Therapeutic Exercise and Manual Therapy
Exercise prescription
Exercise is the cornerstone of physiotherapy. Understand the principles of overload, specificity, reversibility, and progression. Prescribe by manipulating frequency, intensity, time, type (FITT). Know the difference between mobility, strength, endurance, power and motor-control exercise, and match the mode to the impairment. For strength, work in the 6–12 repetition range at moderate-to-high load for hypertrophy and strength; for endurance, use higher repetitions at lower load. Respect tissue healing timelines and irritability.
Motor control and proprioceptive training follow strength work but can begin early with low load. Include a home programme that is realistic and adherent.
Manual therapy
Manual therapy includes mobilisation, manipulation, and soft-tissue techniques. Know Maitland grades I–V: grades I–II for pain modulation, grades III–IV for stiffness, grade V as a high-velocity thrust. Understand that manual therapy is an adjunct that creates a window for exercise, not a stand-alone cure. Screen for contraindications: malignancy, infection, instability, osteoporosis (for thrust techniques), anticoagulation.
Traps
Items often ask which grade is appropriate for a painful, irritable joint (answer: low grade, I–II). Another trap is prescribing strengthening during an acute inflammatory flare. Watch for questions that confuse manipulation with mobilisation.
Rule of thumb
Match the dose to the irritability: low irritability allows higher grade and load; high irritability demands gentle grade and pain-free movement. Always pair manual therapy with an active programme.