J. Young et al’s study 1 published in the March 2018 JOSPT highlights the need for a clinical framework to appropriately manipulate the dose and dosage parameters for patients with knee disorders. Success of therapeutic intervention depends on the ability to establish the appropriate stimuli and overload throughout the recovery process for the targeted physiological objectives, which are related to:
- Symptom reduction / moderation
- Impairment correction which include
- Range of motion restrictions related to inert tissue; contractile tissue; joint positioning, limited nerve glides, etc.
- Sensory-neuro-muscular control which include posture, stabilization, proprioception, balance, etc.
- Neuro-muscular performance, which include strength, endurance, power, etc.
- Objective performance
Within the MET- odology, Medical Exercise Therapy uses a framework for appropriate therapeutic exercise dosing starting with an isometric dynamometry test with exercise bias. Handheld dynamometers are most useful for local exercises, while tension gauges are more suitable for functional semi-global and global exercises. The measured and calculated exercise resistance is validated by performing a Clinical Fatigue Test (CFT) 2 . Using specific dosing guidelines, the exercise is appropriate dosed to create an appropriate overload for the healing tissue, specific to each targeted physiological objective and tailored to each individual functional need.
Precision exercise design, dosing, and delivery allows for early functional integrationand ensures efficient and effective rehabilitation with a biopsychosocial approach in a value based healthcare delivery system.
- Young JL, Rhon DI, Cleland JA, Snodgrass SJ. The Influence of Exercise Dosing on Outcomes in Patients With Knee Disorders: A Systematic Review. J Orthop Sports Phys Ther. 2018 Mar;48(3):146-161.
- Aerts F, Carrier K, Alwood B. Inter-rater Reliability of Sustained Aberrant Movement Patterns as a Clinical Assessment of Muscular Fatigue. The Open Orthopaedics Journal, 2016, 10, 125-134.