Movement Rehabilitation Laboratory #1 Part 3: Exercise Prescription Carlos Leon-Carlyle # Bruce Monkman # Loriana Costanzo # Michael Bois #

Case Study 1 Case Study #1 The shoulder complex Problem: Abduction and Flexion

Case Study 1 Pendulum Exercises (Flexibility) Patient is bent over with back perpendicular to the floor. The patient rests their unaffected arm on the table to help with support. They swing the afflicted arm in an alternating flexion/extension motion. The patient’s legs assume a forward-backward straddle position. 10 Repetitions 3 Sets 10 Seconds (If pain is present, wait for pain to subside) This exercise helps warm up the shoulder complex. This exercise also distracts the glenohumeral joint, and provides pain modulation. The forward-backward straddle position allows for the transfer of weight during the exercise.

Case Study 1

Wand Abduction (Flexibility) The patient can stand or lie supine. He or she grasps the end of the wand with the involved hand and places the uninvolved had toward the other end of the wand. The uninvolved arm upward into abduction. 8 Repetitions 3 Sets 30 Seconds (If pain is present, wait for pain to subside) This exercise increases shoulder abduction. The wand helps move the afflicted arm through the full ROM without the use of the muscles in that arm.

Case Study 1

Pendulum Circumduction Exercise (Flexibility) This exercise is a variation of the first stretch in this presentation. Patient is bent over with back perpendicular to the floor. The patient rests their unaffected arm on the table to help with support. They swing the afflicted arm in a circumductive motion. The patient’s legs assume a forward-backward straddle position. 10 Repetitions 3 Sets 10 Seconds (If pain is present, wait for pain to subside) This exercise once again helps warm up the shoulder complex. This exercise also distracts the glenohumeral joint, and provides pain modulation. Unlike the Flexion/Extension Pendulum, The forward-backward straddle position will not provide for the transfer of weight during the exercise.

Case Study 1 Shoulder Abduction Exercise (Strength) The patient stands with the involved side facing a wall or doorway. The arm is positioned in slight abduction with the dorsum of the hand against the wall. The patient keeps the elbow extended and pushes the arm against the wall, attempting to move the arm into abduction. Hold for 5-10 seconds 10 Repetitions Performed frequently throughout the day At least 10 seconds Contraction is gradually increased to a maximum contraction, held at the maximum, and then decreased gradually until the muscle is relaxed.

Case Study 1 Shoulder Flexion w/ Theraband (Strength) Patient stands upright holding a Theraband in their hand (afflicted limb). The Theraband is tied to the leg of a table which is behind the patient. The patient flexes their arm at the shoulder raising the limb through the ROM (within a pain free limit) Repetitions (Work up to) 3 Sets This is an isotonic exercise. The patient should ensure that they keep their arm in complete extension at the elbow throughout the motion.

Case Study 1 Shoulder Abduction w/ Theraband (Strength) The patient stands with the involved arm away from a wall or a door way. With a theraband attached to the door or the wall, hold the the theraband in the involved arm and move through an abductive motion Repetitions (Work up to) 3 Sets For the first set, the patient moves from 0 degrees to 30. In the second set the patient moves from 30 degrees to 90, and the last set the exercise is completed using full range of motion.

Case Study 1 Swiss Stabilisation (Stability) Ball is placed on the floor. The patient lies prone on the ball with their feet off the floor and the body anchored with the hands on the floor, shoulder-width apart. 30 Seconds or until you fall off 4 times daily 30 Seconds between sets The patient can move their body forward and backward and from side to side on the ball while maintaining weight bearing through the arms.

Case Study 1 Diagonal Plane w/Theraband (Stability) Patient ties the Theraband to a table leg opposite their afflicted limb. The patient holds the Theraband in their hand and moves the limb through flexion/abduction through the oblique plane. At the end of ROM, hold for 2-3 seconds, and then slowly return to the starting position. 5 Repetitions 3 Sets (Due to difficulty of exercise) 1 minute between sets This exercise helps develop stability in the shoulder by having the shoulder complex stabilize itself with a resistive force. This shoulder also allows the patient to incorporate an abduction and flexion exercise into one.

