THERAPEUTIC

EXERCISE
MOVING TOWARD
FUNCTION

4th
EDITION
Lori Thein Brody, PT, PhD, SCS, ATC
Senior Clinical Specialist, Sports and Spine Physical Therapy
UW Health
Research Park Clinic
Madison, Wisconsin
Professor
Rocky Mountain University of Health Professions
Provo, Utah

Carrie M. Hall, PT, MHS

Physical Therapist
President, Movement Systems Physical Therapy, P.S.
Clinical Faculty
University of Washington
Seattle, Washington

with contributors
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Fourth edition
Copyright © 2018 Wolters Kluwer.
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Library of Congress Cataloging-in-Publication Data
Names: Brody, Lori Thein, author. | Hall, Carrie M., author.
Title: Therapeutic exercise : moving toward function / Lori Thein Brody,
Carrie M. Hall ; with contributors.
Description: Fourth edition. | Philadelphia : Wolters Kluwer
Health/Lippincott Williams & Wilkins, [2018] | Includes bibliographical
references and index.
Identifiers: LCCN 2016055435 | ISBN 9781496302342
Subjects: | MESH: Exercise Therapy—methods
Classification: LCC RM725 | NLM WB 541 | DDC 615.8/2—dc23 LC record available at
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 To my father, Jack, whose motto
“Never say can’t; do it and say it was hard”
has sustained me throughout my life,
and is carried forward by his grandchildren Nathaniel,
Louisa, Benjamin, and Ethan.
—Lori Thein Brody

I would like to dedicate this book to

my three daughters, Caroline, Gabrielle, and Jillian,
who encourage me daily to be my best; my patients, who continuously
teach me about the complexity of the movement system;
my amazing colleagues who challenge me to stay current
and maintain a growth mind-set;
and my mother Carol,
who lived her life with courage and resolve and continues to
serve as my daily inspiration.
—Carrie M. Hall
Contributors

Kimberly D. Bennett, PT, PhD Lisa M. Flexner, DPT, DMT, CSCS, FAAOMPT
Physical Therapist and Lecturer with the Department of Physical Therapist
Rehabilitation Medicine Focus Physical Therapy
University of Washington Part-time Instructor, Kinesiology Program
Owner Liberty Physical Therapy, PLLC Oregon State University - Cascades
Seattle, Washington Bend, Oregon
Janet R. Bezner, PT, DPT, PhD Colin R. Grove, PT, MS, NCS
Associate Professor Physical Therapist
Department of Physical Therapy Department of Orthopaedics and Rehabilitation
Texas State University Neuro Outpatient Rehabilitation
San Marcos, Texas UW Health Rehabilitation Clinic
Middleton, Wisconsin
Elizabeth A. V. Bloom, PT, DPT
Physical Therapist, Advanced Clinician Carrie M. Hall, PT, MHS
UW Health Department of Orthopedics and Physical Therapist
Rehabilitation President, Movement Systems Physical Therapy, P.S.
Spine Physical Therapy Clinical Faculty
University of Wisconsin Hospital and Clinics University of Washington
Madison, Wisconsin Seattle, Washington
Lori Thein Brody, PT, PhD, SCS, ATC Darlene Hertling, PT, Retired
Senior Clinical Specialist, Sports and Spine Lecturer, Division of Physical Therapy
Physical Therapy Department of Rehabilitation Medicine
UW Health University of Washington School of Medicine
Research Park Clinic Seattle, Washington
Madison, Wisconsin Sherri S. Holt, PT, DPT, MHSc, MTC, FAAOMPT
Professor Physical Therapist
Rocky Mountain University of Health Professions UW Health Department of Orthopedics and Rehabilitation
Provo, Utah Spine Physical Therapy
Judith Dewane, PT, DSc, NCS University of Wisconsin Hospital and Clinics
Assistant Professor (CHS) Madison, Wisconsin
Physical Therapy Program Adjunct Instructor, Transitional Doctor of Physical Therapy
Department of Orthopedics and Rehabilitation Sciences
Rehabilitation Medicine University of St. Augustine for Health Sciences
UW Health Department of Orthopedics and Rehabilitation St. Augustine, Florida
Madison, Wisconsin Carol N. Kennedy, BScPT, MClSc (Manipulative Therapy),
Rafael F. Escamilla, PhD, PT, CSCS, FACSM FCAMPT
Professor Clinical Specialist - MSK
Physical Therapist
Department of Physical Therapy
Partner, Treloar Physiotherapy Clinic
California State University, Sacramento
Vancouver, British Columbia
Sacramento, California
Results Physical Therapy and Training Center Danny McMillian, PT, DSc, OCS, CSCS
Sacramento, California Clinical Associate Professor
Melissa Fischer, DPT Physical Therapy Program
University of Puget Sound
Physical Therapist, Advanced Clinician
Tacoma, Washington
UW Health Department of Orthopedics and
Rehabilitation Jill McVey, DPT, ATC
Sports Physical Therapy Physical Therapist
University of Wisconsin Hospital and Clinics Movement Systems Physical Therapy, P.S.
Madison, Wisconsin Seattle, Washington
 CONTR I BUTOR S vii

Elizabeth R. Shelly, PT, DPT, WCS, BCB-PMD Kyle M. Yamashiro, PT, CSCS
Physical Therapist President
Board certified specialist in women’s health Results Physical Therapy and Training Center
Beth Shelly Physical Therapy Medical Adjunct Faculty
Moline, Illinois Sacramento State University
M. J. Strauhal, PT Program Coordinator
SF Giants Sports Medicine Conference
Physical Therapist
Physical Therapist Consultant
Clinical Specialist in OB-GYN and Women’s Health
Sacramento River Cats
Providence St. Vincent Medical Center Rehabilitation Services
Rehab and Strength and Conditioning Consultant
Portland, Oregon
Sacramento Republic FC
Scott Tauferner PT, ATC Rehab Consultant
Physical Therapist, Advanced Clinician Oakland A’s
UW Health Department of Orthopedics and Rehabilitation
University of Wisconsin Hospital and Clinics
Madison, Wisconsin
Jill Thein-Nissenbaum, PT, DSc, SCS, ATC
Associate Professor
University of Wisconsin-Madison
Doctor of Physical Therapy Program
Madison, Wisconsin
Staff PT, UW Athletics
Badger Sports Medicine
Madison, Wisconsin
Reviewers

The publisher and authors gratefully acknowledge the many Yasser Salem, PT, PhD, NCS, PCS
professionals who shared their expertise and assisted in de- Associate Professor
veloping this textbook, appropriately targeting our marketing Physical Therapy
efforts, creating useful ancillary products, and setting the stage University of North Texas Health Science Center
for subsequent editions. These individuals include: Fort Worth, Texas
Mary Kay Solon, PT, MS
FOURTH EDITION
Department Chair, Professor
Physical Therapist Assistant Studies
Ellen Anderson, PT, MA, GCS University of Saint Francis
Associate Professor Fort Wayne, Indiana
Rutgers School of Health Professions
Doreen Stiskal, PT, PhD
Newark, New Jersey
Department Chair and Associate Professor
Suzanne Brown, PT, MPH, PhD Department of Physical Therapy
College of Health and Human Services Seton Hall University
School of Physical Therapy South Orange, New Jersey
Touro University Nevada
Henderson, Nevada Eddie Traylor
Assistant Professor
Marcey Keefer Hutchison, PT, DPT, SCS, ATC, CMP
School of Physical Therapy
Assistant Professor of Physical Therapy Langston University
George Fox University Langston, Oklahoma
Newberg, Oregon
Gregory T. Thielman, EdD, MSPT, ATC
Joseph Kelly, MSPT
Assistant Professor Associate Professor
Department of Physical Therapy & Health Science Department of Physical Therapy
Bradley University University of the Sciences
Peoria, Illinois Philadelphia, Pennsylvania

