Download Exercise Therapy Carolin Kisner PDF

TitleExercise Therapy Carolin Kisner
File Size40.9 MB
Total Pages957
Table of Contents
Therapeutic Exercise: Foundations and Techniques, Fifth Edition
	Copyright © 2007 by F. A. Davis Company
	Brief Contents
	Part I
: General Concepts
		Chapter 1: Therapeutic Exercise: Foundational Concepts
		Chapter 2: Prevention, Health,and Wellness
	Part II: Applied Science of Exercise and Techniques
		Chapter 3: Range of Motion
		Chapter 4: Stretching for Impaired Mobility
		Chapter 5: Peripheral Joint Mobilization
		Chapter 6: Resistance Exercise For Impaired Muscle Performance
		Chapter 7: Principles of Aerobic Exercise
		Chapter 8: Exercise for Impaired Balance
		Chapter 9: Aquatic Exercise
	Part III: Principles of Intervention
		Chapter 10: Soft Tissue Injury, Repair, and Management
		Chapter 11: Joint, Connective Tissue, and Bone Disorders and Management
		Chapter 12: Surgical Interventions and Postoperative Management
		Chapter 13: Peripheral Nerve Disorders and Management
	Part IV: Exercise Interventions by Body Region
		Chapter 14: The Spine and Posture: Structure, Function, Postural Impairments, and Management Guidelines
		Chapter 15: The Spine: Impairments, Diagnoses, and Management Guidelines
		Chapter 16: The Spine: Exercise Interventions
		Chapter 17: The Shoulder and Shoulder Girdle
		Chapter 18: The Elbow and Forearm Complex
		Chapter 19: The Wrist and Hand
		Chapter 20: The Hip
		Chapter 21: The Knee
		Chapter 22: The Ankle and Foot
	Part V: Special Areas of Therapeutic Exercise
		Chapter 23: Women’s Health: Obstetrics and Pelvic Floor
		Chapter 24: Management of Vascular Disorders of the Extremities
		Chapter 25: Management of Pulmonary Conditions
	Appendix: Systematic Musculoskeletal Examination Guidelines
Document Text Contents
Page 2

Therapeutic Exercise
Foundations and Techniques


00Kisner (F)-FM 3/9/07 1:28 PM Page i

Page 478

the patient to roll forward or backward during the
stretch. Hold this position for a sustained period of time
(Fig. 16.13).
Patient position and procedure: Side-lying over the edge
of a mat table with a rolled towel at the apex of the
curve and the top arm stretched overhead. Stabilize the
iliac crest. Hold this head-down position as long as pos-
sible (Fig. 16.14).

they may be beneficial in gaining some flexibility prior to
surgical fusion of the spine for correcting a scoliotic defor-
mity. They may also be used to regain flexibility in the
frontal plane when muscle or fascial tightness is present
with postural dysfunction. All of the following exercises
are designed to stretch hypomobile structures on the con-
cave side of the lateral curvature.

When stretching the trunk, it is necessary to stabilize
the spine either above or below the curve. If the patient
has a double curve, one curve must be stabilized while
the other is stretched.

Patient position and procedure: Prone. Stabilize the
patient at the iliac crest (manually or with a belt) on
the side of the concavity. Have the patient reach toward
the knee with the arm on the convex side of the curve
while stretching the opposite arm up and overhead
(Fig. 16.10). Instruct the patient to breathe in and
expand the rib cage on the side being stretched.

C H A P T E R 1 6 The Spine: Exercise Interventions 449

FIGURE 16.10 Stretching hypomobile structures on the concave side of the
thoracic curve. Illustrated is a patient with a right thoracic left lumbar curve.
The therapist stabilizes the pelvis and lumbar spine while the patient actively
stretches the thoracic curve.

Patient position and procedure: Prone. Have the patient
stabilize the upper trunk (thoracic curve) by holding onto
the edge of the mat table with the arms. Lift the hips and
legs and laterally bend the trunk away from the concavity
(Fig. 16.11).
Patient position and procedure: Heel-sitting. Have the
patient lean forward so the abdomen rests on the anterior
thighs (Fig. 16.12A); the arms are stretched overhead
bilaterally, and the hands are flat on the floor. Then have
the patient laterally bend the trunk away from the con-
cavity by walking the hands to the convex side of the
curve. Hold the position for a sustained stretch (Fig.
Patient position and procedure: Side-lying on the convex
side of the curve. Place a rolled towel at the apex of the
curve, and have the patient reach overhead with the top
arm. Stabilize the patient at the iliac crest. Do not allow

FIGURE 16.11 Stretching hypomobile structures on the concave side of a
left lumbar curve. The patient stabilizes the upper trunk and thoracic curve
as the therapist passively stretches the lumbar curve.

