Definition of therapeutic exercise: The systematic planned performance Uses of CPM: 1) Ligament repair. 2) Complete joint replacement.

3) Internal
of bodily movements, postures, or physical activities that is meant to improve fixation of fracture. 4) Contractures. Clinical advantage of CPM: 1) Providing
physical function. Components of physical function: 1) Stability. 2) Mobility.early motion. 2) Achieving functional ROM. 3) Reducing pain and edema. 4)
3) Flexibility. 4) Neuromuscular control. 5) Coordination. 6) Cardiopulmonary Increasing circulation. 5) Decreasing stiffness. 6) Reducing hospital stay. 7)
fitness. 7) Muscular performance. 8) Balance. Types of therapeutic exercises:Enhancing healing. 8) Improving synovial fluid. 9) Delaying muscle atrophy.
1) Aerobic. 2) Balance. 3) Breathing. 4) Joint mobilization. 5) Muscular 10)Decreasing incidence of complication. Disadvantages of CPM: 1) Increased
performance. 6) Neuromuscular control. 7) Postural control. 8) Relaxation. 9) time in bed. 2) Does not increase muscular performance. 3) Has high
Stretching. Factors that affect patient safety: 1) Health history. 2) maintenance costs. 4) Mismatching of the united due to different sizes.
Medication. 3) Environment. 4) Exercise safety (comfortable position, no pain, Contraindications of CPM: 1) Unstable fracture. 2) Loss of sensation. 3)
proper posture alignment). Definition of impairment: 1) Change in Untreated infection. CPM precautions: 1) Inability to apply properly. 2) Lack of
physiological, anatomical, and psychological functions and structures of the training. Risks of CPM: 1) Wound complication. 2) Disruption of surgical
body reflects a person’s health status. 2) Pathological conditions that lead to procedure. 3) Malfunction of device. CPM materials: 1) Limb carrier. 2) Motor.
signs and symptoms which reflect abnormalities in the body system. 3) Control. CPM variables: 1) Size of motion arc. 2) The position of motion arc
Classification of impairments: 1) Primary: From main trauma (rotator cuff relative to normal arc of the joint. 3) Rate of motion. Characteristics of CPM: 1)
muscles inflammation). 2) Secondary: Problems that are left untreated Fit to anatomy. 2) Adjustable. 3) Designed to resist fatigue. 4) Easy to control. 5)
(example: change of mechanics of upper limb extremity). Types of Portable. Application of CPM: 1) 72 hours after surgery. 2) For 24 hours. 3) For
impairments: 1) Musculoskeletal (muscle weakness, tightness, pain, or faulty 1-4 weeks.
posture) 2) Neuromuscular (pain, hypotonia, incoordination, impaired Definition of AAROM: Movement performed within the unrestricted
balance). 3) Cardiopulmonary (impaired circulation, decreased ROM controlled by the voluntary contraction of the muscle, in which
cardiopulmonary endurance). 4) Dermatological (skin hypermobility, scar). assistance is provided by an outside force, either manual or mechanical, when
What is the patient management model? 1) Examination (history, chief x strength is inadequate to complete the motion. Principles of AA exercises: 1)
complaint, observation, palpation, special tests and measurement) 2) Collect When the voluntary contraction is inadequate to produce movement, an
and evaluate data. 3) Determine diagnosis. 4) Set treatment plan. i. Short term external force may be added. 2) The external force must be in the direction of
goals. ii. Long term goals. iii. Intervention. General aims of therapeutic the muscle’s action. 3) The magnitude of the force must be enough to assist but
exercise: 1) Reduce pain and edema. 2) Restore joint flexibility. 3) Regain not to substitute. 4) As muscular power increases, assistance should be
confidence. 4) Increase ROM, muscular performance, and circulation. decreased. Types of assistance: 1) Manual. i. By therapist. ii. By sound limb
ROM definition: The degree to which a body segment can move relative to (self-assisted). 2) Mechanical. i. Slings. ii. Pulleys. iii. Wheels. Uses of AAROM:
another body segment. Types of ROM: 1) Passive. 2) Active. 3) Active-assisted. 1) Increase strength. 2) Increase ROM. 3) Increase confidence. 4) Increase
Types of movements: 1) Abduction & adduction. 2) Flexion & extension. 3) circulation. 5) Improve coordination. 6) Maintain elasticity and contractility. 7)
Internal & external rotation. 4) Elevation & depression. 5) Supination & Provide sensory feedback (Muscle reeducation). Indication of AA exercise: 1)
pronation. 6) Dorsiflexion & plantarflexion. 7) Protraction & retraction. 8) Increase ROM. 2) Muscle weakness. 3) Muscle reeducation. 4) Inability to do
Circumduction. 9) Opposition. 10)Gliding. Planes of movement and their ADL. 5) After tendon transplantation. Contraindication of AA exercise: 1)
axes: 1) Sagittal - Mediolateral or frontal. 2) Frontal - Anteroposterior or Fever. 2) Pain. 3) DVT. 4) Recent fracture. 5) Myocardial infarction. 6)
sagittal. 3) Horizontal - Longitudinal or vertical. 4) Oblique - No axis. Types of Cardiopulmonary dysfunction. Precautions of AA exercise: Only proximal or
joints: 1) Fibrous: No movement (Skull joints). 2) Cartilaginous: Limited distal to injured sites to minimize venous stasis and thrombus formation.
