Advanced Physical Therapy Practice

100
BASIC KEY POINTS
FOR PHYSICAL THERAPISTS
2023 Edition

DR.FAHD ABD ELAZIM PT.PHD (C)

PHYSICAL THERAPY CONSULTANT
ORTHOPEDICS AND SPORTS INJURIES
Advanced Physical
Therapy Practice
Basic Key Point 1
Physical Therapists main goal not only to relief
pain but also to restore function
We are people dealing with function
Advanced Physical
Therapy Practice

Basic Key Point 2

Physical therapy long term goal
To make the patient functional and
independent By restoring optimal
1-Mobility
2-Stability
3-Controlled mobility
4-Skill
Advanced Physical
Therapy Practice

Basic key Point 3

Mobility means restore ROM by stretching
exercises, Mobilizing ex and strengthening ex
for superficial muscles (mobilizer)
Advanced Physical
Therapy Practice

Basic key Point 4

Stability means restore stability for the proximal
part to mobilize the distal part by
strengthening ex for the deep muscles
(stabilizers)
Advanced Physical
Therapy Practice

Basic key Point 5

Controlled mobility means restore the normal
pattern of movement by training patients on
the correct pattern of movement (functional
training)
Advanced Physical
Therapy Practice
Basic key Point 6
Skill means restore The ability to maintain
consistency in performing functional tasks
with economy of effort
Advanced Physical
Therapy Practice
Basic key Point 7
Posture is the base on which all movements and
function occur
It is the way by which Body parts arranged over
each other
Advanced Physical
Therapy Practice
Basic Key Point 8
Restoring Range of motion is the 1st step to
achieve your goal which is restoring patient’s
functional level before injury
 Advanced Physical
Therapy Practice
Basic Key Point 9
End feel is the type of resistance you feel during
applying pressure at the end of the available
range
It may be
Hard due to bony block
Firm due to soft tissue shortening
Soft due to soft tissue edema
Springy due to torn meniscus
Empty due to fracture or tumor
Advanced Physical
Therapy Practice
Basic Key Point 10
For full ROM consider accessory movement like
rolling gliding and spinning as well as
physiological movement like flexion-
extension, abduction-adduction and internal
–external rotation
Advanced Physical
Therapy Practice

Basic key Point 11

Osteokinematics or Physiologic Motion:
Gross movements of limbs relative to the body
Like flexion extension abduction adduction
external rotation internal rotation
Occurred by active and passive ROM exercises
Advanced Physical
Therapy Practice

Basic key Point 12

Arthrokinematics or Accessory Motion: Relative
motions that occur between articular surfaces
These motions include roll, spin, glide, roll-glide
that occurred in conjunction with physiological
movement for full ROM or as response for
external force like joint mobilization
Advanced Physical
Therapy Practice
BASIC KEY POINTS 13
To increase ROM
Stretch shortened muscles
Activate muscles responsible for limited ROM
Joint mobilization to restore accessory
movement
Mange intra-articular causes which limit ROM
Advanced Physical
Therapy Practice
Basic Key Point 14
Activation of muscles in the newly gained ROM
is a must to maintain this ROM
Advanced Physical
Therapy Practice