Jiu-Jenq Lin, PhD, PT Linda J. Tsoumas, PT, MS, EdD

School of Physical Therapy Professor of Physical Therapy (Retired)
National Taiwan University School of Physical Therapy
Taipai City, Taiwan Massachusetts College of Pharmacy and Health Sciences
University
Daniel McGovern, PT, DPT, SCS
Worcester, Massachusetts
Assistant Professor of Physical Therapy
School of Physical Therapy Krista Wolfe, PT, ATC
Massachusetts College of Pharmacy and Health Sciences Dean, Nursing and Health Sciences
University Central Penn College
Worcester, Massachusetts Summerdale, Pennsylvania
Dawn Roberts, PT, PhD
Department of Physical Therapy THIRD EDITION
Springfield College
Springfield, Massachusetts Cara Adams, PT, MS
Associate Professor
Becky Rodda, PT, DPT, OCS, OMPT
Department of Rehabilitation Sciences
Physical Therapy Department Division of Physical Therapy
School of Health Studies and Professions The University of Alabama at Birmingham
University of Michigan – Flint School of Health Related Sciences
Flint, Michigan Birmingham, Alabama

viii
 R EVI EWE R S ix

Patricia M. Adams, MPT Paul Rockar, PT, MS, OCS

Assistant Professor of Clinical Physical Therapy Vice President, Human Resources
Master of Physical Therapy Program CORE Network, LLC
UMDMJ McKeesport, Pennsylvania
Stratford, New Jersey Richard Ruoti, PT, PhD, CSCS
Karen Blaschke OTR/L, CHT Certified WATSU Practitioner
Occupational Therapist Cofounder of Aquatic Physical Therapy Section
Advance Clinical Hand and Upper Extremity Clinic of APTA
University of Wisconsin Hospital and Clinics Doylestown, Pennsylvania
Madison, Wisconsin Leslie Russek, PT, PhD, OCS
Cynthia M. Chiarello, PT, PhD Associate Professor
Assistant Professor of Clinical Physical Therapy Physical Therapy Department
Columbia University—Doctoral Programs in Physical Therapy Clarkson University
New York, New York Potsdam, New York
Lisa M. Dussault, OTR Amy Schramm, PT
Occupational Therapist Senior Physical Therapist
TMD Clinic JFK Medical Center
University of Wisconsin Hospitals and Clinics Edison, New Jersey
Madison, Wisconsin Mary Sesto, PT, PhD
Joan E. Edelstein, PT, MA, FISPO Physical Therapist
Director of Programming in Physical Therapy Department of Occupational Medicine
Associate Professor of Clinical Physical Therapy University of Wisconsin
Columbia University Assistant Researcher
College of Physicians and Surgeons Department of Industrial Engineering
New York, New York University of Wisconsin
Susan E. George, PT, MS Madison, Wisconsin
Associate Professor Jamie Smith, MSPT, ATC, CSCS
Department of Physical Therapy Director of Physical Therapy/Instructor
Southwest Texas State University Orthopedic Center for Sports Medicine and Reconstructive
San Marcos, Texas Surgery
Terry Hoobler, PT, MAE Louisiana State University
Kenner, Louisiana
Physical Therapist
University of Alabama at Birmingham Gary Sutton, PT, MS, SCS, OCS, ATC, CSCS
Birmingham, Alabama Adjunct Clinical Assistant Professor
Aimee Klein, PT, MS, OCS Department of Physical Therapy
Virginia Commonwealth University
Clinical Assistant Professor in Physical Therapy
Richmond, Virginia
MGH Institute of Health Professions
Senior Rehabilitation Services C. Buz Swanik, PhD, ATC
Beth Israel Deaconess Medical Center Athletic Trainer
Boston, Massachusetts Temple University
Laura Knapp, PT, MS, OCS Philadelphia, Pennsylvania
Clinical Assistant Professor Linda J. Tsoumas, PT, MS
Division of Physical Therapy Chairperson and Associate Professor of Physical Therapy
University of Utah Department of Physical Therapy
Salt Lake City, Utah Springfield College
Robin L. Marcus, PT, MS, OCS Springfield, Massachusetts
Clinical Assistant Professor Cynthia Watson, PT, MS, OCS
Division of Physical Therapy Instructor, Department of Physical Therapy
College of Health University of Texas
University of Utah Southwestern Medical Center
Salt Lake City, Utah Dallas, Texas
David J. Pezzullo, PT, MS, SCS, ATC Nancy J. Whitby, OTR, CHT
Clinical Assistant Professor Lead Therapist
Department of Physical Therapy Hospital and Clinics
University of Pittsburgh University of Wisconsin
Pittsburgh, Pennsylvania Madison, Wisconsin
Preface to the First Edition
hoosing the title of this book was not easy, but once it was
C decided, the choice seemed obvious. Therapeutic Exercise:
Moving Toward Function is the title that encapsulates the
premise of this book. The emergence of managed care in the
United States has altered the delivery of health care. Although
value has always been important, its role in today’s health care
management is even more critical. Value can be defined as
patient satisfaction (i.e., functionally meaningful patient out-
comes), divided by the financial and social costs of providing
care (Kasman GS, Cram JR, Wolk SL. Clinical Applications in
Surface Electromyography. Rockville: Aspen, 1998). Physical
therapists are challenged daily to provide value to their patients
in delivering care to improve function and quality of life. Among
the many interventions available to the physical therapist,
therapeutic exercise is the cornerstone in providing patients
with the means to improve their functional capabilities and,
ultimately, their quality of life. Although other interventions
can improve these elements, it is the assumption of this book
that only through careful therapeutic exercise prescription
can an individual make the permanent changes necessary to
maintain, optimize, or prevent future loss of function. It is the
premise of this book to use therapeutic exercise for patients with
musculoskeletal dysfunction for the sole purpose of achieving
functionally meaningful patient outcomes.
It was our decision to write this book as a textbook and
not a manual of activities and techniques. The latter deals
with providing activities and techniques without the theoretic
framework to make decisions about what would or could be the
best possible course of treatment and the possible alternatives.
Therapeutic Exercise: Moving Toward Function attempts to
provide a conceptual framework for learning how to make
clinical decisions regarding the prescription of therapeutic exer-
cise—from deciding which exercise(s) to teach to how to teach
them to the dosage required for the best possible outcome. The
common thread throughout the text is to treat, with the use of
therapeutic exercise and related interventions, the impairments
that correlate with functional limitations and disability and to
work toward the most optimal function possible.
Because this book was written primarily as a textbook,
decisions were made to provide the reader and instructor with
a variety of educational features:
■ Extensively illustrated. Therapeutic exercise is a visual in-
tervention. This book uses photographs and line drawings
to illustrate examples of therapeutic exercises.
■ Selected Interventions. Featured at the end of pertinent
chapters, these are activities or techniques written for the
student and are included to provide examples of application
of the therapeutic exercise intervention model presented
in Chapter 2. Faculty can use the Selected Interventions
as models for the student to develop exercise prescriptions.
x
■ Self-Management boxes. These are activities or techniques
written for the patient. These are included as examples to
show the student how to write an exercise for a patient so
that all the important features of an exercise prescription
are clearly understood.
■ Patient-Related Instruction boxes. These are similar to
Self-Management boxes. The primary difference is that
these are not exercises, but rather educational features to
assist in the carryover of exercise into functional activities.
■ Key Points. This feature summarizes key concepts the author
wants to convey in the chapter. A thorough understanding
of the Key Points should be realized following the reading
of each chapter.
■ Critical Thinking Questions. These were provided to stimu-
late the reader’s thinking after studying the chapter. Case
Studies are used to create hypothetical situations to which
concepts can be applied.
■ Lab Activities. These provide examples of applied use of the
concepts to practice teaching and execution of selected
activities and techniques.
■ Case Studies. The final unit of the book provides the reader
with a description of 11 cases. These cases are used in Crit-
ical Thinking Questions and Lab Activities to provide the
student with real-life situations in which to apply concepts
learned in the relevant chapter.
The book is organized into seven units. The purpose of each
unit is as follows:
■ Unit 1 provides the foundations of therapeutic exercise,
beginning with a presentation of the disablement model to
provide conceptual clarity for the remainder of the book,
and ending with concepts of patient management. In the
second chapter, a proposed therapeutic exercise intervention
model is presented. This model attempts to separate the
clinical reasoning process into the individual but cumulative
steps to take in order to prescribe an effective therapeutic
exercise. Chapter 3 describes two crucial elements of pa-
tient management: motor learning and self-management.
■ Unit 2 provides the reader with a functional approach to
therapeutic exercise for physiologic impairments. Although
we attempted to include a somewhat extensive review of
the scientific literature on muscle performance, balance,
endurance, mobility, posture, movement, and pain, our pur-
pose was not to publish a review of the material. Instead, we
have selected pertinent literature to illustrate the concepts
needed for a basic knowledge of physiologic impairments
as it relates to therapeutic exercise prescription.
■ Unit 3 presents special physiologic considerations to heed
when prescribing therapeutic exercise. They include soft
tissue injury, postoperative issues, arthritis, fibromyalgia

syndrome and chronic fatigue, and obstetrics. Although this
list is not comprehensive, we chose these special consid-
erations because of the frequency with which the clinician
encounters them.
■ Unit 4 provides the reader with selected methods of
intervention. Although there are numerous schools of
thought regarding the prescription of exercise, we chose
these methods to provide the reader with examples of a
variety of contrasting methods—each has its own merits.
The authors have attempted to illustrate how each method
can be incorporated into a cohesive program of therapeutic
exercise prescription.
■ Units 5 and 6 provide the reader with a regional approach to
therapeutic exercise prescription. Each chapter is organized
into a brief review of anatomy and kinesiology, examination
and evaluation guidelines, therapeutic exercise for common
physiologic impairments affecting the region, and therapeutic
exercise for common medical diagnoses affecting the region.
The anatomy, kinesiology, and examination and evaluation
sections set the foundation for prescription of therapeutic
exercise for physiologic impairments. Therapeutic exercise
for physiologic impairments provides the reader with ex-
amples of exercises to improve physiologic capability and,
PR E FACE TO TH E FI R ST E DITION xi
ultimately, function. Therapeutic exercise for common
medical diagnoses provides the reader with examples of
comprehensive interventions, including therapeutic exer-
cise for common medical conditions affecting the region.
■ Unit 7 consists of 11 Case Studies, which are used in Critical
Thinking Questions and Lab Activities at the end of selected
chapters. Faculty can use these Case Studies for a variety
of learning experiences.
■ Appendices 1 and 2 give the student a quick reference for
red flags of serious pathology or visceral referred symptoms
and clinical actions to take in the event of serious signs and
symptoms in the exercising patient.
We worked diligently to provide a comprehensive textbook
designed to prepare the foundation of knowledge and skills
necessary to prescribe therapeutic exercise. We urge our readers
to write to us to tell us how well we accomplished our goal. We
hope that subsequent editions can address your comments as
well as the ever-changing needs of those involved in therapeutic
exercise prescription.
Carrie M. Hall
Lori Thein Brody
Preface to the Fourth Edition
herapeutic exercise remains the primary intervention provided
T by physical therapists and physical therapist assistants around
the world. Although the exercises may appear simple in
application, the processes that drive the decisions that ultimately
result in an exercise program are complex. Therapeutic exercise
is applied at the impairment, activity limitation, and participation
restriction levels, and ranges from simple stretching to complex
multijoint and system-level integrated activities. Therapeutic
exercise is employed in the care of patients ranging from the
youngest infants to the oldest seniors, across a broad range of
abilities, needs, and goals, in a variety of settings.
This multidimensionality underscores the complexity of suc-
cessful therapeutic exercise application in the patients we care for.
Although determining that a patient with impaired quadriceps
muscle performance needs quadriceps strengthening activities,
choosing the appropriate type and dosage of therapeutic exercise is
far more challenging. Consider the following examples of patients
with impaired quadriceps performance: a young athlete post knee
ligament reconstruction; an elderly woman recovering from a
femur fracture resulting from a fall; a young man with a recent
below knee amputation. The starting point, rate of progression,
program focus, and goals may be different, and therefore require
different exercise programs, all with the goal of improving an
impairment. Remediation of the impairment is only one level
of consideration; activity limitations (stair descent, rising from a
chair, extending the knee during gait) and performance restric-
tions (return to sport, performing instrumental activities of daily
living, return to work) are also part of the therapeutic exercise
prescription. In addition, impairments rarely exist in singularity. The
complexity of evaluation and therapeutic exercise prescription of
the entire movement system, with integrated and interdependent
impairments, is a complex, high-level decision-making process
requiring skilled intervention to reach the desired outcome of
function and participation in society. Choosing and dosing the
exercise is only the beginning. The patient then must learn the
motor control to carry out the specificity of the prescription,
adhere to the dosage, and be progressed appropriately to reach
his or her personal desired outcome. We continuously hear that
students struggle with the daunting task of the decision-making
process, teaching, and developing compliance with therapeutic
exercise prescription in their varied patient populations. Although
we are unable to fully impart all the skills necessary to prescribe
and teach therapeutic exercise in a textbook, the fourth edition
of Therapeutic Exercise: Moving Toward Function continues to
emphasize the decision-making process necessary for successful
outcomes of therapeutic exercise programs.
Successful outcomes require consideration of the therapeu-
tic exercise prescription (exercise choices, frequency, intensity,
duration, progression), motivators and barriers to adherence,
adjunctive interventions, and evidence to support choices within
the framework of a third-party payer system. The focus of this
xii
text is on providing the foundational information, and examples,
to help clinicians decide where on the continuum of exercise to
start a specific patient and how to progress that patient through
rehabilitation to and including wellness. Although wellness has
often been considered separate from rehabilitation, it should
be considered concurrently with remediation of impairments
and activity limitations. Wellness is multidimensional, including
physical health, emotional health, spirituality, and social connec-
tivity. Physical therapists who place therapeutic exercise within
the context of wellness provide that patient with the opportunity
to choose a lifetime of physical activity, which is a cornerstone of
public health. Availability and individual preferences notwith-
standing, consider the difference between an exercise program
prescribed to be performed alone at home and one to be per-
formed at a community center. A therapeutic exercise program
that is initiated and/or progressed to an environment that allows
a seamless transition to wellness is a successful program and one
that is vital to the management and prevention of chronic disease
The World Health Organization (WHO) (www.who.int) and
the Centers for Disease Control and Prevention (www.cdc.gov)
both emphasize the many facets of wellness including physical
activity. The WHO’s International Classification of Functioning,
Disability, and Health (ICF) includes all people in its classifi-
cation from a continuum of people with no known disease to
those with disease-related impairments, activity limitations, and
participation restrictions. All people are served by participating
in health and wellness-promoting activities, with some requiring
the unique skills of a physical therapist in order to participate
successfully. The WHO is currently in the process of develop-
ing a companion publication, the International Classification
of Health Interventions (ICHI) that categorizes interventions
associated with impairments of body structures and functions
as well as interventions for activity limitations and participation
restrictions. Like the ICF, the ICHI will provide a common
language for further research into the effectiveness of different
types and dosages of therapeutic exercise in patient groups.
With this backdrop, the changes to this edition of Therapeutic
Exercise: Moving Toward Function capitalize on initiatives such
as the ICF, ICHI, and work by the American Physical Therapy
Association (APTA) and other professional organizations. Our
goal is to deepen the reader’s understanding of the complexities
of therapeutic exercise prescription in health care today, and
to provide examples and evidence of its application to promote
a healthy population.
CHANGES AND ADDITIONS IN THE
FOURTH EDITION
The changes and additions to the fourth edition of this text
reflect extensive user feedback. These changes and additions

are consistent with commitment to improve the delivery of
successful, evidence-based therapeutic exercise interventions
to patients. Language used throughout the book is consistent
with that of the ICF and the APTA’s Guide to Physical Thera-
pist Practice. This provides a consistent and common language
when discussing physical therapy interventions and evidence.
The therapeutic exercise model has been updated to improve
clarity and ease of use. APTA has embraced the concept of the
movement system as the primary system treated by physical
therapists. The premise of the updated model is that ideal move-
ment can be thought of as the result of a complex interaction of
several subsystems (support, passive, active, neural, cognitive/
emotional) of the larger encompassing movement system.
Organizing impairments into subsystems of the movement
system will assist the practitioner in systematizing the complex
interaction of impairments and guide prioritization, sequencing,
and progression of the therapeutic exercise intervention.
Chapter 3 has been expanded beyond patient-related edu-
cation to include a broader range of information on improving
patient outcomes. Patient education and instruction in home
exercise programs are just a couple of the strategies to improve
patient outcomes. Listening and the many components of com-
munication are critical to ensure that information is delivered
in a manner that respects and motivates patients. This chapter
describes several opportunities to engage the patient in the
therapeutic exercise decision-making process.
Chapter 14, previously labelled “Closed Kinetic Chain,”
has been revised to “Kinetic Chain Applications in Functional
Movement.” This change reflects further development in the
body of evidence around the kinetic chain and functional move-
ment assessments and interventions. This chapter includes an
in-depth discussion of the rationale for and application of kinetic
chain concepts, both open and closed kinetic chain. Integrating
open and closed chain activities in functional movements is
a foundational concept in therapeutic exercise prescription.
All chapters have expanded references and a new feature,
Evidence and Research (EAR) Boxes. Each chapter con-
tinues to be extensively referenced to provide the best current
evidence for the reader. We understand that the reader may
want to know more details of some research studies. Rather
than embedding extensive details in the body of the text, key
research is highlighted in EAR boxes throughout the chapter. In
this way, the interested reader can readily access the evidence
supporting the chosen intervention. These boxes, along with
PR E FACE TO TH E FOU RTH E DITION xiii
the citations and reference lists, provide a strong evidence
resource for the reader.
The look of the text has changed significantly, with more
streamlined writing and bulleted lists for ease of finding
information quickly. The easily identifiable boxes such as
Patient-Related Instruction, Building Blocks, Case Studies,
Self-Management, and Selected Interventions remain as
strong pedagogical features designed to integrate therapeutic
exercise applications into the many facets of effective patient
care. ThePoint website contains videos of selected exercises to
view and listen to a practitioner teach exercise. The website
also contains supportive anatomy, kinesiology, and examination
information that provides background knowledge as an easily
accessible refresher for the reader. New to this edition is a
change to full color images to provide greater clarity in photos
and to better engage the reader.
We hope that these changes and additions will make for
better reading and help to provide a comprehensive, effective
therapeutic exercise program for patients and clients.
ONLINE INSTRUCTOR RESOURCES
Adopting instructors will be given access to the following
resources on thePoint:
■ Image Bank
■ PowerPoint Presentations
■ Test Generator
■ Answers to Building Blocks
ONLINE STUDENT RESOURCES
Students who have purchased Therapeutic Exercise: Moving
Toward Function, Fourth Edition, will have access to the
following resources:
■ Video clips showing various therapeutic exercise techniques
■ Additional chapter material not found in text
Materials for students and instructors can be found online at
Lori Thein Brody
Carrie M. Hall
Acknowledgments
n addition to all those individuals who helped create the first
I three editions, we wish to thank many people for their contri-
butions to this revision. This book was made possible through
the individual and collective contribution of many individuals.
We are privileged to have had so many knowledgeable
and dedicated chapter contributors. We are indebted to their
contribution to the original work and revisions to create an
outstanding fourth edition. We are also acutely aware that
the fourth edition could not have been done without input
from the reviewers. We appreciate the insights they offered to
finalize the content and design of the text. A special thanks is
extended to Jill Thein-Nissenbaum who provided additional
expertise and extensive editing crucial to the consistency and
structure of the fourth edition. A book of this magnitude with
its large numbers of figures, legends, displays, tables, special
feature boxes, and references cannot be produced without the
cohesive efforts of the talented editorial and production teams.
For this we thank the editorial and production staff and the art
department at Lippincott, Williams & Wilkins. We would like
to extend a special thanks to production manager, John Larkin,
who, among many other vital functions, played the critical be-
hind-the-scenes role of keeping us organized and on schedule
in a professional, kind, and respectful manner.
We would like to extend our gratitude to our colleagues at
the UW Health Research Park Clinic and Movement Systems
Physical Therapy, P.S. in Seattle, WA, for the use of their facilities.
We are also grateful for the time and energy provided by the
models, videographers, and photographer Andy Manis, whose
calm and organization helped us manage an extensive photo
shoot. Over the course of a person’s career, many individuals
assist in the development of a person’s theories, knowledge, and
expertise. In the years between editions, we have continued to
learn from the patients, students, and teachers who perpetually
challenge our thoughts and decisions, and shape our skills.
Last, but most certainly not least, we would like to especially
thank our family, friends, and colleagues who offered their
emotional support and gave of their time generously to allow
us to complete this project.
Lori Thein Brody
Carrie M. Hall
Each coauthor would like to extend her personal acknowledgments:
As we publish the fourth edition of our book, it is more evi-
dent now than ever that I am who I am because of the numerous
influential and inspirational researchers, practitioners, instructors,
business owners, administrators, and advocates, whom I have had
the pleasure to work with over my 30+ year career. I was particu-
larly fortunate to work with some of the best and brightest in our
field during my formative years at Washington University in St.
Louis. I would particularly like to thank Shirley Sahrmann, PhD,
PT, FAPTA, for her incredibly insightful theories and devotion
xiv
to the field of physical therapy. Her philosophy toward exercise
prescription is woven into my thoughts and writing. Dr. Sahr-
mann has planted seeds that are found in research and clinical
practice around the world. She is an icon in the field of physical
therapy, and I am immensely indebted to her for teaching me
how to view education, clinical practice, business acumen, and
even advocacy through a movement system lens. I consider this
book a result of the responsibility I feel to pay it forward to the
next generation of practitioners whom I am confident will take
the field of physical therapy into primary care and demonstrate
our critical value to public health. I view therapeutic exercise
as a cornerstone of our professional identity, and believe that
movement is medicine and that physical therapists are uniquely
qualified to integrate the biopsychosocial elements of the move-
ment system into a therapeutic and transformative intervention.
The writing of a textbook takes tremendous time and energy
away from work, friends, and family. Words cannot express my
appreciation for my colleagues at Movement Systems Physical
Therapy and my close friends whose support has been truly
remarkable. I especially thank my clinic Administrator, Scott
Spradling, who kept my business thriving during the hours I
spent on research and writing, my three children whose uncon-
ditional love keeps me going every day, and my dog, Winston,
who kept me running to maintain my fitness and mental clarity.
Carrie M. Hall
My life has been blessed with exceptional colleagues who have
believed in and advocated for me as my career has wound its way
through physical education, athletic training, physical therapy,
preventive medicine, and adult education. My deepest gratitude
goes to Peg Houglam, PT, ATC; Bill Flentje, PT, ATC; Susan
Harris, PT, PhD, FAPTA; and Joseph PH Black, MDiv, PhD.
These individuals provided examples of exceptional leadership
and set the standard for professionalism and integrity. I am deeply
grateful to them for their past and continued guidance. My sister,
Jill Thein-Nissenbaum, PT, DSc, ATC, played a pivotal role, picking
up the pieces Carrie and I left in our wake. She was there to take
on just about anything, including moral support and providing that
kind but critical “you already know that answer to that question,
just do it” advice. I am truly blessed by her presence in my life.
Thanks to my colleagues at University of Wisconsin Research
Park Clinic, particularly those who contributed to the writing
and editing of chapters, and Carrie Schwoerer, who always had
an ear or a box of tissues to lend.
I am also deeply grateful to the doctoral students at Rocky
Mountain University of Health Professions. They are a remark-
able group of bright, inquisitive current and future leaders who
do justice to our profession. I am grateful for the opportunity
to learn from each of them.
Lori Thein Brody
 Brief Contents

