

Examples of Soft Tissue Lesions–Musculoskeletal Disorders, 295

Clinical Conditions Resulting from Trauma or Pathology, 296

Severity of Tissue Injury, 297

Irritability of Tissue: Stages of Inflammation and Repair, 297

MANAGEMENT DURING THE ACUTE STAGE, 298

Tissue Response–Inflammation, 298

Management Guidelines–Protection Phase, 298

MANAGEMENT DURING THE SUBACUTE STAGE, 300

Tissue Response–Repair and Healing, 300

Management Guidelines–Controlled Motion Phase, 300

MANAGEMENT DURING THE CHRONIC STAGE, 302

Tissue Response–Maturation and Remodeling, 302

Management Guidelines–Return to Function Phase, 303

CUMULATIVE TRAUMA–CHRONIC RECURRING PAIN, 305

Tissue Response–Chronic Inflammation, 305

Etiology of Chronic Inflammation Leading to Prolonged or Recurring Pain, 305

Contributing Factors, 305

Management Guidelines–Chronic Inflammation, 306

INDEPENDENT LEARNING ACTIVITIES, 307

Chapter 11. Joint, Connective Tissue, and Bone Disorders and Management, 309

ARTHRITIS–ARTHROSIS, 309

Clinical Signs and Symptoms, 309

Rheumatoid Arthritis, 310

Osteoarthritis–Degenerative Joint Disease, 314

FIBROMYALGIA AND MYOFASCIAL PAIN SYNDROME, 316

Fibromyalgia, 316

Myofascial Pain Syndrome, 318

OSTEOPOROSIS, 318

Risk Factors, 318

Prevention of Osteoporosis, 319

Recommendations for Exercise, 320

Exercise Precautions and Contraindications, 320

FRACTURES–POST-TRAUMATIC IMMOBILIZATION, 320

Risk Factors, 322

Bone Healing Following a Fracture, 322

Principles of Management–Period of Immobilization, 323

Postimmobilization Period, 323

INDEPENDENT LEARNING ACTIVITIES, 325

Chapter 12. Surgical Interventions and Postoperative Management, 329

INDICATIONS FOR SURGICAL INTERVENTION, 329

GUIDELINES FOR PREOPERATIVE AND POSTOPERATIVE MANAGEMENT, 329

Considerations for Preoperative Management, 330

Considerations for Postoperative Management, 331

Potential Postoperative Complications, 334

OVERVIEW OF COMMON ORTHOPEDIC SURGERIES AND POSTOPERATIVE MANAGEMENT, 335

Surgical Approaches-Open, Arthroscopic, and Arthroscopically Assisted Procedures, 335

Use of Tissue Grafts, 336

Repair, Reattachment, Reconstruction, Stabilization, or Transfer of Soft Tissues, 336

Release, Lengthening, or Decompression of Soft Tissues, 339

Joint Procedures, 339

Extra-articular Bony Procedures, 343

INDEPENDENT LEARNING ACTIVITIES, 345

Chapter 13. Peripheral Nerve Disorders and Management, 349

REVIEW OF PERIPHERAL NERVE STRUCTURE, 350

Nerve Structure, 350

Nervous System Mobility Characteristics, 350

Common Sites of Injury to Peripheral Nerves, 351

IMPAIRED NERVE FUNCTION, 363

NERVE INJURY AND RECOVERY, 363

Mechanisms of Nerve Injury, 363

Classification of Nerve Injuries, 364

Recovery of Nerve Injuries, 365

Management Guidelines-Recovery from Nerve Injury, 365

NEURAL TENSION DISORDERS, 366

Symptoms and Signs of Nerve Mobility Impairment, 367

Causes of Symptoms, 367

Principles of Management, 367

Neural Testing and Mobilization Techniques for the Upper Quadrant, 367

Neural Testing and Mobilization Techniques for the Lower Quadrant, 368

Prevention, 370

MUSCULOSKELETAL DIAGNOSES INVOLVING IMPAIRED NERVE FUNCTION, 370

THORACIC OUTLET SYNDROME, 370

Related Diagnoses, 370

Etiology of Symptoms, 371

Location of Compression or Entrapment and Tests of Provocation, 371

Common Impairments in TOS, 372

Common Functional Limitations/Disabilities, 372

Nonoperative Management of TOS, 373

CARPAL TUNNEL SYNDROME, 373

Etiology of Symptoms, 374

Tests of Provocation, 374

Common Impairments, 374

Common Functional Limitations/Disabilities, 375

Nonoperative Management of CTS, 375

Surgical Intervention and Postoperative Management, 376

COMPRESSION IN TUNNEL OF GUYON, 377

Etiology of Symptoms, 377

Tests of Provocation, 377

Common Impairments, 377

Common Functional Limitations/Disabilities, 377

Nonoperative Management, 378

Surgical Release and Postoperative Management, 378

COMPLEX REGIONAL PAIN SYNDROME: REFLEX SYMPATHETIC DYSTROPHY AND CAUSALGIA, 378

Related Diagnoses and Symptoms, 378

Etiology and Symptoms, 378

Three Stages of CRPS Type I (RSD), 378

Common Impairments, 379

Management, 379

INDEPENDENT LEARNING ACTIVITIES, 381

Part IV. Exercise Interventions by Body Region, 383

Chapter 14. The Spine and Posture: Structure, Function, Postural Impairments, and Management Guidelines, 383