Basic key Point 15

Static stretching is effective in increasing ROM.
The greatest change in ROM with a static
stretch occurs with holding time between 15
and 30 seconds and 3 to 5 repetitions
Advanced Physical
Therapy Practice
Basic Key Point 16
Restoring normal neuromuscular function is the
2nd step to achieve your goal which is restoring
patient’s functional level
Advanced Physical
Therapy Practice
Basic Key Point 17
Neuromuscular function include
Initiation
Strength
Endurance
Elongation
Advanced Physical
Therapy Practice
Basic Key Point 18
Tensed muscle increase of the muscle firing
state (same muscle length)
-May be due to inhibited antagonist muscles
-May be due converted muscle function from
tonic to phasic
It needs inhibitory techniques like prolonged
stretching and prolonged icing
Advanced Physical
Therapy Practice
Basic Key Point 19
Tight muscle invasion of passive component
(connective tissue) to muscle fiber to decrease the
energy demands needed by the tensed muscle
and it becomes shorter in length
It needs inhibitory techniques, stretching exercises
and positioning (1st degree muscle length disorder)
Advanced Physical
Therapy Practice
Basic Key Point 20
Spasmed muscle persistent strong muscle
contraction during rest may be due to pain or due
to decrease in blood supply
It needs to treat the cause of pain in neurogenic
spasm and to increase blood supply in chemical
spasm
Advanced Physical
Therapy Practice
Basic Key Point 21
shortened muscle reversible decrease of the
muscle length due to bad habits without over
activity of the muscle
It needs stretching exercises, positioning,
strengthening exercises to antagonist and
splinting (2nd degree muscle length disorder)
Advanced Physical
Therapy Practice
Basic Key Point 22
contractured muscle irreversible decrease of
muscle length due to diminish of blood supply
to the muscles and conversion from muscular
tissue to fibrous tissue
It needs surgical interference (3rd degree
muscle length disorder)
Advanced Physical
Therapy Practice
Basic Key Point 23
weakened muscle decrease in muscle size and
tension which it produce
it needs progressive resisted exercises
Advanced Physical
Therapy Practice
Basic Key Point 24
inhibited muscle decrease of excitatory
impulses from nervous system for the muscle
it needs facilitatory techniques like quick stretch
and quick icing
Advanced Physical
Therapy Practice

Basic key Point 25

For any movement production we need
Prime movers muscles which produce the
actual movement
Secondary movers (synergists ) muscles which
assist the prime mover to produce the actual
movement
Stabilizers muscles which stabilize the proximal
joint to produce the movement in distal joint
Advanced Physical
Therapy Practice

Basic key Point 26

As A movement therapist you have to restore
the affected movements by considering the
prime movers, synergists or secondary movers
and stabilizers
Advanced Physical
Therapy Practice

Basic key Point 27

Some times muscles have certain changes
which affect their ability to do their movements
like weakness or inhibition
Advanced Physical
Therapy Practice
Basic Key Point 28
Activation of a muscle it is any muscle training
against resistance below than 70% of its
1repeatation maximum Strengthening of a
muscle it is any muscle training against
resistance above than 70% of its 1repeatation
maximum
Advanced Physical
Therapy Practice
Basic Key Point 29
Do not start strengthening exercises until you
regain full ROM
Advanced Physical
Therapy Practice

Basic key Point 30

Muscle energy technique (MET)
It is one of the most important manual therapy
techniques which used to mange the muscle
over activity state through Autogenic
inhibition or Reciprocal inhibition
Advanced Physical
Therapy Practice
Basic Key Point 31
Muscles over activity is normal response for
increased demands upon muscles
Muscles trying to compensate weakness of
another muscles in the same chain to do
certain function
Advanced Physical
Therapy Practice
Basic Key Point 32
Managing muscles over activity problem needs
not only to release them but also to
strengthen the weak muscles in the chain
and Activate antagonist muscles for the over
activity ones
Advanced Physical
Therapy Practice

Basic key Point 33

Active insuffiency Refers to inability of
a two joint muscle to produce an effective
muscle contraction over the two joints in
the same time
example Rectus femoris which flex hip and
extend knee can not produce powerful
hip flexion with extended knee but it can
with flexion knee that because
muscle tension –length relationship
Advanced Physical
Therapy Practice

Basic key Point 34

Passive insuffiency refers to inability of a two
joint muscles to be stretched over the
two joints in the same time
Example hamstring muscles which pass
across hip and knee joints stretch is more
difficult when hip flexed and knee
extended than when hip flexed with
knee flexed
Advanced Physical
Therapy Practice

Basic key Point 35

To restore normal muscle function with patients
suffering from trigger points in their muscles
use these methods by same sequence
1-trigger point deactivation
2-myofascial release
3-muscle stretching
Advanced Physical
Therapy Practice

Basic Key Point 36

Manual Pressure for 30 sec to 2 min over the
trigger points (until pain change ) helpful in
Trigger point deactivation
Advanced Physical
Therapy Practice

Basic Key Point 37

During patient assessment we think about
myofascial chains as an expected cause for
patient problem after we checked local area
carefully and radiological examination for
local area is free
Advanced Physical
Therapy Practice
Basic key Point 38
Motor control is the 3rd step to achieve your goal
which is restoring patient functional level
Advanced Physical
Therapy Practice
Basic key Point 39
Human movement sequences

