LAB: Exercise prescription Flashcards
Describe the quadriceps or rectus femuris stretch
- Position as shown with care taken to:
a. Keep hip of quads being stretched straight.
b. Opposite knee is ideally slightly flexed.
c. Contract the gluteus muscles during stretch.
Describe the iliopsoas stretch
- Kneel, with the knee on the side of dysfunction on the floor, and the non- dysfunctional leg flexed to 90 degrees.
- Contract your gluteal muscles for 3 deep breaths or 20 seconds.
- Repeat 3-5 times.
- Can repeat on both sides if both are dysfunctional.
If a patient presents with a hip flexion SD, what stretch should you recommend?
iliopsoas stretch or lower extremity adductors
Describe the upward dog ioliopsoas stretch
- Lay down on your stomach, with your hands at shoulder level on either side of your chest (Figure A)
- Push up, but try to keep the part of your abdomen that is inferior to your belly button on the floor, resulting in the “cobra” posture (Figure B).
- Take 5 deep breaths & slowly lower yourself downward again (Back to Figure A).
- Rest for a breath or 2 & then repeat it again 2-4 more times.
- Alternate stretch – repeat steps 1-4 but with one leg off of table (Figure C).
Describe the lower extremity adductor stretch
- Sit on the floor with your back straight and your gluteal muscles as close to the wall as possible.
- Place your hands on the floor behind your hips & press your hands into the floor.
- Next, arch your back & feel your pelvis rotate anteriorly.
- Hold this position for 20 seconds.
- Repeat this exercise 3 times and then 3 times a day.
Describe the piriformis self MET
- Lay on your back with dysfunctional leg crossed over the other, as shown above.
- Grab the table to stabilize your hip against the table.
- Place your other hand on the outside of your thigh or knee. Inhale deeply & gently press your thigh/knee into your hand for 3-5 seconds.
- Then, exhale and relax your leg, allowing your hand to pull your dysfunctional leg further towards the other side (in example, pull left leg towards the right side).
- Repeat steps 3 & 4 another 3-5 times.
Describe the prone piriformis self stretch
- Start off on all fours & bring your involved leg closer to your hands, getting it as close to the horizontal position as possible (Figure A, treating L piriformis in photo).
2/Then, lower yourself onto your forearms & slide your other leg further farther behind you, keeping it as straight as possible (Figure B).
- Hold this position for 20 seconds.
- Repeat this 3-5 times & then repeat the whole activity 2-3 times a day.
Describe the Tensor Fascia Lata stretch (the one laying down)
Start lying supine, with your arms out to the sides (abducted to 90 degrees).
While maintaining a posterior pelvic tilt (tuck the tailbone in), externally rotate the leg to be stretched, while also adducting that leg.
Allow the pelvis to rotate towards leg to be stretched.
Hold stretch for 20 seconds.
To transition to a stretch of the quadratus lumborum:
– Place hands behind head.
– Bend the unaffected leg to 90 degrees, and bend and flex the affected leg to 90 degrees.
Describe the standing tensor fascia lata stretch
To treat a tight RIGHT tensor fascia lata muscle (as shown in image on R)
Stand with you legs crossed at the knees, as shown
Then shift your weight mostly onto the foot of the side you are trying to stretch (shift weight onto R foot, as in photo), allowing your hip to shift toward the affected side (the R side).
Reach the arm on that side over towards the other side (reach arm to the LEFT).
Reverse the position and direction to treat a tight LEFT TFL. Can also hold onto a supportive chair instead of hip.
Describe the quadratic lumborum stretch
To treat a tight LEFT QL muscle (as shown in image to the right):
- Stand with your legs a little more than shoulder width apart and reach your arm (on the unaffected side) down your thigh toward your knee, looking at the ceiling (Figure A).
- Then, exhale and look down (Figure B).
a. Upon looking down your hand should be able to slide down your leg more.
3. Repeat 3-5 times. The whole exercise should be repeated 2-3 times a day.
You can perform on both sides as a treatment option. To treat only a tight RIGHT QL, reverse the directions in the above instructions.
Describe the hamstring stretch (standing)
- Using a wall or flat table, place your hands upon it. Your feet should be about 6 inches apart.
a. The goal is to keep your neck, upper & lower back relatively flat and elongated, putting your feet beneath your lower abdomen. - Try to straighten your legs so that your gluteal muscles move toward the ceiling.
- Hold this position for 20 seconds. Then, relax and, while keeping your spine straight, bend your knees as if you were going to sit down on something.
- Repeat this exercise 3 times.
Describe the hamstring stretch (sitting)
Start seated on the floor with one leg straight out in front of you & the other bent with your foot against your inner thigh.
Reach your hands as far down your leg as possible. When you can’t reach your hands any further, try to push your heel through the floor for 20 seconds.
Rest for 5 seconds & then repeat this stretch 2-3 times on each side.
Repeat this routine 2-3 times a day.
