When Verbal Cues Are Not Enough

When Verbal Cues Are Not Enough

Many times, when educating patients/clients on performing specific exercises correctly, our verbal cues just don't seem to do the trick.  We verbalize how we want the exercise to be performed, yet sometimes our patient/client just can't get it.  Session after session, we find ourselves making the same corrections.  This can be problematic, especially if we expect our clients to be performing the same exercises at home, when we are not present to assist them. Simple techniques can be used to prevent recurring technique errors.  

One example of an exercise that is repeatedly performed incorrectly is Resisted Shoulder External Rotation.  To be performed correctly, simple commands that are used are "Keep your bent elbow tucked into your rib-cage.  Then turn your arm outward by rotating at the shoulder joint so that your hand moves away from the midline of your body." Performed correctly, Shoulder External Rotation in the neutral position should look like image 1 and 2. 

Image 1

Image 2

Unfortunately, most clients/patients perform the exercise as shown in Image 3 and 4

Image 3

Image 4

In Image 4, you can see that instead of keeping the elbow and upper arm tucked closely into the rib-cage, the arm raises in a diagonal direction.  There are times when you may want a client to perform this diagonal or PNF pattern with resistance, and there are times when you may want your client to perform Resisted Shoulder External Rotation in the shoulder abducted position.  However, if you want the exercise to be performed in the neutral shoulder abduction position (upper arm tucked into the rib cage), then you must correct any errors to the technique.  If verbal or manual cues only correct the exercise temporarily, try the following...

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Roll up a towel and place it between the elbow and rib-cage of the 'working' arm.  Tell your client that they must perform Shoulder External Rotation without dropping the towel.  This external cue works like a charm.  And if the client performs this exercise as part of their home exercise program, you can rest assured that they will perform it correctly once you educate them to use a towel roll.

For more Shoulder Rehabilitation Exercises, click here

Another exercise that is commonly performed incorrectly is the    2-Leg Bridge.  Performed correctly, the Bridge exercise focuses on hip extensors, and is beneficial in improving gait, transferring out of a chair, scooting in bed and rehabilitating patients suffering from lower back pain.   Image 1 and 2 show correct form.

Image 1

Image 2

 At times, it may be difficult for your client to maintain proper lower extremity positioning during this exercise, particularly if they are recovering from a stroke, in which one side of their body is weaker than the other.  Image 3 shows an example of a patient I worked with in the past who could not keep her right leg in the proper position throughout the Bridge.  Her right knee kept falling out to the side due to weak hip muscles.

Image 3

No matter how many times I cued her to keep her knees close together, she would only correct it temporarily.  Eventually the right knee would drop to the side again.  I used a pillow to correct this problem and I never had to cue her again.  She was also able to perform the Bridge as part of her Home Exercise Program without making the same mistake.  All she had to do was remember to place a pillow between her knees, and no further cues were needed.  In Image 4 and 5, you can see that the patient's focus is not only lifting her hips off the bed, but to do it while squeezing the pillow.

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FYI: With patients who are unable to  maintain the initial Bridge position with their knees bent and feet flat on the bed/floor due to extreme weakness or lack of flexibility, you can still train the hip extensors by performing a Straight Leg Bridge.   

Place 2 or 3 pillows under your client's lower legs.  Ask them to clench their butt and raise their hips off the bed by pressing their lower legs into the pillows.  Avoid hyperextension of the lower back in the top position.  See Image 6 and 7

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Image 7

For more Hip Rehabilitation Exercises, click here