POSTURE AND BIOMECHANICAL INFLUENCES, 384

Curves of the Spine, 384

Postural Alignment, 384

Postural Stability in the Spine, 385

Effects of Limb Motion on Spinal Stability, 392

Effects of Breathing on Posture and Stability, 392

IMPAIRED POSTURE, 393

ETIOLOGY OF PAIN, 393

Effect of Mechanical Stress, 393

Effect of Impaired Postural Support from Trunk Muscles, 393

Effect of Impaired Muscle Endurance, 394

Pain Syndromes Related to Impaired Posture, 394

COMMON FAULTY POSTURES: CHARACTERISTICS AND IMPAIRMENTS, 394

Pelvic and Lumbar Region, 394

Cervical and Thoracic Region, 395

Frontal Plane Deviations from Lower Extremity Asymmetries, 397

MANAGEMENT OF IMPAIRED POSTURE, 398

GENERAL MANAGEMENT GUIDELINES, 398

Postural Alignment: Proprioception and Control, 398

Relationship of Impaired Posture and Pain, 400

Joint, Muscle, and Connective Tissue Mobility Impairments, 400

Impaired Muscle Performance, 401

Body Mechanics, 401

Stress Provoking Postures and Activities: Relief and Prevention, 401

Stress Management/Relaxation, 401

Healthy Exercise Habits, 402

TENSION HEADACHE/CERVICAL HEADACHE, 403

Presenting Signs and Symptoms, 403

General Management Guidelines, 403

INDEPENDENT LEARNING ACTIVITIES, 404

Chapter 15. The Spine: Impairments, Diagnoses, and Management Guidelines, 407

REVIEW OF THE STRUCTURE AND FUNCTION OF THE SPINE, 408

Functional Components of the Spine, 408

Motions of the Spinal Column, 408

Structure and Function of Intervertebral Disks, 409

Intervertebral Foramina, 409

Inert Structures: Influence on Movement and Stability, 410

Neuromuscular Function: Dynamic Stabilization, 410

SPINAL PATHOLOGIES AND IMPAIRED SPINAL FUNCTION, 410

PATHOLOGY OF THE INTERVERTEBRAL DISK, 410

Injury and Degeneration of the Disk, 410

Disk Pathologies and Related Conditions, 412

Signs and Symptoms of Disk Lesions and Fluid Stasis, 412

PATHOMECHANICAL RELATIONSHIPS OF THE INTERVERTEBRAL DISK AND FACET JOINTS, 414

Three-Joint Complex, 414

Related Pathologies, 414

PATHOLOGY OF THE ZYGAPOPHYSEAL (FACET) JOINTS, 415

Facet Joint Characteristics, 415

Common Diagnoses and Impairments from Facet Joint Pathologies, 415

PATHOLOGY OF MUSCLE AND SOFT TISSUE INJURIES: STRAINS, TEARS, AND CONTUSIONS, 416

General Symptoms from Trauma, 416

Common Sites of Lumbar Strain, 416

Common Sites of Cervical Strain, 416

Postural Strain, 416

Emotional Stress, 417

Functional Limitations/Disabilities, 417

PATHOMECHANICS OF SPINAL INSTABILITY, 417

Neutral Zone, 417

Instability, 417

MANAGEMENT GUIDELINES BASED ON IMPAIRMENTS, 418

PRINCIPLES OF MANAGEMENT FOR THE SPINE, 418

Examination and Evaluation, 418

General Guidelines for Managing Acute Spinal Problems: Protection Phase, 420

General Guidelines for Managing Subacute Spinal Problems: Controlled Motion Phase, 421

General Guidelines for Managing Chronic Spinal Problems: Return to Function Phase, 423

MANAGEMENT GUIDELINES-NON-WEIGHT-BEARING BIAS, 424

Management of Acute Symptoms, 424

Progression, 424

MANAGEMENT GUIDELINES-EXTENSION BIAS, 424

Principles of Management, 424

Indications, Precautions, and Contraindications for Interventions-Extension Approach, 425

Techniques Using an Extension Approach in the Lumbar Spine, 425

Techniques to Manage a Disk Lesion in the Cervical Spine, 428

MANAGEMENT GUIDELINES-FLEXION BIAS, 429

Principles of Management, 429

Indications and Contraindications for Intervention-Flexion Approach, 429

Techniques Utilizing a Flexion Approach, 429

MANAGEMENT GUIDELINES-STABILIZATION, 430

Identification of Clinical Instability, 430

Principles of Management, 431

MANAGEMENT GUIDELINES-MOBILIZATION, 431

Management-Lumbar Spine, 431

Management-Cervical Spine, 432

MANAGEMENT GUIDELINES-SOFT TISSUE INJURIES, 432

Management During the Acute Stage: Protection Phase, 432

Management in the Subacute and Chronic Stages of Healing: Controlled Motion and Return to Function Phases, 433