FIGURE 16.12 (A) Heel-sitting to stabilize the lumbar spine. (B) Hypomobile
structures on the concave side of a right thoracic curve are stretched by hav-
ing the patient reach the arms overhead and then walk the hands toward the
convex side.

FIGURE 16.13 Stretching tight structures on the concave side of a right
thoracic curve. The patient is positioned side-lying with a rolled towel at the
apex of the convexity. The lumbar spine is stabilized by the therapist.

16Kisner (F)-16 3/9/07 1:12 PM Page 449

Page 479

Techniques to Increase Hip Muscle Flexibility
Hip muscles have a direct effect on spinal posture and
function because of their attachment on the pelvis. It is
important that they have adequate flexibility for proper
pelvic and spinal alignment. See Chapter 20 for specific
stretching techniques of hip musculature.

Traction as a Stretching Technique
Manual Traction—Lumbar Spine
Manual traction is not as easily applied in the lumbar
region as in the cervical region. At least one-half of the
body weight of the patient must be moved, and the coeffi-
cient of friction of the part to be moved also must be over-
come to cause vertebral distraction and stretching. It is
helpful to place the patient on a split-traction table for ease
in moving and stretching the spine.

Patient position: Supine or prone. Stabilize the thorax with
a harness that is secured to the head end of the table or
have an assistant stabilize the patient by standing at the
head of the table and holding the patient’s arms. Position
the patient so there is maximal stretch on the hypomobile

To stretch into extension, extend the hips.
To stretch into flexion, flex the hips.
To stretch into side bending, move the lower extremities
to one side.

Therapist position and procedures: Position yourself so
effective body mechanics and body weight can be used.

If the lower extremities are extended to emphasize spinal
extension, exert the pull at the ankles.
If the lower extremities are flexed to emphasize spinal
flexion, drape the legs over your shoulders and exert the
stretch force with your arms wrapped across the patient’s
thighs. As an alternative, place a pelvic belt with straps
around the patient and manually pull on the straps.

Positional Traction—Lumbar Spine
The value of positional traction is that the primary traction
force can be directed to the side on which symptoms occur,
or it can be isolated to a specific facet and is therefore ben-
eficial for selective stretching.39

Patient position: Side-lying, with the side to be stretched
uppermost. A rolled blanket is placed under the spine at the
level where the traction force is desired; this causes side
bending away from the side to be treated and therefore an
upward gliding of the facets (Fig. 16.15A).

Therapist position: Standing, at the side of the treatment
table facing the patient. Determine the segment that is to
receive most of the traction force and palpate the spinous
processes at that level and the level above.

Procedure: The patient relaxes in the side-bent position.
Rotation is added to isolate a distraction force to the
desired level. Rotate the upper trunk by gently pulling
on the arm on which the patient is lying while simultane-
ously palpating the spinous processes with your other
hand to determine when rotation has arrived at the level
just above the joint to be distracted. Then flex the patient’s
uppermost thigh, again palpating the spinous processes
until flexion of the lower portion of the spine occurs at
the desired level. The segment at which these two oppos-
ing forces meet now has maximum positional distraction
force (Fig. 16.15B).

N O T E : Mechanical traction units can provide consider-
able stretch force to the tissues of the thoracic and lumbar
spine. Positioning considerations are as described for manual
traction. Instructions for use of the equipment are not part
of this text.


FIGURE 16.14 Side-lying over the edge of a mat table to stretch hypomobile
structures of a right thoracic scoliosis. The therapist stabilizes the pelvis.


FIGURE 16.15 Positional traction for the lumbar spine. (A) Side bending over
a 6- to 8-inch roll causes longitudinal traction to the segments on the
upward side. (B) Side-bending with rotation adds a distraction force to the
facets on the upward side.

16Kisner (F)-16 3/9/07 1:12 PM Page 450

Page 956

adaptations to resistance exercise, 159
inferior vena cava compression during preg-

nancy, 808, 810, 810f
in reflex sympathetic dystrophy, 378–379
in thoracic outlet syndrome, 370, 371
varicose veins in pregnancy, 806–807
vascular disorders of extremities, 825–847

