movement rehabilitation laboratory #1 part 3: exercise prescription carlos leon-carlyle #0317752...

Movement RehabilitationMovement RehabilitationLaboratory #1Laboratory #1

Part 3: Exercise PrescriptionPart 3: Exercise Prescription

Carlos Leon-Carlyle #0317752Carlos Leon-Carlyle #0317752

Bruce Monkman #0310446Bruce Monkman #0310446

Loriana Costanzo #0308293Loriana Costanzo #0308293

Michael Bois #0308171Michael Bois #0308171

Case Study 1Case Study 1

Case Study #1Case Study #1

The shoulder complexThe shoulder complex

Problem: Abduction and FlexionProblem: Abduction and Flexion


Pendulum Exercises (Flexibility)Pendulum Exercises (Flexibility)Patient is bent over with back perpendicular to the floor. Patient is bent over with back perpendicular to the floor. The patient rests their unaffected arm on the table to help The patient rests their unaffected arm on the table to help with support. They swing the afflicted arm in an alternating with support. They swing the afflicted arm in an alternating flexion/extension motion. The patient’s legs assume a flexion/extension motion. The patient’s legs assume a forward-backward straddle position.forward-backward straddle position.

10 Repetitions10 Repetitions

3 Sets3 Sets

10 Seconds (If pain is present, wait for pain to subside)10 Seconds (If pain is present, wait for pain to subside)

This exercise helps warm up the shoulder complex. This This exercise helps warm up the shoulder complex. This exercise also distracts the glenohumeral joint, and provides exercise also distracts the glenohumeral joint, and provides pain modulation. The forward-backward straddle position pain modulation. The forward-backward straddle position allows for the transfer of weight during the exercise. allows for the transfer of weight during the exercise.


Wand Abduction (Flexibility)Wand Abduction (Flexibility)The patient can stand or lie supine. He or she grasps the The patient can stand or lie supine. He or she grasps the end of the wand with the involved hand and places the end of the wand with the involved hand and places the uninvolved had toward the other end of the wand. The uninvolved had toward the other end of the wand. The uninvolved arm upward into abduction.uninvolved arm upward into abduction.


3 Sets3 Sets

30 Seconds (If pain is present, wait for pain to subside)30 Seconds (If pain is present, wait for pain to subside)

This exercise increases shoulder abduction. The wand This exercise increases shoulder abduction. The wand helps move the afflicted arm through the full ROM without helps move the afflicted arm through the full ROM without the use of the muscles in that arm.the use of the muscles in that arm.


Pendulum Circumduction Pendulum Circumduction Exercise (Flexibility)Exercise (Flexibility)

This exercise is a variation of the first stretch in this This exercise is a variation of the first stretch in this presentation. Patient is bent over with back perpendicular presentation. Patient is bent over with back perpendicular to the floor. The patient rests their unaffected arm on the to the floor. The patient rests their unaffected arm on the table to help with support. They swing the afflicted arm in table to help with support. They swing the afflicted arm in a circumductive motion. The patient’s legs assume a a circumductive motion. The patient’s legs assume a forward-backward straddle position.forward-backward straddle position.10 Repetitions10 Repetitions3 Sets3 Sets10 Seconds (If pain is present, wait for pain to subside)10 Seconds (If pain is present, wait for pain to subside)This exercise once again helps warm up the shoulder This exercise once again helps warm up the shoulder complex. This exercise also distracts the glenohumeral complex. This exercise also distracts the glenohumeral joint, and provides pain modulation. Unlike the joint, and provides pain modulation. Unlike the Flexion/Extension Pendulum, The forward-backward Flexion/Extension Pendulum, The forward-backward straddle position will not provide for the transfer of weight straddle position will not provide for the transfer of weight during the exercise.during the exercise.


Shoulder Abduction Exercise Shoulder Abduction Exercise (Strength)(Strength)

The patient stands with the involved side facing a wall or The patient stands with the involved side facing a wall or doorway. The arm is positioned in slight abduction with the doorway. The arm is positioned in slight abduction with the dorsum of the hand against the wall. The patient keeps the dorsum of the hand against the wall. The patient keeps the elbow extended and pushes the arm against the wall, elbow extended and pushes the arm against the wall, attempting to move the arm into abduction.attempting to move the arm into abduction.

