Get A Jump Start On Your Recovery

Get A Jump Start On Your Recovery

The above is something that has become very common regarding health care coverage.  Many times, your medical insurance will not cover enough Physical Therapy treatment, or not enough local providers will accept your insurance.  Either way, you are left wondering if you will be able to return to your prior athletic or functional level.  That is where www.strengthondemand.com comes in.  

Exercises for common therapy diagnoses are offered in the Protocol section of our website, including protocols for the ankle, knee, hip, shoulder, elbow, neck and lower back.  There is also a protocol for people who are Homebound & Deconditioned, recently released from the hospital, and those who are having difficulty with balance, transfers, bed mobility and fall recovery.  All protocols are in video format based on time frames following your injury or surgery.  You are not only educated on what exercises to do, but you are also advised on when to perform the exercises in order to maximize your rehabilitation.  

KB Fitness Home Exercise Physical Therapy Protocols can be used alongside your present therapy treatment.  If you do not feel that you are receiving an adequate amount of Physical Therapy from your current provider due to insurance issues, or if you can not afford to attend therapy at all, KB Fitness Protocols can help! You are provided with printouts of each protocol's exercises so that you can consult with your doctor or therapist for further guidance. A Consultation Service is also offered to ensure that your questions are answered, further guiding your recovery.  

Let KB Fitness be your Knowledge Base!!

Incorporate This Trunk Rotation Stability Exercise

Incorporate This Trunk Rotation Stability Exercise

 

When lifting anything, we hear "lift with your legs, not your back!"  When using the spine  to perform resistive activities, many times a dangerous amount of pressure is placed on the ligaments and intervertebral discs.  Over time, this may lead to injuries such as bulging or herniated discs.  Spinal flexion places strain on the discs.  Spinal rotation also places strain on the discs.  But when you combine the movements (flexion with rotation), the discs are most vulnerable.  If these motions are dangerous, is it wise to perform them with resistance added?  I prefer to focus on Spinal Stabilization rather than Resistive Trunk Strengthening Exercises.   

 



Some common trunk exercises you may have seen are the Side Bend QL, Resistance Tubing Trunk Rotation, and the Medicine Ball Trunk Twist.

 





 

 

These exercises are aimed at strengthening the spine throughout the range of motion.  But at what cost? 

 

Try to incorporate the following exercise to your routine for Spinal Rotation Stability. 

Rack a Kettlebell in 1 hand.  This alone places an asymmetric force on your spine.  Your goal is to maintain a neutral spine and not allow the trunk to side-bend toward the added weight.  This is already working the QL on the opposite side of the Kettlebell

 

Press the weight overhead.  This continues to challenge your trunk's stability with the  direction of the force applied from a different position/angle

 

Here's where the rotation comes in.  Instead of actively twisting your spine with the applied resistance (as shown in the Med Ball Twist and Resistance Band Trunk Rotation pics above), rack the weight, rotate your trunk about 30 degrees to the right while maintaining forward facing hips (Your knees and pelvic bones continue to point straight ahead), and then perform the shoulder press.  Attempt a few reps in this position   

 

 

Then, rotate your trunk a little further from the 30 degrees to about 60 degrees trunk rotation.  Again, keep your hips and knees pointing forward.  Press the weight overhead.

 

 

Repeat to the other side at 30degrees, then 60degrees. 

 

The point to this exercise is to engage your trunk stabilizers at a spinal position, and maintaining this stability throughout the lift.  You are challenging multiple spinal positions by varying the amount of trunk rotation.  You are NOT using the spine to rotate a load. You are using the trunk musculature to stabilize the spine when in a rotated position.  This, in my opinion is a safer way to train your trunk.

 

Add even more of a challenge to your grip, trunk and shoulder stabilizers by performing the same activity with the Kettlebell in the Bottoms Up Position...Then try it with Neurogrips!!(www.neurogrips.com)

 



Many Benefits To This Knee Exercise

Many Benefits To This Knee Exercise

 

Following an injury or surgery to your knee, regaining strength and mobility is a very important goal to establish.  In addition, your standing balance and hip stability may also be impaired during this time.  These goals are all very important if you have stairs at home, because you will need to safely navigate them so that you do not fall and become a "frequent flyer" at your local hospital. 

