An-Najah National University ‫بسم هللا الرحمن الرحيم‬

‫جامعة النجاح الوطنية‬

Faculty of Medicine & Health Sciences
‫كلية الطب وعلوم الصحة‬
Department of Applied and allied
‫دائرة العلوم الطبية التطبيقية والمساندة‬
Medical Sciences
‫قسم العالج الطبيعي‬
Department of Physiotherapy
Therapeutic Exercise/theory (1/2/7242210)
Spring semester 2022
Class time/section #: Class 2 (Tuesday 02:00- 04:00

Group Number:
N Student Name Student UN. ID .N
1 Nour Lubadeh 12011469
2
3
4
5

Rubric Scale
Weighting
Categories 5 4 3 2 1
Assignment format
Summary of impairments & functional limitations
Short and long term goals
Therapeutic exercise techniques
Exercise parameters
Outcome and outcome measures
Total grade /30 /20
 Therapeutic exercise assignment

1. The patient has sustained injuries in a rear-end collision and presents with constant posterior cervical
pain, headaches, and pain radiating into the shoulder region bilaterally, along with intermittent tingling
in the right thumb, index, and middle finger. The patient has difficulty sleeping due to pain and is
unwilling to move more than 10° into flexion or extension, 25° into side bending bilaterally, and
minimal rotation. The patient also presents with a guarded forward-head posture and tenderness in upper
trapezius and posterior cervical and anterior throat muscles bilaterally. The increased tenderness is also
noted along facet margins of C4–5, 5–6 and 6–7, right > left. These impairments and functional
limitations impact the patient's ability to move the neck, perform daily activities, and work, causing
distress and reduced quality of life.

2. Short-term goals:

Within one week, the patient will be able to perform cervical range of motion exercises (flexion,
extension, side bending, and rotation) within a pain score of 6/10 or lower.

Within two weeks, the patient will be able to perform cervical range of motion exercises (flexion,
extension, side bending, and rotation) within a pain score of 4/10 or lower.

Reduce pain intensity by 50% within the next 2 weeks through manual therapy and modalities.

Within three weeks, the patient will be able to perform cervical range of motion exercises (flexion,
extension, side bending, and rotation) within a pain score of 2/10 or lower.

Increase cervical range of motion by 25% within the next 4 weeks through specific cervical exercises.

Reduce tenderness in upper trapezius and posterior cervical muscles bilaterally by 50% within the next 4
weeks through soft tissue mobilization.

Long-term goals:
Within six weeks, the patient will be able to return to work and perform daily activities without
significant pain or discomfort.

Restore cervical range of motion to normal limits within 12 weeks through a combination of specific
exercises and manual therapy.

Improve muscle strength and endurance of the cervical and shoulder muscles by 50% within 12 weeks
through a targeted strengthening program.

So within twelve weeks, the patient will be able to perform full cervical range of motion exercises
(flexion, extension, side bending, and rotation) without significant pain or discomfort.

Improve functional activities, including working at the computer, driving, and sleeping, within 16 weeks
through a graded activity program and postural training.

Within six months, the patient will be able to resume all pre-injury activities, including recreational
activities and hobbies, without significant pain or discomfort.

3. Based on the patient's impairments and functional limitations, the following therapeutic exercise
techniques may be suitable to achieve the goals:

Cervical range of motion exercises: To improve cervical range of motion, the following exercises can be
incorporated:

Cervical flexion and extension: The patient is asked to slowly move their head forward and backward,
aiming for pain-free movement. The exercise can be repeated for 10-15 repetitions, 2-3 times a day.

Cervical lateral flexion: The patient is asked to slowly move their head towards the right and left, aiming
for pain-free movement. The exercise can be repeated for 10-15 repetitions, 2-3 times a day.

Cervical rotation: The patient is asked to slowly turn their head to the right and left, aiming for pain-free
movement. The exercise can be repeated for 10-15 repetitions, 2-3 times a day.

Strengthening exercises: To improve muscle strength and endurance of the cervical and shoulder
muscles, the following exercises can be incorporated:
Deep neck flexors strengthening: The patient is asked to lie down with a rolled towel under their neck
and chin, and then perform a chin tuck. Hold for 5-10 seconds and repeat for 10-15 repetitions, 2-3 times
a day.

Scapular retraction: The patient is asked to sit with arms at their sides, and then slowly pull their
shoulders back and together, squeezing the shoulder blades together. Hold for 5-10 seconds and repeat
for 10-15 repetitions, 2-3 times a day.

Postural exercises: To improve posture and reduce forward head posture, the following exercises can be
incorporated:

Scapular setting: The patient is asked to sit with arms at their sides, and then gently pull their shoulder
blades down and back. Hold for 5-10 seconds and repeat for 10-15 repetitions, 2-3 times a day.

Soft tissue mobilization: To reduce tenderness in upper trapezius and posterior cervical muscles
bilaterally, the following techniques can be incorporated:

Self-massage with a foam roller: The patient is asked to lie down with a foam roller under their upper
back and gently roll back and forth, focusing on the tender areas. Repeat for 5-10 minutes, 2-3 times a
day.

4. Improved cervical range of motion: The cervical range of motion can be measured using a
goniometer, which is a tool that measures angles. The outcome measure that can be used is the Neck
Disability Index (NDI), which is a self-reported questionnaire that assesses the level of disability related
to neck pain.

Reduced pain intensity: Pain intensity can be measured using a visual analog scale (VAS) or numeric
rating scale (NRS).

Improved muscle strength and endurance: Muscle strength and endurance can be measured using
manual muscle testing and endurance tests. The outcome measure that can be used is the Neck Pain and
Disability Scale (NPDS), which is a self-reported questionnaire that assesses the level of disability
related to neck pain. A change of 5 points or more on the NPDS is considered clinically significant.
Improved posture: Posture can be assessed visually or using posture analysis software. The outcome
measure that can be used is the Posture Assessment Scale for Stroke Patients (PASS), which is a tool
that assesses the quality of standing posture.

Improved quality of life: Quality of life can be measured using the Short-Form Health Survey, which is
a self-reported questionnaire that assesses the physical and mental health status of the patient.