Case Study 1 Distal Movement Stabilisation (Stability) The patient stands or sits with the arm outstretched at from 60 to 110 degrees elevation in the scapular plane. In this position the patient spells out the alphabet with the ball held in their hand. Approx. 30 seconds Repeat 2-3 times 30 seconds in between repetitions The patient must keep their arm in full extension at the elbow. The resistance can be increased by increasing the weight of the ball being held.

Case Study 1 Power Drop (Plyometric) Lie supine on the ground arms outstretched. Your partner stands on the box holding the medicine ball at arm’s length. Partner drops the medicine ball into your hands. Catch the ball with arms bent. Allow the ball to fall to you chest. Then extend the arms to propel the ball back to the partner. 10 Repetitions 2-3 Sets 1 minute rest in between sets. Keep the catch time as short as possible. You can change the weight and size of the ball to increase or decrease the difficulty of this exercise.

Case Study 1 Hook Shot (Plyometric) Does not necessarily involve a basketball. Any ball can be used. Patient stands with their feet shoulder width apart, knees slightly bent, and a ball in the hand of their afflicted limb. The patient uses elevation through abduction to toss the ball overhead towards a basket/target. The target should be opposite the afflicted limb Tosses 3 Sets 30 seconds in between sets Make sure that the movement has an explosive start. Change up the weight of the ball for increased resistance.

Case Study 1 Underhand Baseball Toss (Functional Exercise) Patient stands with their feet shoulder width apart and their knees slightly bent. Using an underhand motion toss the ball to a partner standing 5-10 feet away Tosses 3 Sets 30 seconds in between sets Try using a weighted ball for increased difficulty.

Case Study 1 Hook Shot (Functional Exercise) Does not necessarily involve a basketball. Any ball can be used. Patient stands with their feet shoulder width apart, knees slightly bent, and a ball in the hand of their afflicted limb. The patient uses elevation through abduction to toss the ball overhead towards a basket/target. The target should be opposite the afflicted limb Tosses 3 Sets 30 seconds in between sets Change up the weight of the ball for increased resistance.

Case Study 1 Case Study #2 The elbow and wrist complexes Problem: Overuse injury in posterior compartment of forearm

Case Study 2 Elbow Extensor Stretch (Flexibility) The patient grasps the involved forearm with uninvolved hand. The elbow is stabilized next to the side or on a tabletop. The patient attempts to pull the involved forearm toward the shoulder with the uninvolved hand. Hold 30 seconds. Repeat 2-3 times 30 seconds in between stretches. This stretch can be made more effective and more comfortable if a rolled-up towel or pad is placed in the antecubital fossa. The pad provides distraction on the joint during the stretch. Make sure no shoulder extension or scapular retraction occurs as this reduces the effectiveness of the stretch.

Case Study 2 Wrist Extension Stretch (Flexibility) The afflicted arm is held out in front of the patient at 90 degrees of flexion at the shoulder. The patient extends the fingers first and then moves the wrist into flexion by the uninvolved hand. No wrist muscles should be used in this action. Hold 30 seconds. Repeat 2-3 times 30 seconds in between stretches. The wrist should be stretched with the elbow in flexion and in extension.

Case Study 2 Triceps Stretch (Flexibility) The long head of the triceps can be stretched with the patient sitting. The elbow is flexed by the clinician’s hand on the distal forearm. The shoulder is then flexed overhead by the other hand on the patient’s elbow. Hold 30 seconds. Repeat 2-3 times 30 seconds in between stretches. This exercise should be performed in supination and any pronation can be controlled by the clinician’s hand.