MANAGEMENT GUIDELINES-TEMPOROMANDIBULAR JOINT DYSFUNCTION, 433

Signs and Symptoms, 433

Etiology of Symptoms, 433

Principles of Management, 434

INDEPENDENT LEARNING ACTIVITIES, 435

Chapter 16. The Spine: Exercise Interventions, 439

BASIC CONCEPTS OF SPINAL MANAGEMENT WITH EXERCISE, 440

FUNDAMENTAL INTERVENTIONS, 440

PATIENT EDUCATION, 440

GENERAL EXERCISE GUIDELINES, 441

Kinesthetic Awareness, 441

Mobility/Flexibility, 441

Muscle Performance, 441

Cardiopulmonary Endurance, 441

Functional Activities, 442

KINESTHETIC AWARENESS, 443

ELEMENTS OF KINESTHETIC TRAINING-FUNDAMENTAL TECHNIQUES, 443

Position of Symptom Relief, 443

Effects of Movement on the Spine, 443

Integration of Kinesthetic Training With Stabilization Exercises and Fundamental Body Mechanics, 443

PROGRESSION TO ACTIVE AND HABITUAL CONTROL OF POSTURE, 443

MOBILITY/FLEXIBILITY, 444

CERVICAL AND UPPER THORACIC REGION-STRETCHING TECHNIQUES, 444

Techniques to Increase Thoracic Extension, 444

Techniques to Increase Axial Extension (Cervical Retraction)-Scalene Muscle Stretch, 445

Techniques to Increase Upper Cervical Flexion-Short Suboccipital Muscle Stretch, 445

