Table Of ContentExercise Therapy in the Management of
Musculoskeletal Disorders
Exercise Therapy in the Management
of Musculoskeletal Disorders
Edited by
Fiona Wilson
John Gormley
Juliette Hussey
Discipline of Physiotherapy
School of Medicine
Trinity College, Dublin
Ireland
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2011
© 2011 by Blackwell Publishing Ltd
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Library of Congress Cataloging-in-Publication Data
Exercise therapy in the management of musculoskeletal disorders / edited by Fiona Wilson, John Gormley,
Juliette Hussey.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4051-6938-7 (pbk. : alk. paper) 1. Musculoskeletal system–Diseases–Exercise therapy.
I. Wilson, Fiona, 1966- II. Gormley, John. III. Hussey, Juliette.
[DNLM: 1. Musculoskeletal Diseases–therapy. 2. Exercise Therapy. WE 140]
RC925.5.E94 2011
616.7′0642–dc22
2010041337
A catalogue record for this book is available from the British Library.
This book is published in the following electronic formats: ePDF 9781444340143; ePub 9781444340150
Set in 9.5/11.5pt Sabon by Toppan Best-set Premedia Limited
1 2011
Contents
Contributors xi Exercise frequency 11
Preface xiii Progression of the programme 12
Prescription of muscle strength and
endurance exercise 12
Part 1 The Principles of the Types of resistance 12
Use of Exercise in Isometric exercise 12
Isotonic exercise 13
Musculoskeletal Disorders 1
Plyometric exercise 13
Open versus closed kinetic chain
1 Introduction 3
exercise 13
John Gormley
Intensity, frequency and volume
Historical perspectives 3 of exercise 14
History of exercise 3 Prescription of range of motion or
Exercise and physiotherapy 4 fl exibility exercise 14
The benefi ts of exercise 4 Passive exercise 15
References 5 Active range of motion 15
Active-assisted range of motion
2 The Role of Exercise in Managing exercise 15
Musculoskeletal Disorders 6 Types of stretching 15
Fiona Wilson Frequency, intensity and duration 16
Prescription of proprioception,
Section 1: Introduction and Background 6
co-ordination and balance exercise 17
Evidence for the role of exercise in
References 17
managing musculoskeletal
disorders 6
3 Measurement and Assessment
Section 2: Practical Application
in the Management of
of Exercise 8
Musculoskeletal Disorders 19
Components of fi tness 8
Alison H. McGregor
Exercise prescription 8
Components of an exercise session 8 Introduction 19
Warm-up 9 What is normal function? 19
Endurance phase 9 Biomechanics of movement 21
Recreational activities 9 Observed analysis 22
Cool-down 9 Kinematic assessment methods and
Prescription of aerobic exercise 9 measurement tools 23
Type of exercise 9 Goniometers 23
Exercise intensity 11 Imaging 24
Exercise duration 11 Optical motion analysis systems 25
vi Contents
How can kinematic assessments Disorders of the thoracic spine 56
be used? 25 Scheuermann’s disease 57
Assessment of muscles 26 Scoliosis 57
References 27 Ankylosing spondylitis 57
Section 2: Practical Use of Exercise 57
Assessment of the patient 58
Part 2 Regional Application Posture 58
of Exercise 29 Assessment of aerobic capacity 58
Assessment of endurance 58
4 The Cervical Spine 31 Assessment of fl exibility 58
Kirsty Peacock The exercise programme 59
Early phase 59
Section 1: Introduction and Background 31
Intermediate phase 60
Cervical spine dysfunction and
Late phase 61
neuromuscular impairment 32
Section 3: Case Studies and
Effi cacy of exercise for cervical
Student Questions 63
dysfunction 32
Case study 1 63
Aerobic exercise 32
Case study 2 64
Muscle strength and endurance
Case study 3 65
training 32
Student questions 65
Range of movement and fl exibility
References 65
exercises 33
Sensorimotor and proprioceptive
exercise 33 6 The Lumbar Spine 67
Section 2: Practical Use of Exercise 33 Fiona Wilson
Aerobic exercise 33
Section 1: Introduction and
Endurance and strength training 34
Background 67
Endurance training 34
Evidence for the use of exercise in the
Strength training 39
management of low back pain 67
Range of movement/fl exibility exercises 40
Aerobic exercise 69
Sensorimotor and proprioceptive
Muscle strength and endurance 71
rehabilitation 43
Range of motion and fl exibility 73
Motor control 44
Balance and proprioception 73
Section 3: Case Studies and
Summary 74
Student Questions 46
Lumbar spine injury 74
Case study 1 46
Vertebrae 75
Case study 2 48
Neural arch 75
Case study 3 48
Disc 75
Student questions 50
Ligaments 75
References 50
End plates 75
Section 2: Practical Use of Exercise 75
5 The Thoracic Spine and Rib Cage 53
Assessment of the patient 75
Fiona Wilson
Assessment of endurance 75
Section 1: Introduction and Background 53 Lateral musculature test 76
Evidence for the use of exercise in the Flexor endurance test 76
management of disorders of the Back extensor test 76
thoracic spine and rib cage 53 Assessment of aerobic capacity 76
Aerobic exercise 55 Assessment of motor control 76
Muscle strength and endurance 55 Assessment of proprioception 76