movement (Intervertebral joints). 3) Synovial: Free movement. Technique of AA exercise: 1) The starting position must be stable and reduce
Characteristics of synovial joints: 1) Covered by smooth cartilage to reduce the tension in antagonistic muscles. 2) The pattern of movement is explained
friction. 2) The joint is enclosed by capsular ligament. 3) Capsular ligament is on the sound limb. 3) Fixation of proximal segment to avoid substitution. 4)
lined with synovial membrane. 4) Synovial membrane secrets synovial fluid Support of moving parts to eliminate gravity and reduce load. 5) Traction of the
which works as waterproofing, lubricates joints, shock absorber. 5) The joint is weak muscles stimulates contraction. 6) The direction of assistance must be
covered by strong ligaments and strong connective tissue to allow normal the same as movement. 7) Movement is performed smoothly. 8) Repetition
ROM and prevent dislocation. Types of synovial joints: 1) Ball and socket (Hip depends on the patient’s condition. 9) Patients must exert maximum effort.
and shoulder). 2) Hinge (Elbow and knee). 3) Pivot (Radioulnar joint). 4) Saddle Definition of AROM: Performed by the patient’s own muscular efforts
(Thumb). 5) Ellipsoid (Atlantoaxial). 6) Gliding (Carpals and tarsals). Types of within the unrestricted ROM without the assistance or resistance of any
muscle fibers: 1) ST I: i. Red in color (Due to high hemoglobin and external force other than gravity. Types of active movements: 1) Generalized.
mitochondria). ii. Slow. iii. O2 efficient. iv. Fatigue resistant. v. Useful in 2) Localized. Indications of active free exercise: 1) Muscle weakness. 2)
endurance ex. 2) FT II A: i. Pink in color. ii. Rapid. iii. Intermediate fatigue Postural deformities. 3) Inability to do ADL. 4) Increase lung capacity. 5)
resistance. iv. Produce more force. 3) FT II B: i. White in color. ii. Rapid. iii. Low Improve circulation. Contraindications of active free exercise: 1) Recent
fatigue resistance. iv. Max strength. v. Useful in strength ex. Types of fracture. 2) Recent tendon or ligament tear. 3) Inflammation and pain. 4)
contractions: 1) Isometric (Constant length). 2) Isotonic (Contant load). i. Recent surgery. 5) TB of bone. Uses of active free exercise: 1) Relaxation. 2)
Concentric. ii. Eccentric. 3) Isokinetic (Constant speed). Roles of muscles: 1) Joint mobility. 3) Increase power and endurance. 4) Coordination. 5)
Agonist. 2) Antagonist. 3) Synergist. 4) Fixator. Confidence. 6) Circulatory and respiratory cooperation. Goals of active free
Definition of PROM ex: Movement performed within unrestricted ROM exercise: 1) Increase circulation. 2) Increase ROM. 3) Increase muscular
by external force (Therapist or equipment) without any muscle contraction performance. 4) Increase rate and depth of breathing. 5) Improve posture and
done by patient. Types of passive movement: 1) Relaxed. 2) Stretching. 3) gait. 6) Improve coordination and balance. 7) Correct deformities. 8) Achieve
Mobilizing. Goals of passive movement: 1) Maintain ROM. 2) Reduce pain and ADL. Causes of immobilization: 1) Fractures 2) Surgeries. 3) Paralysis. 4)
edema. 3) Improve circulation. 4) Increase nutrition to joint capsule. 5) Explain Arthritis. 5) Pain. Effects of immobilization: 1) Loss bone density/
active exercise. 6) Evaluate muscle. 7) Assist in healing process. 8) Provide Osteoporosis (Lack of muscle contraction and weight bearing forces). 2)
sensory stimulation. Indications of relaxed passive movement: 1) Comatose. Muscle atrophy (ST fibers exhibit greater atrophy than FT). 3) Collagenous: i.
