CVR Physiotherapy › Technique cards › Therapy skills
Handling skills and exercise equipment
The practical syllabus lists handling techniques (stockings, bandaging, dressings, taping, splints) and equipment skills that are easy to be asked to demonstrate in the short case and viva, but rarely written about. This card gives the steps and the safety checks for each.
- Syllabus
- Practical 3 (handling: stockings, bandaging, dressing, taping, splints and orthotics); 5 (exercise and monitoring equipment); 7 (monitoring compliance and contextual factors)
- Priority
- Practical. Short-case demonstrations and viva questions; not asked in the theory papers.
- Asked as
- Practical exam
- Usual split
- Short-case skill (10 marks)
- Checked against
- Standard compression therapy and wound-care practice; ACSM guidance on exercise equipment and monitoring. Full list under Sources.
- Content checked
- 19 October 2026. Next review due October 2027.
- My revision
-
1Compression stockings
- Two kinds: anti-embolism stockings for bed-bound patients (DVT prevention) and graduated compression stockings for walking patients with venous disease or lymphoedema (pressure highest at the ankle, falling up the leg). Pressure classes differ between national standards: follow the prescription (light, medium or strong).
- Check first: ABPI (no compression below about 0.5; specialist advice between about 0.5 and 0.8), skin (infection, fragile skin, ulcers), sensation, and uncontrolled heart failure.
- Measure in the morning, when swelling is least: ankle at its narrowest, calf at its widest, and leg length (heel to just below the knee crease for below-knee stockings).
Putting on (donning)
- In the morning, before getting out of bed (or after 15–20 minutes of leg elevation).
- Turn the stocking inside out down to the heel, leaving the foot part inside.
- Slide the foot in and centre the heel in the heel pocket.
- Ease the stocking up the leg a little at a time, without pulling at the top band; rubber gloves help the grip; a frame-type donning aid helps weak hands, arthritis or obesity.
- Smooth out all wrinkles; the top band sits about two fingers below the knee crease (for below-knee stockings) and is never rolled or folded down (that acts like a tourniquet).
Taking off and care
- Peel down from the top, turning it inside out, then off over the heel; at night unless prescribed day and night.
- Check the skin daily (red marks, blisters, colour, pain, numbness); stop and report problems.
- Wash as instructed; replace every few months, when the elastic slackens.
2Bandaging
- Venous ulcer (compression bandaging): after ABPI; ankle at 90°; padding over bony points; bandage from the base of the toes to just below the knee, including the heel, in a spiral or figure-of-eight with about 50% overlap, firmest at the ankle; check toe colour and warmth after applying.
- Lymphoedema: multilayer short-stretch bandaging (see the mastectomy page).
- Amputation stump: figure-of-eight, firmest at the end, no circular turns (see the amputation page).
- Always: loosen and report if there is pain, numbness, tingling, a pale or blue toe or finger, or swelling above the bandage.
3Working around dressings
- Physiotherapists do not usually change complex dressings, but must work safely around them: avoid shear and friction on dressings and grafts, support the wound during coughing, and keep dressings dry.
- Time exercise with dressing changes in burns, when the wound can be seen and analgesia is working (see the burns page).
- Report: blood or fluid soaking through, a loose or wet dressing, redness spreading from the wound, heat, pus, a bad smell, fever, or a wound opening.
- Common types: gauze, clear film, hydrocolloid, foam (heavy exudate), alginate (very wet wounds), silver (infected wounds).
4Taping
- Kinesiology tape is sometimes used after breast cancer surgery for mild lymphoedema and for posture (scapular retraction), and on the chest wall for musculoskeletal pain. Evidence is limited; it does not replace compression for lymphoedema.
- Before taping: clean, dry, intact skin; test a small piece for allergy; not over wounds, drains, grafts, radiotherapy-damaged or very fragile skin, or areas with poor sensation.
- Remove if itching, redness or blistering appears; peel slowly along the hair, supporting the skin.
5Splints, binders and orthoses
| Device | Used for | Check |
|---|---|---|
| Burns splints (resting hand, neck conformer, axillary, knee and ankle) | Hold anti-deformity positions | Pressure areas and fit daily; swelling changes the fit |
| Ankle–foot splint or orthosis | Prevent foot drop and heel sores in ICU, GBS, head and spinal injuries | Heel off the mattress; skin checks every shift |
| Abdominal binder | Tetraplegia (better breathing and BP when sitting); support after abdominal surgery if the surgeon advises | Over the lower ribs and abdomen, not over the chest; remove for skin checks |
| Sternal support vest | Some patients after sternotomy (large breasts, obesity, coughing) | Comfort; does not replace sternal precautions |
| Cervical collar, thoracolumbar brace | Spinal stability after injury or surgery | Worn as the surgeon orders; log-roll; skin under the collar |
| Pressure garments | Burns scars, lymphoedema | Worn about 23 hours a day; replaced as they loosen |
6Exercise and monitoring equipment
| Equipment | How to use it safely |
|---|---|
| Treadmill | Show the emergency stop and safety clip; start slow and flat; light hand support only; increase speed or gradient in small steps; slow down before stopping |
| Cycle and arm ergometers | Seat height so the knee is slightly bent at the bottom of the pedal stroke; start with little resistance; arm ergometer at shoulder height or below (after sternotomy, only when allowed) |
| Heart-rate monitor | Chest-strap monitors are more accurate than wrist devices during exercise; check against the pulse; heart rate is unreliable with beta-blockers and atrial fibrillation |
| Pulse oximeter | Warm finger, no nail polish, wait for a steady trace; during walking use an ear probe or recheck at rest if the signal is poor |
| Sphygmomanometer | Right cuff size, arm supported at heart level, patient seated and rested; recheck high readings |
| Free weights and resistance bands | Choose the load from 1RM or the repetitions possible; breathe out on effort; progress when 2 extra repetitions are easy in 2 sessions |
| Pressure biofeedback unit | An inflatable pad with a gauge, placed under the lower back (supine, commonly inflated to about 40 mmHg) or the abdomen (prone); the patient keeps or lowers the pressure while drawing in the lower abdomen. Used for deep abdominal (core) training and posture, for example after abdominal surgery once healed and in back pain with breathing pattern problems |
| Balance boards, Swiss (therapy) balls | Balance and trunk training in deconditioned and older patients, after ICU stays and in pulmonary rehab; near a rail or wall with supervision; avoid in severe breathlessness, unstable BP or high fall risk |
7Monitoring adherence and contextual factors
- How to monitor: exercise and symptom diaries, step counts on a phone or pedometer, attendance, checking inhaler and breathing technique at each visit, and asking open questions ("How many days did you walk last week?").
- Common barriers: cost and travel, work hours, fear of breathlessness or chest pain, low mood, poor understanding, family beliefs ("rest is best"), other illnesses (arthritis, diabetes, memory problems).
- Helps: goals the patient chose; a short written or picture programme in the patient's language; linking exercise to daily routines; family involvement; phone or WhatsApp reminders and video reviews; praise for small gains; reviewing and adjusting the plan.
Sources
- MUHS BPTh syllabus (2012), CVR practical skills list.
- Compression therapy and venous ulcer guidance (for example SIGN guideline on chronic venous leg ulcers; wound-care consensus documents on ABPI thresholds).
- International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 consensus document.
- American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription (equipment, monitoring).
- Structure and classical content: Kisner & Colby, Therapeutic Exercise; Hillegass (2022).
Educational notes for exam preparation. Not medical advice.
Version 1. Content checked 19 October 2026. Next review October 2027.