Therapeutic exercise is defined as exercise prescribed to correct impairments, improve function, or maintain well-being. The document outlines the definition, aims, goals, principles, techniques, areas of application, and values of therapeutic exercise. Specifically, it discusses how therapeutic exercise can be used to improve musculoskeletal, neurological, and cardiorespiratory function and rehabilitation through increasing range of motion, strength, endurance, and functional ability. The principles of therapeutic exercise include determining the purpose and stress level of exercises and gradually increasing intensity. Techniques include various types of movement and manual techniques.

1. CHAPTER- 1
Introduction to
therapeutic exercise

2. CHAPTER: 1 INTRODUCTION TO THERAPEUTIC EXERCISE
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DEFINITION OF THERAPEUTIC EXERCISE
Therapeutic exercise means, accelerating the patient's recovery from injury & diseases,
which have altered his normal way of life. (Gardiner, M. D, 1998, p. 26)
OR
Therapeutic exercise as the prescription of bodily movement, to correct impairment,
improves musculoskeletal function or maintains a state of well-being. It may vary from
highly selected activities restricted to specific muscles or parts of the body, to general and
vigorous activities that can return a convalescing patient to the peak of physical condition.
OR
Therapeutic exercise is a physical therapy intervention encompassing a broad range of
activities designed to restore or improve musculoskeletal, cardiopulmonary and/or
neurologic function.
The ultimate goal of any therapeutic exercise program is to achievement of symptom-free
movement & function. To apply an effective therapeutic exercise to a patient, a therapist
must have knowledge about basic Principles & Effects of exercise on the Musculoskeletal,
Neuromuscular, Cardiovascular & Respiratory systems. Also therapist must able to perform
a functional evaluation of the patient & must know the inter-relationship of anatomy &
kinesiology of the body, as well as have an understanding of the state of the injury, diseases
& surgical procedure & its potential rate of recover, complications, precautions &
contraindications. (Kisner, C., 1998, pp 3 -22)
AIMS OF THERAPEUTIC EXERCISE
 To promote activity, whenever or wherever it is possible to minimize the effects of
inactivity
 To regain normal joint range of motion.
 To increase the muscle power.
 To increase the strength & endurance.
 To encourage the patient activity.
 To accelerate the patient rehabilitation
N.B: Q: Define Therapeutic exercise. Write down the aims of Therapeutic exercise.

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GOALS OF THERAPEUTIC EXERCISE
In the clinical decision making process, the therapist must determine the type of therapeutic
exercise that can be used to meet the predicted functional outcomes.
Therapeutic exercise seeks to accomplish the following goals:
 Enable ambulation
 Release contracted muscles, tendons, and fascia
 Maintain or improve Strength of muscles
 Mobilize joints
 Improve circulation
 Improve respiratory capacity
 Improve coordination
 Reduce rigidity
 Improve balance & stability
 Promote relaxation
 Improve muscle strength and, if possible, achieve and maintain maximal voluntary
contractile force (MVC)
 Improve exercise performance and functional capacity (endurance)
N.B: Q: Write down the goals of Therapeutic exercise
PRINCIPLES OF THERAPEUTIC EXERCISE
The principles of therapeutic exercise can be categorized in to two groups. That is ‘Basic
principles’ & ‘Mechanical principles’.
A. Basic principles:
 Determine the purpose of the exercises. Whether patient's condition needs to be
improved or whether improve the joint function or muscle strengthening.
 Determine the amount of stress the exercise place on the patient.
 Ensure that the type of stress imposed by the exercise should be relevant & that is
to be effective.
 The intensity & duration of stress imposed on the joint or muscles should increase
gradually to achieve increase in tolerance, endurance & strength.
 Last but not least, the exercise regimen should not make the patient exhausted &
tired.

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B. Mechanical principles:
The mechanical principles that are utilized in exercise therapy for treating patient are given
below:
1. Force
2. Position
 Gravity
 Center of gravity (COG)
 Line of gravity. (LOG)
 Base of support
 Equilibrium.
 Fixation & stabilization.
3. Movement
 Axes & planes
 Speed
 Velocity
 Work
 Energy
 Power
 Acceleration
 Momentum
 Inertia
 Friction
4. Levers
 1st class lever
 2nd class lever
 3rd class lever
5. Pulleys
6. Pendulums
7. Elasticity
(Gardiner, M. D 1998, p. 1-20)
TECHNIQUES OF THERAPEUTIC EXERCISE
The techniques which are used to treat the patients in exercise therapy are-
1. Positioning (Fundamental & Derived positioning)
2. Relaxation (General & Specific relaxation)
3. Movement
 Active movement
 Passive movement
 Resisted movement
 Manual mobilization techniques
4. Suspension therapy
5. Breathing exercise
6. PNF
7. Balance & co-ordination
8. Manual muscle testing
(Gardiner, M. D 1998, p. 26-27)

