Week 5 Async Notes PDF

Shoulder Exercises Exercise/Stretch Targeted Muscles How to Perform Pec Stretch Chest Find a corner or doorway. Place hands at 90 degrees and lean into the corner. Do not bring the head forward during the stretch. The stretch should be felt i...

Shoulder Exercises Exercise/Stretch Targeted Muscles How to Perform Pec Stretch Chest Find a corner or doorway. Place hands at 90 degrees and lean into the corner. Do not bring the head forward during the stretch. The stretch should be felt in the chest. Rotator cuff Shoulder External Place a folded small towel between your inner arm and side. Make a fist, but don’t squeeze it. Slowly rotate your arm out to the side while engaging the back of your shoulders. (infraspinatus and Rotation The work should be felt on the surface of the shoulder blade, not the upper back or arm. Stop if you feel compensatory muscles (upper back, neck, upper arm). teres minor) Self-Mobilization Techniques for the Shoulder Technique Targeted Area How to Perform Caudal Glide Humerus Sit on a firm surface and grasp fingers under the edge. Lean the trunk away from the stabilized arm. Anterior Glide Humerus Sit with both arms behind the body or lie supine supported on a solid surface. Lean the body weight between the arms. Posterior Glide Humerus Prone, propped up on both elbows. Shift body weight downward between the arms. Self-Stretching Techniques to Increase Shoulder ROM Targeted Muscles/ Stretch How to Perform Area Posterior GH joint Sitting or standing, adduct the tight shoulder horizontally across the chest. Apply sustained overpressure by pulling the arm towards the chest, being careful not to rotate the Cross-Chest Stretch structures trunk. Increase Flexion/Elevation of Sit with the involved side next to a table. Forearm rests along the table edge, with elbow slightly flexed. Slide the forearm forward along the table while bending from the Shoulder flexion Arm waist. Eventually, the head should be level with the shoulder. Shoulder external (A) Stand facing a doorframe, elbow flexed to 90°, back of hand against the frame. Turn the trunk away from the fixed hand. (B) Use a table to stabilize the forearm with the Increase External Rotation rotators arm in the plane of the scapula. Avoid B if anterior GH instability is present. Shoulder internal (A) Stand facing a doorframe with elbow flexed to 90° and the back of the hand against the frame. Turn the trunk toward the fixed hand. (B) Lie on the affected side, with the Increase Internal Rotation rotators shoulder and elbow flexed to 90° and arm internally rotated to end position ("sleeper" position). Push the forearm towards the table with the opposite hand. Increase Extension of Arm Shoulder extensors Stand with your back to a table, hands grasping the edge with fingers forward. Begin to squat while letting the elbows flex. Increase Abduction/Elevation Sit with side next to a table. Forearm rests on the table, palm up, pointing towards the opposite side of the table. Slide the arm across the table as the head comes down Shoulder abductors of Arm towards the arm and the thorax moves away from the table. Avoid if prone to anterior subluxation or dislocation Manual Stretching Techniques Targeted Stretch How to Perform Muscles Latissimus Latissimus Supine with hips and knees flexed, stabilizing pelvis. Grasp the distal humerus and flex, laterally rotate, and partially abduct the shoulder to end range. Have the patient contract into extension, Dorsi Stretch Dorsi adduction, and medial rotation while providing resistance. Elongate during the relaxation phase. Pectoralis Pectoralis Sitting with hands behind head. Grasp the patient’s elbows. Have patient breathe in while bringing elbows out (horizontal abduction and scapular adduction). Hold at the end point as the Major Stretch Major patient breathes out. Repeat three times to avoid hyperventilation. Be sure the head and neck remain in the neutral position. Levator Levator Scapulae Stabilize the head and scapula. Have the patient breathe in and contract the muscle against the resistance. As the patient relaxes, depress the rib cage and scapula to stretch the muscle. Scapulae Stretch Upper Upper Sitting with the ipsilateral hand behind the back to stabilize the scapula