Range of motion and fl exibility 56 Assessment of fl exibility 77
Balance and proprioception 56 Design of an exercise programme 79
Contents vii
The exercise programme 79 The evidence for exercise therapy
Early phase 79 post-dislocation and fracture 115
Intermediate phase 82 Overuse injuries of elbow ligaments 116
Late or advanced phase 85 The evidence for exercise therapy in
Range of motion and fl exibility unstable elbows 116
training 86 Tennis elbow 116
Discharging the patient 88 The evidence for exercise in tennis
Section 3: Case Studies and elbow 117
Student Questions 89 Section 2: Practical Use of Exercise 117
Case study 1 89 Practical guidelines for exercise
Case study 2 89 therapy post-dislocation and
Case study 3 90 fracture 117
Student questions 91 Range of motion and fl exibility 117
References 91 Strengthening 118
Practical guidelines for exercise
7 The Shoulder Complex 94 therapy in unstable elbows 120
Anne S. Viser, Michael M. Reinold, Strengthening 120
Kyle J. Rodenhi and Thomas J. Gill Proprioception 122
Practical guidelines for exercise in
Section 1: Introduction and
tennis elbow 122
Background 94
Strengthening 123
Evidence of role of exercise in
Flexibility and stretching 124
shoulder rehabilitation 94
Proprioception 125
Range of motion and fl exibility
Conclusion 125
exercise 94
Section 3: Student Questions 125
Strengthening exercise 95
Student questions 125
Proprioception 99
References 125
Aerobic exercise 100
Section 2: Practical Use of Exercise 101
Functional rehabilitation of the shoulder: 9 The Wrist and Hand 129
Clinical application of dynamic Mandy Johnson
stabilisation 101
Section 1: Introduction and
Acute phase 101
Background 129
Intermediate phase 102
Evidence for the use of exercise in
Advanced phase 104
the rehabilitation of wrist and
Return to activity phase 106
hand injuries 129
Conclusion 106
Injuries to the wrist and hand 130
Section 3: Case Studies and
Fractures, dislocations and ligament
Student Questions 107
injuries 130
Case study 1 107
Tendinopathy 131
Case study 2 108
Overuse injuries 132
Case study 3 108
Joint diseases 132
Student questions 109
Section 2: Practical Use of Exercise 133
References 109
Assessment of the wrist and hand 133
Exercise management of the wrist
8 The Elbow and Forearm Complex 113
and hand 134
Bill Vicenzino, Michelle Smith and
The early phase – passive exercises/
Leanne Bisset
mobilisation 134
Section 1: Introduction and Background 113 Intermediate stage – strengthening
Acute traumatic injuries of bone and exercises 135
ligaments 115 Late or functional stage 137
viii Contents
Section 3: Case Studies and 11 The Knee 159
Student Questions 138 Mandy Johnson
Case study 1 138
Case study 2 139 Section 1: Introduction and
Case study 3 139 Background 159
Student questions 139 Evidence for the use of exercise in
References 140 the rehabilitation of knee
injuries 159
Aerobic exercise 160
10 The Hip and Pelvic Complex 141
Balance and proprioception 161
Kevin Sims
Range of movement and fl exibility
Section 1: Introduction and exercises 162
Background 141 Muscle strength and endurance 162
Evidence of exercise effi cacy in the Disorders of the knee joint complex 164
management of hip pain 141 Ligament sprains 164
Aerobic exercise 142 Meniscus injuries 165
Muscle strength and endurance 142 Osteoarthritis of the knee 165
Range of motion and fl exibility 143 Anterior knee pain 165
Balance and proprioception 143 Muscle injuries 166
Common injuries/conditions 143 Quadriceps 166
Evidence of exercise effi cacy in the The hamstrings 167
management of pelvic girdle pain 144 Section 2: Practical Use of
Aerobic exercise 145 Exercise 167
Muscle strength and endurance 145 Osteoarthritis of the knee joint 167
Range of motion and fl exibility 145 Aerobic exercise 167
Balance and proprioception 145 Range of motion and fl exibility
Common pelvic conditions/injuries 146 exercises 168
Section 2A: Practical Use of Proprioception and balance exercise 170
Exercise Around the Hip 146 Muscle strength and endurance
Aerobic exercise 146 exercise 170
Strengthening exercise 146 Patellar tendinopathy 174
Early phase 146 Patellofemoral pain syndrome 176
Later phase 148 Early phase 176
Range of motion and fl exibility Late and functional phase 176
exercises 150 Anterior cruciate ligament injury 178
Proprioceptive and balance training 151 Phase 1 (weeks 1–4) –
Summary 151 protection 178
Section 2B: Practical Use of Phase 2 (weeks 5–8) – early
Exercise Around the Pelvis 151 strength training 180
Aerobic exercise 152 Phase 3 (weeks 9–12) – intensive
Strengthening exercise 152 strength training 180
Range of motion and stretching Phase 4 (weeks 13–16) – intensive
exercises 152 strength training and return
Proprioception exercises 153 to sports 181
Section 3: Case Studies and Section 3: Case Studies and
Student Questions 154 Student Questions 182
Case study 1 154 Case study 1 182
Case study 2 155 Case study 2 182
Case study 3 156 Case study 3 183
Student questions 156 Student questions 184
References 156 References 184