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AREA OF APPLICATION OF THERAPEUTIC EXERCISE
Therapeutic exercise is a physical therapy intervention encompassing a broad range of
activities designed to restore or improve musculoskeletal, cardiopulmonary and/or
neurologic function. That’s why therapeutic exercises are used in different area of medical
science as well as different conditions. The areas & conditions where therapeutic exercises
are applied are given below:
1. In musculoskeletal area
 Any muscular pain
 Any joint pain
 Low back pain (LBP)
 Neck pain
 Thoracic pain
 Capsulitis in any joint (i.e. Frozen Shoulder)
 Bursitis in any joint
 Muscle injury (Strain)
 Ligament injury (Sprain)
2. In traumatology
 Fracture in the bone
 Dislocation in the joint
 Post operative Hip & Knee replacement
 Arthroscopy
 Spinal fixation
3. In Rheumatology
 Osteoarthritis
 Rheumatoid arthritis
 Septic arthritis
 Juvenile arthritis
 Osteoporosis
 Rheumatic fever
4. In Cardiopulmonary area
 Cardiac rehabilitation
 Post operative chest condition
 Cardiothoracic ICU

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5. In Neurological area
 Stroke Rehabilitation
 Head injury
 Multiple sclerosis
 Peripheral nerve injury
 Motor neuron injury
 Spinal cord injury
 GBS
 Leprosy
6. In Pediatric area
 Developmental delay (Cerebral palsy)
 Congenital dislocation of hip (CDH)
 Knock knee problem
 Pase cavus
 Pase planus
 Telipase equinovarus
 TA tightness
 Spina bifida
 Hydrocephalus
 Congenital limb deficiency
7. In Sports
 Any joint, muscular & Ligament injury
 Faulty biomechanics
 Strength problems
 Muscle conditioning
 Co-ordination & Balance problem
 Sports Rehabilitation
8. In Gynecological area
 Pre & post Gynecological problems
 Gynecological Bowel, bladder problems
9. In Dermatology
 Burn
 Skin grafting
 Some skin diseases
10. In geriatric

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VALUE OF THERAPEUTIC EXERCISE IN MUSCULOSKELETAL AREA
1. Management of pain (e.g. Decrease musculoskeletal pain)
2. Maintain joint mobility & flexibility
3. Maintain or increase joint Range of motion
4. Maintain or increase muscular strength & power
5. Maintain or increase endurance
6. Improve relaxation
7. Prevent further soft tissue injury by increasing muscle strength & flexibility
8. Prevent osteoporotic change by weight bearing therapeutic training
9. Correction of posture & thus improve quality of life
10. In sports correct biomechanics & improve performance by muscle conditioning
VALUE OF THERAPEUTIC EXERCISE IN NEUROLOGICAL AREA
1. Motor re-education
2. Normalization of muscle tone
3. Maintain or increase joint Range of motion (ROM)
4. Maintain or increase muscular strength & power
5. Maintain or increase muscle length
6. Improve co-ordination & balance
7. Improve sensory integration
8. Improve motor skills
9. Improve core stability
10. Prevent further injury e.g. Shoulder subluxation due to Stroke
VALUE OF THERAPEUTIC EXERCISE IN CARDIO PULMONARY AREA
1. Maintain or increase Cardiovascular fitness
2. Promote Cardiac Rehabilitation
3. Promote Thoracic rehabilitation
4. Maintain or increase lung Volume
5. Improve force expiratory rate
6. Reduce shortness of Breath (SOB) or Breathlessness
7. Remove excess secretion
8. Prevent lung collapse
9. Prevent the risk of further infection
10. Improve quality of life

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Study question:
1. Define Therapeutic exercise. Write down the aims of Therapeutic exercise.
2. Write down the goals of Therapeutic exercise
3. Write down the principles of therapeutic exercise
4. What are techniques applied in Therapeutic exercise?
5. Write down the area of application of Therapeutic exercise
6. What are values of Therapeutic exercise in Musculoskeletal area?
7. What are the values of Therapeutic exercise in Neurological area?
8. What are the values of Therapeutic exercise in Cardio pulmonary area?
Advance question:
1. By knowing about Therapeutic exercise which goal can be fulfilled?
2. Under which basic principles a physiotherapist can apply his/her
knowledge about therapeutic exercise?
3. Suppose a Physiotherapist is appointed in a hospital. He/she has knowledge
about Therapeutic exercise. So in which areas he/she can apply this?
4. What can a physiotherapist do after getting knowledge about Therapeutic
exercise?
5. How can a physiotherapist manage disable, handicap condition by
therapeutic exercise?
6. Write down the disablement model according to Therapeutic exercise
Reference: