Therapeutic Exercise II

Course Description

Therapeutic Exercise II includes therapeutic exercises for orthopaedic problems, balance and coordination problems, and cardiovascular clients, including the indications, precautions, and contraindications, along with the application of Manual Muscle Testing.

Within the SCNS taxonomy, PHT is the Physical Therapist Assistant prefix. Daytona State publishes this at 4 credits, offered summer, giving approximately 60 contact hours at the PHT lecture convention. It is the second of the three-course therapeutic exercise sequence and, at 4 credits with a 2-credit laboratory alongside it, the largest single block in the programme.

The three patient populations named in the catalog are deliberately different from one another. Orthopaedic patients need progressive loading; balance patients need graded challenge with controlled risk; cardiovascular patients need monitored exertion within physiological limits. Learning that the same exercise principle applies differently across them — and that the precautions differ most of all — is the substance of the course.

Learning Outcomes

Required Outcomes

• Describe orthopaedic conditions commonly treated in physical therapy.
• Describe post-surgical orthopaedic protocols and their restrictions.
• Select therapeutic exercise appropriate to a specific orthopaedic condition and stage.
• Apply exercise interventions for the shoulder, elbow, wrist, and hand.
• Apply exercise interventions for the hip, knee, ankle, and foot.
• Apply exercise interventions for the spine and trunk.
• Describe indications, precautions, and contraindications for orthopaedic exercise.
• Perform manual muscle testing accurately and grade consistently.
• Position and stabilize correctly for manual muscle testing and recognize substitution.
• Document manual muscle testing results in a reproducible form.
• Describe the systems contributing to balance and postural control.
• Assess balance using standardized measures within the PTA scope.
• Apply balance and coordination training with graded progression.
• Describe fall risk factors and evidence-based fall prevention.
• Apply vestibular and sensory organization concepts to balance training.
• Describe cardiovascular and pulmonary conditions relevant to exercise.
• Describe exercise physiology, the cardiovascular response to exercise, and its measurement.
• Monitor vital signs and perceived exertion during exercise.
• Apply exercise prescription parameters to cardiovascular clients.
• Describe indications, precautions, and contraindications for cardiovascular exercise.
• Recognize adverse responses requiring exercise to stop and escalation to occur.
• Describe cardiac and pulmonary rehabilitation programmes and phases.
• Progress exercise within an established plan of care across all three populations.
• Document intervention and response in a form demonstrating skilled care.

Optional Outcomes

• Describe isokinetic testing and training.
• Describe return-to-sport criteria and testing.
• Describe aquatic exercise for orthopaedic and cardiovascular clients.
• Describe outcome measures specific to each population.
• Describe evidence for common orthopaedic protocols.
• Continue preparation for the NPTE-PTA.

Major Topics

Required Topics

• Orthopaedic conditions
• Post-surgical protocols and restrictions
• Exercise selection by condition and stage
• Upper extremity interventions
• Lower extremity interventions
• Spine and trunk interventions
• Orthopaedic indications and contraindications
• Manual muscle testing
• Positioning, stabilization, substitution
• MMT documentation
• Systems of balance and postural control
• Balance assessment within scope
• Balance and coordination training
• Fall risk and prevention
• Vestibular and sensory organization
• Cardiovascular and pulmonary conditions
• Exercise physiology and cardiovascular response
• Vital sign and exertion monitoring
• Cardiovascular exercise prescription
• Cardiovascular precautions and contraindications
• Adverse responses and escalation
• Cardiac and pulmonary rehabilitation
• Progression within the plan
• Documentation

Optional Topics

• Isokinetic testing
• Return-to-sport criteria
• Aquatic exercise
• Population-specific outcome measures
• Evidence for protocols
• NPTE-PTA preparation

Resources & Tools

• Therapeutic Exercise: Foundations and Techniques (Kisner & Colby) — the reference for this sequence, and the book PTAs keep.
• Physical Rehabilitation (O'Sullivan, Schmitz & Fulk) — the comprehensive clinical reference.
• Daniels and Worthingham's Muscle Testing — the manual muscle testing standard.
• Measurement of Joint Motion: A Guide to Goniometry (Norkin & White) — the goniometry standard.
• Kinesiology of the Musculoskeletal System (Neumann) — carried forward from PHT1128; the exercise rationale rests on it.
• APTA (apta.org) and its clinical practice guidelines — student membership is inexpensive and the guidelines are the evidence base.
• Shirley Ryan AbilityLab Rehabilitation Measures Database — free; the fastest lookup for any outcome measure.
• FSBPT (fsbpt.org) — free NPTE-PTA content outline; therapeutic exercise is the most heavily weighted domain.
• CAPTE (capteonline.org) — free accreditation lookup and programme pass rates.
• A goniometer, a gait belt, and a practice partner — the working kit, and the partner matters most.

Career Pathways

• Physical therapist assistant — SOC 31-2021.
• Outpatient orthopaedic clinics — the largest PTA setting, and where therapeutic exercise is the daily work.
• Skilled nursing and long-term care — a very large Florida sector.
• Inpatient rehabilitation and acute care.
• Home health — frequently the best-paid PTA setting.
• Cardiac and pulmonary rehabilitation — a defined setting where this content applies directly.
• Sports and performance settings.
• Aquatic therapy — Florida has many facilities.
• Paediatric and school-based practice.
• Travel PTA work — higher pay for mobility.
• ⚠ Becoming a physical therapist requires a doctoral degree, and PTA coursework generally does not transfer into it.

Special Information

⚠⚠ Cardiovascular clients: know the stop criteria before you start

• This is the population where an exercise session can become a medical emergency, and the precautions are the reason the catalog names them explicitly.
• Take vital signs before, during, and after — a baseline you did not record is a baseline you cannot compare against.
• Know your facility's parameters for withholding or terminating exercise, and know that they exist because people have been harmed.
• Stop immediately for chest pain or pressure, disproportionate dyspnoea, dizziness or light-headedness, pallor or diaphoresis, an abnormal blood pressure response, or a patient who simply looks wrong. Get help; do not "walk them off."
• A falling systolic pressure during exercise is an emergency sign, not merely an abnormal reading.
• Rate of perceived exertion is a genuinely useful tool, particularly in patients on beta blockers whose heart rate response is blunted — which is a common and easily missed situation.
• Medications change the response. Beta blockers, antihypertensives, and diuretics all alter what the numbers mean.
• Know the sternal precautions after cardiac surgery and the restrictions they impose on upper extremity activity.
• Document the response, not just the activity. Vital signs at rest, during, and after, with the exertion level, is what makes the note clinically useful and billable.

⚠ Balance training means creating controlled risk — do it deliberately

• Balance improves only when it is challenged, which means the patient must be near the edge of their ability — and that is inherently a fall risk you are creating on purpose.
• Guard properly, every time. Gait belt, correct position, and a clear environment. Never train balance without being able to control a fall.
• Grade the challenge systematically — base of support, surface, external support, vision, head movement, and dual tasking. Change one variable at a time so you know what the patient responded to.
• Removing vision is a large step. Many patients rely on vision to compensate for impaired proprioception or vestibular function, and closing the eyes reveals it dramatically.
• Dual tasking is functionally important. Real falls happen while doing something else, so training balance in isolation under-prepares patients.
• Falls are the leading cause of injury in older adults, and Florida's demographics make this a very large share of PTA caseloads. Evidence-based fall prevention is among the highest-value interventions in the profession.
• Address the whole risk profile. Medication review, vision, footwear, home hazards, and orthostatic hypotension all contribute — and while several are outside the PTA scope to manage, identifying and reporting them is not.
• Use a standardized measure so progress is demonstrable rather than impressionistic.

⚠ Manual muscle testing must be reliable to be worth doing

• MMT is a core PTA data collection skill, and it sits squarely within scope — you measure and report; the PT interprets what it means for the plan.
• Position determines the grade. Gravity-eliminated and against-gravity positions distinguish the lower grades, and using the wrong position produces a meaningless number.
• Stabilization is where accuracy is lost. Allowing compensatory movement inflates the grade, and an unstabilized test measures something other than the muscle you named.
• Watch for substitution. Patients recruit other muscles unconsciously, and recognizing it is much of the skill.
• Apply resistance consistently — same position, same point of application, same gradual build.
• Pain invalidates the test. Note it rather than recording a number that reflects pain inhibition rather than strength.
• Reliability matters more than precision. Tracking change over time requires the same technique every time, and progress is what the documentation must demonstrate.
• Document position, grade, and any limiting factor. The next clinician must be able to repeat it.

⚠⚠ Safe patient handling and exercise safety

• Musculoskeletal injury from patient handling is the leading occupational injury in rehabilitation, and body mechanics alone are not sufficient protection — no amount of correct technique makes manually lifting an adult safe. Use the equipment.
• Never catch a falling patient. Guide a controlled descent and protect the head.
• Guard with a gait belt during any activity where balance is challenged, and position yourself on the appropriate side.
• Clear the environment before mobility or balance work — cords, rugs, wet floors, and furniture cause falls unrelated to the patient's ability.
• Know your stop criteria. Abnormal vital sign response, chest pain, disproportionate dyspnoea, dizziness, new neurological symptoms, or unusual pain all mean stop and notify.
• Monitor rather than assume. A patient's tolerance varies by day, by time of day, and by medication.
• Report injuries and near misses, including your own.

⚠⚠ PTA scope: you may not evaluate, establish, or alter the plan of care

• Physical therapy is licensed in Florida under Chapter 486, Florida Statutes. Both physical therapists and physical therapist assistants are licensed.
• The physical therapist evaluates, interprets, and establishes the plan of care. The PTA implements it. A PTA may not perform an initial evaluation, may not independently modify the plan, and may not discharge a patient.
• Progressing an exercise within the plan is different from changing the plan. That distinction is the everyday application of scope in these courses, and it is worth getting precise about.
• Data collection is within scope; interpretation is not. Measuring range of motion, grading strength, and reporting response is your job; deciding what it means for the plan is not.
• Report changes to the supervising PT promptly. A patient whose condition has changed needs re-evaluation.
• Supervision requirements are set by rule and differ by setting and payer, and Florida's differ from other states'.
• Documentation must support the billed service and demonstrate skilled care; therapy over-utilization has been a major federal enforcement area, particularly in Florida skilled nursing, and a PTA has personal exposure.
• CAPTE accreditation gates the pathway to NPTE-PTA eligibility and Florida licensure — verify before enrolling anywhere.
• Rule 11 applies — verify current requirements with the Board and the payer.

How Florida course levels affect transfer

The first digit of an SCNS number denotes the year of offering, not transferability. Courses at the 1000 and 2000 levels transfer transparently between Florida public institutions, and 3000 to 4000 is unproblematic since both are upper division. The boundary that actually matters is 2000 to 3000, where lower-division credit generally cannot satisfy an upper-division requirement.

PHT2221 is 4 credits and approximately 60 contact hours, offered summer, with the corequisite laboratory PHT2221L (2 credits) — distinct SCNS numbers, both required. Together they are the largest block in the PTA programme.

Expect examinations plus practical assessment of manual muscle testing, balance training, and exercise progression across three quite different patient populations.