Techniques to Increase Scapular and Humeral Muscle Flexibility, 446

Traction as a Stretching Technique, 446

Other Techniques for Increasing Mobility, 447

MID AND LOWER THORACIC AND LUMBAR REGIONS-STRETCHING TECHNIQUES, 447

Techniques to Increase Lumbar Flexion, 447

Techniques to Increase Lumbar Extension, 448

Techniques to Increase Lateral Flexibility in the Spine, 448

Techniques to Increase Hip Muscle Flexibility, 450

Traction as a Stretching Technique, 450

MUSCLE PERFORMANCE: STABILIZATION, MUSCLE ENDURANCE, AND STRENGTH TRAINING, 451

STABILIZATION TRAINING-FUNDAMENTAL TECHNIQUES AND PROGRESSIONS, 451

Guidelines for Stabilization Training, 451

Deep Stabilizing (Core) Muscle Activation and Training, 452

Global Muscle Stabilization Exercises, 456

ISOMETRIC AND DYNAMIC EXERCISES, 465

Exercises for the Cervical Region, 466

Exercises for the Thoracic and Lumbar Regions, 467

CARDIOPULMONARY ENDURANCE, 472

COMMON AEROBIC EXERCISES AND EFFECTS ON THE SPINE, 472

Walking and Running, 473

Stair Climbing, 473

Cross-Country Skiing and Ski Machines, 473

Upper Body Ergometry Machines, 473

Step Aerobics and Aerobic Dancing, 473

“Latest Popular Craze”, 473

FUNCTIONAL ACTIVITIES, 473

EARLY FUNCTIONAL TRAINING-FUNDAMENTAL TECHNIQUES, 474

PREPARATION FOR FUNCTIONAL ACTIVITIES-BASIC EXERCISE TECHNIQUES, 474

Weight-Bearing Exercises, 474

Transitional Stabilization Exercises, 476

BODY MECHANICS AND ENVIRONMENTAL ADAPTATIONS, 476

Principles of Body Mechanics-Instruction and Training, 476

Environmental Adaptations, 477

INTERMEDIATE TO ADVANCED EXERCISE TECHNIQUES FOR FUNCTIONAL TRAINING, 477

Repetitive Lifting, 477

Repetitive Reaching, 478

Repetitive Pushing and Pulling, 478

Rotation or Turning, 478

Transitional Movements, 478

Transfer of Training, 478

EDUCATION FOR PREVENTION, 478

INDEPENDENT LEARNING ACTIVITIES, 479

Chapter 17. The Shoulder and Shoulder Girdle, 481

STRUCTURE AND FUNCTION OF THE SHOULDER GIRDLE, 482

JOINTS OF THE SHOULDER GIRDLE COMPLEX, 482

Synovial Joints, 482

Functional Articulations, 484

SHOULDER GIRDLE FUNCTION, 486

Scapulohumeral Rhythm, 486

Clavicular Elevation and Rotation With Humeral Motion, 486

External Rotation of the Humerus With Full Elevation, 487

Internal Rotation of the Humerus With Full Elevation, 487

Elevation of the Humerus Through the Plane of the Scapula-Scaption, 487

Deltoid-Short Rotator Cuff and Supraspinatus Mechanisms, 487

REFERRED PAIN AND NERVE INJURY, 487

Common Sources of Referred Pain in the Shoulder Region, 487

Nerve Disorders in the Shoulder Girdle Region, 487

MANAGEMENT OF SHOULDER DISORDERS AND SURGERIES, 488

JOINT HYPOMOBILITY: NONOPERATIVE MANAGEMENT, 488

Glenohumeral Joint, 488

Acromioclavicular and Sternoclavicular Joints, 493

GLENOHUMERAL JOINT SURGERY AND POSTOPERATIVE MANAGEMENT, 494

Glenohumeral Arthroplasty, 494

Arthrodesis of the Shoulder, 501

PAINFUL SHOULDER SYNDROMES (ROTATOR CUFF DISEASE, IMPINGEMENT SYNDROMES, SHOULDER INSTABILITIES): NONOPERATIVE MANAGEMENT, 502

Related Pathologies and Etiology of Symptoms, 502

Common Impairments, 505

Common Functional Limitations/Disabilities, 506

Management: Painful Shoulder Syndromes (Without Dislocation), 506

PAINFUL SHOULDER SYNDROMES: SURGERY AND POSTOPERATIVE MANAGEMENT, 508

Subacromial Decompression and Postoperative Management, 508

Rotator Cuff Repair and Postoperative Management, 511

SHOULDER DISLOCATIONS: NONOPERATIVE MANAGEMENT, 518

Related Pathologies and Mechanisms of Injury, 518

Common Impairments, 519

Common Functional Limitations/Disabilities, 519

Closed Reduction of Anterior Dislocation, 519

Closed Reduction Posterior Dislocation, 521

SHOULDER INSTABILITIES: SURGERY AND POSTOPERATIVE MANAGEMENT, 521

Glenohumeral Joint Stabilization Procedures and Postoperative Management, 521

Acromioclavicular and Sternoclavicular Joint Stabilization Procedures and Postoperative Management, 529

