Therapeutic Exercise

1 Therapeutic ExerciseFoundations and TechniquesFOURTH EDITIONC arolyn Kisner, MS, PTAssociate ProfessorPhysical Therapy ProgramCollege of Mount St. JosephCincinnati, OhioAssistant Professor EmeritusThe Ohio State UniversitySchool of Allied Medical ProfessionsPhysical Therapy DivisionColumbus, OhioLynn Allen Colby, MS, PTAssistant Professor EmeritusThe Ohio State UniversitySchool of Allied Medical ProfessionsPhysical Therapy DivisionColumbus, OhioIllustrations by Jerry L. Kisner, Davis Company 2/15/02 9:10 AM Page iF. A. Davis Company1915 Arch StreetPhiladelphia, PA 2002 by F. A. Davis CompanyCopyright 1996, 1990, 1985 by F. A. Davis Company. All rights reserved. This book is protected bycopyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form orby any means, electronic, mechanical, photocopying, recording, or otherwise, without written permis-sion from the in the United States of AmericaLast digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher:Margaret BiblisDevelopmental Editor:Peg WaltnerCover Designer:Louis J.

2 ForgioneAs new scientific information becomes available through basic and clinical research, recommendedtreatments and drug therapies undergo changes. The author(s) and publisher have done everythingpossible to make this book accurate, up to date, and in accord with accepted standards at the time ofpublication. The author(s), editors, and publisher are not responsible for errors or omissions or forconsequences from application of the book, and make no warranty, expressed or implied, in regard tothe contents of the book. Any practice described in this book should be applied by the reader in ac-cordance with professional standards of care used in regard to the unique circumstances that may ap-ply in each situation. The reader is advised always to check product information (package inserts) forchanges and new information regarding dose and contraindications before administering any is especially urged when using new or infrequently ordered of Congress Cataloging-in-Publication DataKisner, Exercise : foundations and techniques / Carolyn Kisner, Lynn Allen Colby;illustrations by Jerry L.

3 Kisner. 4th bibliographical references and 0-8036-0968-X1. Exercise therapy Handbooks, manuals, etc. I. Colby, Lynn Allen. II. 2 dc212002017442 Authorization to photocopy items for internal or personal use, or the internal or personal use of spe-cific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Cen-ter (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly toCCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted aphotocopy license by CCC, a separate system of payment has been arranged. The fee code for usersof the Transactional Reporting Service is: 8036-0968/0 $. 2/15/02 9:10 AM Page iiTo Jerry and our growing family as always, your love and support has sustained methrough this project CKTo Rick and my extended family a source of constant support and joy LCTo our parents who have been supportive throughout our livesTo our students who have taught us so muchTo our colleagues who have been helpful and stimulating in our professional growth LC and 2/15/02 9:10 AM Page iiiContributorsTerri M.

4 Glenn, PhD, PTDirector, Physical Therapy ProgramCollege of Mount St. JosephCincinnati, OhioBarbara Settles Huge, PTWomen s Health Specialist/ConsultantAdjunct Faculty, Indiana University PhysicalTherapy ProgramFishers, IndianaJanet A. Mulcare, PhD, FASCMP rofessor, Physical Therapy ProgramAndrews UniversityDayton, OhioRobert Schrepfer, MS, PTFormer Clinical Director, The Center for AquaticRehabilitationMBA Candidate 2003 Duke University, The FuquaSchool of BusinessDurham, North 2/15/02 9:10 AM Page ivPrefaceprogression of comprehensive Therapeutic will be most obvious to those who are fa-miliar with previous editions of this text are thechanges in format and design of this edition. Thedouble-column format and the use of color were se-lected to help the reader to locate information moreeasily and to enhance organization of the have kept the succinct language and straightfor-ward presentation of the content that has been wellreceived in the previous editions; in addition we haveexpanded the discussion of concepts and techniquesto provide the reader with a more comprehensiveanalysis of the material.

