NHPC BPT key terms

The standard reference posture: standing upright, face forward, arms at the sides with palms facing forward, feet flat and parallel. All directional terms such as medial, lateral, proximal and distal are described relative to this posture.

Imaginary flat surfaces used to describe motion: sagittal (flexion, extension), frontal (abduction, adduction) and transverse (rotation). Movement is described as occurring within a plane and about an axis perpendicular to that plane.

Damage to the anterior horn cell, nerve root or peripheral nerve, producing flaccid weakness, reduced or absent deep tendon reflexes, muscle wasting, fasciculation and hypotonia on the same side. Distinguishes peripheral from central causes of weakness.

Damage to the corticospinal or corticobulbar pathway anywhere above the anterior horn cell, producing spasticity, hyperreflexia, clonus, extensor plantar response and loss of fine dexterity, with minimal early wasting.

A rhythmic series of involuntary muscle contractions evoked by sudden passive stretch, most often at the ankle. It reflects hyperexcitability of the stretch reflex and is a recognised sign of upper motor neuron dysfunction.

A six-point ordinal clinical scale grading resistance to passive movement from 0 (no increase in tone) to 4 (rigid limb), with 1+ indicating catch followed by minimal resistance through less than half the range.

A velocity-dependent increase in tonic stretch reflexes resulting from hyperexcitability of the stretch reflex after upper motor neuron damage. It varies with speed of passive movement and may coexist with contracture and weakness.

The study of gross bone movement during joint motion, describing the path and range travelled by the moving segment in space without considering the articular surfaces themselves.

The study of motion occurring between articular surfaces of a joint, described as roll, glide and spin. Correct arthrokinematic glide is essential for normal pain-free osteokinematic range.

The small accessory movement available between joint surfaces that cannot be produced actively but is necessary for normal painless active movement. Assessed and restored with mobilisation techniques.

A five-grade system for passive joint mobilisation: grades I and II are small-amplitude oscillations at the beginning of range, grade III is a large amplitude to the limit of range, and grade IV is a small amplitude at the limit.

The quality of resistance felt by the examiner at the end of passive joint range, such as bony, capsular, soft tissue approximation or springy block. Abnormal end-feel suggests specific pathology rather than simple stiffness.

The principle that a muscle generates greatest active tension at its resting length, with force declining when it is over-shortened or over-lengthened. Explains why both tightness and excessive lengthening reduce force output.

Active insufficiency is loss of force when a multi-joint muscle is shortened over all joints simultaneously. Passive insufficiency is limitation of range when the same muscle is stretched over all joints at once.

Concentric force output falls as shortening velocity rises, whereas eccentric contractions can generate greater force than isometric ones. This guides prescription of resistance, speed and tempo in strengthening programmes.

Active lengthening of a muscle under load, producing high force with low metabolic cost. Widely used in tendinopathy and return-to-sport rehabilitation, though it commonly causes delayed onset muscle soreness.

Systematic strengthening in which load, repetitions or volume are increased as adaptation occurs. Typically begins at a tolerated intensity and advances toward heavier loads for strength or more repetitions for endurance.

The heaviest load a person can lift once through full range with acceptable technique. Used to set training intensity as a percentage and to monitor strength change, though estimated values are safer in early rehabilitation.

A vascular and cellular response to injury or infection characterised by redness, heat, swelling, pain and loss of function. Physiotherapy dosing during the acute phase aims to control load without prolonging the healing response.

The overlapping sequence of haemostasis and inflammation, proliferation with granulation and collagen deposition, and remodelling with maturation. Each phase tolerates different loading, informing when to protect and when to load tissue.

Persistent tendon pain with impaired function linked to cumulative load and degenerative change rather than acute inflammation. Management centres on graded progressive loading and load education rather than rest alone.

Abnormal accumulation of fluid in interstitial tissue, producing swelling and restricted joint movement. Managed with elevation, compression, movement and positioning, particularly after surgery or in dependent limbs.

Application of external pressure through bandages or garments to control oedema and support venous return. Requires checking for arterial insufficiency and neuropathy, since excessive pressure can cause tissue damage.

A device that cyclically inflates and deflates sleeves around a limb to enhance venous and lymphatic return and reduce oedema. Commonly used post-operatively and in lymphoedema, and contraindicated in suspected deep vein thrombosis.

The proposal that large-diameter afferent input at spinal level can inhibit transmission of small-diameter nociceptive input, reducing pain perception. It underpins the use of transcutaneous electrical nerve stimulation and other sensory stimulation.

Application of low-voltage pulsed current through surface electrodes to modulate pain. High-frequency, high-intensity settings are thought to act largely through the gate mechanism, while low-frequency settings may engage endogenous opioids.

Threshold is the least stimulus intensity perceived as painful; tolerance is the greatest intensity a person will accept. Both are subjective and influenced by emotion, expectation and context, so measurement is indirect.

A 100 mm line anchored at no pain and worst imaginable pain on which the patient marks current pain. Simple and responsive, but requires consistent administration and interpretation of change rather than absolute score.