Trunk control
Proximal fixation
Distal localization
Advanced Physical
Therapy Practice
Basic key Point 40
Motor control include all brain engrams or
movement pattern
The recorded sequence of movement in brain
which occur in different joints by different
muscles to do certain function
Advanced Physical
Therapy Practice
Basic key Point 41
After any injury patients usually do their
functions in a different way than that they
used to do before injury Like walking
This happened as a result of a change of joint
ROM ,neuromuscular function and pain
Advanced Physical
Therapy Practice
Basic key Point 42
New brain engram or new movement pattern
will recorded in brain after a few days of an
injury As this is the way that patient practice in
their activities of daily living
Advanced Physical
Therapy Practice
Basic key Point 43
After restoring ROM ,normal neuromuscular
function we have to train the patient to his
daily activities in normal sequences or normal
movement pattern (Functional activities )
Advanced Physical
Therapy Practice
Basic Key Point 44
Restoring normal posture is the 4th step to
achieve your goal which is restoring patient’s
functional level
Advanced Physical
Therapy Practice
Basic key Point 45
Normal posture needed for normal movements
and function
Postural faults must be corrected if we want
normal movements and function
Advanced Physical
Therapy Practice
Basic key Point 46
Postural faults resulting from Muscle imbalance
Imbalance between agonist and antagonist
acting on certain joints
Advanced Physical
Therapy Practice
Basic key Point 47
Upper crossed syndrome
Forward head
Affects Cervical spine and upper limb function
Advanced Physical
Therapy Practice
Basic key Point 48
Lower crossed syndrome
Anterior pelvic tilting
Affects Lumbar spine and lower limb function
Advanced Physical
Therapy Practice
Basic Key Point 49
Detecting and correcting leg length
discrepancy using insole for example is the main
solution for many postural, pelvic and foot
problems
Advanced Physical
Therapy Practice
Basic Key Point 50
Correction of fault or bad posture is very
important to relief pain
Advanced Physical
Therapy Practice
Basic Key Point 51
Core stability training is a corner stone in both
upper and lower limbs injuries
Advanced Physical
Therapy Practice
Basic Key Point 52
Fascial restriction around ankle joint may be the
root cause of low back pain
Advanced Physical
Therapy Practice
Basic key Point 53
It is important to check the upper crossed
syndrome while dealing with cervical spine and
upper limbs problems
Advanced Physical
Therapy Practice
Basic key Point 54
It is important to check lower crossed syndrome
when dealing with patient with lumbar spine
and lower limbs problems
Advanced Physical
Therapy Practice
Basic key Point 55
Documentation
In physical therapy field
Is very important for continuity of care and
communicate with other health care
professionals
we usually use SOAP notes form for our practice
documentation
Advanced Physical
Therapy Practice
Basic key point 56
Subjective
include all the patient description about his
current status
 Basic key Point 57
Objective

Advanced Include all results about what you re-measure or

retest as a therapist
Physical Also interventions details Like frequency, duration
and machines used
Therapy
Practice
Advanced Physical
Therapy Practice
Basic key Point 58
Assessment
Include your opinion and interpretation as a
therapist about patient current status
Advanced Physical
Therapy Practice
Basic key Point 59
Plan
Include what you plan do in future sessions for
solving patient problems based on your
assessment
Also home exercise program should be included
Advanced Physical
Therapy Practice