Describe the clamshell exercise. What is she strengthening?
The gluteus medius and the adductors
For left side:
- From a lateral recumbent position, flex hips to 45 degrees and flex knees 90 degrees.
- Keeping feet together, raise left knee ~6 inches (~15 cm) while exhaling.
- Return to starting position during inhalation. 4. Repeat 10-15 times per session.
Describe the varying levels of abdominal sit backs
Level 1: arms extended
Level 2: arms folded
Level 3: arms behind head
Obliques
Describe the deep pressure on tender poins in the upper trapezius and levator scapula
Instruct patient to identify any knots in their upper trapezius.
Apply deep pressure to release muscle tension.
Hold pressure and allow tender point to melt.
Follow with self-stretching, if possible
Describe the levator scapula active self stretch
Patient grasps back corner of chair seat and leans towards their contralateral knee (if treating LEFT dysfunctional levator scapula, lean towards RIGHT knee).
Patient places other hand on the back of their head, if able, and stretches slightly further by adding a feather’s edge more weight in direction of contralateral knee.
Patient contracts their ipsilateral armpit inferiorly for 5 seconds.
Upon relaxing the contraction, the patient allows themselves to advance closer to their contralateral knee (further stretching the levator scapula).
Steps 3 and 4 are repeated 3-5 times, or until there is no more advancement towards the knee upon relaxation of the stretch.
Describe the scalenes self stretch
Place the hand of the affected side under your gluteal muscles, palm up. Use your other hand to reach over your head and grab just above the ear of the affected side.
Place your neck into a sidebending stretch toward the unaffected side.
Take a deep breath feel the tension mount in your head placed hand, upon exhalation follow the relaxation of your neck into further sidebending.
Repeat this 3-6 times and make sure the other side is stretched equally.
Do this exercise 3 times a day.
Describe the latissimus dorsi hypertonicity gravity stretch
Start by lying on your unaffected side.
Raise your affected arm over and behind your head (Figure A).
Allow gravity to stretch the muscle in to a more relaxed position (Figure B).
Taking a few deep breaths and breathing through the tension may be very helpful.
Perform this stretch at least 3 times a day as needed.
Describe the latissimus dorsi prayer stretch
- Starting on your knees with you elbows together and planted on the seat of a chair, lower yourself into the position of the image to the right.
- Drop your chest and sit back towards your heels.
a. A stretch should be felt in the upper back.
b. Increasing the curve in your lower back should increase the stretch. - Hold this stretch for 5-6 deep breaths.
- After the 5-6 breaths relax and take the pressure off the back muscles. Repeat this stretch again.
- Perform this at least twice a day and after any exercise, especially when the exercise involves rotating your trunk.
Describe the subscapularis gravity self-stretch
- Start lying supine. Raise the affected arm midway in the palm-up position (Figure A).
- Allow gravity to stretch the muscle to a more relaxed position (Figure B).
- Taking a few deep breaths and breathing through the tension may be very helpful.
- Perform this stretch at least 3 times a day as needed.
Describe the pectoralis minor and major stretch
Stretch for 20 seconds, and repeat 2-3 times.
Repeat 2-3 times/day.
Remember to take deep breaths and go only to the feather’s edge of discomfort.
Describe scapular retraining stabilization
- Stand at arms length from a wall, and place your hands on the wall about shoulder width apart while looking at the ground (Figure A).
- Push the wall away, allowing your shoulder blades to spread apart and drift forwards towards the wall (this protracts the scapula).
- Slowly, allow your body to go forward toward the wall and at the same time uncurl your neck starting at the lowest portion first so that you eventually end with your nose near touching the wall and your shoulder blades squeezing close together (this retracts the scapula) (Figure B).
- Then, push away from the wall allowing your neck to bend forward from the top vertebra down to your shoulders maximally pushing away from the wall
• Your neck should ideally be fully bent with your chin on your chest to return to the Figure A position.
- Hold that position for 2 deep breaths and then return to the start position. Repeat the retraining exercise 8-12 times and then do this 2-3 times a day.
Describe scapular retraining
Push elbows posteriorly and squeeze scapulae together (can also add chin tuck)
Inhale while contracting; Exhale and relax.
Describe how to retrain your standing posture
Tighten your gluteal muscles.
Rotate your arms and shoulders out and back while inhaling (make sure to feel your shoulder blades squeeze together in your back); your thumbs rotate outwards.
Maintain this position while pulling your shoulder down and exhaling (Figure B).
Hold this position while breathing normally and correcting the head posture (pretend you are suspended by a Unicorn horn at a 60 degree angle from the ceiling).
How do you retrain posture in a seated position?
Fully extend, fully slouch…then find the middle.
The middle is probably where you need to retrain your body to be comfortable.
Practice sitting in the middle each time you sit. When your muscles fatigue, you can let go of the posture.
It may take a year to become capable of maintaining this posture.