2) Paralysis. 3) Immobilization. 4) Surgical interference. 5) Muscle reeducation. Fibrosis: Imbalance between collagen synthesis and degradation. ii. Adhesion:
Contraindications of relaxed passive movement: 1) Pain. 2) Inflammation. Formation of cross link fibers. 4) Thinning of cartilage (Due to muscle atrophy,
3) Fever. 4) Recent fracture. 5) DVT. 6) Abnormal blood pressure. 7) Open lack of loading, and decreased synovial fluid formation).
wound. Characteristics of relaxed passive movement: 1) Slow. 2) Rhythmic. Components of muscular performance: 1) Strength. 2) Power. 3)
3) Repetitive. 4) Smooth. 5) Through full ROM. Principles of application of Endurance. Definition of active resisted exercise: It is a form of active
relaxed passive movement: 1) Complete evaluation. 2) Prepare the patient. 3) exercise in which a dynamic or static muscular contraction is resisted by an
Maintain body mechanics. 4) Check the vital signs. 5) Ensure sufficient space. outside force. The external force may be applied manually or mechanically.
6) Prepare for application. 7) Repeat the movement 5 to 10 times. Limitations Indications of AR exercise: Increase muscular performance (SPE). Increase
of relaxed passive movement: 1) Cannot increase ROM. 2) Cannot prevent strength, muscular endurance and power. Contraindications of AR exercise:
atrophy. Mechanism of action for CPM: 1) Movement of synovial fluid. 2) 1) Pain. 2) Inflammation. 3) Cardio-pulmonary problems.
Prevention of scar tissue formation.
Precautions of Active Resisted exercise: 1) Pain. 2) Heavy resistance with Posture is described by: 1) The positions of joints and body segments. 2) The
children or elderly. 3) Osteoporosis. 4) Unstable joints. 5) Avoid holding breath balance between the muscles crossing the joints. Impairments may lead to
(Valsalva maneuver). 6) Prevent sub motions. 7) Avoid cumulative fatigue. 8) faulty posture and vice versa. Curves of the spine: 1) Two primary or
Be aware of medication. Definition of Valsalva maneuver: Moderately posteriorly convex. 2) Two compensatory or anteriorly convex. Lateral
forced expiration against closed air way, usually done by closing mouth while surface landmarks: 1) Anterior to: i. Lateral malleolus. ii. Axis of knee joint. 2)
expelling air out as if blowing up a balloon. Effects of Valsalva maneuver: 1) Posterior to the axis of the hip joint. 3) Through: i. Greater trochanter. ii.
Increase intra-abdominal pressure. 2) Decrease venous return. 3) Decrease Lumbar and cervical vertebrae. iii. Shoulder joint. iv. Lobe of the ear. Spinal
cardiac output. 4) Decrease blood pressure. 5) Increase heart rate. Uses of stability: 1) Passive: i. Inert structures. ii. Bones and ligaments. 2) Active
Valsalva maneuver: 1) Test cardiac function. 2) Nervous control of heart. 3) (Muscles). 3) Neural control. Spinal instability: 1) Tissue damage. 2)
Clear sinuses and ears. Types of muscle soreness: 1) Acute. 2) Delayed Insufficient muscular strength or endurance. 3) Poor neuromuscular control.
