Possible Treatments

Active Assistive Range of Motion

(Pictured for the shoulder only) Patient or therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

Aerobic/Endurance Exercise

Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

Ankle Active Range of Motion

The movement of the ankle, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

Ankle Joint Mobilization

Hands-on therapeutic procedures intended to increase soft tissue or ankle joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

Ankle Joint Passive Range of Motion

The movement of the ankle by the patient or therapist through a range of motion without the use of the muscles that "actively" move the joint(s).

Ankle Progressive Resistive Range of Motion

Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

Core Strengthening

The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

Cryotherapy or Cold Therapy

Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

Elbow Active Range of Motion

The movement of the elbow, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

Elbow Joint Mobilization

Hands-on therapeutic procedures intended to increase soft tissue or elbow joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

Elbow Passive Range of Motion

The movement of the elbow by the patient or therapist through a range of motion without the use of the muscles that "actively" move the joint(s).

Elbow Resistive Range of Motion

Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

Electrotherapeutic Modalities

Here are modalities that are used for this treatment.

• Neuromuscular Electrical Stimulation
• Transcutaneous Electrical Nerve Stimulation (TENS)
• Iontophoresis

Foam Roll Exercise

Exercises typically performed on a cylinder or half cylinder of foam for self-joint mobilization, postural exercise, core stability, and balance training.

Gait or Walking Training

The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

Hand Active Range of Motion

The movement of the hand, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

Heat Pack

Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or "new" injury.

Hip Active Range of Motion

The movement of the hip, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

Hip Joint Mobilization

Hands-on therapeutic procedures intended to increase soft tissue or hip joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

Hip Passive Range of Motion

The movement of the hip, by the patient or therapist, through a range of motion without the use of the muscles that "actively" move the joint(s).

Hip Resistive Range of Motion

Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

Ice Massage

The application of ice directly to the skin's surface to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue.

Iontophoresis

Medications are propelled through the skin by an electrical charge. This modality works on the physical concept that like charges repel each other, therefore, a positively charged medication will be repelled through the skin to the underlying tissues by the positively charged pad of an iontophoresis machine. Iontophoresis is usually prescribed for injuries such as shoulder or elbow bursitis.

Isometric Exercise

An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

Isotonics

Muscle(s) contracting through the range of motion (ROM) with resistance. This is usually prescribed for strengthening.

Knee Active Range of Motion

The movement of the knee, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints

Knee Joint Mobilization

Hands-on therapeutic procedures intended to increase soft tissue or knee joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

Knee Passive Range of Motion

The movement of the knee, by the patient or therapist, through a range of motion without the use of the muscles that "actively" move the joint(s).

Knee Resistive Range of Motion

Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

Low Back Active Range of Motion

The movement of the low back, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion gentle strengthening without trauma to joints.

Low Back Joint Mobilization

Hands-on therapeutic procedures intended to increase soft tissue or low back joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

Low Back Passive Range of Motion

The movement of the low back, by the patient or therapist, through a range of motion without the use of the muscles that "actively" move the joint(s).

Low Back Resistive Range of Motion

Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

Lumbar Traction

The longitudinal/axial pull on the lumbar spine, either manual or mechanical, intermittent or continuous. Pelvic traction may be helpful for the relief of low back pain and muscle spasm.

McKenzie Exercise

Exercises prescribed (based on a patient's presentation of symptoms) to cause the "centralization" of pain or movement of pain out of the thigh and leg. These exercises are part of a complete program that also involves extensive patient education to help manage current and future episodes of pain.

Middle Back Active Range of Motion

The movement of the middle back, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints

Middle Back Joint Mobilization

Hands-on therapeutic procedures intended to increase soft tissue or middle back joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Maitland, Kaltenborn, Isometric Mobilizations, etc.

Neck Active Range of Motion

AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

Neck Joint Mobilization

Hands-on therapeutic procedures intended to increase soft tissue or neck joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

Neck Passive Range of Motion

The movement of the neck, by the patient or therapist, through a range of motion without the use of the muscles that "actively" move the joint(s).