Hold for 5-10 secondsHold for 5-10 seconds


Performed frequently throughout the dayPerformed frequently throughout the day

At least 10 secondsAt least 10 seconds

Contraction is gradually increased to a maximum Contraction is gradually increased to a maximum contraction, held at the maximum, and then decreased contraction, held at the maximum, and then decreased gradually until the muscle is relaxed.gradually until the muscle is relaxed.


Shoulder Flexion w/ Theraband Shoulder Flexion w/ Theraband (Strength)(Strength)

Patient stands upright holding a Theraband in their hand Patient stands upright holding a Theraband in their hand (afflicted limb). The Theraband is tied to the leg of a table (afflicted limb). The Theraband is tied to the leg of a table which is behind the patient. The patient flexes their arm at which is behind the patient. The patient flexes their arm at the shoulder raising the limb through the ROM (within a the shoulder raising the limb through the ROM (within a pain free limit).pain free limit).

3-10 Repetitions (Work up to)3-10 Repetitions (Work up to)

3 Sets3 Sets

This is an isotonic exercise. The patient should ensure that This is an isotonic exercise. The patient should ensure that they keep their arm in complete extension at the elbow they keep their arm in complete extension at the elbow throughout the motion.throughout the motion.


Shoulder Abduction w/ Shoulder Abduction w/ Theraband (Strength)Theraband (Strength)

The patient stands with the involved arm away from a wall The patient stands with the involved arm away from a wall or a door way. With a theraband attached to the door or the or a door way. With a theraband attached to the door or the wall, hold the the theraband in the involved arm and move wall, hold the the theraband in the involved arm and move through an abductive motion. through an abductive motion.

3-10 Repetitions (Work up to)3-10 Repetitions (Work up to)

3 Sets3 Sets

For the first set, the patient moves from 0 degrees to 30. In For the first set, the patient moves from 0 degrees to 30. In the second set the patient moves from 30 degrees to 90, the second set the patient moves from 30 degrees to 90, and the last set the exercise is completed using full range and the last set the exercise is completed using full range of motion.of motion.


Swiss Stabilisation (Stability)Swiss Stabilisation (Stability)Ball is placed on the floor. The patient lies prone on the ball 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 with their feet off the floor and the body anchored with the hands on the floor, shoulder-width apart. hands on the floor, shoulder-width apart.

30 Seconds or until you fall off30 Seconds or until you fall off

4 times daily4 times daily

30 Seconds between sets30 Seconds between sets

The patient can move their body forward and backward and The patient can move their body forward and backward and from side to side on the ball while maintaining weight from side to side on the ball while maintaining weight bearing through the arms.bearing through the arms.


Diagonal Plane w/Theraband Diagonal Plane w/Theraband (Stability)(Stability)

Patient ties the Theraband to a table leg opposite their Patient ties the Theraband to a table leg opposite their afflicted limb. The patient holds the Theraband in their afflicted limb. The patient holds the Theraband in their hand and moves the limb through flexion/abduction hand and moves the limb through flexion/abduction through the oblique plane. At the end of ROM, hold for 2-3 through the oblique plane. At the end of ROM, hold for 2-3 seconds, and then slowly return to the starting position.seconds, and then slowly return to the starting position.


3 Sets (Due to difficulty of exercise)3 Sets (Due to difficulty of exercise)

1 minute between sets1 minute between sets

This exercise helps develop stability in the shoulder by This exercise helps develop stability in the shoulder by having the shoulder complex stabilize itself with a resistive having the shoulder complex stabilize itself with a resistive force. This shoulder also allows the patient to incorporate force. This shoulder also allows the patient to incorporate an abduction and flexion exercise into one.an abduction and flexion exercise into one.


Distal Movement Stabilisation Distal Movement Stabilisation (Stability)(Stability)

The patient stands or sits with the arm outstretched at from The patient stands or sits with the arm outstretched at from 60 to 110 degrees elevation in the scapular plane. In this 60 to 110 degrees elevation in the scapular plane. In this position the patient spells out the alphabet with the ball position the patient spells out the alphabet with the ball held in their hand.held in their hand.

Approx. 30 secondsApprox. 30 seconds

Repeat 2-3 timesRepeat 2-3 times

30 seconds in between repetitions30 seconds in between repetitions

The patient must keep their arm in full extension at the The patient must keep their arm in full extension at the elbow. The resistance can be increased by increasing the elbow. The resistance can be increased by increasing the weight of the ball being held.weight of the ball being held.