Most patients who have stairs in their home and are recovering from a knee or hip injury have been told "Up with the good, down with the bad."  This means that initially you must rely on the uninjured or "good" leg to control your body weight when ascending and descending stairs.  The "good" leg goes up first in order to lift your body to the next step.  On the way down, your "bad" leg goes to the lower step first as you must control the descent of your body using the stronger leg.  This is the safest way to navigate the stairs.  However, your ultimate goal is to regain symmetry in leg strength.  So a few weeks into recovery, as long as there are no weight bearing precautions on the injured leg, I will have my patient stand at the bottom of their staircase to practice placing the weaker leg on the first step.  Once they gain the appropriate range of motion in the hip or knee to allow placement of the foot on the step without compensation, I will progress them to lifting their body to the next step using the "weaker" leg.  Remaining at the lowest section of the staircase ensures client safety, as being at the bottom of the staircase, if the weaker leg does buckle, they will not fall down a flight of steps.  As confidence and strength improves, I will have my client perform multiple repetitions of this activity and eventually navigate the staircase alternating legs.

 

Now, going back to the "up with the good, down with the bad" technique.  Besides safety, there are many other benefits to using this technique.  In order to lift and place the "good" leg onto the first step, you must shift your weight onto the weaker leg.  This weight shift onto the weaker leg helps improve stance time on that leg during gait, which will minimize limping.  It also helps to improve the "weaker" side's hip, knee and ankle stability , as well as single leg balance, and client confidence level.  Many times, my clients will shift their weight onto the weaker leg and very quickly 'throw' the stronger leg up to the step, either because the injured leg is not strong enough to hold the body up, or their confidence in single leg stance on the weaker side is poor.  I provide verbal cues and sometimes manual cues to assist proper technique while letting them know that I will not allow them to fall.  They must perform this step-up slowly and with control.  The slower they lift the "good" leg to the next step, the longer they must stand on the weaker side, thereby improving hip strength, stability and single leg balance.  

As their confidence, balance and strength improve, I ask them to lift the "good" leg up two steps.  I do not require them to lift their body to the second step, but use this technique to challenge their stability and single leg balance on the weaker leg even more.  They must stand on the affected side for a longer time in order to place the "good" leg on the second step with control and coordination.  

If knee mobility is an issue, I will have them perform foot placement of the affected, weaker side on the first step with a progression to the second step, incorporating a lunge stretch in order to maximize knee flexion range of motion.  This technique will be easier  for them as they are standing on the stronger leg in order to place the weaker leg on the first or second step in order to perform the stretch.

 

So, you are not just performing stair training here.  You are also working on balance, stability, confidence, flexibility, and strength.  

 

Stair Training Tips:

1) Lifting the stronger leg first ensures safety and also forces you to balance on the weaker leg.  This improves standing tolerance on the affected side, single leg balance and hip/ankle/knee stability

2)Lifting the weaker leg first will help strengthen that leg as it must then lift your entire body to the next step.  Once the weaker leg is positioned on the next step, lunging into it will improve knee flexibility on that side. 



Total Knee Replacement Protocol Exercises

Total Knee Replacement Protocol Exercises

 

 Following a Total Knee Replacement, the initial most important focus is to gain full knee extension range of motion.  As stated in  prior posts, in order to prevent the knee from being 'stuck' in a flexed position, pillows or towel rolls should not be placed under the surgical knee (even though this is much more comfortable than keeping the knee straight).  One of the more basic exercises that should be performed by patients recovering from a knee replacement is described below.  Multiple videos of the knee replacement protocol exercises are provided in the Strength On Demand Knee Replacement DVD. 

  Many times, immediately following surgery, the operative leg is not strong or flexible enough to perform knee extension or flexion through the available range of motion.  Therefore, using the stronger unaffected side to assist each movement is a great technique to maximize mobility of the surgical knee.  This activity is called Active-Assistive Range of Motion Knee Flexion and Extension.  In the two images above, the surgical knee is the exposed side.  The stronger side's foot is hooked under the weaker side's ankle.  In order to assist knee extension, the strong leg pushes the weaker leg into a straight knee position.  This is Active Assisted Knee Extension.