Neck Resistive Range of Motion

Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

Neck Traction

A gentle longitudinal/axial pull on the neck, either manual or mechanical, intermittent or continuous for relief of neck pain, to decrease muscle spasm, and facilitate unloading of the spine.

Neuromuscular Electrical Stimulation

The application of electrical stimulation to aid in improving strength (e.g., the quadriceps muscle after knee surgery or injury). Neuromuscular Electrical Stimulation (NMES) is also used to decrease pain and swelling and to relieve muscle spasm.

Physical Agents

Here is a partial list of physical agents used for treatment.

• Cryotherapy or Cold Therapy
• Heat Pack
• Ultrasound

Plyometrics

Exercises characterized by the application of a quick muscle stretch followed by rapid muscle shortening enabling muscle(s) to achieve maximal rates of force development. They are intended to improve reactive/explosive muscle performance.

Posture Training

Instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have it. Therapists educate patients about the importance of improving posture and body mechanics with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

Proprioception Exercises

Proprioception is the body's ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body's proprioceptive skills.

Proprioceptive Neuromuscular Facilitation (PNF)

Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

Shoulder Active Range of Motion

The movement of the shoulder, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints

Shoulder Joint Mobilization

Hands-on therapeutic procedures intended to increase soft tissue or shoulder joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

Shoulder Passive Range of Motion

The movement of the shoulder by the patient or therapist through a range of motion without the use of the muscles that "actively" move the joint(s).

Shoulder Resistive Range of Motion

Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

Soft Tissue Mobilization

Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

Stationary Cycling

Aerobic Exercise - The American College of Sports Medicine (ACSM) defines aerobic exercise as "any activity that uses large muscle groups, can be maintained continuously, and is rhythmic in nature." Aerobic means in the presence of oxygen. In other words, your body is burning its fuel (glucose) in the presence of oxygen. It is performed at less than 85% of your maximum heart rate. An aerobically fit individual can work longer, more vigorously and achieve a quicker recovery at the end of the aerobic session. Jogging, cycling, swimming, aerobics classes, and rowing are examples of aerobic exercise.

Stretching/Flexibility Exercise

Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

Therapeutic Ball Exercise

A therapeutic ball a large rubber ball 55 to 85+ centimeters in diameter used for strength, balance, and flexibility exercise. AKA therapy ball or Swiss ball. The ball provides a fulcrum or pivot point around which exercises are performed. The ball also is subject to rolling which requires additional stabilization and concentration to perform a given exercise.

TMJ Active Range of Motion

Movement of the jaw by the patient through a range of motion against gravity. This could be opening of the mouth, movement of the jaw side-to-side, or protrusion (moving the jaw forward).

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS is a relatively low voltage applied over painful areas through small self-adhesive electrodes. The electrical stimulation "disguises" or "overrides" the sensation of pain. It is a small, portable unit, used in intervals, to control pain and reduce dependence on drugs. It is usually prescribed for relief of pain.

Ultrasound

Ultrasound uses a high frequency sound wave emitted from the sound head when electricity is passed through a quartz crystal. The sound waves cause the vibration of water molecules deep within tissue causing a heating effect. When the sound waves are pulsed, they cause a vibration of the tissue rather than heating. The stream of sound waves helps with nutrition exchange at the cellular level and healing. Studies have shown that ultrasound is helpful for ligament healing and clinically, for carpal tunnel syndrome, and muscle spasm.

Whirlpool

Immersion of a body part into water with small "agitators" to provide a gentle massaging motion. A warm whirlpool provides relief from pain and muscle spasm and is often preparatory to stretching or exercise. Cold whirlpool is used to decrease inflammation and swelling.

Wrist Active Range of Motion

The movement of the wrist, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

Wrist Joint Mobilization

Hands-on therapeutic procedures intended to increase soft tissue or wrist joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

Wrist Passive Range of Motion

The movement of the wrist, by the patient or therapist, through a range of motion without the use of the muscles that "actively" move the joint(s).

Wrist Resistive Range of Motion

Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.