Power Drop (Plyometric)Power Drop (Plyometric)Lie supine on the ground arms outstretched. Your Lie supine on the ground arms outstretched. Your partner stands on the box holding the medicine partner stands on the box holding the medicine ball at arm’s length. Partner drops the medicine ball at arm’s length. Partner drops the medicine ball into your hands. Catch the ball with arms ball into your hands. Catch the ball with arms bent. Allow the ball to fall to you chest. Then bent. Allow the ball to fall to you chest. Then extend the arms to propel the ball back to the extend the arms to propel the ball back to the partner.partner.10 Repetitions10 Repetitions2-3 Sets2-3 Sets1 minute rest in between sets.1 minute rest in between sets.Keep the catch time as short as possible. You can Keep the catch time as short as possible. You can change the weight and size of the ball to increase change the weight and size of the ball to increase or decrease the difficulty of this exercise.or decrease the difficulty of this exercise.


Hook Shot (Plyometric)Hook Shot (Plyometric)Does not necessarily involve a basketball. Any ball can be Does not necessarily involve a basketball. Any ball can be used. Patient stands with their feet shoulder width apart, used. Patient stands with their feet shoulder width apart, knees slightly bent, and a ball in the hand of their afflicted knees slightly bent, and a ball in the hand of their afflicted limb. The patient uses elevation through abduction to toss limb. The patient uses elevation through abduction to toss the ball overhead towards a basket/target. The target the ball overhead towards a basket/target. The target should be opposite the afflicted limb.should be opposite the afflicted limb.

10-15 Tosses10-15 Tosses

3 Sets3 Sets

30 seconds in between sets30 seconds in between sets

Make sure that the movement has an explosive start. Make sure that the movement has an explosive start. Change up the weight of the ball for increased resistance.Change up the weight of the ball for increased resistance.


Underhand Baseball Toss Underhand Baseball Toss (Functional Exercise)(Functional Exercise)

Patient stands with their feet shoulder width apart and their Patient stands with their feet shoulder width apart and their knees slightly bent. Using an underhand motion toss the knees slightly bent. Using an underhand motion toss the ball to a partner standing 5-10 feet away.ball to a partner standing 5-10 feet away.


3 Sets3 Sets


Try using a weighted ball for increased difficulty.Try using a weighted ball for increased difficulty.


Hook Shot (Functional Exercise)Hook Shot (Functional Exercise)Does not necessarily involve a basketball. Any ball can be Does not necessarily involve a basketball. Any ball can be used. Patient stands with their feet shoulder width apart, used. Patient stands with their feet shoulder width apart, knees slightly bent, and a ball in the hand of their afflicted knees slightly bent, and a ball in the hand of their afflicted limb. The patient uses elevation through abduction to toss limb. The patient uses elevation through abduction to toss the ball overhead towards a basket/target. The target the ball overhead towards a basket/target. The target should be opposite the afflicted limb.should be opposite the afflicted limb.


3 Sets3 Sets


Change up the weight of the ball for increased resistance.Change up the weight of the ball for increased resistance.


Case Study #2Case Study #2

The elbow and wrist complexesThe elbow and wrist complexes

Problem: Overuse injury in posterior Problem: Overuse injury in posterior compartment of forearmcompartment of forearm


Elbow Extensor Stretch Elbow Extensor Stretch (Flexibility)(Flexibility)

The patient grasps the involved forearm with uninvolved The patient grasps the involved forearm with uninvolved hand. The elbow is stabilized next to the side or on a hand. The elbow is stabilized next to the side or on a tabletop. The patient attempts to pull the involved forearm tabletop. The patient attempts to pull the involved forearm toward the shoulder with the uninvolved hand.toward the shoulder with the uninvolved hand.Hold 30 seconds.Hold 30 seconds.Repeat 2-3 timesRepeat 2-3 times30 seconds in between stretches.30 seconds in between stretches.This stretch can be made more effective and more This stretch can be made more effective and more comfortable if a rolled-up towel or pad is placed in the comfortable if a rolled-up towel or pad is placed in the antecubital fossa. The pad provides distraction on the joint antecubital fossa. The pad provides distraction on the joint during the stretch. Make sure no shoulder extension or during the stretch. Make sure no shoulder extension or scapular retraction occurs as this reduces the effectiveness scapular retraction occurs as this reduces the effectiveness of the stretch.of the stretch.