 

In these two images, the stronger side hooks on top of the weaker side.  To assist knee flexion of the surgical knee, the stronger knee bends, pushing the surgical side's foot back, under the chair.  This causes the operative knee to bend further and is called Active Assisted Knee Flexion.

With limited knee flexion and extension range of motion, daily functional activities such as transferring from sit to stand and vice versa are usually affected and asymmetrical. 

In the above three images, the surgical side is represented by the 'non-sock' side.  Usually, upon attempting to sit down, the patient will bring the affected side forward, lowering their body down to the chair using the non-surgical side.  This limits the amount of knee flexion required from the surgical side and places most of the body weight on the non surgical leg.  Initially, patients use this technique to avoid pain.  In the seated position you can see the difference in the amount of knee flexion range of motion required from either leg.  To return to standing, a patient usually takes on the same position, placing more body weight (and therefore more stress) on the unaffected side.  Using this technique for an extended period of time not only 'underworks' the recovering leg but also 'overworks' the unaffected leg.  This may cause knee problems on the "good side" in the future.

                  

The above three images show the goal for the sit to stand technique.  Both feet remain in alignment as your patient moves from stand to sit to stand.  There is no compensation and both knees appear to have similar flexibility.  Focusing on this positioning technique each time you attempt to sit or stand will actually help to stretch the recovering knee, allowing gains in both knee mobility and strength daily.

 

Some of the other common Knee Replacement Exercises provided in the Strength On Demand Video Protocol are: 

 

Ankle Pumps

Glute Sets

Quad Sets

Straight Leg Raises

Heel Slides

Hamstring Stretch

Mini Squats

Step Ups

Tugboats

Single Leg Stance.....
and more!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

High Plank Modification Adds Multiple Benefits

High Plank Modification Adds Multiple Benefits

 

 

The High Plank Exercise is a great exercise that focuses on shoulder and trunk static stabilization.  There is no motion...only a timed positional hold.  This can be easily modified using a Strength On Demand Resistance Band. 

 

The following progression will challenge:

-dynamic shoulder and scapula stability on the weight-bearing arm

-strength of the postural scapular muscles, including the rear deltoids and middle traps on the moving arm's side

-rotational stability of the trunk



Start in a high plank position anchoring the resistance band with one hand, gripping the other end of the resistance band with the opposite hand.  The closer your hands grip on the resistance band, the more difficult this technique will be, so leave some slack in the band when you first attempt.  A little bit of resistance is all you need to feel this exercise!

 

 

While one end of the resistance band is anchored to the floor with one hand, the 'moving arm' is lifted to the side into horizontal abduction.  Here, my right arm (the anchor) remains stable (shoulder/scapula stability) while my other arm is moving out to the side (working the rear delts and middle traps).  The motion of my arm is creating rotational force on my trunk, which I must resist.  My hips and torso remain "squared-off" with the floor.  This is rotational stabilization.  This is a great progression for clients in the mid to later stages of rehabilitation from shoulder and/or lower back injuries.

Get your resistance band HERE!!



Fine Tuning Your Home Care Patient's Squat

Fine Tuning Your Home Care Patient's Squat

 

 

The previous post discussed the techniques and benefits of both the Box Squat and the Face the Wall Squat.  Both types of squats are performed using body weight, and they are very helpful in providing external cues for performing a correct squat.  In the Home Care setting, I have the majority of my patients (most of which are elderly) perform squats while holding onto their kitchen sink.  The kitchen sink is a great place to perform standing exercises at home because it is stable enough to support you if you lose your balance (unlike holding onto the back of a chair which may tip over).  I include squats in almost all of my home treatments because of its functional everyday value.  However, most of my patients require verbal and tactile cues to perform the squat correctly.  Incorrect performance may cause more harm than good, so it is extremely important to cue your patients as needed.

 

 

I first have my patient stand comfortably facing the sink with their feet shoulder width apart.

 

As they squat, I make sure that their knees are in proper alignment in reference to their feet, their lower back remain straight (not vertical), and their body weight shifts posteriorly onto their heels as they hinge at the hips.