(DOMS). Signs of DOMS (Delayed-onset muscle soreness): 1) Decreased Influence of inert structures: 1) Neutral zone (Minimal resistance and
ROM. 2) Increased soreness with passive or active contraction after 12-24 hours stability). 2) Elastic zone (Restraint as passive resistance and stability in the
of exercise, peaks at 48-72 hours, and can last up to 10-14 days. 3) Muscle direction of movement limits). Influence of bones and ligaments: Sensory
stiffness. 4) Tenderness with palpation. 5) Local edema and warmth. 6) receptors sense position and changes in it to provide feedback to the CNS and
Decreased strength. Etiology of DOMS: 1) Microtrauma to muscle fiber. 2) influence the neural control system. Influence of muscles: 1) Trunk and neck:
Elevated creatine kinase in blood. 3) Force production deficits in Z bands. How i. Prime movers of antagonists during dynamic activity. ii. Stabilizers of the
to prevent DOMS: 1) Progress intensity slowly. 2) Perform low intensity spine. 2) Superficial and deep: maintain upright position. 3) Global muscles: i.
warmup and cooldown activities. 3) Use repetitive concentric exercises before Multisegmented ii. Respond to external load on the trunk to maintain COG. iii.
eccentric. Types of resistance: 1) Isotonic. 2) Isometric. 3) Isokinetic. Their reaction is direction specific. iv. Contain more ST I muscle fibers
Determinates of resisted exercise: 1) Intensity. 2) Volume. 3) Frequency. 4) (Inactivity can change their composition and cause low back pain). Influence
Velocity. 5) Duration. Types of applied resistance: 1) Manual. 2) Mechanical. of neural control: Neck and trunk muscles are controlled by the nervous
Advantages of manual resisted exercise: 1) Useful for dynamic or static system, which is influenced by peripheral and central mechanisms in response
strengthening. 2) Direct stabilization prevents sub motions. 3) Most effective to fluctuating forces and activities. The nervous system coordinates
during early stages of rehab. 4) Gives the therapist an opportunity for direct response of muscles to: 1) Expected and unexpected forces at the right time by
interaction with the patient. Disadvantages of manual resisted exercise: 1) the right amount. 2) By modulating stiffness and movement to match the
The amount of resistance is subjective. 2) Speed is only slow to moderate. 3) Not imposed forces. Definition of kyphosis: 1) Posterior convexity of the vertebra.
useful in home program. 4) Time and effort consuming. 5) Impractical for 2) Excessive forward bending in the thoracic area. Types of kyphosis: 1)
increasing endurance. Advantages of mechanical resisted exercise: 1) The Postural. 2) Scheuermann. 3) Congenital. Causes of kyphosis: 1) Anterior
amount of resistance is objective. 2) Useful for resistance training. 3) Can compression of intervertebral discs. 2) Stretched thoracic extensors (Middle
provide more resistance than manual. Types of resistance equipment: 1) Free and lower traps) and posterior ligaments. 3) Tightness of: i. Anterior
weights: i. Barbell. ii. Dumbbell. iii. Cuff weights. iv. Sandbags. v. Weight longitudinal ligaments. ii. Upper abdominal. iii. Anterior chest. Muscle
boots. 2) Elastic resistance bands. 3) Exercise bicycle. 4) Pulley system. General contractures that lead to Scheuermann kyphosis: 1) Hamstrings. 2)
principles for equipment: 1) Evaluate: i. Strength. ii. ROM. iii. Bone and joint Pectoralis. Scheuermann kyphosis is more common in Males.