Wrist Extension Stretch (Flexibility)Wrist Extension Stretch (Flexibility)The afflicted arm is held out in front of the patient at 90 The afflicted arm is held out in front of the patient at 90 degrees of flexion at the shoulder. The patient extends the degrees of flexion at the shoulder. The patient extends the fingers first and then moves the wrist into flexion by the fingers first and then moves the wrist into flexion by the uninvolved hand. No wrist muscles should be used in this uninvolved hand. No wrist muscles should be used in this action.action.Hold 30 seconds.Hold 30 seconds.Repeat 2-3 timesRepeat 2-3 times30 seconds in between stretches.30 seconds in between stretches.The wrist should be stretched with the elbow in flexion and The wrist should be stretched with the elbow in flexion and in extension.in extension.


Triceps Stretch (Flexibility)Triceps Stretch (Flexibility)The long head of the triceps can be stretched with the The long head of the triceps can be stretched with the patient sitting. The elbow is flexed by the clinician’s hand patient sitting. The elbow is flexed by the clinician’s hand on the distal forearm. The shoulder is then flexed overhead on the distal forearm. The shoulder is then flexed overhead by the other hand on the patient’s elbow.by the other hand on the patient’s elbow.Hold 30 seconds.Hold 30 seconds.Repeat 2-3 timesRepeat 2-3 times30 seconds in between stretches.30 seconds in between stretches.This exercise should be performed in supination and any This exercise should be performed in supination and any pronation can be controlled by the clinician’s hand.pronation can be controlled by the clinician’s hand.


Triceps Extension (Strength)Triceps Extension (Strength)Tie a Theraband to the leg of a table. While standing Tie a Theraband to the leg of a table. While standing upright with shoulder flexed over head and forearm flexed upright with shoulder flexed over head and forearm flexed at the elbow. Patient then extends the elbow. at the elbow. Patient then extends the elbow. 10 repetitions10 repetitions3 sets3 sets30 seconds in between exercises30 seconds in between exercisesMotion should be performed at an even pace throughout Motion should be performed at an even pace throughout the ROM. This action can be performed in supination and the ROM. This action can be performed in supination and pronation. pronation.


Sledgehammer (Strength)Sledgehammer (Strength)This exercise can be performed with a wooden dowel or bar This exercise can be performed with a wooden dowel or bar with a weighted end. The patient stands with their arms at with a weighted end. The patient stands with their arms at their sides. With hands turned inwards towards the body, their sides. With hands turned inwards towards the body, the patient holds the bar and attempts to raise it using the patient holds the bar and attempts to raise it using radial deviation.radial deviation.10 Repetitions10 Repetitions3 Sets3 Sets30 seconds in between sets30 seconds in between setsThe resistance can be increased by lengthening the bar or The resistance can be increased by lengthening the bar or increasing the weight on the end of the bar.increasing the weight on the end of the bar.


Wrist Extension (Strength)Wrist Extension (Strength)The forearm rest on a tabletop in pronation with The forearm rest on a tabletop in pronation with the hand over the end of the table. The patient the hand over the end of the table. The patient lifts a dumbbell, moving through the full ROM lifts a dumbbell, moving through the full ROM from wrist flexion to wrist extension. The forearm from wrist flexion to wrist extension. The forearm must stay in contact with the tabletop throughout must stay in contact with the tabletop throughout the exercise.the exercise.10 Repetitions10 Repetitions3 sets3 sets30 seconds in between sets30 seconds in between setsIt may be necessary to stabilize the forearm with It may be necessary to stabilize the forearm with a hand across the proximal forearm. a hand across the proximal forearm.


Rubber Band Exercise (Stability)Rubber Band Exercise (Stability)Place rubber band around fingertips. Extend fingers Place rubber band around fingertips. Extend fingers outward, and hold before releasing.outward, and hold before releasing.3 repetitions3 repetitionsHold for 20 seconds. Perform exercise twice a day. Hold for 20 seconds. Perform exercise twice a day. 1 minute rest. 1 minute rest. To increase resistance, a thicker elastic may be used. To increase resistance, a thicker elastic may be used.


Elbow Extension (Stability)Elbow Extension (Stability)This exercise can be performed from a sitting or standing This exercise can be performed from a sitting or standing position. The patient flexes their forearm to 90 degrees. position. The patient flexes their forearm to 90 degrees. Resistance (upwards) is applied to the distal portion of the Resistance (upwards) is applied to the distal portion of the forearm as the patient attempts to extend the elbow. forearm as the patient attempts to extend the elbow.

