Week 1 - Foundations for Effective Therex
PTA 104 Orthopedic Dysfunctions

Instructional Use Statement

The following information is used for instructional purposes for students enrolled in the Physical Therapist Assistant Program at Lane Community College. It is not intended for commercial use or distribution or commercial purposes. It is not intended to serve as medical advice or treatment.

Contact howardc@lanecc.edu for permissions.


Now you get to apply your knowledge of kinesiology and therapeutic exercise while expanding your understanding of pathologies, impairments, functional limitations and disabilities affecting the musculoskeletal system. Before we move directly into movement-based rehabilitation, we need to revisit normal muscle and skeletal anatomy and physiology, principles of motor learning, and postural alignment.

Lesson Objectives

  1. Review structure and function of the musculoskeletal system
  2. Recall principles of progressive:
    1. strengthening
    2. stretching
    3. ROM
  3. Review common pathologies associated with imbalances in strength and flexibility
    1. muscle strain
    2. abnormal posture
  4. Identify principles of motor learning and training
  5. Relate therapeutic exercise principles to the role of the PTA.


Introduction Video From Christina - Approximately 4.5 minutes

Musculoskeletal Anatomy Key Term Review


Key Term



single muscle cell


myofiber contractile units


a single contractile unit

motor unit

one neuron and the muscle fibers it innervates

Type I

Slow-twitch; dominant fiber type for endurance/posture;

Type II

Fast-twitch; dominant fiber type for agility, quick actions


muscles that function to maintain motion within a target plane of motion


muscles that function to provide support a region while another area moves


loose, ubiquitous connective tissue


thick connective tissue that attaches muscle to bone. Myotendinous junction (where muscle connects to tendon) is the most common site of muscle strain


thick connective tissue that connects bones across joints; contributes to proprioception and pain perception

articular cartilage

avascular viscoelastic material that provide a smooth frictionless surface for joint motion


blend of fibrous and cartilaginous tissue that provides flexibility, toughness, and elasticity






Strengthening Benefits


Muscle Strengthening Methods

Neuromuscular electrical stimulation

Primarily used for muscle reeducation; timing of contraction


Slow tension build with sustained hold, followed by a slow release. "Rule of tens" - 2 second ramp up, 6 second hold, 2 second release; used when joint motion is contraindicated to prevent atrophy or loss of tensile strength from disuse and promote circulation


Progression: single angle submaximal, multiple angle submaximal, and multiple angle maximal


Muscle shortening producing enough force to produce joint motion


Deceleration, controlled lowering against gravity; stimulates contractile and non-contractile elements


Requires exercise equipment that maintains torque throughout the range of motion

Proprioceptive neuromuscular facilitation

Manual resistance applied to promote stability or motion depending on the target outcome


Goal is to focus maintaining a closed-chain position in varying levels of support


Muscle Tissue Pathology

Disuse Atrophy

Muscle Strain

 Review from PTA 101


Stretching versus ROM

Range of Motion (ROM)



Stretching is not the same as applying PROM nor progressing to AAROM and AROM


Static stretch is the safest form of stretching. A constant load applied over time will allow the soft tissue to safely yield, target collagen fibers which restrict motion, yet protect from strain and/or tear.

PNF stretching is the most effective method to increase muscle length over time.


What is Therapeutic Exercise?


Therapeutic exercise is the systematic, planned performance of bodily movements, postures, or physical activities intended to provide a patient/client with the means to

Therapeutic exercise is used in physical therapy to prevent disability, to minimize the progression of factors which result in disabilities, and to provide rehabilitation from pathological processes which result in loss of function and participation in the community. The PT/PTA team consider risk factors which may impact successful progression through a plan of care. Biological, lifestyle, environmental, and socioeconomic factors which impact treatment planning and progression are an integral part of PT/PTA -patient- centered approach to treatment.

How does therapeutic exercise prescription support a need for skilled physical therapy services?

 What factors contribute to the safety of a therapeutic exercise program?


Key Terms in Therapeutic Exercise




range of motion allowed at a joint

static - PROM at a joint

dynamic - ease of movement within the ROM


maximum force produced in a single contraction


sustained contractions or effort over time


a function of speed and strength within a muscle


level of effort


length of time (session or over a rehabilitation/exercise program)


Number of times exercise is performed (session, rehabilitation plan)


Alignment of limb or body (e.g., related to gravity, end-range, etc.)


