Preface

The vision statement adopted by the American Physical Therapy Association (APTA) House of Delegates in June 2013 remains central to the tenets and contents of this fourth edition of this textbook:

The editors and authors contributing to this edition assert that movement is a primary contributor to the human experience, and that functional and movement system–oriented interventions are the cornerstone of the contemporary practice of physical therapy. Although the concept of the movement system is not new (dating back to the APTA Vision Statement of 2013), many professionals have recently been exposed to or become familiar with this framework which has been proposed to not only inform about the identity of physical therapists, but also to be considered as the system for which physical therapists are responsible, and should be considered experts.

The APTA has defined the movement system as follows:

In the 8 years since the last edition of this textbook much has changed with regard to the education of physical therapists and the practice of physical therapy. Online/hybrid learning has become an important way of teaching and learning, physical therapists are expected to do “more with less” in terms of visits and reimbursement, and telehealth has become an accepted method of addressing some movement system problems. This textbook (with a newly developed/updated e-book) attempts to provide resources via Access Physiotherapy to assist educators and students alike in their quest for current, evidence-based information related to interventions for patients and clients with musculoskeletal pathology and associated movement dysfunction.

The editors and authors who have contributed to this edition remain committed to the practice of physical therapy structured around human movement and have sought to articulate this functional framework throughout. Together, we provide the lens of decades of teaching, research, and clinical experience, combined with a progressive view of how the movement system relates to the ongoing growth of the profession of physical therapy. We hope that this vision is contagious.

Now more than ever, evidence-based practice, scientific discovery and application, and the value of the “art” of physical therapy practice must be synthesized and realized to continue the growth of the profession of physical therapy. Therefore, this edition offers a comprehensive, updated evidence-based collection of rehabilitation techniques, strategies, and considerations for patients and clients of all ages, abilities, and functional levels reflective of the authors’ unique experiences and ingenuity. Collectively, the authors hope to inspire innovation, inspiration, and acceleration of the movement system as a basis for physical therapist practice.

Each of the 31 chapters in this edition has been updated, revised, and adapted to reflect a contemporary movement system approach to the care of patients and clients. Each chapter is authored by experts in the field, whose insights represent a collective dedication to the practice of physical therapy and a genuine desire to share knowledge.

The purpose of this edition (like prior editions) is to provide a comprehensive guide to assist practitioners with design, implementation, alterations, and progressions of rehabilitation programs for patients and clients with musculoskeletal dysfunction. Such dysfunction could occur due to injury, postoperative conditions, as well as disuse, or suboptimal or inefficient movement. It is intended for use in musculoskeletal courses that teach students the tenets of clinical decision-making, exercise selection/prescription, and progression in therapeutic interventions and rehabilitation programs, as well as for practicing clinicians seeking novel exercise interventions. Additional video resources have been provided and are available on Access Physiotherapy.

Organization

The text is divided into the same five parts as the previous edition. In Part 1: Foundations of the Rehabilitation Process a heavily revised chapter has been provided (Chapter 1) that introduces the human movement system, while reviewing parts of the Guide to Physical Therapist Practice, and addressing clinical reasoning, in the context of a four-phased approach to treatment. The chapters on tissue healing (Chapter 2), neuromuscular scan examination (Chapter 3), pain (Chapter 4), and posture and function (Chapter 5) complete the foundational concepts portion of the text, which provides the basis for each of the upcoming sections. Very little time is spent on the process of examination in musculoskeletal practice, as the focus of this text is intervention.

Part 2: Treating Physiologic Impairments During Rehabilitation provides in-depth information about the general impairments that may need to be addressed throughout all phases of rehabilitation. These chapters include information about treating impairments related to muscle performance (Chapter 6), endurance and aerobic capacity (Chapter 7), mobility and range of motion (Chapter 8), and neuromuscular control (Chapter 9). Each of these introductory chapters highlights both methods for managing impairments described in the subsequent chapters as well as “clinical pearl” boxes to focus on the authors’ unique experiences with regard to interventions.

Part 3: The Tools of Rehabilitation provides the reader with an overview of rehabilitation “tools” that can be used during the rehabilitation of many types of patients or clients. It provides the reader with detailed information on how each tool can be applied throughout the rehabilitation process in order to achieve high-level outcomes that are functionally relevant. The tools of rehabilitation covered in this part include plyometric exercise (Chapter 10), open- and closed-kinetic chain interventions (Chapter 11), proprioceptive neuromuscular facilitation techniques (Chapter 12), joint mobilization (Chapter 13), postural stability and balance interventions (Chapter 14), core stabilization training (Chapter 15), aquatic therapy (Chapter 16), functional movement screening (Chapter 17), functional exercise progression and testing (Chapter 18), and the essentials of functional exercise interventions, including a novel exercise prescription and progression matrix (Chapter 19). The updated chapters on functional movement screening and functional intervention continue to reflect paradigm shifts in practice.

Part 4: Interventions Strategies for Specific Regions of the text uses a regional approach to address specific application of intervention throughout the body. This part of the text builds upon the varied information presented in Parts 2 and 3, by offering applications of techniques and interventions related to common movement-based, overuse, traumatic, and postoperative musculoskeletal dysfunctions. Included are detailed rehabilitation suggestions for conditions common to the shoulder complex (Chapter 20), the elbow (Chapter 21), the wrist, hand, and digits (Chapter 22), the groin, hip, and thigh (Chapter 23), the knee (Chapter 24), the lower leg (Chapter 25), the ankle and foot (Chapter 26), the cervical and thoracic spines (Chapter 27), and the lumbar spine (Chapter 28). Each of these regionally based chapters provides in-depth discussion of pathomechanics and injury mechanisms while focusing on rehabilitation strategies and concerns for specific injuries and providing example protocols. As the title indicates, this is a textbook dedicated to intervention. Thus, it should again be noted that detailed examination strategies and special test procedures are not a part of these regional chapters; therefore, it is likely that this text will accompany a text on examination, differential diagnosis, evaluation, and prognosis.

Part 5: Special Considerations for Specific Patient Populations provides application of all the previous intervention strategies and how these may need to be selected, adapted, and utilized in three unique groups of patients: the geriatric patient (Chapter 29), the pediatric patient (Chapter 30), and the physically active female (Chapter 31). The editors and authors believe that these groups of patients deserve special consideration and attention during the rehabilitation process.

Learning Aids

The learning aids provided in this text include:

• Objectives—provided at the beginning of each chapter to identify critical concepts presented within each chapter

• Tables—for presentation of concepts and organization of complex information

• Figures and Videos—updated full-color illustrations and figures, as well as video content to enhance visual presentation

• Clinical Pearls—to assist the reader in application of concepts and offer insights or connections between information, as provided by the authors of chapters

• Summary Points—provided at the end of each chapter outlining major points within, for the reader to determine their level of comprehension

• End-of-Chapter Treatment Guidelines—present in the regionally organized chapters to illustrate a possible sequence of interventions or a postoperative protocol

• References—a comprehensive, updated list of references is provided with each chapter

Instructor Resources

PowerPoints—Tables and photographs in the text will be available as PowerPoints to professors who adopt the text.

Videos—Videos of critical skills in the text will be available to professors who adopt the text and a larger selection of the video library will be available to AccessPhysiotherapy subscribers.

Enhanced E-book—This fourth edition will also be offered as an enhanced e-book, on AccessPhysiotherapy, which will incorporate videos and include interactive quizzes.