Hold against resistance for 10-15 seconds.Hold against resistance for 10-15 seconds.

2-3 Times2-3 Times

30 seconds in between exercises30 seconds in between exercises

This exercise should be performed at several different This exercise should be performed at several different positions in the range of motion.positions in the range of motion.


Independent Isometric (Stability)Independent Isometric (Stability)Sitting with arm resting on table, extend wrist. With Sitting with arm resting on table, extend wrist. With uninvolved hand, apply pressure to extended hand. The uninvolved hand, apply pressure to extended hand. The patient should try to oppose the force. patient should try to oppose the force.

Hold for 10 seconds Hold for 10 seconds

3 Sets performed twice daily 3 Sets performed twice daily

1 minute recovery1 minute recovery

Elbow should be flexed at 90 degrees.Elbow should be flexed at 90 degrees.


Stress Ball Exercise (Plyometric)Stress Ball Exercise (Plyometric)Hold a stress ball in the afflicted limb’s hand and Hold a stress ball in the afflicted limb’s hand and explosively squeeze the ball. explosively squeeze the ball. 10 Repetitions10 Repetitions3 Sets3 Sets30 Seconds in between sets30 Seconds in between setsMake sure that the exercise is not done in a rapid fire Make sure that the exercise is not done in a rapid fire motion as this is not effective.motion as this is not effective.


Clap Push-Up (Plyometric)Clap Push-Up (Plyometric)Patient is in a prone position. They will use their Patient is in a prone position. They will use their arms to raise and lower the body bringing their arms to raise and lower the body bringing their chest close but not in contact with the ground. chest close but not in contact with the ground. The patient will lower their body until their elbows The patient will lower their body until their elbows are flexed at 90 degrees. At this point, they will are flexed at 90 degrees. At this point, they will explosively push the body into the air for enough explosively push the body into the air for enough time to clap the hands together, then bring them time to clap the hands together, then bring them back into position to cushion the fall. Repeat.back into position to cushion the fall. Repeat.5 Repetitions5 Repetitions2-3 Sets2-3 Sets1 minute in between sets.1 minute in between sets.The width of the hand stance can be changed to The width of the hand stance can be changed to alter the difficulty of this exercise.alter the difficulty of this exercise.


Frisbee Toss (Functional Exercise)Frisbee Toss (Functional Exercise)Patient holds a frisbee. The patient should be standing Patient holds a frisbee. The patient should be standing upright with their knees slightly bent and their feet upright with their knees slightly bent and their feet shoulder width apart. shoulder width apart. Fingers are curled under the disc's Fingers are curled under the disc's rim, and the thumb is placed on top of the disc to hold it in 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 place. The index finger may either be on the edge of the disc (to help aim), or four fingers may be tucked disc (to help aim), or four fingers may be tucked underneath the rim (to aid power). The thrower draws the underneath the rim (to aid power). The thrower draws the throwing arm across the body to build velocity for the disc. throwing arm across the body to build velocity for the disc. During this movement, the arm straightens out. As the arm During this movement, the arm straightens out. As the arm becomes straight, the wrist is flicked, to impart spin. After becomes straight, the wrist is flicked, to impart spin. After release, the arm usually points towards the target. release, the arm usually points towards the target. 10 Repetitions10 Repetitions3 Sets3 Sets1 minute in between sets.1 minute in between sets.Different sizes of frisbees can be used based on the Different sizes of frisbees can be used based on the patient’s rehab level.patient’s rehab level.


Wrist Rotations (Functional Wrist Rotations (Functional Exercise)Exercise)

Patient holds a dowel or weighted bar in their hand. They Patient holds a dowel or weighted bar in their hand. They hold their arm out in flexion at the shoulder. Then the hold their arm out in flexion at the shoulder. Then the patient rotates their hand at the wrist in a back and forth patient rotates their hand at the wrist in a back and forth motion. motion. 20 Repetitions20 Repetitions2-3 Sets2-3 Sets1 minute in between sets.1 minute in between sets.Different weights and lengths of bars can be used to further Different weights and lengths of bars can be used to further increase the difficulty of this exercise.increase the difficulty of this exercise.

movement rehabilitation laboratory #1 part 3: exercise prescription carlos leon-carlyle #0317752...

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