EXERCISE INTERVENTIONS FOR THE SHOULDER GIRDLE, 529

EXERCISE TECHNIQUES DURING ACUTE AND EARLY SUBACUTE STAGES OF TISSUE HEALING, 529

Early Motion of the Glenohumeral Joint, 529

Early Motion of the Scapula, 531

Early Neuromuscular Control, 531

EXERCISE TECHNIQUES TO INCREASE FLEXIBILITY AND RANGE OF MOTION, 531

Self-Stretching Techniques, 531

Manual and Self-Stretching Exercises for Specific Muscles, 533

EXERCISES TO DEVELOP AND IMPROVE MUSCLE PERFORMANCE AND FUNCTIONAL CONTROL, 536

Isometric Exercises, 536

Stabilization Exercises, 539

Dynamic Strengthening Exercises-Scapular Muscles, 541

Dynamic Strengthening Exercises-Glenohumeral Muscles, 545

Functional Activities, 549

INDEPENDENT LEARNING ACTIVITIES, 550

Chapter 18. The Elbow and Forearm Complex, 557

STRUCTURE AND FUNCTION OF THE ELBOW AND FOREARM, 558

JOINTS OF THE ELBOW AND FOREARM, 558

Elbow Joint Characteristics and Arthrokinematics, 558

Forearm Joint Characteristics and Arthrokinematics, 559

MUSCLE FUNCTION AT THE ELBOW AND FOREARM, 560

Primary Actions at the Elbow and Forearm, 560

Relationship of Wrist and Hand Muscles to the Elbow, 560

REFERRED PAIN AND NERVE INJURY IN THE ELBOW REGION, 560

Common Sources of Referred Pain into the Elbow Region, 561

Nerve Disorders in the Elbow Region, 561

MANAGEMENT OF ELBOW AND FOREARM DISORDERS AND SURGERIES, 561

JOINT HYPOMOBILITY: NONOPERATIVE MANAGEMENT, 562

Related Pathologies and Etiology of Symptoms, 562

Common Impairments, 562

Common Functional Limitations/Disabilities, 562

Joint Hypomobility: Management-Protection Phase, 562

Joint Hypomobility: Management-Controlled Motion Phase, 562

Joint Hypomobility: Management-Return to Function Phase, 564

JOINT SURGERY AND POSTOPERATIVE MANAGEMENT, 564

Excision of the Radial Head, 565

Total Elbow Arthroplasty, 567

MYOSITIS OSSIFICANS, 574

Etiology of Symptoms, 574

Management, 574

OVERUSE SYNDROMES: REPETITIVE TRAUMA SYNDROMES, 575

Related Pathologies, 575

Etiology of Symptoms, 575

Common Impairments, 575

Common Functional Limitations/Disabilities, 575

Nonoperative Management of Overuse Syndromes: Protection Phase, 575

Nonoperative Management: Controlled Motion and Return to Function Phases, 576

EXERCISE INTERVENTIONS FOR THE ELBOW AND FOREARM, 578

EXERCISE TECHNIQUES TO INCREASE FLEXIBILITY AND RANGE OF MOTION, 578

Manual, Mechanical, and Self-Stretching Techniques, 578

Self-Stretching Techniques-Muscles of the Medial and Lateral Epicondyles, 579

EXERCISES TO DEVELOP AND IMPROVE MUSCLE PERFORMANCE AND FUNCTIONAL CONTROL, 580

Isometric Exercises, 580

Dynamic Strengthening and Endurance Exercises, 580

Functional Exercises, 583

INDEPENDENT LEARNING ACTIVITIES, 585

Chapter 19. The Wrist and Hand, 589

STRUCTURE AND FUNCTION OF THE WRIST AND HAND, 590

JOINTS OF THE WRIST AND HAND, 590

Wrist Joint-Characteristics and Arthrokinematics, 590

Hand Joints-Characteristics and Arthrokinematics, 590

HAND FUNCTION, 592

Muscles of the Wrist and Hand, 592

Grips and Prehension Patterns, 593

MAJOR NERVES SUBJECT TO PRESSURE AND TRAUMA AT THE WRIST AND HAND, 594

Nerve Disorders in the Wrist, 594

Referred Pain and Sensory Patterns, 594

MANAGEMENT OF WRIST AND HAND DISORDERS AND SURGERIES, 594

JOINT HYPOMOBILITY: NONOPERATIVE MANAGEMENT, 594

Common Joint Pathologies and Associated Impairments, 594

Common Functional Limitations/Disabilities with Joint Pathologies, 596

Joint Hypomobility: Management-Protection Phase, 596

Joint Hypomobility: Management-Controlled Motion and Return to Function Phases, 597

JOINT SURGERY AND POSTOPERATIVE MANAGEMENT, 599

Wrist Arthroplasty, 600

Metacarpophalangeal Implant Arthroplasty, 603

Proximal Interphalangeal Implant Arthroplasty, 608

Carpometacarpal Arthroplasty of the Thumb, 610

Tendon Rupture Associated with RA: Surgical and Postoperative Management, 613

REPETITIVE TRAUMA SYNDROMES/OVERUSE SYNDROMES, 615

Tenosynovitis, Tendinitis, 615

TRAUMATIC LESIONS IN THE WRIST AND HAND, 616

Simple Sprain: Nonoperative Management, 616

Lacerated Flexor Tendons of the Hand: Surgical and Postoperative Management, 616

Lacerated Extensor Tendons of the Hand: Surgical and Postoperative Management, 625