Case Study 1

Case Study 2 Triceps Extension (Strength) Tie a Theraband to the leg of a table. While standing upright with shoulder flexed over head and forearm flexed at the elbow. Patient then extends the elbow. 10 repetitions 3 sets 30 seconds in between exercises Motion should be performed at an even pace throughout the ROM. This action can be performed in supination and pronation.

Case Study 2 Sledgehammer (Strength) This exercise can be performed with a wooden dowel or bar with a weighted end. The patient stands with their arms at their sides. With hands turned inwards towards the body, the patient holds the bar and attempts to raise it using radial deviation. 10 Repetitions 3 Sets 30 seconds in between sets The resistance can be increased by lengthening the bar or increasing the weight on the end of the bar.

Case Study 2 Wrist Extension (Strength) The forearm rest on a tabletop in pronation with the hand over the end of the table. The patient lifts a dumbbell, moving through the full ROM from wrist flexion to wrist extension. The forearm must stay in contact with the tabletop throughout the exercise. 10 Repetitions 3 sets 30 seconds in between sets It may be necessary to stabilize the forearm with a hand across the proximal forearm.

Case Study 2 Rubber Band Exercise (Stability) Place rubber band around fingertips. Extend fingers outward, and hold before releasing. 3 repetitions Hold for 20 seconds. Perform exercise twice a day. 1 minute rest. To increase resistance, a thicker elastic may be used.

Case Study 2 Elbow Extension (Stability) This exercise can be performed from a sitting or standing position. The patient flexes their forearm to 90 degrees. Resistance (upwards) is applied to the distal portion of the forearm as the patient attempts to extend the elbow. Hold against resistance for seconds. 2-3 Times 30 seconds in between exercises This exercise should be performed at several different positions in the range of motion.

Case Study 2 Independent Isometric (Stability) Sitting with arm resting on table, extend wrist. With uninvolved hand, apply pressure to extended hand. The patient should try to oppose the force. Hold for 10 seconds 3 Sets performed twice daily 1 minute recovery Elbow should be flexed at 90 degrees.

Case Study 2 Stress Ball Exercise (Plyometric) Hold a stress ball in the afflicted limb’s hand and explosively squeeze the ball. 10 Repetitions 3 Sets 30 Seconds in between sets Make sure that the exercise is not done in a rapid fire motion as this is not effective.

Case Study 2 Clap Push-Up (Plyometric) Patient is in a prone position. They will use their arms to raise and lower the body bringing their chest close but not in contact with the ground. The patient will lower their body until their elbows are flexed at 90 degrees. At this point, they will explosively push the body into the air for enough time to clap the hands together, then bring them back into position to cushion the fall. Repeat. 5 Repetitions 2-3 Sets 1 minute in between sets. The width of the hand stance can be changed to alter the difficulty of this exercise.

Case Study 2 Frisbee Toss (Functional Exercise) Frisbee Toss (Functional Exercise) Patient holds a frisbee. The patient should be standing upright with their knees slightly bent and their feet shoulder width apart. Fingers are curled under the disc's rim, and the thumb is placed on top of the disc to hold it in place. The index finger may either be on the edge of the disc (to help aim), or four fingers may be tucked underneath the rim (to aid power). The thrower draws the throwing arm across the body to build velocity for the disc. During this movement, the arm straightens out. As the arm becomes straight, the wrist is flicked, to impart spin. After release, the arm usually points towards the target. 10 Repetitions 3 Sets 1 minute in between sets. Different sizes of frisbees can be used based on the patient’s rehab level.

Case Study 1

Case Study 2 Wrist Rotations (Functional Exercise) Patient holds a dowel or weighted bar in their hand. They hold their arm out in flexion at the shoulder. Then the patient rotates their hand at the wrist in a back and forth motion. 20 Repetitions 2-3 Sets 1 minute in between sets. Different weights and lengths of bars can be used to further increase the difficulty of this exercise.