deformities. iv. Pain. v. Integrity of skin. 2) Determine the most appropriate Scheuermann kyphosis is tested by: 1) Adam’s test. 2) Radiological
equipment. 3) Adhere to safety precautions: i. Ensure all attachments are evaluation. Signs of Scheuermann kyphosis: 1) Spine rigidity. 2) Kyphotic
securely adjusted. ii. Apply padding for comfort. iii. Stabilize structures to lump. 3) Increased lordosis. 4) Tightness of hamstrings. 5) Thoracic cobb’s
prevent sub motions. Max rep techniques: 1) Delorme: Low to high (To angle > 45 degrees. 6) Vertebral wedging. 7) Schmorl nodes. 8) Narrowing of
increase strength). 2) Oxford: High to low (To decrease fatigue). intervertebral space. Treatment of Scheuermann kyphosis: 1) Non operative
Definition of flexibility: the ability of body to move (a single joint or (If cobb’s angle = 55-80, Risser 0-3): i. Brace (16-22 hours daily). ii. Exercise. 2)
series of joints) smoothly and easily through an unrestricted, pain-free ROM. Operative (If cobb’s angle > 80 or non-operative failed): i. Smith-Peterson
Types of flexibility: 1) Passive (depends on extensibility of connective tissue). posterior osteotomies. ii. Combined anterior-posterior approach. Schools of
2) Dynamic ( depends on degree of joint movement by muscle contraction). scoliosis: 1) Schroth (Germany). 2) Lyon (France). 3) SEAS (Italy). 4) BSPTS
Importance of flexibility: 1) Increase ROM. 2) Improve performance. 3) (Spain). 5) Side Shift (UK). 6) Dobomed (Poland). 7) FITS (Poland). Aim of non-
Prevent soft tissue injuries. 4) Aid muscle relaxation. 5) Warmup and operative treatment: 1) 3D treatment of deformity. 2) Stop progression. 3)
cooldown. Factors affecting flexibility: 1) Age and gender. 2) Joint structure. Improve appearance. 4) Train for ADL. 5) Decrease pain. 6) Improve breathing
3) Body Fat. 4) Muscle imbalance. 5) Immobilization. Definition of and quality of life. Principles of BSPTS: 1) 3D postural correction. 2)
contracture: Marked shortening of a muscle or other tissue (skin, fascia, or Expansion/Contraction techniques. 3) Self-control of the internal volumes
joint capsule) crossing a joint resulting in a limitation of ROM. Types of (Supported by breathing mechanics). 4) Muscle activation maintaining a stable
contractures: 1) Myostatic: Muscle shortens with no pathology (treated by 3D correction (Any kind of contraction). 5) Integration. Schroth exercises: 1)
stretching). 2) Pseudo Myostatic: Hypertonicity due to CNS lesion (treated by Sagittal: Semi-hanging. 2) Transverse: i. Prone on knees anterior gravity
inhibition). 3) Arthrogenic and peri articular: Intraarticular pathology, like assisted. ii. Supine gravity assisted. Categories of scoliosis: 1) Structural/
adhesions and effusions. 4) Irreversible: Muscle fibrosis. Definition of hypo Morphological (Cobb’s angle > 10 + axial rotation). 2) Non-structural/
mobility: Decreased and ROM due to pathological condition which leads to Functional (No axial rotation). Types of scoliosis: 1) Idiopathic: i. 0-3: Infantile.
contracture and spasm. Factors affecting hypo mobility: 1) Period of ii. 3-9: Juvenile. iii. 10-18: Adolescent (most common in females). iv. More than
immobilization. 2) Sedentary life. 3) Muscle imbalance. 4) Posture 18: Adult. 2) Congenital: i. Better prognosis in hemi-vertebrae. ii. Worse
abnormalities. Indications of stretching: 1) Restricted ROM. 2) Post traumatic prognosis in bar with hemi-vertebrae. 3) Neuromuscular: i. Neuropathic: 1.
or immobilization stiffness. 3) Bone deformity. 4) Joint or soft tissue pathology. Cerebral Palsy. 2. Spinal muscular atrophy. 3. Spinal cord trauma. ii.
5) Contracture and spasm. Contraindications of stretching: 1) Pain. 2) Myopathic: 1. Muscular dystrophy. 2. Polio. 3. Arthrogryposis. 4. Spina Bifida.
Infection. 3) Recent fracture. 4) Synovial effusion. 5) Bony block. Goals of iii. Long curves. iv. Balance and coordination disorders. v. Pelvic obliquity.
stretching: 1) Regain ROM. 2) Prevent irreversible contractures. 3) Increase Classification of scoliosis: 1) Double curve of L & T (Lumbar major). 2) Double
flexibility. 4) Prevent injuries. Types of stretching: 1) Static: i. Position. ii. curve of T & L (Thoracic major. 3) Single thoracic curve. 4) Long thoracic curve.