and head rotated to the tight side. Add cervical flexion, further rotation to the tight side, and side bending away from the Trapezius Trapezius tight side. May depress the distal clavicle and scapula for a more aggressive stretch. Stretch Self-Stretching Techniques Stretch Targeted Muscles How to Perform Pectoralis Major Self- Stand with involved humerus at 90° abduction and elbow at 90° flexion. Stabilize forearm against a doorway. Rotate the trunk away from the involved shoulder until a stretch is Pectoralis Major Stretch felt. Pectoralis Major Self- Pectoralis Major Standing with arms in a reverse-T position to stretch the clavicular portion of the muscle. Stretch (clavicular portion) Pectoralis Major Self- Pectoralis Major (sternal Standing with arms in a V-position to stretch the sternal portion of the muscle. Stretch portion) Levator Scapulae Self- (A) Standing with the head side bent and rotated away from the tight side, place the ipsilateral hand behind the head and the bent elbow against a wall to perform the stretch. Levator Scapulae Stretch (B) The patient can also use depression of the scapula for this stretch. Upper Trapezius Self- Upper Trapezius Sitting with the head rotated to the tight side and then bent to the opposite side. The ipsilateral hand may be used to apply overpressure. Stretch Isometric Exercises Exercise Targeted Muscles How to Perform Apply isometric resistance at varying muscle lengths by changing joint angles. Vary intensity and repetitions based on strength, stage of recovery, and Multiple-Angle Isometrics Shoulder muscles pathomechanics. Self-Applied Multiple Angle Isometrics Shoulder Muscles Use the opposite hand or a stationary object (wall or door frame) to independently apply isometric resistance. Apply manual resistance to elevation/depression and protraction/retraction of the scapula. Patient can reach across the therapists shoulder for protraction Isometric Scapular Exercises Scapular muscles resistance. Isometric Resistance in Scapular Plane Elevation Shoulder muscles Position the shoulder between 30 and 60 degrees of elevation. Apply controlled manual resistance against the humerus Shoulder Isometric Extension Position the humerus at the side or in various positions of flexion and apply resistance against the humerus. extensors Shoulder Isometric Adduction Position the humerus between 15 and 30 degrees of abduction and apply resistance against the humerus. adductors Shoulder Maintain the humerus neutral to rotation and resist abduction at 0°, 30°, 45°, and 60°. If there are no contraindications to motion above 90°, preposition the Isometric Abduction abductors humerus. Self-Resistance Isometric Shoulder Flexion Shoulder flexors Use the opposite hand for resistance and perform a flexion motion Shoulder Self-Resistance Isometric Shoulder Abduction Use the opposite hand for resistance and perform an abduction motion abductors Shoulder Self-Resistance Isometric Shoulder Rotation Use the opposite hand for resistance and perform a rotation motion Rotators Stabilization Exercises Exercise Targeted Muscles How to Perform Patient side-lying with the affected extremity up. Drape the forearm of the involved extremity over your shoulder. Progress to sitting with the patient’s arm draped over Open-Chain Stabilization (Scapular) Scapular muscles your shoulder. Apply resistance to all scapular motions. Proximal Weight bearing activates the stabilizing muscles in proximal joints. Initiate in protected weight-bearing positions if tolerated. Increase weight bearing and resistance as Static Closed-Chain Stabilization stabilizing muscles tissues heal. Side-lying on the uninvolved side. Elbow and shoulder of the involved arm flexed to 90°, hand on the table bearing some weight. Resist scapular motions of elevation/ Scapular Stabilization Scapular muscles depression and retraction. Resist protraction by pushing against the elbow. Alternating Isometrics in Protected Sitting with forearms on thighs or a table, or standing with hands on a table. Lean forward slightly and apply gentle resistance against the shoulders, and ask the Shoulder muscles Weight Bearing patient to "hold". Apply resistance in various directions. Progression of Closed-Chain Shoulder muscles Standing with