UNIT 1 UNIT 4
Foundation of Therapeutic Exercise 1 Sample Specialties of Therapeutic
CHAPTER 1 Exercise Intervention 357
Introduction to Therapeutic Exercise and the Model CHAPTER 14
of Functioning and Ability 2
Kinetic Chain Applications in Functional Movement 358
CHAPTER 2
CHAPTER 15
Patient Management 16
Proprioceptive Neuromuscular Facilitation 388
CHAPTER 3
CHAPTER 16
Strategies for Improving Therapeutic Exercise
Outcomes 39 Aquatic Therapeutic Exercise 413

CHAPTER 4
Prevention and the Promotion of Health, Wellness, and UNIT 5
Fitness 57
Functional Approach to Therapeutic
UNIT 2 Exercise of the Lower Extremities 433
CHAPTER 17
Impairments of Body Functions and The Lumbopelvic Region 434
Therapeutic Exercise 69 CHAPTER 18
CHAPTER 5 The Pelvic Floor 488
Impaired Muscle Performance 70 CHAPTER 19
CHAPTER 6 The Hip 526
Impaired Aerobic Capacity/Endurance 116 CHAPTER 20
CHAPTER 7 The Knee 586
Impaired Range of Motion and Joint Mobility 140 CHAPTER 21
CHAPTER 8 The Ankle and Foot 629
Impaired Balance and Mobility 187
CHAPTER 9 UNIT 6
Impaired Posture and Movement 216
Functional Approach to
CHAPTER 10
Pain 240 Therapeutic Exercise for the Upper
Extremities 657
UNIT 3 CHAPTER 22
The Temporomandibular Joint 658
Special Physiologic Considerations in CHAPTER 23
Therapeutic Exercise 281 The Cervical Spine 684
CHAPTER 11 CHAPTER 24
Soft-Tissue Injury and Postoperative Management 282 The Thoracic Spine 714
CHAPTER 12 CHAPTER 25
Therapeutic Exercise for Arthritis 313 The Shoulder Girdle 743
CHAPTER 13 CHAPTER 26
Therapeutic Exercise in Obstetrics 330 The Elbow, Forearm, Wrist, and Hand 798
xv
xvi BR I E F CONTE NTS

APPENDIX 3
UNIT 7 2016 PAR-Q +: The Physical Activity Readiness
Questionnaire for Everyone 881
Case Studies 845
INDEX 886
APPENDIX 1
Red Flags: Recognizing Signs and Symptoms 872
APPENDIX 2
Red Flags: Potentially Serious Symptoms and Signs in
Exercising Patients 877
 Contents

Key Components of Patient-Related Instruction 40

UNIT 1 Patient–Clinician Communication 40
Patient-Related Instruction in Home Exercise Prescription 41
Foundation of Therapeutic Exercise 1 Cognitive Domain: Informing and Educating 42
CHAPTER 1 Affective Domain: Adherence and Motivation 43
Introduction to Therapeutic Exercise and the Model Psychomotor Domain: Motor Learning 45
of Functioning and Ability 2 Applications: Home Exercise Prescription 48
LORI THEIN BRODY and CARRIE M. HALL Considerations in Exercise Prescription 48
Determining Exercise Levels 52
Definition of Physical Therapy 2
Formulating the Program 53
Therapeutic Exercise Intervention 2
Key Points 53
The Language of Health: Abilities and Disabilities 3
Terminology of the Biopsychosocial Model of CHAPTER 4
Functioning and Disability 3 Prevention and the Promotion of Health, Wellness, and
International Classification of Functioning, Fitness 57
Disability, and Health 5 JANET R. BEZNER
Part 1: Functioning and Disability 5 The Context for Primary Prevention 57
Part 2: Contextual Factors 8 Definitions 57
Application of the Model to Physical Therapist Practice 8 Prevention, Health Promotion, and Health Education 57
Health Conditions 11 Physical Fitness, Exercise, and Physical Activity 59
Impairments of Body Functions and Structures 11 Wellness, Lifestyle, and Quality of Life 60
Activity Limitations, Participation Restrictions, Measurement of Wellness 61
and Quality of Life 11 Health Promotion and Wellness-Based Practices 63
Contextual Factors and Interventions 12 From Illness to Wellness 63
Prevention and the Promotion of Health, Wellness, The Use of Screening as an Examination Tool Within a
and Fitness 13 Wellness-Based Practice 63
Summary 13 Starting a Wellness-Based Practice 64
Key Points 14 Physical Well-Being: Physical Activity Programs 65
CHAPTER 2 Conducting Health-Related Physical
Patient Management 16 Fitness Assessments 65
CARRIE M. HALL Establishing Physical Activity Interventions 65
Key Points 67
Patient Management Model 16
Examination 16
Evaluation 18
Diagnosis 21
UNIT 2
Prognosis and Plan of Care 22
Intervention 22
Impairments of Body Functions and
Outcome 24 Therapeutic Exercise 69
Modification 25 CHAPTER 5
Clinical Decision-Making 26
Impaired Muscle Performance 70
Therapeutic Exercise Intervention 26
LORI THEIN BRODY and CARRIE M. HALL
Therapeutic Exercise Intervention Model 27
Summary 34 Definitions 70
Exercise Modification 34 Strength 70
Adjunctive Interventions 36 Power and Work 71
Key Points 37 Endurance 71
Muscle Actions 71
CHAPTER 3
Physical Factors Affecting Muscle Performance 72
Strategies for Improving Therapeutic Exercise Fiber Type 72
Outcomes 39 Fiber Diameter 72
LORI THEIN BRODY Muscle Size 72
Patient Education: Definition and Scope 39 Force–Velocity Relationship 73
xvii
xviii CONTE NTS

