Movement Rehabilitation Laboratory #2 Part 3: Exercise Prescription Carlos Leon-Carlyle # Bruce Monkman # Loriana Costanzo # Michael Bois #

Case Study #1 Patient has 60% flexion range ad is 20 degrees from full extension and is limited in lateral flexion and rotation. Problem: Muscular tear to the erector spinae at L2 and experienced muscular spasm and extreme pain due to a lifting motion.

Case Study #1 Spinal Twist (Flexibility) The patient uses a straight-backed chair without arms. The feet are firmly planted on the floor, and the trunk is rotated tward the back of the chair. With one hand placed on the chair back, the other hand is placed on the outside of the knee, and the patient uses the hands to pull around and provide the stretch. Hold seconds. Repeat 2-3 times 30 seconds in between stretches. The thighs should not move but should remain in place during the stretch. Do not allow the patient to rotate their hips.

Case Study #1

Prolonged Sidebending (Flexibility) Patient is sidelying with the tight region on the top and a rolled towel or pillow supporting the portion of the trunk that is directly under the tight region. The top arm is placed overhead, and the top leg is straight in extension. Hold seconds. Repeat 2-3 times 30 seconds in between stretches. Increasing or decreasing the size of the rolled towel or pillow can alter the degree of the stretch. Watch out for trunk flexion. The patient must remain in a straight- aligned position of the trunk relative to the pelvis to attain maximum results.

Case Study #1

Quadruped Leg Raise (Stability)  The purpose of this exercise is to enhance pelvic stabilization. The patient is in a quadruped position with the pelvis in neutral. The patient extends one leg and moves it backward by tightening the buttocks and hamstrings.  Repetitions: 10 reps  Frequency: 3 sets  Rest: 1 minute in between sets  Exercise Mechanics: The motion should be smooth and steady. As with the arm exercises an object placed across the lumbar spine can detect any pelvic rotation.

Case Study #1 Quadruped Arm Raise (Stability) This exercise is for spinal stabilization. The patient is in a quadruped position and in pelvic neutral. One arm is raised and lowered, and the movement is repeated on the opposite side. Reps: 10 repetitions on each side Frequency: 3 sets Rest: 1 minute in between sets. Exercise Mechanics:The hips and back should not move throughout the exercise. A good feedback technique to help the patient detect hip motion during these exercises is to balance an object on the lower back. If the object falls to either side, he/she knows that the hips have rotated.

Case Study #1

Posterior Pelvic tilt (Strength) This exercise strenghtens the abbs and gluteals and encourges the patient to maintain pelvic neutral. It can also increase pelvic mobility. The patient lies supine with the legs extended, or with the hips and knees flexed and the feet flat on the floor, and the arms relaxed at the side. The patient tightens the the buttocks, and pushes the back to the floor. The pelvis should roll posteriorly. Reps: 10 repetitions Frequency: 3 sets Rest: 1 minute in between sets Exercise Mechanics: Once the patient is able to perform this exercise in supine, he or she can also perform it in a sitting or standing position. Common errors include using the legs to move the pelvis rather than the abbs and back muscles, arching the back rather than preforming the tilt, and pushing the abbs outward rather than tensing the abb muscles to pull the navel toward the spine.

Case Study #1

Supine Straight-leg Exercise (Strength) The purpose of this exercise is to strengthen the lower abs and facilitate maintenance of pelvic neutral. The patient lies supine with knees bent at 90 degrees, feet flat on floor, and arms across the stomach. The spine is kept in neutral throughout the exercise. One hip is flexed with the knee extended, foot pointing towards the ceiling. The leg is slowly lowered to the floor. 10 Repetitions on each leg 3 Sets 1 minute in between sets If the patient has difficulty with the exercise, initial performance may be with arms at sides. The back should not arch or roll, and the abs should not push outward during the movement. As the patient gradually lowers the leg, they must progressively tighten the abs to maintain a pelvic neutral position.

Case Study #1

Trunk Rotation Using Medicine Ball (Agility) The patient stands upright or in a seating position, back to back with a partner. Keeping feet planted shoulder width apart, the patient rotates the trunk while passing a medicine ball to their partner. The patient then rotates the trunk to the opposite direction to retrieve the medicine ball from their partner. 15 passes for each direction 2-3 sets of 15 passes 1 minute in between sets Exercise Mechanics: This action should be performed as quickly and smoothly as possible, but in a controlled manner. The weight and size of the medicine ball may be altered to decrease of increase the difficulty of the exercise.