the shoulder at 90 degrees, and one or both hands leaning against a wall or on a ball. Stabilzation Exercises Dynamic Strengthening Exercises: Scapular Muscles Exercise Targeted Muscles How to Perform Rhomboids and Middle (A) Clasp hands behind low back, which causes scapular adduction. Lower arms to sides while holding the adducted position, then repeat without arm Scapular Retraction Trapezius motion. (B) Prone with arm over the edge of the table, with weight in hand, pinch scapulae together. Rhomboids and Middle Prone with arms abducted and externally rotated. Lift the arms off the table while pinching the scapulae. Add weights or do rowing motion. Can be done Horizontal Abduction with Retraction Trapezius with the elbows extended for greater resistance. Corner Press-Out Scapular retractors Sitting or standing in a corner with forearms against the walls, press out into horizontal abduction. Scapular Retraction with Horizontal Middle and Lower Sitting or standing with shoulders in 90/90 position. Secure elastic resistance in front and pull hands and elbows back (horizontal abduction and external Abduction and External Rotation Trapezius rotation), while adducting scapulae. Scapular Protraction Serratus Anterior Sitting or standing with shoulder flexed to 90° and elbow extended. Push outward against resistance without rotating the body. Push-up with an added protraction of the scapula at the end of the movement. Ipsilateral leg raise during this exercise increases serratus anterior activity, Push-ups with "Plus" Serratus Anterior contralateral leg raises increases lower trapezius activity. Lower Trapezius, Lower Scapular Depression Sitting with elbow flexed and apply manual resistance to the shoulder girdle depression. Also can use body weight for resistance to strengthen the muscles. Serratus Anterior Lower Trapezius, Scapular Upward Rotation with Depression Shoulder girdle depression with upward rotation of the scapula against elastic resistance. Also activates the upper and middle trapezius. Serratus Anterior Dynamic Strengthening Exercises: Glenohumeral Muscles Exercise Targeted Muscles How to Perform Shoulder External Infraspinatus, Teres Minor (A) Arm at the side using elastic resistance. (B) Arm at 90° using a free weight, lying prone. (C) Shoulder in scapular plane elevation using a free weight, sitting. Rotation Shoulder Internal (A) Side-lying, arm forward in partial flexion. Lift weight upward off the table into internal rotation. (B) Sitting or standing using elastic resistance or a pulley system, Subscapularis Rotation pull across the front of the trunk into internal rotation. Abduct the arm in the scapular plane to 90° with the shoulder held in external rotation ("full can" exercise). Do not perform "empty can" exercise because it can cause Shoulder Abduction Supraspinatus, Deltoid impingement. Military Press-Up Supraspinatus, Deltoid Begin with the arm at the side in neutral to slight external rotation with the elbow flexed. Lift the weight overhead. Posterior Deltoid, Latissimus Dorsi, (A) Prone with the arm over the side of the table in 90° flexion, lift the weight and extend the shoulder (elbow can be flexed or extended). (B) Sitting or standing with the Shoulder Extension Rhomboids arm flexed. Pull down against resistance into extension. Elbow Flexion Biceps Brachii Sitting or standing. Flex elbow while holding a weight, keeping the forearm supinated, and the arm at the side or with the shoulder moving into slight extension. (Biceps Curl) Functional Progression for the Shoulder Girdle Exercise Targeted Muscles How to Perform PNF Pattern (D2 Shoulder and Scapular Muscles Emphasizes shoulder flexion, abduction, and external rotation against elastic resistance. Flexion) Simulated Rowing Scapular Retractors, Trunk Simulate rowing motion against elastic resistance. Motion Stabilizers Pushing a Weighted Shoulder Girdle, Trunk, and Arm Standing with a stable base of support, push the cart on a flat surface with light loads. Emphasize proper body mechanics. Progress by increasing weight, uneven Cart muscles surfaces, or by using only one hand. Elbow and Forearm Exercises Stretch/Exercise Targeted Muscles How to Perform Biceps Brachii Self-Stretch Biceps Brachii Standing at the side of a