The smallest change in an outcome score that a patient would regard as beneficial, distinguishing statistical significance from real clinical value. Used to judge whether treatment response is meaningful.

The reciprocal of the absolute risk reduction, expressing how many patients must receive an intervention for one additional good outcome. A single figure that combines benefit size and baseline risk.

A range of values within which the true population parameter is likely to lie, at a stated probability such as 95 percent. Its width conveys precision, and intervals crossing no effect indicate uncertainty.

The probability of observing a result at least as extreme as that found if the null hypothesis were true. It indicates compatibility with the null hypothesis, not the size or importance of an effect.

Rejecting a true null hypothesis, that is, declaring a difference when none exists, conventionally controlled at a five percent significance level. Its probability rises when many outcomes or repeated tests are analysed.

The probability of detecting a true effect of a specified size, conventionally set at 80 percent or more. It depends on effect size, sample size, variability and the chosen significance level.

A study in which participants are allocated by chance to intervention or control, minimising selection bias and supporting causal inference. Blinding, allocation concealment and intention-to-treat analysis strengthen its validity.

A hierarchy ranking study designs by susceptibility to bias, from systematic reviews of randomised trials at the top through cohort and case-control studies to expert opinion and mechanism-based reasoning at the base.

Systematic assessment of a study's validity, results and applicability to decide whether its findings should change practice. It examines bias, confounding, precision and relevance to the patient in front of you.

Clinical decisions that integrate the best available research evidence, the clinician's expertise and the patient's values and circumstances. It is a decision process, not the automatic application of research findings.

Voluntary agreement to assessment or treatment given after the patient receives and understands information on nature, benefits, risks and alternatives. It must be documented and may be withdrawn at any time.

The professional duty to protect patient information from unauthorised disclosure, including records, images and informal conversation. Breach is permissible only with consent or where law requires disclosure.

The boundaries of assessment and intervention a practitioner is trained, competent and legally authorised to perform. Working beyond these limits, even with good intent, exposes patients to harm and the clinician to sanction.

Directing a patient to another practitioner when the problem exceeds one's competence, requires medical investigation or needs specialist input. Timely referral is a professional obligation, not a failure of care.

A clinical feature suggesting serious underlying pathology such as fracture, infection, tumour or cord compression, requiring investigation before treatment. Examples include night pain, unexplained weight loss and progressive neurological deficit.

A psychosocial or belief-related factor, such as fear of movement, catastrophising or low expectations of recovery, that predicts poorer outcome in musculoskeletal pain. Addressed through education and graded activity.

Structured, hierarchical confrontation with feared movements or activities, beginning at a tolerable level and progressing as confidence grows. Used for fear-avoidance, chronic pain and anxiety-driven activity limitation.

Progressive, non-noxious stimulation or graded activity intended to reduce hypersensitivity of the nervous system. Applied in complex regional pain syndrome and peripheral nerve injury, starting below the provocation threshold.

Pain caused by a lesion or disease of the somatosensory nervous system, often described as burning, shooting or electric with associated numbness or allodynia. It responds less predictably to standard analgesics than nociceptive pain.

A submaximal field test measuring the greatest distance walked in six minutes along a measured corridor, with standardised encouragement. It assesses functional exercise capacity and is responsive in cardiopulmonary rehabilitation.

A rating scale for perceived exertion or breathlessness, commonly the 6 to 20 or 0 to 10 version. It guides exercise intensity when heart rate targets are unreliable or unavailable.

A breathing technique in which the patient exhales slowly through pursed lips, creating back pressure that helps prevent airway collapse and reduces breathlessness in obstructive lung disease.

Positioning the patient so that gravity assists drainage of secretions from a specific lung segment toward the larger airways, usually combined with percussion or vibration and followed by coughing.

A group of techniques, including active cycle of breathing, autogenic drainage and assisted cough, that mobilise and remove retained secretions. Selection depends on patient effort, secretion viscosity and haemodynamic stability.

Individualised specification of exercise mode, intensity, duration, frequency and progression based on assessment, goals and precautions. It is documented, reviewed and adjusted like any other treatment.

Measurement of joint range of motion in degrees using a goniometer aligned with proximal and distal segment landmarks. Reliability depends on standardised positioning, landmarking and consistent tester technique.

Grading of a muscle's capacity to produce force against gravity and resistance on a scale from 0 to 5. It is subjective at higher grades, so dynamometry is preferred when precise change matters.

Sensory information from muscle spindles, Golgi tendon organs and joint receptors about position, movement and force. It underpins balance and coordinated movement and is retrained after injury or neurological damage.

The capacity of the nervous system to reorganise structure and function in response to experience, learning and injury. Task-specific, repetitive and meaningful practice drives beneficial reorganisation after neurological damage.

Restraint of the less affected limb combined with intensive, shaped practice of the more affected limb. It targets learned non-use after stroke and requires sufficient residual movement and patient tolerance.

Progressive challenge of postural control by altering base of support, sensory input or task complexity. Progression should be difficult but safe, with appropriate supervision and environmental modification.