Therapeutic+Exercise+Assignment


 * During each joint lab, we will be designing a therapeutic exercise program for various cases. You will need to collect these exercise programs and post them here. Students will work in a group of 5-6. This assignment must be completed by April 16. However, you are welcome to add more exercises to this document to make a comprehensive exercise program that you can use during your clinical internships.

__**Ankle Lab**__ 1. Describe your treatment for the acute phase of healing __Education__: The patient would need to be educated on the anatomy of the injury sustained, weight bearing status, proper use of assistive devices, pain control and healing via rest/ice/compression/elevation, and bracing. __Modalities__: Cryotherapy for reduction in pain/swelling; Elevation for reduction in swelling; Intermittent compression for reduction in swelling; Low-Power laser for pain reduction; Ultrasound (non-thermal) for promoted healing; Electrical stimulation for pain reduction __Manual Therapy__: Talocrural joint distraction (grade 1-2) for pain relief as tolerated; Manual lymphatic drainage to decrease swelling; PROM as tolerated __Exercise__: Ankle pumps; ankle alphabet; seated gastroc/soleus stretch with towel; seated heel/toe raises; initiate weight bearing during this stage via partial closed chain like the seated ankle rolls on a board

2. The patient is now in the sub-acute phase of healing. What passive accessory movements would you assess? Do you think any of these would be stiff? If so, demonstrate the appropriate joint mobilization technique. Assess dorsiflexion, plantarflexion, inversion, and eversion, using caution with inversion and plantar flexion, going through all four grades. Stiffness would be expected in eversion and dorsiflexion due to hypomobility caused partly by __muscle__ guarding. The joint mobilization to help dorsiflexion is posterior glide of the talus, and for eversion is lateral glide of the calcaneus.

3. Describe one day of therapeutic exercise in the subacute phase of healing.
 * 1) Alphabet Ankle 2x26
 * 2) Pain Free AROM in Inverion/Eversion/DF/PF
 * 3) Seated Baps Board 2x15
 * 4) __Single__ Leg Stand 2x30sec
 * 5) Gastroc/Soleus Stretch – Lean against wall
 * 6) Possibly work on gait with a brace if the patient can tolerate

4. Describe one day of therapeutic exercise in the chronic/functional phase of healing. (Andrew Towell, Adam Mathers, Ethan Quinn, Jimmy Wernel, Zac Snow, Kylie Palermo, Katie Martin) (Begin with 5 minutes of warm-up on a bike.) 1. Theraband inversion, eversion, PF, DF 2x15 2. SL rebound throws (or both legs if pt. unable to do SL) on Airex pad x25 3. Agility ladder to simulate cutting in basketball 4. Multidirectional lunges 2x10 5. Step-ups and step-downs 2x30 6. SL heel raises (or both legs if needed) 2x20 7. Trampoline jumps 2x10

5. Your patient wants to return to basketball. Describe how you would assess his ability to return to sport. (Mallory, Rick, Garrett, Brandon S., Brandon W., Luke)

A. Single leg jump B. Single leg squat C.T-drill: accel, decel, cutting, back pedaling D. Single leg dot drill: land and push off in all directions E. Running : 5- 10 minutes

Perform running first to get pt fatigued and to assess biomechanics. Abnormalities in biomechanics often surface with prolonged exercise. Perform remainder of tests to ensure that pt can demonstrate typical movements of basketball players when fatigue is a factor. All exercises should be performed with maximal effort, no pain, and no instability. The patient should also be educated and provided with a protective brace worn when engaging in exercise.

__**Hip Lab - Feb. 8th**__

 * Stretches to Improve Hip Flexors**
 * **Dosage: 2x :30second each time**
 * Lunge with opposite reach -- to isolate quad put knee on ground and add knee flexion
 * Lunge with knee on table and reach
 * Hang leg off the side of the table
 * Quad Stretch with Hip Extension (standing)
 * Arch Back over the Swiss Ball
 * Side Lying Quad Stretch


 * Stretches to Improve Hamstrings**
 * Long sitting with anterior pelvis tilt
 * Supine using a belt or towel around thigh or foot (which ever is more tolerable)
 * Downward dog
 * Sit in chair and bend over to touch toes
 * Standing in boxer stance and lean into front leg
 * seated, one leg straight out and other bent in (single leg HS stretch)

**Describe five exercises for rehabilitating a hamstring strain. Include both open and closed chain exercises and dosage:**


 * Acute Stage (Pain Free)**
 * **Injury can occur due to over use of the hamstrings, which may be caused by weak gluteal activation**
 * Look at Glute Activation as well
 * Heel Slides
 * Heel Digs
 * Prone Leg Curls -> If cannot handle do prone, take to flexion and eccentrically control the downward
 * PROM
 * ICE
 * NSAIDS
 * Knee ROM with Swiss ball (lying supine)