EXERCISE INTERVENTIONS FOR THE WRIST AND HAND, 631

TECHNIQUES FOR MUSCULOTENDINOUS MOBILITY, 631

Tendon-Gliding and Tendon-Blocking Exercises, 631

Scar Tissue Mobilization for Tendon Adhesions, 633

EXERCISE TECHNIQUES TO INCREASE FLEXIBILITY AND RANGE OF MOTION, 634

General Stretching Techniques, 634

Stretching Techniques for the Intrinsic and Multijoint Muscles, 635

EXERCISES TO DEVELOP AND IMPROVE MUSCLE PERFORMANCE, NEUROMUSCULAR CONTROL, AND COORDINATED MOVEMENT, 636

Techniques to Strengthen Muscles of the Wrist and Hand, 636

Functional Activities, 638

INDEPENDENT LEARNING ACTIVITIES, 638

Chapter 20. The Hip, 643

STRUCTURE AND FUNCTION OF THE HIP, 644

ANATOMICAL CHARACTERISTICS OF THE HIP REGION, 644

Bony Structures, 644

Hip Joint Characteristics and Arthrokinematics, 644

Influence of the Hip Joint on Balance and Posture Control, 645

FUNCTIONAL RELATIONSHIPS OF THE HIPS AND PELVIS, 645

Pelvic Motions and Muscle Function, 645

Pathomechanics in the Hip Region, 647

THE HIP AND GAIT, 648

Hip Muscle Function During Gait, 648

Effect of Musculoskeletal Impairments on Gait, 648

REFERRED PAIN AND NERVE INJURY, 648

Major Nerves Subject to Injury or Entrapment, 648

Common Sources of Referred Pain in the Hip and Buttock Region, 648

MANAGEMENT OF HIP DISORDERS AND SURGERIES, 649

JOINT HYPOMOBILITY: NONOPERATIVE MANAGEMENT, 649

Related Pathologies and Etiology of Symptoms, 649

Common Impairments, 650

Common Functional Limitations/Disabilities, 650

Management: Protection Phase, 650

Management: Controlled Motion and Return to Function Phases, 650

JOINT SURGERY AND POSTOPERATIVE MANAGEMENT, 652

Total Hip Arthroplasty, 652

Hemiarthroplasty of the Hip, 663

FRACTURES OF THE HIP-SURGICAL AND POSTOPERATIVE MANAGEMENT, 664

Hip Fracture-Incidence and Risk Factors, 664

Sites and Types of Hip Fracture, 664

Open Reduction and Internal Fixation of Hip Fracture, 665

PAINFUL HIP SYNDROMES/OVERUSE SYNDROMES: NONOPERATIVE MANAGEMENT, 671

Related Pathologies and Etiology of Symptoms, 671

Common Impairments and Functional Limitations/Disabilities, 671

Management: Protection Phase, 671

Management: Controlled Motion Phase, 671

Management: Return to Function Phase, 672

EXERCISE INTERVENTIONS FOR THE HIP REGION, 672

EXERCISE TECHNIQUES TO INCREASE FLEXIBILITY AND RANGE OF MOTION, 672

Techniques to Stretch Range-Limiting Hip Structures, 672

Techniques to Stretch Range-Limiting Two-Joint Muscles, 674

EXERCISES TO DEVELOP AND IMPROVE MUSCLE PERFORMANCE AND FUNCTIONAL CONTROL, 676

Non-Weight-Bearing Exercises, 676

Closed-Chain Weight-Bearing Exercises, 678

Functional Training, 681

INDEPENDENT LEARNING ACTIVITIES, 682

Chapter 21. The Knee, 687

STRUCTURE AND FUNCTION OF THE KNEE, 688

JOINTS OF THE KNEE COMPLEX, 688

Tibiofemoral Joint, 688

Patellofemoral Joint, 689

PATELLAR FUNCTION, 689

Patellar Alignment, 689

Patellar Compression, 691

MUSCLE FUNCTION, 691

Knee Extensor Muscle Function, 691

Knee Flexor Muscle Function, 692

Dynamic Stability of the Knee, 692

THE KNEE AND GAIT, 692

Muscle Control of the Knee During Gait, 692

Hip and Ankle Impairments, 692

REFERRED PAIN AND NERVE INJURIES, 693

Major Nerves Subject to Injury at the Knee, 693

Common Sources of Referred Pain, 693

MANAGEMENT OF KNEE DISORDERS AND SURGERIES, 693

JOINT HYPOMOBILITY: NONOPERATIVE MANAGEMENT, 693

Common Joint Pathologies and Associated Impairments, 693

Common Functional Limitations/Disabilities, 695

Joint Hypomobility: Management-Protection Phase, 695

Joint Hypomobility: Management-Controlled Motion and Return to Function Phases, 695

JOINT SURGERY AND POSTOPERATIVE MANAGEMENT, 698

Repair of Articular Cartilage Defects, 698

Synovectomy, 699

Total Knee Arthroplasty, 702

PATELLOFEMORAL DYSFUNCTION: NONOPERATIVE MANAGEMENT, 711

Related Patellofemoral Pathologies, 711

Etiology of Symptoms, 712

Common Impairments and Functional Limitations/Disabilities, 712

Patellofemoral Symptoms: Management-Protection Phase, 712

Patellofemoral Symptoms: Management-Controlled Motion and Return to Function Phases, 712