5 Major changes we havemade in this Fourth Edition include the following:Complete rewriting of Chapter 1 incorporating in-formation on the disablement process and the po-tential impact of Therapeutic Exercise on thatprocess, as well as the components of a compre-hensive, systematic approach to patient manage-ment consistent with the guidelines proposed inthe Guide to Physical Therapist revisedoutline of a systematic and detailed muscu-loskeletal examination that used to be in Chapter1 is now in Appendix reorganization of Chapter 3, ResistanceExercise, to include the multi-faceted aspects ofmuscle performance. In addition, principles andtechniques of proprioceptive neuromuscular facil-itation for applications of the extremity patternshave been added. Addition of material on mobilization with move-ment (MWM), based on the work of Brian Mulli-gan, by contributor Jack Miller, an accreditedMulligan concept teacher.

6 The concepts and prin-ciples of MWM are presented in Chapter 6, withspecific techniques described in each of the re-spective regional chapters on the extremities(Chapters 9 14).Each revision of this textbook is a challenging,demanding, sometimes daunting, and in thefinal analysis, satisfying task. We believe thisedition, as with past editions, is inclusive and up-to-date in light of current research and trends in prac-tice. It continually amazes us how quickly theknowledge base and creative interpretations of basicand applied research including outcome studies in-fluence the delivery of healthcare. Since publicationof the Third Edition of Therapeutic Exercisein 1996,the American Physical Therapy Association has pub-lished and revised the Guide to Physical TherapistPractice,many new studies on patient outcomeshave been published, technology for communicationhas expanded, and the healthcare environment hasdemanded continued high-quality care but more ef-ficient delivery of services.

7 Each of these major fac-tors has influenced the way we think and practiceand thus has influenced the presentation of materialin this original intent when developing the first edi-tion of this textbook over 16 years ago was to pro-vide a foundation of concepts and techniques uponwhich an individualized program of Therapeutic ex-ercise could be built. With each revision we haveexpanded the content to include new methods ofexercise intervention that have been shown to bebeneficial in remediating a patient s physical im-pairments and functional limitations. The founda-tional material remains an important component ofthis text. Yet, functional Exercise progressions thatare built on basic Exercise techniques and that pre-pare patients or clients to return to optimal levels ofindependence are also integral components of thistext.

8 In addition to principles of Exercise , back-ground information on various pathologies andmusculoskeletal surgeries, descriptions of exercisetechniques, and management guidelines are in-cluded to assist the reader in the development 2/15/02 9:10 AM Page vAddition of a new chapter on aquatic Exercise (Chapter 7) by contributor Robert Schrepfer, MS,PT. Research supporting the use of the aquatic en-vironment in the rehabilitation process of muscu-loskeletal impairments is integrated with varioustechniques of Exercise of a section at the completion of eachchapter entitled Independent Learning section has several types of activities for stu-dents using this text. The subsection called Criti-cal Thinking and Discussionhas discussionpoints or a series of questions to stimulate activelearning and problem solving or to direct the stu-dent to further inquiry.

9 The subsection calledLaboratory Practicedirects the learner toward ac-tivities that can be practiced in order to developspecific skills related to the application of thera-peutic Exercise interventions. The subsectioncalled Case Studiespresents several case scenar-ios and questions that reflect the content of thechapter to help the learner integrate the informa-tion presented and apply it to real-life of the spine chapters with the ad-dition of material that reflects current thinking onways to categorize patient conditions and ap-proaches to intervention (Chapter 15), and thepresentation of Exercise interventions with empha-sis on activation of core stabilizers and stabiliza-tion techniques integrated into a comprehensiveapproach to management of spinal impairmentsand functional limitations (Chapter 16).

10 Thosereaders familiar with previous editions will noticethat the chapter on spinal traction is not in this edi-tion. Nevertheless we still believe that spinal trac-tion is a useful tool for intervention in the treatmentof spinal disorders. Because it can be used to stretchjoints and tissues in the spinal region, content spe-cific to this purpose is integrated into the stretchingsection of the treatment chapter (Chapter 16).The chapter on Principles of Exercise for the Ob-stetric Patient (Chapter 17) has been revised andexpanded by contributor Barb Settles Huge, PT, toinclude basic information and interventions forthe management of urinary thorough revision of Chapter 18, Management ofVascular Disorders of the Extremities, now includesdescriptions and illustrations of exercises for thecomprehensive management of previous editions there were two chapters oninterventions for and management of pulmonaryconditions.