 * Subacute Stage**


 * Stool scoots
 * Good mornings
 * Prone hamstring curls
 * Dead lift
 * Seated leg curl with TB
 * Prone hip extension (SLR)
 * Walking on treadmill (incline, backwards)
 * US/MHP


 * Return to Sport**
 * Dosage depends on which sport the patient is returning to.
 * I.e. for higher level activities, dynamic activities to return to sport.
 * Soccer = high repetition, low weight (endurance)
 * more intense lifts (i.e. deadlift) that you're doing 1 RM on, space out to 3X per week
 * Bridge curl on stability balldeadlift - single or double leg
 * [|bridge HS curl on stability ball]
 * backpedaling
 * [|backpedal]
 * forward stool pulls - can add resistance with weight or theraband
 * lunges with weight (multi-directional)
 * [|lunge with weight]
 * [|clock lunges]
 * box jumps

=Knee Lab (Feb. 15)= 24 y/o female soccer player with 8 month history of R Patellar tendinosis
 * Assessment
 * Assess the Hip Musculature – MMT of Glute Med, Glute Max, Modified Ober’s Test
 * Assess Knee
 * Girth Measurements
 * Patellar Motion – PAM of the patella (inferior, superior, medial, and lateral)
 * Patellar Tilts and Rotation
 * Critical Test
 * Palpate Structures of the Knee (Joint Line, Tibial Tuberosity)
 * MMT Quads and Hamstrings
 * ROM
 * Treatment
 * Cross Friction of the Patellar Tendon
 * Stay away from plyometric exercises
 * Emphasize low load, high rep
 * Eccentric Single Leg Press, Down in 4, up as quick as possible (3x50 or until fatigue overtakes form; to 90 degrees unless it's the kicking leg is affected)
 * <span style="font-family: Arial,Helvetica,sans-serif;">Quad Sets or Terminal Knee Extension (100x, 3x/day)
 * <span style="font-family: Arial,Helvetica,sans-serif;">Step Downs or Dips, focus on the eccentric portion (2" step, 100x, 3x/day, bilateral, push thru heel)
 * <span style="font-family: Arial,Helvetica,sans-serif;">Quad stretching (30 sec x 3, 2x/ day)
 * <span style="font-family: Arial,Helvetica,sans-serif;">Main Points of Focus
 * <span style="font-family: Arial,Helvetica,sans-serif;">Education on cross friction and explain the principle behind it
 * <span style="font-family: Arial,Helvetica,sans-serif;">No ICE or NSAIDs, expect some pain
 * <span style="font-family: Arial,Helvetica,sans-serif;">Do not let the knees go forward or in, on the squats, leg press or step downs
 * <span style="font-family: Arial,Helvetica,sans-serif;">This might mean there needs to be some hip strengthening involved

Pt. is 1 week post op ACL-R with BTB: What to assess: What exercises to start with: Exercises from Instructor: Patient education:
 * swelling, skin temperature, skin integrity
 * Pain
 * Incision - check for weeping and drainage
 * Gait - use of appropriate AD, fit, training
 * General strength/mobility
 * quad sets
 * ankle pumps
 * SAQ
 * Heelslides (PROM with sheet)
 * SLR - only if pt is able to perform with leg straight
 * Weight shifting activities
 * Gait training
 * hamstring/gastroc stretches
 * perform 6x day, high reps (ex: x50 with good technique til fatigue)
 * Quad set
 * Heel prop - initally start with towel roll under calf and as tolerance increases move closer to ankle
 * Toe pulls - pt is long sitting. Stabilize the thigh. Pull ankle into passive DF until the heel comes up from the mat. Have pt. actively hold that position
 * Quad set with towel roll under the knee
 * Tubing leg press
 * Positioning - keep knee in extension in bed, no pillows under the knees
 * Pain/swelling control
 * Gait training/crutch training
 * Incision care, weeping can occur up to 4 weeks post, if continues refer to physician.

__PT is 4 Weeks Post Op ACL-R with BTB__ Assesment
 * ROM
 * Swelling
 * Scar
 * Infection
 * Pain
 * MMT
 * Gait
 * Patellar Tracking
 * AVOID tibofemoral anterior glide

Exercises
 * Bike 10 min warm up
 * Step up/step downs
 * Squats (do in front of mirror to watch form)
 * Terminal knee extension
 * Clamshells w/ theraband

Education
 * Educate them about their gait. Make sure the patient isn't limping and has good knee extension.
 * Home exercise program

__Pt is 10 weeks post op ACL-R with BTB__ Assessment
 * pain
 * ROM
 * strength- use biodex or isokinetic strength testing if possible
 * gait
 * sit-to-stand
 * step-down