table, grasp the edge and walk forward, causing shoulder extension with elbow extension. Long Head of Triceps Self- Long Head of Triceps Brachii Sitting or standing, flex the elbow and shoulder as far as possible. The other hand can push on the forearm to flex the elbow, or push the shoulder into more flexion. Stretch Mild Elbow Extension Sitting with arm supported, towel under distal humerus. Using opposite hand apply stretch force against the distal forearm, positioned in pronation, mid-position, Elbow flexors Contracture Self-Stretch and supination. Mild Elbow Flexion Prone-lying, propped up on elbows, lower chest as far as elbow flexion allows. or sit with elbow flexed as much as possible, and use the opposite hand for Elbow extensors Contracture Self-Stretch overpressure. Muscles of the lateral Stand with elbow extended, forearm pronated, and back of hand against a wall (fingers down). Slide the back of the hand up the wall. Add finger flexion for more of Elbow Flexion Self Stretch epicondyle a stretch. Alternating Isometrics and Apply manual resistance to alternating isometric contractions of antagonists at multiple angles of elbow flexion/extension and forearm pronation/supination. Elbow and forearm muscles Rhythmic Stabilization Progress to using total upper extremity patterns. Can add a Bodyblade for dynamic stability. Positions include standing with hands against a wall or table, in the quadruped position, or in the prone push-up position. Apply alternating isometrics and Closed-Chain Stabilization Elbow and forearm muscles rhythmic stabilization by means of manual resistance against the shoulders and trunk. Biceps Brachii, Brachialis, Elbow Flexion Hold a weight or elastic band and flex and extend the elbow with forearm in supination, pronation, and mid-position. Brachioradialis (A) Prone with humerus abducted to 90° and supported on a rolled towel. Extend the elbow while holding a weight. (B) Supine with the shoulder flexed to 90°, Elbow Extension Triceps, Anconeus extend and flex the elbow with a weight. Use the opposite hand to stabilize the humerus. (C) Holding a weight with the forearm supinated, extend the shoulder as the elbow flexes. Elbow Extension (Triceps Long Sitting or standing with arm held overhead. Lift the weight overhead and lower it for concentric and eccentric strengthening. The humerus may be supported with Triceps brachii Head) the other hand. Only perform if the patient has shoulder control. Pronator Teres, Pronator Sitting with the elbow flexed at 90°, rotate the forearm into pronation and supination against resistance. Can also use a small bar with an asymmetrically placed Forearm Pronation/Supination Quadratus, Supinator, Biceps weight for resistance. Brachii Wrist Flexion/Extension Wrist Flexors/Extensors Sit with forearm supported, grasping a weight or elastic resistance. Forearm is supinated to resist flexion or pronated to resist extension. Wrist Flexors/Extensors, Sit with elbows flexed or extended and forearms pronated or supinated. Tie a cord to a short rod with a weight at the end. Turn the rod with an alternating wrist Wrist Roller forearm rotators action to wind the cord around the rod and elevate the weight. Lower the weight with a reverse motion. Elbow flexors and other Bilateral Pull-Ups Bilateral pull-up using elastic resistance. upper extremity muscles Modified Chin-Ups Elbow flexors Closed chain with partial body weight for resistance. "Lawn Mower Pull" Upper extremity muscles Simulate a lawnmower pull for upper extremity strengthening. Triceps brachii, pectoral Modified Push-Up Modified push-up to strengthen the triceps. muscles Triceps brachii, pectoral Seated Push-Up Seated push-up to strengthen the triceps. muscles Triceps Pushing Activities Triceps Push weighted objects across a table, or depress a door handle and push open a door. Tennis Swings Upper Extremity Muscles Use wall pulleys to simulate backhand, forehand and serve tennis strokes. Wrist and Hand Exercises Stretch/Exercise Targeted Muscles How to Perform Self-Mobilization of Ulnomeniscal-triquetral joint Stabilize the ulna. Apply a medial glide to the triquetrum. Ulnomeniscal-Triquetral Joint Mobilization with Movement Apply a lateral glide while the patient actively flexes or extends