Case Study #1

Medicine Ball Throw (Agility) Patient lies supine with knees bent at 90 degrees. They hold a medicine ball with both hands and then using a forward flexing motion, they toss the ball to the clinician. 10 Tosses 3 Sets 30 seconds in between sets Medicine ball toss can be performed in straight plane to body or rotationally to facilitate oblique activity. Try using a different weighted ball for increased difficulty.

Case Study #1

Case Study #2 Post-Pregnancy Woman Problem: SI Joint shift

Case Study #2 Thomas Hip Flexor Stretch (Flexibility) Patient lies supine with both knees to the chest. One thigh is grasped behind the knee, and the leg being stretched is lowered. 2-4 Repetitions Seconds (If pain is present, wait for pain to subside) The thigh of the leg being stretched (the lowered leg) should be kept in alignment with the body’s midline, without hip rotation or abduction and with knee flexion to 90 degrees. Watch out for hyperextension of the spine.

Case Study #2

Piriformis Stretch (Flexibility) Patient is on hands and knees with the uninvloved leg crossed over the involved leg and behind the involved hip. The patient moves the hips backward, keeping the uninvolved leg straight and bending the knee of the involved leg. 2-4 Repetitions Seconds (If pain is present, wait for pain to subside) Watch out for the patient moving the hips toward the extended leg rather than keeping the weight equally distributed over both hips. Instruct the patient not to rotate but move straight back if you observe this trick.

Case Study #2

Supine Stabilization with Leg Movement (Stability) Patient lies supine with the legs flexed. While in a neutral spine position, the patient raises one knee up toward the chest and then extends the leg from the knee without moving the hips as the abdominals are contracted more tightly to maintain pelvic neutral. The patient returns the leg to the starting position and repeats the movement with the opposite leg. 5 Repetitions/Leg 3 Sets 30 Seconds between sets The hips should not rise up or rotate, and the back should not arch.

Case Study #2

Supine Stabilization with Arm and Leg Movement (Stability) Patient lies supine with the knees bent and the spine in a neutral position. One arm and the opposite leg are raised simultaneously and then lowered while pelvic neutral is maintained. The movement is repeated with the contralateral arm and leg. 5 Repetitions/Leg 3 Sets 30 seconds between sets Movement should be smooth, and no trunk motion should occur. The pelvis is maintained in neutral throughout. The back should not roll from one side to another and should not arch off the floor.

Case Study #2

Bridging (Strength) Patient lies supine with the knees bent and feet flat on the floor. The abdominals are tightened and the spine is in neutral. The gluteals are tightened to lift the hips off the floor until the thighs and trunk form a straight line. Hold for seconds 3 Repetitions Patient should use their arms laid flat out at their sides in order to help maintain balance.

Case Study #2

Lunges (Strength) Patient begins in a standing position with the spine in neutral. Keeping the abdominals tightened and the back straight, the patient moves to a lunge position, going down smoothly, and then returns to a standing position Repetitions 2 Sets 1 minute rest in between sets The trunk should not tilt or rotate during a lunge exercise. People often perform these exercises incorrectly with trunk rotation or flexion. The hips and shoulders should remain in the same plane throughout the exercise.

Case Study #2

Resisted Leg Lifts (Agility) Patient lies supine on the floor and the clinician stands at the patient’s head. The patient’s knees are extended, and the hips are flexed to approximately 90 degrees. The patient attempts to lift the legs upward as the clinician attempts to push them back down. 10 Repetitions 2-3 Sets 1 minute rest in between sets. This exercise is performed quickly but with control. It is important that the patient maintain pelvic neutral and that the back not arch throughout the exercise.

Case Study #2

Medicine Ball Throw (Agility) Patient lies supine with knees bent at 90 degrees. They hold a medicine ball with both hands and then using a forward flexing motion, they toss the ball to the clinician. 10 Tosses 3 Sets 30 seconds in between sets Medicine ball toss can be performed in straight plane to body or rotationally to facilitate oblique activity. Try using a different weighted ball for increased difficulty.

Case Study #2