Increasing demand of exercise to effect a change in one or more outcomes (e.g., speed, accuracy, complexity, endurance, power, etc.)


"specific adaptation to imposed demand" - selected exercises should match intended effect


adaptation and training requires a demand greater than normal stress


Types of Resistance


Moving against gravity (concentric); and slow lowering with gravity (eccentric); effective for weakened muscles

Body weight

Leverages body weight as resistance (e.g. push up, squat, side plank)

Small weights

Cuff weights or free weights allow for high repetition motions to build endurance and strengthen weaker muscles

Surgical tubing/theraband

Variable resistance to motion dependent on the elastic qualities of the tubing


Typically used for larger muscle groups to build strength/power

Manual resistance

Clinician uses hand placement during motions or positions to resist through parts of an arc or throughout the arc of motion


Strengthening Programs

Therapeutic exercise selection dependent on the patient goals, tissue healing stage, general conditioning, and pain response. Typical resisted exercise progression gradually increases the load on contractile and non-contractile tissue to optimize function

Sidestep with band


Free Exercise Resource

Would you like to have access to modifiable home exercise pictures and instructions? Try HEP2Go.com! Create an account and design your own home exercise programs and reinforce your understanding of muscle action and function at the same time.

I use this in the clinic and its just great. Don't forget, you have access to home exercises through your APTA membership: Go to PTNow and the Rehab Reference Center to find the exercises that align wiith the PT plan of care.

Motor Learning Principles 

In many of our case simulations, we have provided patient and family education in exercise techniques and safety considerations. How do we optimize our patient/client's chances for mastering the task? How do we evaluate if our instruction led to the intended result? With adequate preparation and applying concepts of motor learning, we can evaluate our effectiveness as patient and family educators.

Suggestions for exercise instruction


Taxonomy of Motor Learning

Taxonomies are classification systems to categorize items, animal, activities, etc., using progressively specific terminology. In motor learning, taxonomies are used to help distinguish levels of complexity between movement-based activities.

Environmental factors

Closed environments are less complex than open environments. Closed environments are static: objects, people and surfaces do not move. Open environments are dynamic: objects, people and surfaces can move and change between episodes.

Intertrial Variability: is absent when there is no change to the environmental conditions; is present when environmental demands change with each attempt

Desired Outcome of the Action

Body stable actions are less complex than body transport actions. Body stable includes maintaining a stationary/stable position while executing a motor task. Body transport includes activities where the patient/client is moving and changing positions through space

Tasks which do not include object manipulation are less complex than tasks where the person is required to move/manipulate an object


Practice and feedback strategies are selected by the PT/PTA based on the instructional readiness of the patient/client and the complexity of the task demands (person/environment). Your text distinguishes between:


Consider the intended outcome of the instruction. Performance is enhance by repeated blocked practice, however, skill retention and transferability of skills to multiple conditions and environments benefits most from task variations. The key is to assess each patient/client and select the most appropriate level of practice to allow for incremental, progressive success in motor performance and skill development.


Feedback is categorized by timing, outcome focus (knowledge of performance vs. knowledge of result), and source.


Test your knowledge of effective instructional strategies for therapeutic exercise by matching the strategy with the most likely stage of motor learning


 Active learning exercise

Consider a patient who has right ankle stiffness and weakness since an ankle sprain 8 weeks ago due to volleyball injury. The patient walks with a minimal limp, with decreased stride length on the left.The patient is athletic and is eager to return to sport, however, this is the third time the patient has had this injury.

Can you think of a series of progressions, with a focus on motor learning principles as a guiding factor? How will you change practice, feedback, environment and stability versus mobility to demonstrate you are making the task progressively more complex and automatic? Is it something you would be willing to do on your own if you had this injury?

Post your response in the CAN YOU HELP ME forum


Faulty Posture Review

Common Faulty Postures

Sample Postural Alignment

Abnormal Postures


Postural impairments are influenced by disease, endurance, strength and flexibility, age, pregnancy, habit, and pain

Muscle length (i.e. too long and too short) influences postural alignment


Role of the PTA


End of Lecture