(See also Peripheral vascular disease

Vasoconstriction, 896
Vastus intermedius muscle, 361f
Vastus lateralis muscle, 361f, 690, 690f
Vastus medialis muscle, 361f, 690, 690f
Vastus medialis obliquus (VMO) muscle

exercises after proximal realignment of exten-
sor mechanism, 720

exercises for patellofemoral pain syndrome,

insufficiency of, 691
open-chain exercises for, 745, 746

VC (vital capacity), 856, 856f, 896
Velocity of exercise

resistance exercise, 165–166, 165f
dynamic constant external resistance, 172
eccentric and concentric, 171
force-velocity relationship, 165–166, 165f
isokinetic, 173, 173t, 211
plyometric activities, 210
variable-resistance, 172

stretching, 80
Velocity spectrum rehabilitation, 166, 211, 896
Venography, 832
Venous disorders, 831–834

chronic venous insufficiency and varicose
veins, 831, 832, 835

management of, 833–834
clinical manifestations of, 831–832
examination and evaluation of venous suffi-

ciency, 832
thrombophlebitis and deep vein thrombosis,

334, 656, 705, 707, 716, 719, 831–833,

management of, 833
prevention of, 833
risk factors for, 831

Venous stasis ulcers, 831, 835
Ventilation, 852–854, 896. See also Breathing.
Ventilatory muscle training, 861–867, 896. See

also Breathing exercises.
Vertebra(e), 408

articulations with ribs, 852, 852f
compression fracture of, 319f, 412

Vesicular breath sounds, 860
Vestibular system, 253
Vestibulo-ocular reflex, 253
Vests, for aquatic exercise, 277
Vibration, during postural drainage, 871, 871f,

Viscosity of water, 275
Visual imagery, during labor, 815
Visual system, 253, 265
Vital capacity (VC), 856, 856f, 896
VMO. See Vastus medialis obliquus muscle.


balance during, 258
in balance training program, 266, 267
deep-water, 290, 290f
effects on spine, 473
fundamental techniques for, 474

for knee disorders, 697
movements in the air, 847, 847f
in patients with deep vein thrombosis and

thrombophlebitis, 833
program for patients with chronic arterial

insufficiency, 830
against resistance, 476, 681, 681f, 791

Wall climbing, 60, 60f
Wall press, overhead, 846, 846f
Wall slides, 475–476, 475f, 680, 680f, 697, 708,

723, 749
with external hip rotation, for lymphedema,

846–847, 847f
gravity-assisted supine, 743–744, 744f

Wall (window) washing, 530
Wand (T-bar) exercises, 59–60, 59f

for early motion of glenohumeral joint, 530,

for lymphedema, 845
to stretch pectoralis major muscle,

535, 535f
Warm-up period

for aerobic exercise, 240
for resistance exercise, 163, 181
for stretching, 91, 92–93

Water. See also Aquatic exercise.
physical properties of, 274–276, 275f, 276f
temperature for therapeutic exercise,

Watson-Jones procedure, 780
Weakness, 65–66, 71, 296

patterns with peripheral nerve injuries
in lower extremity, 359t–360t
in upper extremity, 354t

in peripheral arterial disease, 827
Weaver’s bottom, 671
Weight bearing

after Achilles tendon repair, 783–784, 784t,

ankle/foot hypomobility and pain during,

after ankle or foot arthrodesis, 775
after anterior cruciate ligament reconstruction,

avoiding unilateral activities in pregnancy,

810, 817
after distal realignment of extensor mecha-

nism of knee, 721
exercises for patellofemoral pain syndrome,

after lateral retinacular release, 716
after meniscal surgery, 740, 742
after posterior cruciate ligament reconstruc-

tion, 736
after proximal realignment of extensor mecha-

nism of knee, 719
after repair of ankle ligaments, 780
after total ankle arthroplasty, 772
after total hip arthroplasty, 657–658
after total knee arthroplasty, 705–706

Weight-bearing exercise. See also Closed-chain

in spinal rehabilitation, 474–476, 475f
Weight-pulley systems, 214, 214f

advantages and disadvantages of, 215
characteristics of, 214–215
for dynamic constant external resistance exer-

cise, 172, 172f
for elbow exercises, 584, 584f
for spine exercises, 471
walking against resistance of, 476, 681

Weight-shift strategy for balance control, 255

Tunnel of Guyon, 356
ulnar nerve entrapment in, 377–378, 594

TV (tidal volume), 856, 856f, 896

Ulna, 127f, 131f, 559f, 590f, 599
Ulnar artery, 374f
Ulnar nerve, 353, 353f, 356, 357f, 374f, 561

compression in cubital tunnel, 561
compression in tunnel of Guyon, 377–378,

injury of, 354t, 356–357
testing and mobilization techniques for, 368,

368f, 378
Ulnomeniscal-triquetral joint, 133

self-mobilization of, 598, 598f
subluxated, unlocking of, 597

ULNT (upper limb neurodynamic test), 367
Ultrasound feedback, 30, 30f, 452–453
ULTT (upper limb tension test), 351, 367,

Upper body ergometer, 221, 221f, 473, 549,

Upper extremity. See also Elbow; Forearm;