Length–Tension Relationship 73 Systems Review 122

Muscle Architecture 74 Screening Examination 122
Clinical Considerations 74 Tests and Measures 123
Dosage 74 Therapeutic Exercise Intervention 128
Program Design 77 Mode 128
Training Specificity 78 Dosage 129
Neurologic Adaptation 78 Precautions and Contraindications 133
Muscle Fatigue 79 Graded Exercise Testing Contraindications and Supervision
Muscle Soreness 79 Guidelines 133
Life Span Considerations 80 Supervision During Exercise 134
Cognitive Aspects of Performance 84 Patient-Related Instruction/Education and Adjunctive
Effects of Alcohol 84 Interventions 134
Effects of Medications 84 Life Span Issues 135
Causes of Decrease Muscle Performance 85 Guidelines for Cardiovascular Endurance Training in the
Neurologic Pathology 85 Young 135
Muscle Strain 85 Guidelines for Cardiovascular Endurance Training in the
Disuse and Deconditioning 86 Elderly 136
Length-Associated Changes 87 Key Points 137
Physiologic Adaptations to Training 87
CHAPTER 7
Strength and Power 87
Endurance 89 Impaired Range of Motion and Joint Mobility 140
Examination and Evaluation of Muscle Performance 89 LORI THEIN BRODY
Classification of Resistance Exercise 90 Continuum of Mobility 140
Isometric Exercise 90 Morphology and Physiology of Normal Mobility 141
Dynamic Exercise 92 Immobility, Immobilization, and Remobilization 141
Methods of Resistance Training 93 Mobility Examination and Evaluation 143
Manual Resistance 93 Range of Motion Intervention For Impaired Mobility 144
Pulley System 94 Subsystems of the Movement System 144
Variable Resistance Machines 95 Considerations in Choosing Mobility Activities 145
Elastic Resistance 96 Range of Motion 145
Free Weights 98 Stretching 156
Isokinetic Devices 101 Indications 156
Body Weight 103 Principles and Considerations in Stretching 156
Therapeutic Exercise Intervention for Impaired Muscle Neurophysiology of Stretching 157
Performance 103 Static Stretching 158
Program Initiation 103 Ballistic Stretching 158
Program Progression 105 Proprioceptive Neuromuscular Facilitation Stretching 159
Therapeutic Exercise Intervention for Prevention, Health Dynamic Stretching 159
Promotion, and Wellness 107 Effects of Stretching 160
Dosage for Strength Training 107 Stretching and Joint Contractures 162
Dosage for Power Training 108 Joint Mobilization to Increase Mobility 163
Plyometric Exercise 108 Biomechanics of Joint Mobilization 164
Dosage for Endurance Training 109 Mobilization Grades 165
Dosage for the Advanced or Elite Athlete 109 General Procedures 165
Precautions and Contraindications 110 Applications to Specific Joints 165
Key Points 110 Neural Mobility 165
Self-Mobilization 172
CHAPTER 6
Mobility Exercise Dosage 174
Impaired Aerobic Capacity/Endurance 116 Sequence 174
JANET R. BEZNER Frequency, Intensity, and Duration 175
Aerobic Capacity and Endurance 117 Hypomobility Exercise Precautions and Contraindications 176
Definitions 117 Causes and Effects of Hypermobility 177
Normal and Abnormal Responses to Acute Aerobic Therapeutic Exercise Intervention for Hypermobility 178
Exercise 117 Stabilization Exercises 178
Physiologic and Psychological Adaptations Exercise Dosage 180
to Cardiorespiratory Endurance Training 118 Hypermobility Exercise Precautions and
Causes of Impaired Aerobic Capacity/Rehabilitation Contraindications 180
Indications 120 Lifespan Issues 180
Examination/Evaluation of Aerobic Capacity 122 Adjunctive Agents 181
Patient/Client History 122 Key Points 181
 CONTE NTS xix

CHAPTER 8 Intervention 233

Impaired Balance and Mobility 187
COLIN R. GROVE, JUDITH DEWANE, and LORI THEIN BRODY
Definitions 187
Physiology of Balance 188
Biomechanical Contributions 189
Contributions of the Sensory Systems 189
Neural Integration and Processing of Sensory
Information 190
Generating Motor Output—Movement Strategies 191
Control of Walking—Navigation 193
Higher-Level Influences 193
Causes of Impaired Balance 193
Examination and Evaluation of Impaired Balance and
Mobility 194
Biomechanical Domain 195
Sensory Strategies Domain 196
Movement Strategies Domain 197
Dynamic Control Domain 197
Cognitive Domain 197
Affective Domain 197
Determining Risk for Falling 198
Treating Impaired Balance 198
Diagnosis and Prioritization 198
Customization 199
Environmental Context 199
Mode 199
Motor Learning 200
Intervention Strategies for Specific Systems—Examples 200
Sequencing Considerations 207
Feedback 208
Expanded Ecological Model of Balance Rehabilitation 208
Precautions and Contraindications 209
Patient Education 209
Falls—A Significant Problem 209
Effects of Training on Balance 210
Key Points 211
CHAPTER 9
Impaired Posture and Movement
CARRIE M. HALL
Definitions 218
Posture 218
Standard Posture 218
Deviations in Posture 220
Movement 221
Contributors to Impaired Posture and Movement
Range of Motion 224
Muscle Length 224
Joint Mobility 224
Muscle Performance 225
Pain 227
Anatomic Impairments and Anthropometric
Characteristics 228
Psychologic Impairments 229
Lifespan Considerations 229
Environmental Influences 230
Examination and Evaluation 230
Posture 230
Movement 232
The Movement System 233
Activity and Dosage 234
Patient-Related Instruction and Adjunctive Interventions 235
Key Points 236
CHAPTER 10
Pain 240
LORI THEIN BRODY
Definitions 240
Physiology of Pain 240
Sources of Pain 241
Pain Pathways 242
Pain Theory 243
Examination and Evaluation 244
Pain Scales 244
McGill Pain Questionnaire 245
Disability and Health-Related Quality of Life Scales 246
Therapeutic Exercise Intervention for Pain 250
Acute Pain 251
Chronic Pain 253
Therapeutic Exercise Guidelines for Patients with Chronic
Pain 253
Adjunctive Agents 260
Transcutaneous Electrical Nerve Stimulation 261
Heat 261
Cold 261
Medication 261
Special Considerations in Chronic Pain: Complex Regional
Pain Syndrome, Fibromyalgia, and Chronic Fatigue
Syndrome 262
Complex Regional Pain Syndrome 262
Fibromyalgia Syndrome 264
Chronic Fatigue Syndrome 266
Therapeutic Exercise Interventions for Common
Impairments 267
Impaired Muscle Power Functions 267
Exercise Tolerance Functions: Impaired Aerobic
Capacity 268
216 Mobility of Joint Functions: Impaired Range of Motion 269
Muscle Endurance Functions: Impaired Posture 269
Emotional Functions: Impaired Response to Emotional
Stress 271
Precautions and Contraindications 272
Pacing 272
Pharmacological and Psychological Intervention 272
223 Key Points 273
UNIT 3
Special Physiologic Considerations in
Therapeutic Exercise 281
CHAPTER 11
Soft-Tissue Injury and Postoperative
Management 282
LORI THEIN BRODY
Physiology of Connective Tissue Repair 282
Microstructure of Connective Tissues 282
xx CONTE NTS