Passive: 1. Manual (20-30 seconds). 2. Mechanical (20-30 minutes). 2) Dynamic: 5) Double thoracic curve. Radiological examination of scoliosis: 1) X-Ray: i.
Ballistic (Not real stretch). 3) Self. 4) PNF (Proprioceptive Neuromuscular Frontal. ii. Sagittal. 2) Vertebral rotation. 3) Risser sign. Nash and Moe: 0) Both
Facilitation): i. CR (Contract-relax method: Reciprocal inhibition). ii. HR (Hold- pedicles in view. 1) Pedicle in concave side. 2) Pedicle disappears. 3) Pedicle in
relax method: Autogenic inhibition). iii. Slow reversal HR (Reciprocal midline. 4) Pedicle crosses midline. Signs of scoliosis: 1) Head is not centered
inhibition). Ballistic stretching causes muscle: 1) Soreness. 2) Injury. 3) over pelvis. 2) One shoulder is higher on the convex side. 3) One hip is higher or
Microtrauma to muscle fiber. 4) Tension and spasm. more prominent on concave side. 4) One scapula is higher or more prominent
Definition of posture: 1) Position or attitude of body. 2) The relative than the other. 5) There is space between arms and body on one side.
arrangement of body parts for a specific activity. 3) A characteristic manner of Progression factor= Cobb’s angle – (3*Risser’s sign)/Age.
bearing one’s body. 4) Alignment of body parts, whether upright, sitting, or lying.
Types of scoliosis braces: 1) Milwaukee. 2) Boston. 3) Nighttime/Charlston. 4) There are special terms to active resisted ex.: •1- Strength :the ability of the
Soft. 5) Rigo/Cheneau/Gensigen. muscle to contract and produce tension maximal load one time (1RM). •2-
The progression factor is the ratio of the desired total rotation needed to Power: muscles generate tension to do work and work performed over period
achieve a certain band pattern structure (Target Angle), to the total rotation of of time. Power : force x distance /time •3-Endurance : the ability of the muscle
the generated path around the mandrel for one circuit (Actual angle). to produce low intensity repetitive movement. Muscle performance: •is
Benefits of Cooling down and warming up: 1)warming up: increase the usually considered a function of strength; however, strength is only one of the
heart rate and respiratory rate which increases the blood flow. 2) cooling three components of muscle performance: strength, power, endurance.
down: rid waste products from the muscles, prevent blood pooling and
promote the delivery of oxygen and nutrients to the muscles. Aids in recovery 1- d 2- e 3- b 4- c 5- a 6- a 7- b 8- d 9- e 10- a 11- c 12- a 13- a 14- d 15- a
process. how to avoid Valsalva maneuver? instruct patient not to hold 16- b 17- c 18- d 19- a
breath- ask patient to count or talk with him- breath rhythmically-
discontinue exercise if patient feels pain, dizziness or shortness of breath.
Idiopathic Scoliosis Definitions: Lateral curve of the spine in an otherwise
healthy child, for which a currently recognizable cause has not been found.
Lateral curvature of the spine greater or equal to 10° with rotation, of unknown
cause. Complex 3D deformity of the spine and the trunk involving
morphological as well as geometrical changes, not yet well understood.
Idiopathic Scoliosis can be defined as a complex three- dimensional deformity
of the spine and trunk, which appears in apparently healthy children, and can
progress in relation to multiple factors during any rapid period of growth, or
later in life. Signs of Scoliosis: The head is not centered over the pelvis. One
shoulder may be higher than the other (on the convex side). One scapula
(shoulder blade) may be higher or more prominent than the other. With the
arms hanging loosely at the side, there may be more space between the arm
and the body on one side. One hip may appear to be higher or more prominent
than the other. (on concave side).
Differential diagnosis/Clinical evaluation: 1)Postural/Functional kyphosis:
• Poor posture • Shoulders internal rotation, often forward head position •
Flexible spine • No angular kyphotic hump (Adam's test) • Sedentary lifestyle. •
Lack of exercise 2)Scheuermann kyphosis: • Poor posture • Shoulders internal
rotation, often forward head position • Spine rigidity • Angular kyphotic hump
• Difficult of active extension during Adam's test • Often increased lordosis •
Pain 20-60% • Tightness of ischiotibialis.