Upper Limb Exercises Flashcards
What to do for stiffness, weakness and instability in muscles?
Stiff= stretch/mobilise Weak= strengthen Unstable= increase stability
What considerations should you make when prescribing exercises?
Aim?
Is it related to problem list? Patient AGGS or goals? capacity of muscle or tendon? Demand upon the soft tissue, proprioception exercises and stretches- NEEDS TO BE SPECIFIC
Dosage? Reps and sets DEPENDS ON THEIR INDIVIDUAL CAPABILITY- test them before to guide this
Build them up (graded loading) - needs to be built up slowly for someone that is very deconditioning- gauge the level they are currently at -eg tendon problems don’t like sudden load spiking- factor in goals and rest periods
Equipment?- NHS SETTING HAS LIMITED EQUIPMENT- have to be creative
How likely are they to do the exercise?- a deconditioned patient with lots of co morbidities isn’t very likely to do lots and lots of exercises-start them slowly with 1-2 that they can do throughout the day.
Check the patient doing the exercise and their response before they leave. - don’t stir the patient up. 8 reps and 3 sets. - write the exercise down ( or film them on their phone)
What are isometric shoulder exercises useful for?
Can be good for pain relief, can use towels, doors, walls other hand etc
How to target the posterior cuff bias? SUPRAPINATUS, INFRASPINATUS AND TERES MINOR
Theraband, hands in front external, rotated, shoulders into full flexion and step forwards at the same time.
Progression- add weights and load- side laying, towel underneath elbow, weight in hand,elbow at 90 degrees and externally rotate shoulder in slow and controlled movement. GO TO EXERCISE
PROGRESSION- sitting, elbow at 90 degrees resting on a pillow- abducted position, 5kg weight- slow and controlled movement- don’t allow the shoulder to medially rotate.
Even harder- open chain unsupported position- control lateral rotation and abduction
Or take patient into prone laying- against gravity- still a slow and controlled movement to target the posterior cuff.
Exercise ideas for the anterior surface of the scapula- subscapularis bias.
Medicine ball slam
Progression - supine laying- eccentric work (lowering down against gravity) weight in abducted position- all about a slow and controlled movement.
Propriceptive exercises
Drop and catch tennis ball- could use a weight- close eyes, stand on wobble boards on stand on one leg or count from 100 backwards.
Medicine ball on wall and move around with one hand- standing at arms length from the door.
Reaction exercises- getting muscles to fire quickly
Throwing and catching- reaction balls
Combining movements - lawnmower exercises with a theraband, cables, dumbbells, kettle bells
How to target levater scapulae and upper traps?
Shrug exercises with dumbbell
How to strengthen the elbow?
Lots of the shoulder exercises overlap with elbow exercises- lawnmower theraband- etc.
SPECIFIC ELBOW EXERCISES INCLUDE- early stages- laying supine- flexion and extension supported with other hand, flex to forehead? Mouth or shoulder? Can pronate and supinate onto forehead, involve dumbbell to strengthen as well
How to strengthen the wrist and forearm?
Pronation and supination- arm supported by plinth- use a loaded weight- pronate and supinate forearm whilst holding the weight.
Another elbow exercise
Loop the theraband around the hand and stand on the other part. Isometrically hold the theraband and extend and flex the elbow.
Do in a pronated and supinated position- progress to an isometric hold on a long lever.
In rehab- must make the exercises sport specific or job specific
What to think about now
BE SPECIFIC
EXERCISES SHOULD BE TAILORED TO THE INDIVIDUAL, INCLUDING NUMBER OF EXERCISES AND DOSAGE.
CLINICALLY REASON
MAKE SURE ITS DIFFICULT ENOUGH TO STIMULATE A CHANGE IN THE TISSUE
BUILD THEM UP (GRADED LOADING)