Response to Loading 283 Therapeutic Exercise Intervention for Wellness in

Phases of Healing 284 Pregnancy 348
Principles of Treating Connective Tissue Injuries 286 Precautions and Contraindications 349
Restoration of Normal Tissue Relationships 286 Exercise Guidelines 349
Optimal Loading 286 Exercise Intensity 350
Specific Adaptations to Imposed Demands 287 Exercise Classes 351
Preventing Complications 287 Key Points 351
Management of Impairments Associated with Connective
Tissue Dysfunction and Localized Inflammation 287
Sprain: Injury to Ligament and Capsule 287 UNIT 4
Strain: Musculotendinous Injury 288
Application of Treatment Principles 288 Sample Specialties of Therapeutic
Tendinopathy 291 Exercise Intervention 357
Articular Cartilage Injury 294
Contusion 296 CHAPTER 14
Management of Impairments Associated with Fractures 296 Kinetic Chain Applications in Functional
Classification of Fractures 296 Movement 358
Application of Treatment Principles 297 DANNY MCMILLIAN
Management of Impairments Associated with Bony and Understanding the Kinetic Chain 358
Soft-Tissue Surgical Procedures 298 Posture and Alignment 359
Soft-Tissue Procedures 299 Muscle Performance 360
Bony Procedures 305 Neuromuscular Control 361
Management of Impairments Associated with Joint Examination and Evaluation 363
Arthroplasty 308 Qualitative Examination 363
Key Points 309 Quantitative Examination 365
CHAPTER 12 Choosing Therapeutic Movements to Enhance Kinetic Chain
Function 366
Therapeutic Exercise for Arthritis 313
Applying Therapeutic Movement 369
LORI THEIN BRODY and KIMBERLY D. BENNETT
Key Points 384
Pathology 313
Osteoarthritis 313 CHAPTER 15
Rheumatoid Arthritis 314 Proprioceptive Neuromuscular Facilitation 388
Exercise Recommendations for Prevention and Wellness in OA KYLE M. YAMASHIRO and RAFAEL F. ESCAMILLA
and RA 318 History and Background 388
Therapeutic Exercise Intervention For Common Philosophy and Principles of PNF 388
Impairments 318 PNF Physiology and Applied Concepts 389
Pain and Fatigue 319 Research in PNF to Increase Muscle Length 390
Impaired Mobility and ROM 320 Research in PNF to Improve Muscle Performance 391
Impaired Muscle Performance 321 PNF Procedures 393
Impaired Aerobic Capacity 324 Manual Therapeutic Exercise Using PNF Procedures 393
Special Considerations in Exercise Prescription and Evaluation and Treatment Implementation 395
Modification 325 Direct Treatment 395
Patient Education 327 Indirect Treatment 395
Key Points 327 Manual Therapeutic Exercise Using PNF Techniques 395
CHAPTER 13 Movement 395
Stability 404
Therapeutic Exercise in Obstetrics 330
Flexibility 405
ELIZABETH A. V. BLOOM, MELISSA FISCHER, and M. J. STRAUHAL
Key Points 409
Physiologic Changes Related to Pregnancy 330
CHAPTER 16
Endocrine System 330
Cardiovascular System 331 Aquatic Therapeutic Exercise 413
Respiratory System 333 LORI THEIN BRODY
Musculoskeletal System 334 Physical Properties of Water 413
Therapeutic Exercise Intervention in Buoyancy 413
Pregnancy 335 Hydrostatic Pressure 415
Uncomplicated Antepartum Pregnancy 335 Viscosity 416
High-Risk Antepartum 343 Physiologic Responses to Immersion 418
Therapeutic Exercise Intervention for Common Effects of Hydrostatic Pressure 418
Impairments 346 Effects of Water Temperature 419
Nerve Compression Syndromes 346 Physiologic Responses to Exercise While Immersed 419
Other Impairments 347 Examination and Evaluation for Aquatic Rehabilitation 420
 CONTE NTS xxi

Therapeutic Exercise Intervention 420 Therapeutic Exercise Interventions for Common Physiologic
Mobility Impairment 421 Impairments 497
Muscle Strength/Power/Endurance Impairment 422 Impaired Muscle Performance 498
Balance Impairment 424 Active PFEs 498
Aquatic Rehabilitation to Treat Activity Limitations 426 Pain 501
Coordinating Land and Water Activities 427 Joint Mobility and Range of Motion (Including Muscle
Patient-Related Education 427 Length) Impairments 503
Precautions/Contraindications 428 Posture Impairment 504
Key Points 428 Coordination Impairment 504
Clinical Classifications of Pelvic Floor Muscle Dysfunction 506
Underactive PFM 506
UNIT 5 Overactive PFM 508
Incoordination Dysfunction 509
Functional Approach to Therapeutic Visceral Dysfunction 510
Therapeutic Exercise Interventions for Common Diagnoses 510
Exercise of the Lower Extremities 433 Incontinence 511
CHAPTER 17 Pelvic Organ Prolapse 513
The Lumbopelvic Region 434 Chronic Pelvic Pain 514
Levator Ani Syndrome 514
CARRIE M. HALL
Coccygodynia 514
Review of Anatomy and Kinesiology 435 Vulvodynia 515
Myology 435 Vaginismus 515
Gait 438 Nonrelaxing Puborectalis Syndrome 516
Examination and Evaluation 439 Dyspareunia 516
Patient History 440 Adjunctive Interventions 516
Screening Examination 441 Biofeedback 516
Tests and Measures 441 Basic Bladder Training 517
Therapeutic Exercise Intervention for Common Impairments of Scar Mobilization 518
Body Functions 448 Externally Palpating the Pelvic Floor Muscles 519
Aerobic Capacity Impairment 448 Key Points 520
Balance and Coordination Impairment 449
CHAPTER 19
Muscle Performance Impairment 450
Range of Motion, Muscle Length, and Joint Mobility 462 The Hip 526
Pain 464 CARRIE M. HALL
Posture and Movement Impairment 470 Impairments of Body Structures 526
Therapeutic Exercise Intervention for Common Diagnoses 473 Angles of Inclination and Torsion 526
Lumbar Disk Herniation 473 Center Edge Angle or Angle of Wiberg 527
Spinal Stenosis 477 Leg Length Discrepancy 527
Spondylolysis and Spondylolisthesis 478 Cam and Pincer Morphology 528
Key Points 479 Examination and Evaluation 529
History 530
CHAPTER 18
Lumbar Spine Clearing Examination 530
The Pelvic Floor 488 Other Clearing Tests 530
ELIZABETH R. SHELLY and SHERRI S. HOLT Gait and Balance 530
Review of Anatomy and Kinesiology 488 Joint Mobility and Integrity 531
Skeletal Muscles 488 Muscle Performance 531
Pelvic Diaphragm Muscles 489 Pain and Inflammation 531
Pelvic Floor Function 491 Posture and Movement 532
Physiology of Micturition 492 Range of Motion and Muscle Length 532
Impairments of Body Structures 493 Work (Job/School/Play), Community, and Leisure
Birth Injury 493 Integration or Reintegration (Including Instrumental
Neurologic Dysfunction 493 Activities of Daily Living) 533
Impairments of Mental Functions 493 Special Tests 533
Motivation 493 Therapeutic Exercise Interventions for Common Physiologic
Sexual Abuse 493 Impairments 535
Examination/Evaluation 494 Pain 535
Risk Factors 494 Muscle Performance 536
Screening Questionnaires 495 ROM, Muscle Length, Joint Mobility, and Integrity
Results of the Internal Examination 496 Impairments 549
Patient Self-Assessment Tests 496 Balance 557
Ultrasound Imaging for PFM Dysfunction 497 Posture and Movement Impairment 562
xxii CONTE NTS