PATELLOFEMORAL AND EXTENSOR MECHANISM DYSFUNCTION: SURGICAL AND POSTOPERATIVE MANAGEMENT, 715

Lateral Retinacular Release, 716

Proximal Realignment of the Extensor Mechanism, 718

Distal Realignment of the Extensor Mechanism, 721

LIGAMENT INJURIES: NONOPERATIVE MANAGEMENT, 722

Mechanisms of Injury, 722

Ligament Injuries in the Female Athlete, 722

Common Impairments and Functional Limitations/Disabilities, 723

Ligament Injuries: Nonoperative Management, 723

LIGAMENT INJURIES: SURGICAL AND POSTOPERATIVE MANAGEMENT, 725

Background, 725

Anterior Cruciate Ligament Reconstruction, 726

Posterior Cruciate Ligament Reconstruction, 735

MENISCAL TEARS: NONOPERATIVE MANAGEMENT, 737

Mechanisms of Injury, 737

Common Impairments and Functional Limitations/Disabilities, 737

Management, 738

MENISCAL TEARS: SURGICAL AND POSTOPERATIVE MANAGEMENT, 738

Meniscus Repair, 738

Partial Meniscectomy, 742

EXERCISE INTERVENTIONS FOR THE KNEE, 742

EXERCISE TECHNIQUES TO INCREASE FLEXIBILITY AND RANGE OF MOTION, 743

To Increase Knee Extension, 743

To Increase Knee Flexion, 743

EXERCISES TO DEVELOP AND IMPROVE MUSCLE PERFORMANCE AND FUNCTIONAL CONTROL, 744

Nonweight-Bearing Exercises, 745

Closed-Chain Exercises, 748

Techniques to Simulate Functional Activities, 750

INDEPENDENT LEARNING ACTIVITIES, 751

Chapter 22. The Ankle and Foot, 759

STRUCTURE AND FUNCTION OF THE ANKLE AND FOOT, 760

STRUCTURAL RELATIONSHIPS AND MOTIONS, 760

Anatomical Characteristics, 760

Motions of the Foot and Ankle Defined, 760

Leg, Ankle, and Foot Joint Characteristics and Arthrokinematics, 761

FUNCTION OF THE ANKLE AND FOOT, 763

Structural Relationships, 763

Muscle Function in the Ankle and Foot, 763

THE ANKLE/FOOT COMPLEX AND GAIT, 764

Function of the Ankle and Foot Joints During Gait, 764

Muscle Control of the Ankle and Foot During Gait, 764

REFERRED PAIN AND NERVE INJURY, 764

Major Nerves Subject to Pressure and Trauma, 764

Common Sources of Segmental Sensory Reference in the Foot, 765

MANAGEMENT OF FOOT AND ANKLE DISORDERS AND SURGERIES, 765

JOINT HYPOMOBILITY: NONOPERATIVE MANAGEMENT, 766

Common Joint Pathologies and Etiology of Symptoms, 766

Common Impairments and Functional Limitations/Disabilities, 766

Joint Hypomobility: Management-Protection Phase, 767

Joint Hypomobility: Management-Controlled Motion and Return to Function Phases, 767

JOINT SURGERY AND POSTOPERATIVE MANAGEMENT, 769

Total Ankle Arthroplasty, 770

Arthrodesis at the Ankle and Foot, 773

OVERUSE (REPETITIVE TRAUMA) SYNDROMES: NONOPERATIVE MANAGEMENT, 776

Related Pathologies and Etiology of Symptoms, 776

Common Impairments and Functional Limitations/Disabilities, 776

Overuse Syndromes: Management-Protection Phase, 777

Overuse Syndromes: Management-Controlled Motion and Return to Function Phases, 777