Basic Key Point 60

Evidence based practice
Means that our methods or techniques we use
to mange patients problems should have an
evidence by research work
Advanced Physical
Therapy Practice
Basic Key Point 61
Evidence based practice levels
Systematic review which is the strongest
evidence
Randomized controlled trial
cohort study
Case control study
Expert opinion which is the weakest
evidence
Advanced Physical
Therapy Practice
Basic Key Point 62
No real treatment for shoulder without care
giving to scapula
Advanced Physical
Therapy Practice
Basic Key Point 63
For normal shoulder joint function shoulder
external rotators should be 60% to 70% of
shoulder internal rotators strength that can be
achieved through improve shoulder external
rotators strength and mange shoulder internal
rotators over activity
Advanced Physical
Therapy Practice
Basic Key Point 64
Shoulder weight bearing exercises will improve
shoulder stability which is needed for normal
shoulder function
Advanced Physical
Therapy Practice
Basic Key Point 65
Managing scapular dyskinsia is a key stone for
restoring normal shoulder function
Advanced Physical
Therapy Practice
Basic Key Point 66
Shoulder mobilization techniques is the 1st line
of treatment in frozen shoulder patients
Advanced Physical
Therapy Practice
Basic Key Point 67
Restoration of muscle balance between upper
fiber of trapezius and middle, lower fiber of
trapezius is essential in mangling shoulder
impingement patients
Advanced Physical
Therapy Practice
Basic key Point 68
patient who suffer from rotator cuff
tendenopathy We have to achieve 2 main goals
maintain the head of humerus centered in the
glenoid cavity in static and dynamic posture
maintain the subacromial space wide enough
in static and dynamic posture
Advanced Physical
Therapy Practice
Basic Key Point 69
Eccentric contraction training for wrist extensors
is a key stone in rehabilitation program for lateral
epicondylitis patients (Tennis Elbow)
Advanced Physical
Therapy Practice
Basic Key Point 70
Counter force brace (golfer’s elbow band)is
useful for medial epicondylities patients cause it
decrease stress over common flexors tendon by
creating new origin point for flexors tendon
Advanced Physical
Therapy Practice
Basic Key Point 71
Splinting wrist in neutral position (slightly
extended and ulnar deviated )during sleep
and daily activities which increase patient
symptoms plays an important role in
decreasing symptoms of carpal tunnel
syndrome patients who are not indicated
for surgery
Advanced Physical
Therapy Practice
Basic Key Point 72
Flexor tendon gliding is helpful for managing
decreased flexibility of long finger flexors and
limited ROM in digits in patients with carpal
tunnel syndrome
Advanced Physical
Therapy Practice
Basic Key Point 73
Patient with piriformis syndrome will benefit from
adductors muscles strengthening rather than
piriformis stretching
Advanced Physical
Therapy Practice
Basic Key Point 74
In adductor strain patients You have to treat the
adductors , correct lower limbs mechanics,
apply groin rehabilitation , apply core training
and stretch pectoralis muscles
Advanced Physical
Therapy Practice
Basic Key Point 75
Aquatic therapy is beneficial for hip osteoarthritis
patients cause it provides environment for
strengthening exercise for hip muscles with
less stress on patient’s hip joint
Advanced Physical
Therapy Practice
Basic Key Point 76
Improving hip joint dynamic stability by
strengthening deep hip joint muscles ( flexors-
abductors-external rotators) is helpful for
patients with femoro-acetubular
impingement syndrome
Advanced Physical
Therapy Practice
Basic Key Point 77
No real treatment for knee without care giving
to patella
Advanced Physical
Therapy Practice
Basic Key Point 78
For normal knee functions hamstrings muscles
strength must reach be 55 % to 70% of
quadriceps muscles strength
Advanced Physical
Therapy Practice
Basic Key Point 79
Patellar mobilization Is helpful to restore knee
ROM for patients post ACL reconstruction
Advanced Physical
Therapy Practice
Basic Key Point 80
Kinisiotape application for chondromalicia
patients help so much in doing rehabilitation
activities with least pain in anterior aspect of
the knee
Advanced Physical
Therapy Practice
Basic Key Point 81
Not only vastus medialis obliques activation is
effective for chondromalacia patellae but also
illiotibial band release
Advanced Physical
Therapy Practice
Basic Key Point 82
In post ACL reconstruction patients for full
extension ROM Patellar mobilization Knee
external rotators training Hamstring and calf
muscles stretching exercises Quadriceps
especially VMO activation
Advanced Physical
Therapy Practice
Basic Key Point 83
In post ACL reconstruction patients for full flexion
ROM Patellar mobilization Knee internal rotation
training Illio-psoas and quadriceps stretching
exercises Hamstrings and calf muscles activation
Advanced Physical
Therapy Practice
Basic Key Point 84
Patients with knee OA one of his main problems
knee stiffness or difficulty in knee flexion which
can be managed by activation of tibial medial
rotators (knee unlockers) to unlock the knee
which is crucial to intiate knee flexion Popliteus
muscle, sartoruis muscle ,gracilis muscle and
semi tendenosis are the tibial medial rotators
Advanced Physical
Therapy Practice
Basic Key Point 85
In patients post ACL reconstruction Strength the
hamstrings muscles until it reach to 55 % - 70%
of the quadriceps muscles strength is needed
for proper knee functions
Advanced Physical
Therapy Practice
Basic Key Point 86
Patients with hamstrings tightness or over active
may be resulting from weakness of gluteus
Maximus or uncontrolled anterior pelvic tilting
so correct that causes to avoid recurrence of
symptoms
Advanced Physical
Therapy Practice
Basic Key Point 87
Patient with flat feet which result from spring
ligament weakness Progressive resisted exercises
for tibialis anterior and tibialis posterior with using
insole is very helpful to support his medial arch
and modulating his symptoms
Advanced Physical
Therapy Practice
Basic Key Point 88
Proprioceptive training for those Who suffer from
recurrent ankle sprain is the key for successful
rehabilitation and prevention of recurrent
ankle sprain
Advanced Physical
Therapy Practice
Basic Key Point 89
Spine consist of 33 vertebrae
7 cervical spine
12 dorsal spine
5 lumbar spine
5 sacral spine fused into 1vertebrae
4 coccyx spine fused into 1vertebrae
Advanced Physical
Therapy Practice
Basic Key Point 90
Vertebrae articulate to each other by
Anterior articulation through intervertebral disc
Posterior articulation through right and left facet
joints
Advanced Physical
Therapy Practice

