What’s a therapeutic exercise?
Therapeutic exercise refers to a range of physical activities that helps restore and build physical strength, endurance, flexibility, balance, and stability. The goal of therapeutic exercise is returning an injured person to a pain-free, fully functioning state. Therapeutic exercise is managed by a physical therapist (PT) or chiropractor.
A PT or chiropractor begins therapeutic exercise by taking a medical history and evaluating a patient’s physical condition and capabilities. Based on an initial assessment, the care provider will determine a treatment plan that includes an exercise program tailored to the patient’s needs. Therapeutic exercise programs are carefully monitored and emphasize slow progression. A provider may assist the patient with some physical movements, if warranted, and will continuously modify the treatment plan according to the patient’s progress.
The first goal of any therapeutic exercise plan is to reduce pain and inflammation. Next, the goal may shift to regaining range of motion, rebuilding muscle strength, and developing endurance.
Therapeutic exercise programs may include:
- Strengthening exercises: To develop strength, the emphasis is on heavy resistance and a limited number of repetitions.
- Endurance exercises: To develop endurance, large muscle groups are engaged for a longer period of time.
- Flexibility exercises: To develop flexibility, stretching and movement are emphasized.
- Balance and coordination exercises: To develop balance and coordination, the emphasis is on center of gravity.
- Functional movement assessment: The Selective Functional Movement Assessment (SFMA) is a movement-based diagnostic system that assesses seven movement patterns. This system quickly identifies the root cause of musculoskeletal pain symptoms, allowing providers to select therapeutic exercises that will address the underlying problem.
Neuromuscular Reeducation Therapy
The American Medical Association defines neuromuscular reeducation as the use of therapeutic exercise techniques to improve impaired movement, balance, coordination, decreased kinesthetic sense, and impaired proprioception (sense of one’s location in space). Two key approaches for neuromuscular reeducation therapy are proprioceptive neuromuscular facilitation (PNF) and muscle energy techniques (MET).
Proprioceptive Neuromuscular Facilitation (PNF) retrains the nervous system in two ways. First, it stimulates proprioceptors, which are receptors in joints that relay information about the body’s position through the nervous system to the brain. Second, it uses a particular pattern of stretching to help increase movement. PNF can be a particularly effective treatment modality. Patients who are in pain are often unaware of the various ways that their bodies compensate for that pain, and these unconscious adaptations can introduce new sources of pain. The stretching patterns and sense of body positioning can help make patients aware of the unhealthy, painful postures and promote greater strength and flexibility.
Muscle Energy Techniques (MET) is a form of active resistance that involves a patient resisting a gentle force that a provider applies. Contracting muscles against the provider’s resistant involves an active, voluntary action on the part of the client that engages higher brain function. The idea behind this technique is that involvement of higher brain function empowers the client, making the patient an active part of the treatment process, which can result in changing chronic pain patterns. MET has numerous positive benefits for injured tissues. It stimulates the growth of new cells, helps realign and strengthen connective tissues, lengthens tissues if necessary, increases range of motion, and balances muscle strength across joints. Overall, it provides a gentle alternative to traditional manipulation.