 

Many patients squat vertically.  They keep a straight spine, and lower themselves vertically toward the floor.  Their knees cross anterior to their toes, causing excessive stress on the knees

 

This is incorrect.  You want to maintain a straight lower back.  However you should do this by hip hinging, not by holding a vertical position

 

If the patient squats incorrectly, I will place a chair behind them for an external/visual cue.  I then ask them to lower themselves as if they are trying to sit in the chair. 

 

The chair will provide them with the "motivation" to hinge their hips, pushing their butt back to the chair.  As you can see, the lower back remains straight, not vertical

 

If the chair cue doesn't work I have my patient step as close to the sink as possible, placing their feet under the cabinet so that their knees come close to touching the cabinet door

 

Upon squatting, if still performed incorrectly with anterior knee translation in relation to the feet, the knees will hit the cabinet doors which will prevent any further anterior motion. 

 

As they continue to lower themselves, they will have no other option than to hinge at the hips, driving their butt back.  This will transfer their body weight onto their heels and should correct their squat

The Wall Squat

The Wall Squat

 

 Does the exercise above look familiar to you?  It may, especially if you have had Physical Therapy or Personal Training before.  In this exercise, a therapy ball is placed between the wall and your lower back.  You lean back against the ball, compressing it into the wall as you lower yourself into a squat, and return to upright.  This may be a leg strengthener, but how functional is it?  The squat is one of the most prevalent activities of your day.  Getting up and down from the edge of your bed in the morning, moving from the sitting to standing position from your chair at work, lowering yourself to pick something up from the floor are all examples of squatting activities.  In these activities, you must rely on your ankle, knee, hip and trunk stability to safely and efficiently lower your body and raise your body.  If you lean back too far, you will fall back, and if you shift forward onto your toes too much, you will fall forward.  There is no "safety mechanism" such as the therapy ball rolling on the wall to maintain your trunk's vertical orientation as you raise and lower your body. 

I prefer to customize my patient's exercises to be as efficient and focused as possible.  If I want them to strengthen their legs and I choose the squat as one of the exercises, they must first squat properly.  To do this, I have them train with a "real-life" version of the squat.  Instead of the Therapy Ball-Wall Squat, I will use the Box Squat or the Face The Wall Squat.

 

 

Above is the Box Squat.  Here, a bench, chair or plyo-box is placed behind you.  You hinge at your hips and push your butt back towards the box as you lower yourself down into the seated position.  Initially, I will have patients lower to the seated position, rest and then return to standing.  However, as they become stronger, I progress this exercise by having them lower themselves until they just about touch the box, and then return to stance.  Taking away the rest portion of the activity makes it more challenging due to the increased control and stability that is needed.  In the box squat, you must hip hinge and maintain proper knee alignment.

 

Do not allow the knees to cross anterior to your toes and do not allow the knees to "cave in" towards each other.

 

The Facing Wall Squat is another great activity that teaches proper squat technique while relying on your own body's feedback mechanism for stability rather than an external support.

Here, you stand close to the wall, facing it and lower yourself into a squat.  Your goal is to avoid hitting your knees or your head on the wall.  You will feel your weight shift back onto your heels and must stabilize to avoid falling backward.  Because of your position, the wall will give you the proper feedback to prevent your knees from shifting anterior to your toes.

 

The Therapy Ball Wall Squat reminds me of the Smith Machine.





The Smith Machine is another type of external support mechanism that in my opinion, reduces the use of your joint stabilizers to perform a movement such as the Bench Press, Shoulder Press or the Squat.

Here, the Smith Machine controls the bar, preventing it from shifting forward or back.  All you have to do is raise and lower it.  Less stabilization is required than if you had to control a free weight.

 



The Smith Machine Squat is similar to the Therapy Ball Wall Squat, as it prevents you from shifting forward or back as you raise and lower your body.  Less ankle, knee, hip, and trunk stability is required than if you were to perform a free standing squat (Box Squat or Face Wall Squat) that does not provide an external support system.

In my opinion, if a person can not do a proper body weight squat, then I would not have them perform a Smith Machine Squat using resistance/weight.  It is more important to perfect the squat movement prior to adding resistance to it.  I choose to use help my patients learn to properly squat for their everyday needs, rather than provide a bunch of external support so that they can increase the amount of weight that they squat.  If they can not squat their bodyweight properly, you should not be adding resistance to the movement.  This will only lead to bad habits, worse technique and injury.