Exercise Prescription for Pathologic Tissue

Daemen College, Class of 2018

In order to appropriately prescribe therapeutic exercises, physical therapists gather patient’s complaints, a thorough history, as well as current limitations to determine which stage of healing their injury is in. As a result, the patient is progressed through exercises appropriate for acute, subacute, and maturation phases of tissue healing to assure an adequate rate of recovery and to avoid further tissue injury. Additionally, patients should be educated on these stages of tissue healing so they can properly recognize if a daily activity is now appropriate to perform as they progress through PT. For example, a patient should be able to identify the signs of the inflammatory stage of healing, which are pain, warmth, swelling, redness, or loss of function, in order to avoid exacerbating their symptoms and delaying their rate of recovery.

Based off which tissues are injured, physical therapists apply the principle of specificity of training, which encompasses precise loading strategies that target the tissue’s individual cellular components. For example, patients who experience symptoms associated with arthritic changes require cyclic loading exercises that aim to stimulate cartilage cell’s density; however, if static loading exercises were applied, such as maintaining constant load in single leg balance exercises, this stationary position can actually harm cartilage cells as their cellular fluid creeps out of the cells and accumulates outside of the weight bearing zone. On the other hand, if a patient experienced a ligament sprain, research has shown that closed-chain weight bearing exercises increase the stability around the affected joint by stimulating sensory receptors due to the approximation of tissues. Therefore, exercise prescription is specific to the impaired tissue’s specific cellular properties.

In conclusion, physical therapists have vast knowledge and provide great value on how to progress therapeutic exercises based on tissue involvement and the current stage of tissue healing. Specificity of training and the stages of tissue healing serve as the foundation for exercise prescription as it guides which loading strategies are appropriate, which aides in one’s rate of recovery.

  1. Cameron MH.  Physical Agents in Rehabilitation: From Research to Practice, 4th edition. Sunders C., Philadelphia, 2013.
  2. Duchesne E, Dufresne S, and Dumont N. Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing: from fundamental research to the clinic. Phys Ther. 2017;97:807.
  3. Brody L. Knee osteoarthritis: clinical connections to articular cartilage structure and function. Phys Ther Sport. 2015;16:301-316.
  4. Zhang F, Wang J, Wang F. Comparison of the clinical effects of open and closed chain exercises after medial patellofemoral ligament reconstruction. J Physl Ther Sci. 2014;26:1557-1560.
  5. Hincapie O, Elkins J, Vasquez-Welsh L. Proprioception retraining for a patient with chronic wrist pain secondary to ligament injury with no structural instability. J Hand Ther. 2016;29:183-189.