LIGAMENTOUS INJURIES: NONOPERATIVE MANAGEMENT, 777

Common Impairments and Functional Limitations/Disabilities, 777

Management: Protection Phase, 778

Management: Controlled Motion Phase, 778

Management: Return to Function Phase, 778

TRAUMATIC SOFT TISSUE INJURIES: SURGICAL AND POSTOPERATIVE MANAGEMENT, 779

Repair of Complete Lateral Ligament Tears, 779

Repair of a Ruptured Achilles Tendon, 782

EXERCISE INTERVENTIONS FOR THE ANKLE AND FOOT, 786

EXERCISE TECHNIQUES TO INCREASE FLEXIBILITY AND RANGE OF MOTION, 786

Flexibility Exercises for the Ankle Region, 786

Flexibility Exercises for Limited Mobility of the Toes, 788

Stretching the Plantar Fascia of the Foot, 788

EXERCISES TO DEVELOP AND IMPROVE MUSCLE PERFORMANCE AND FUNCTIONAL CONTROL, 788

Activities to Develop Dynamic Neuromuscular Control, 788

Open-Chain Strengthening Exercises, 789

Weight-Bearing Exercises for Strength, Balance, and Function, 790

INDEPENDENT LEARNING ACTIVITIES, 792

Part V. Special Areas of Therapeutic Exercise, 797

Chapter 23. Women's Health: Obstetrics and Pelvic Floor, 797

OVERVIEW OF PREGNANCY, LABOR, AND RELATED CONDITIONS, 798

CHARACTERISTICS OF PREGNANCY AND LABOR, 798

ANATOMICAL AND PHYSIOLOGICAL CHANGES OF PREGNANCY, 800

Weight Gain During Pregnancy, 800

Changes in Organ Systems, 800

Changes in Posture and Balance, 801

OVERVIEW OF PELVIC FLOOR ANATOMY, FUNCTION AND DYSFUNCTION, 801

Pelvic Floor Musculature, 801

Effect of Childbirth on the Pelvic Floor, 802

Classification of Pelvic Floor Dysfunction, 803

Risk Factors for Dysfunction, 803

Interventions for Pelvic Floor Impairments, 804

PREGNANCY-INDUCED PATHOLOGY, 804

Diastasis Recti, 804

Postural Back Pain, 805

Sacroiliac/Pelvic Girdle Pain, 806

Varicose Veins, 806

Joint Laxity, 807

Nerve Compression Syndromes, 807

EXERCISE INTERVENTIONS FOR PREGNANCY, LABOR, AND RELATED CONDITIONS, 807

PHYSIOLOGICAL EFFECTS OF AEROBIC EXERCISE DURING PREGNANCY, 807

Maternal Response to Aerobic Exercise, 807

Fetal Response to Maternal Aerobic Exercise, 808

EXERCISE FOR THE UNCOMPLICATED PREGNANCY AND POSTPARTUM, 808

Guidelines for Managing the Pregnant Woman, 810

Recommendations for Fitness Exercise, 811

Precautions and Contraindications to Exercise, 811

Critical Areas of Emphasis and Selected Exercise Techniques, 812

Pelvic Floor Awareness, Training and Strengthening, 814

Relaxation and Breathing Exercises for Use During Labor, 815

Unsafe Postures and Exercises During Pregnancy, 816

Exercise Critical to the Postpartum Period, 817

CESAREAN CHILDBIRTH, 817

Significance to Physical Therapists, 817

Suggested Activities for the Patient Following a Cesarean Section, 818

HIGH-RISK PREGNANCY, 819

High-Risk Conditions, 819

Management Guidelines and Precautions for High-Risk Pregnancies, 820

INDEPENDENT LEARNING ACTIVITIES, 821

Chapter 24. Management of Vascular Disorders of the Extremities, 825

DISORDERS OF THE ARTERIAL SYSTEM, 825

Types of Arterial Disorders, 825

Clinical Manifestations of Peripheral Arterial Disorders, 826

Examination and Evaluation of Arterial Sufficiency, 827

Management of Acute Arterial Occlusion, 828

Management of Chronic Arterial Insufficiency, 829

Special Considerations in a Graded Exercise Program for Patients with Chronic Arterial Insufficiency, 830

DISORDERS OF THE VENOUS SYSTEM, 831

Types of Venous Disorders, 831

Clinical Manifestations of Venous Disorders, 831

Examination and Evaluation of Venous Sufficiency, 832

Prevention of Deep Vein Thrombosis and Thrombophlebitis, 833

Management of Deep Vein Thrombosis and Thrombophlebitis, 833

Management of Chronic Venous Insufficiency and Varicose Veins, 833

DISORDERS OF THE LYMPHATIC SYSTEM, 834

Conditions Leading to Insufficiency of the Lymphatic System, 835

Clinical Manifestations of Lymphatic Disorders, 835

Examination and Evaluation of Lymphatic Function, 836

Prevention of Lymphedema, 836

Management of Lymphedema, 836

BREAST CANCER-RELATED LYMPHATIC DYSFUNCTION, 838

Background, 838

Surgical Procedures, 838

Impairments and Complications Related to Breast Cancer Treatment, 839

Guidelines for Management After Breast Cancer Surgery, 840

EXERCISES FOR THE MANAGEMENT OF LYMPHEDEMA, 842

Background and Rationale, 842

Components of Exercise Regimens for Management of Lymphedema, 842

Guidelines for Lymphatic Drainage Exercises, 843

Selected Exercises for Lymphatic Drainage: Upper and Lower Extremity Sequences, 843

INDEPENDENT LEARNING ACTIVITIES, 847

Chapter 25. Management of Pulmonary Conditions, 851

REVIEW OF RESPIRATORY STRUCTURE AND FUNCTION, 852

Thorax and Chest Wall: Structure and Function, 852

Muscles of Ventilation, 852

Mechanics of Ventilation, 853

Anatomy and Function of the Respiratory Tracts, 854

The Lungs and Pleurae, 855

Lung Volumes and Capacities, 856

EXAMINATION, 856

Components of the Examination, 857

BREATHING EXERCISES AND VENTILATORY TRAINING, 861

Guidelines for Teaching Breathing Exercises, 861

Diaphragmatic Breathing, 862

Segmental Breathing, 863

Pursed-Lip Breathing, 864

Preventing and Relieving Episodes of Dyspnea, 865

Positive Expiratory Pressure Breathing, 865

Respiratory Resistance Training, 866

Glossopharyngeal Breathing, 866

EXERCISES TO MOBILIZE THE CHEST, 867

Specific Techniques, 867

The Normal Cough Pump, 868

Factors that Decrease the Effectiveness of the Cough Mechanism and Cough Pump, 868

Teaching an Effective Cough, 868

Additional Techniques to Facilitate a Cough and Improve Airway Clearance, 869

Suctioning: Alternative to Coughing, 870

POSTURAL DRAINAGE, 870

Manual Techniques Used with Postural Drainage Therapy, 870

Postural Drainage Positions, 872

Guidelines for Implementing Postural Drainage, 874

Modified Postural Drainage, 874

Home Program of Postural Drainage, 875

MANAGEMENT OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE, 875

Types of Obstructive Pulmonary Disorders, 875

Pathological Changes in the Pulmonary System, 875

Impairments and Impact on Function, 875

Management Guidelines: COPD, 876

MANAGEMENT OF PATIENTS WITH RESTRICTIVE PULMONARY DISORDERS, 876

Acute and Chronic Causes of Restrictive Pulmonary Disorders, 876

Pathological Changes in the Pulmonary System, 876

Management Guidelines: Post-Thoracic Surgery, 876

INDEPENDENT LEARNING ACTIVITIES, 880

Appendix: Systematic Musculoskeletal Examination Guidelines, 883

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ABOUT THIS TITLE - DESCRIPTION

The authoritative source for exercise guidelines for individualizing interventions for individuals with movement disorders! Now, with even more illustrations, this text encompasses all of the principles of therapeutic exercise and manual therapy.

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