Therapeutic Exercise Interventions for Common Diagnoses 563 Pain 635

Osteoarthritis 563 Posture and Movement Impairment 635
Iliotibial Band–Related Diagnoses 569 ROM, Muscle Length, Joint Integrity, and Mobility 637
Nerve Entrapment Syndromes 573 Swelling 641
Key Points 577 Therapeutic Exercise Intervention for Common Ankle and Foot
CHAPTER 20 Diagnoses 641
Ligament Sprains 642
The Knee 586
Ankle Fractures 644
JILL THEIN-NISSENBAUM and LORI THEIN BRODY Functional Nerve Disorders 645
Review of Anatomy and Kinesiology 586 Plantar Fasciitis 646
Anatomy 586 Posterior Tibial Tendon Dysfunction 648
Kinematics 587 Medial Tibial Stress Syndrome 649
Kinetics 588 Achilles Tendinosis 649
Impairments of Body Structures 589 Postoperative Management 650
Genu Valgum 589 Adjunctive Interventions 651
Genu Varum 590 Adhesive Strapping 651
Examination and Evaluation 590 Wedges and Pads 651
Patient/Client History 590 Biomechanical Foot Orthotics 652
Tests and Measures 590 Heel and Full Sole Lifts 652
Therapeutic Exercise Intervention for Body Function Key Points 653
Impairments 590
Mobility Impairment 590
Muscle Performance Impairments 596 UNIT 6
Therapeutic Exercise Intervention for Common Diagnoses 600
Ligament Injuries 600 Functional Approach to
Treatment of Ligament Injuries 605
Fractures 607
Therapeutic Exercise for the Upper
Treatment of Fractures 609 Extremities 657
Meniscal Injuries 610 CHAPTER 22
Treatment 611
The Temporomandibular Joint 658
Degenerative Arthritis Problems 612
LISA M. FLEXNER and DARLENE HERTLING
Articular Cartilage Lesions 612
Surgical Procedures 613 Review of Anatomy and Kinesiology 658
Interventions for Degenerative Arthritis Problems 615 The Temporomandibular Joint Structures 658
Tendinopathies 616 Associated Structures 660
Patellar Tendinopathy 616 Kinesiology 660
Iliotibial Band Syndrome 617 Examination and Evaluation 662
Patellofemoral Pain Syndrome 617 Subjective History 663
Key Points 623 Screening Exam for the TMJ 664
Therapeutic Exercise for Common Impairments of Body
CHAPTER 21
Functions 664
The Ankle and Foot 629 Mobility Impairments 664
JILL MCVEY and CARRIE M. HALL Posture Impairments 673
Common Foot Types 629 Swallowing and Respiratory Impairments 674
Subtalar Varus 629 The Rocabado 6 × 6 675
Forefoot Varus 629 Therapeutic Exercise for Common Diagnoses 675
Forefoot Valgus 629 Capsulitis and Retrodiskitis 676
Ankle Equinus 630 Internal Derangement of the Disk 676
Examination and Evaluation 630 Degenerative Joint Disease/Osteoarthritis 678
Patient/Client History 630 Postoperative Physical Therapy Following Surgical
Balance 630 Intervention 678
Joint Integrity and Mobility 630 Adjunctive Therapies 679
Muscle Performance 630 Key Points 679
Pain 630
CHAPTER 23
Posture 630
Range of Motion and Muscle Length 630 The Cervical Spine 684
Impairments of Body Structures 631 CAROL N. KENNEDY
Other Examination Procedures 631 Review of Anatomy and Kinesiology 684
Therapeutic Exercise Intervention for Common Impairments of Muscles 685
Body Functions 631 Examination and Evaluation 686
Balance Impairment 631 History and Clearing Tests 686
Muscle Performance 632 Physical Examination 686
 CONTE NTS xxiii

Therapeutic Exercise Interventions for Common Impairments of Adjunctive Interventions: Taping 786
Body Functions 687 Scapular Corrections 787
Impaired Muscle Performance 687 Prevention of Allergic Reaction 787
Mobility Impairment 697 Key Points 789
Posture Impairment 703
CHAPTER 26
Therapeutic Exercise Interventions for Common Diagnoses 708
Disk Dysfunction 708 The Elbow, Forearm, Wrist, and Hand 798
Cervical Sprain and Strain 709 LORI THEIN BRODY
Neural Entrapment 710 Anatomy 798
Cervicogenic Headache 710 Elbow and Forearm 798
Key Points 711 Wrist 799
CHAPTER 24 Hand 801
Regional Neurology 802
The Thoracic Spine 714
Kinesiology 803
ELIZABETH A. V. BLOOM and CARRIE M. HALL Wrist 805
Examination and Evaluation 715 Hand 805
History 715 Examination and Evaluation 808
Systems Review 715 History and Observation 808
Tests and Measures 716 Mobility Examination 808
Therapeutic Exercise Interventions for Common Impairments of Muscle Performance Examination 808
Body Structures and Functions 716 Other Tests 809
Impaired Muscle Performance 718 Therapeutic Exercise Interventions for Common Impairments of
Impaired ROM, Muscle Length, and Joint Mobility/ Body Functions 809
Integrity 722 Mobility of Joint Functions: Impaired
Pain 728 Range of Motion 809
Impaired Posture and Motor Function 728 Impaired Muscle Power Functions 811
Therapeutic Exercise Intervention for Common Diagnoses 736 Endurance Impairment 814
Prevention and Intervention in Patients with Pain and Inflammation Impairment 814
Osteoporosis 736 Muscle Endurance Functions: Impaired Posture and
Exercise Management of Parkinson Disease 736 Movement 815
Thoracic Outlet Syndrome 738 Therapeutic Exercise Interventions for
Key Points 739 Common Diagnoses 816
CHAPTER 25 Osteoarthritis and Rheumatoid Arthritis 816
Cumulative Trauma Disorders 817
The Shoulder Girdle 743
Nerve Injuries 818
CARRIE M. HALL
Musculotendinous Disorders 822
Review of Anatomy and Kinesiology 743 Bone and Joint Injuries 827
Examination and Evaluation 743 Stiff Hand and Restricted Motion 836
Patient/Client History 743 Key Points 837
Clearing Examinations 744
Motor Function (Motor Control and Motor Learning) 744
Muscle Performance 745 UNIT 7
Pain 745
Peripheral Nerve Integrity 746 Case Studies 845
Posture 746 LORI THEIN BRODY, CARRIE M. HALL, and ELIZABETH A. V. BLOOM
ROM, Muscle Length, Joint Mobility, and Joint Integrity 746
Work (Job/School/Play), Community, and Leisure
Integration or Reintegration (Including APPENDIX 1
Instrumental ADLs) 747 Red Flags: Recognizing Signs and Symptoms 872
Therapeutic Exercise Interventions for Common Impairments of
DAVID MUSNICK and CARRIE M. HALL
Body Structures and Functions 747
Pain 747 APPENDIX 2
ROM and Joint Mobility Impairments 757 Red Flags: Potentially Serious Symptoms and Signs in
Impaired Muscle Performance 761 Exercising Patients 877
Posture and Movement Impairment 770 SCOTT TAUFERNER and CARRIE M. HALL
Therapeutic Exercise Interventions for Common Diagnoses 771
Rotator Cuff Disorders 771 APPENDIX 3
Pathomechanics 771 2016 PAR-Q +: The Physical Activity Readiness
Pathogenesis 773 Questionnaire for Everyone 881
Glenohumeral Hypermobility/Instability 780
Frozen Shoulder 783 INDEX 886