the wrist and then applies a passive stretch with their other hand at the end of the Wrist Flexors and Extensors (MWM) range. Medially or laterally glide the involved phalanx in a painless direction, then have the patient actively flex or extend the finger and apply a pain-free, MWM of MCP and IP Joints MCP and IP joints end-range stretch. Internal or external rotation of the more distal phalanx may be required. Flexor Digitorum Profundus (FDP) and Move fingers through five positions: straight hand (all joints extended), hook fist (MCP joints extended, IP joints flexed), full fist (all joints flexed), Tendon-Gliding (Flexor) Flexor Digitorum Superficialis (FDS) tabletop position (MCP joints flexed, IP joints extended), and straight fist (MCP and PIP joints flexed, DIP joints extended). Tendon-Blocking (Flexor) Isolated Lumbricals and Palmar Interossei Flex only the MCP joint of one digit while stabilizing the others. Perform each finger separately. MCP Flexion Tendon-Blocking (Flexor) Isolated Finger Extensors Move from full fist to the hook fist position. Have patient hook fingers around a pencil while extending the MCP joints. MCP Extension Terminal-Range Extension of IP Stabilize hand, palm down on a flat surface, extend the involved phalanx into hyperextension. Can place a pencil or block under the proximal or Extensor muscles Joints middle phalanx. Passively flex the MCP and IP joints of one finger while actively maintaining the other fingers in extension. Can stabilize three fingers and passively Extensor Tendon-Gliding Extensor Digitorum Communis flex one digit, then have the patient attempt to keep all fingers on the table while one digit is flexed. Stretching (Individual Joints) Finger Joints Position the phalanx at the edge of a table and apply stretch force against the distal bone while stabilizing the proximal bone against the table. Self-Stretching Lumbricals and Lumbricals and Interossei Actively extend the MCP joints, flex the IP joints, and apply a passive stretch with the opposite hand. Interossei Manual Stretching of Extrinsic Elongate each tendon of the extrinsic muscles over all the joints simultaneously. Begin by stretching the tendon unit over the most distal joint first, Extrinsic finger muscles Muscles and work proximally. Place the hand flat on a table, palm down, MCP joints extended. Abduct or adduct the digit and apply stretch force to the distal end of the proximal Self-Stretching Interossei Interossei muscles phalanx. Hold the adjacent digit for stabilization. Rest the ulnar border of the hand on the table and abduct the thumb. Apply stretch force against the metacarpal head of the thumb and index finger Self-Stretching Adductor Pollicis Adductor Pollicis to increase web space. Self-Stretching Extrinsic Finger Extend the wrist and fingers at the same time. With the opposite hand apply the stretch to the fingers, also stabilizing over the distal joints. Fingers Extrinsic Finger Flexors Flexors may flex over the edge of a table to isolate stretch to wrist flexors. Wrist Flexion/Extension Wrist Flexors/Extensors Sit with forearm supported, grasping a weight or elastic resistance. Forearm is supinated to resist flexion or pronated to resist extension. Stand while holding a bar with a weight on one end. To resist radial deviation, the weight is on the radial side of the wrist. To resist ulnar deviation, Wrist Radial/Ulnar Deviation Wrist Flexors/Extensors the weight is on the ulnar side of the wrist. Isolated or Combined Abduction/ Dorsal and Volar Interossei Rest palm of the hand on the table and apply resistance at the distal end of the proximal phalanx for either abduction or adduction. Adduction of Each Finger Self-Resistance Extrinsic Finger Extrinsic Finger Flexors Use the opposite hand to apply resistance to finger flexion, while simultaneously flexing the wrist. Flexion Towel or Newspaper Crumple Intrinsic and Extrinsic muscles Crumple a towel or newspaper into the hand, maintaining contact with the heel of the hand. Please note: Some exercises include precautions or specific considerations (like avoiding certain positions with instabilities) from the original sources which have been noted in the tables. Be sure to consider those while performing any of these exercises.