Basic Key Point 91

Spinal movements includes
Flexion – extension
RT and LT Side bending
RT and LT Rotation
Advanced Physical
Therapy Practice

Basic key Point 92

For spinal management we have to consider all
spinal movements What is called 3d
correction
Advanced Physical
Therapy Practice
Basic Key Point 93
Mobilization of cervical, dorsal and lumbar spine
is the 1st line of treatment for patients suffering
from spinal problems with chief complaint
pain and muscle spasm in neck or lower back
region
Advanced Physical
Therapy Practice
Basic Key Point 94
Spinal decompression is the 1st line of treatment
for patients suffering from spinal disc problems
with chief complaint radiating pain or
numbness either in upper or lower limbs
Advanced Physical
Therapy Practice
Basic Key Point 95
Modalities usage for therapeutic interventions is
parameter dependent more than modalities it self
It is not a matter of using electrical stimulation or
ultrasound to modulate pain
it is a matter of what parameter you use to modulate
pain
If you don’t know the proper parameter
use the guided treatment therapy program (GTS) which
is included in most of electrical stimulation or
ultrasound machines software
Advanced
Physical Therapy
Practice
Basic Key Point 96
Electrical stimulation parameter for

Muscle Strengthening
Muscle reeducation
Muscle Spasm Reduction
Muscle pump for edema reduction
Advanced Physical
Therapy Practice
Basic Key Point 97
Electrical stimulation parameter for Pain modulation
Acute pain
Gate control theory
Sensory level stimulation
Pulse intensity until patient feels tingling sensation (10% less motor level stimulation)
Pulse duration 50-80 microseconds
Duty cycle continuous
Pulse frequency 80-120 hertz
Treatment duration 20-30 min
Immediate effect and last for 30 min to1 hour after treatment
Electrode placement over painful area at least 1 inch between the 2 electrodes
Current name high frequency TENS
Advanced Physical
Therapy Practice
Basic Key Point 98
Electrical stimulation parameter for Pain modulation
Chronic pain
Endogenous opiate theory
Motor level stimulation
Pulse intensity until visible or palpable contraction
Pulse duration 200 -600 microseconds
Duty cycle continuous
Pulse frequency 1-4 hertz
Treatment duration 40-60 min
Late effect 25 to 30 min of application and last 4-5 hour after treatment
Electrode placement over painful area
Current name low frequency TENS
Advanced Physical
Therapy Practice
Basic Key Point 99
Electrical current will not penetrate bone so
avoid place electrodes around bone like
around knee joint (one electrode medial and
the other lateral) but use 2 channels one
medial and the other lateral
Advanced
Physical Therapy
Practice
Basic Key Point 100
Ultrasound parameter like
frequency intensity duty cycle
and duration should be
selected carefully to achieve
your goals from ultrasound
application
 Advanced Physical Therapy Practice

Advanced Physical Therapy Practice

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