Hand; Shoulder; Wrist; specific structures.
aquatic exercises for

independent strengthening exercises,
288–289, 288f

manual resistance exercises, 283–285,

manual stretching, 280–281, 280f
self-stretching, 282

breast cancer–related lymphedema of,


extension pattern, 196t, 198–199, 198f,


flexion pattern, 196t, 197–198, 198f, 548

extension pattern, 196t, 199–200, 199f,


flexion pattern, 196t, 199, 199f, 548, 548f

functional performance tests for, 885
lymphatic drainage exercises for, 844–846,

manual resistance exercises for, 188–191,

manual stretching techniques for, 94–99,

neural testing and mobilization techniques for,

367–368, 368f
plyometric activities for, 209, 211
PNF diagonal patterns for, 196t, 197–200,

198f–199f, 548, 548f
range of motion techniques for, 47–51,

self-assisted, 57–58, 57f–58f

Upper limb neurodynamic test (ULNT), 367
Upper limb tension test (ULTT), 351, 367, 371
Urinary incontinence, 803
Urinary system, in pregnancy, 800

involution of, 799
in pregnancy, 800, 808

Vaginal birth after cesarean, 817
Valsalva maneuver, 392–393, 896

avoiding in pregnancy, 821
during resistance exercise, 182–183

Variable-resistance exercise, 172, 894
Variable-resistance machines, 172, 215–216,

Varicose veins, 831, 832, 833–834

Index 927

28Kisner (F)-Index 3/9/07 1:26 PM Page 927

Page 957

Weights. See Free weights.
Wellness, 37, 40–42
Western Ontario and McMaster Universities

Osteoarthritis Index (WOMAC), 695–696
Wheezes, 860, 896
Windlass effect, 763
Wolff’s law, 150
WOMAC (Western Ontario and McMaster Uni-

versities Osteoarthritis Index), 695–696
Women’s health issues

anterior cruciate ligament injuries in athletes,

osteoporosis prevention, 320
pregnancy, 797–821
risk for hip fracture, 664

Work, 234
intermediate to advanced exercises for spinal

control during, 477–478
site assessment, 38t

World Health Organization
International Classification of Functioning,

Disability, and Health, 5, 5t, 8
International Classification of Impairments,

Disabilities, and Handicaps, 4–5, 5t
Wound healing, 835, 836
Wrist, 589–638. See also Hand; specific

bones and joints of, 131f, 590, 590f
in carpal tunnel syndrome, 373–377
exercise techniques for, 631–638

to improve muscle performance, neuromus-
cular control, and coordinated move-
ment, 636–638, 636f–637f

to increase flexibility and range of motion,
634–636, 635f

to increase musculotendinous mobility,
631–634, 631f–633f

exercises for lymphedema, 846
joint hypomobility in, 594–599
joint protection in, 597, 598
manual stretching techniques for, 98, 98f
mobility of, 598
mobilization techniques for, 131–133,

mobilization with movement of, 598, 598f
nerve disorders in, 594
osteoarthritis in, 596, 596f
PNF diagonal patterns for, 196t
preferred practice patterns for pathologies of,

radial and ulnar deviation of, 50, 98

manual resistance exercise for, 191
range of motion techniques for, 50, 50f, 51,

self-assisted, 57, 57f

rheumatoid arthritis of, 311f, 594–596, 595f,

sprain of, 616–617
surgery for disorders of

arthrodesis, 343, 343t, 599
carpal tunnel syndrome, 376–377
total wrist arthroplasty, 600–603
ulnar nerve entrapment in tunnel of Guyon,

tenosynovitis/tendinitis in, 615–616

Wrist extension

manual resistance exercise for, 191, 191f
range of motion techniques for, 50
strengthening exercises for, 636, 636f
stretching techniques for, 98, 98f, 634

Wrist flexion
manual resistance exercise for, 191, 191f
range of motion techniques for, 50, 50f
strengthening exercises for, 636
stretching techniques for, 98, 634–635

Wrist muscles, 592–593
extensors, 592f

in elbow overuse syndromes, 576
self-stretching of, 580

flexors, 592f
in elbow overuse syndromes, 576
self-stretching of, 579, 579f

length–tension relationships for, 592
relationship to elbow, 560
strengthening exercises for, 582, 582f,

636–638, 636f–637f
Wrist roller, 582, 582f

Xiphisternal joint, 852f
Xiphoid process, 852f

Y ligament of Bigelow (iliofemoral), 644, 645f,


Zigzag deformity of thumb, 596
Zygapophyseal joints. See Facet joints.

928 Index

28Kisner (F)-Index 3/9/07 1:26 PM Page 928

Similer Documents