Exercises to start today
 * exercises will be low weight and high rep to work on endurance of the muscles, even up to 50+ reps, but stop if form is compromised due to fatigue
 * elliptical machine- it is important to watch the patient's stance, you should not see any valgus movement of the legs
 * can do a bike with resistance if the elliptical does not allow for proper stance of the patient
 * this is done to begin conditioning
 * step ups/downs with a higher box (6-8")
 * full squats, can put a band around the legs as well
 * monster walks/lateral walks with theraband
 * lunges
 * fire hydrants with or without theraband
 * squat holds
 * standing hip abduction/adduction/flexion/extension with theraband
 * can begin to add a speed component (beginning of plyometrics)
 * ex= quick feet- on balls of your feet with knees slightly bent, step forward/backward over a line as fast as possible for 30 seconds
 * It is important to watch for form and symmetry- at this point you want the two legs to be looking similar

Education
 * The patient needs to know the tissues are not fully healed. This means:
 * they should not be running yet
 * they need to take it easy and not rush back in to activity, especially sport related
 * they need to use pain as an indicator to stop an activity
 * this is a prime time for re-injury so do not push it just because the patient thinks they feel good
 * Educate on proper gait pattern and tell the patient they need to be working on a normal gait and full weight baring through the leg if they are not already there

__**16 weeks post op ALC-R with BTB**__
__Assessment__:
 * ROM
 * Gait
 * Palpation & scar assessment
 * Stability – Lachman’s and pivot shift
 * Strength: Quad, hamstring, and hip musculature. Check for muscle imbalances
 * Patellar tracking

__Exercises__
 * Progress cardiovascular activity from biking to elliptical to straight jog. Once successful, can progress to sprinting, jumping, agility, and sport specific skills.
 * LE strengthening should be progressed
 * Closed chain exercises emphasized
 * Performed 2-3x/week with 15+ repetitions and at least 2 sets per exercise.
 * Squats progressed to single leg squats
 * Lunges can be progressed with added resistance or on bosu ball
 * Fire hydrants to strengthen glutes - add resistance
 * Add balance and proprioceptive work: For example, squats on Bosu ball or perform exercise on unstable surfaces
 * __**Sport specific drills and exercises are very important at this point**__
 * Cutting exercises to incorporate acceleration and deceleration
 * T - Drill (run forward, side shuffle to right and left and then run backwards)
 * Rebounder drills
 * Higher level plyometrics can be introduced
 * Double leg plyometrics must be successfully performed before single leg
 * Examples are speed squats, speed squat with heel bounce, bunny hops, forward and backward jumps, box jumps
 * Perform functional tests on both uninvolved and involved LEs to determine if pt is ready to return to sport - should be at 90% of output compared to uninvolved side
 * Activities are sport specific, but are __**NON-CONTACT**__

__Patient Education__: =**Shoulder Dislocation Exercises**= Shoulder Blade Squeeze Internal Rotator Strengthening Exercises Isometric Shoulder External Rotation Isometric Shoulder Abduction Wall Push-ups **Wrist Lab** (March 7th)
 * Body mechanics should be instructed to safely perform all exercise in the HEP
 * Instruct patient how to maintain/increase strength through their HEP
 * Patient must be instructed on how to progress the exercises in their program
 * Brandon Smith**
 * Shoulder Flexion**
 * You can do this exercise laying down and using a broomstick or plastic pipe. 1. Lie on your back, holding a broom with your hands. Your palms face down as you hold the broom. Place your hands slightly wider than your shoulders.
 * Keeping your elbows straight, slowly raise your arms over your head until you feel a stretch in your shoulders, upper back, and chest
 * Hold 15-30 seconds
 * Reapeat 2-4 times
 * While standing with your arms at your sides, squeeze your shoulders blades together. Do not raise your shoulders as you are squeezing.
 * Hold for 6 seconds
 * Repeat 8-12 times
 * Using a piece of thera-band or thera-tube tye a piece to doorknob
 * Stand or sit with your shoulder relaxed and your elbow bent 90 degrees. Your upper arm should rest comfortably against your side. Squeeze a rolled towel between your elbow and your body for comfort and to help keep your arm at your side.
 * Hold one end of the elastic band in the hand of the affected arm.
 * Rotate your forearm toward your body until it touches your stomach
 * Keep your elbow and upper arm firmly tucked against the towel roll or the side of your body during this movement. Repeat 8-12 times
 * Stand with your affected arm close to a wall.
 * Bend your arm up so your elbow is at a 90 degree angle and turn your palm as if you are about to shake someone's hand.
 * Hold our forearm and elbow close to the wall Press the back of your hand in to the wall with moderate pressure.
 * Hold for 6 seconds. Repeat 8-12 times.
 * Stand with your affected arm close to a wall
 * Bend your arm up so your shoulder is at a 90 degree angle and turn your palm as if you are about to shake someone's hand
 * Hold your forearm and elbow close to the wall. Press your elbow in the the wall with moderate pressure.
 * Hold for 6 seconds. Repeat 8-12 times.
 * Stand against a wall with your feet about 12-24 inches away. If any pain is felt when exercise is performed, then stand close to wall
 * Place your hands on the wall slightly wider apart than your shoulders, and lean forward.
 * Gently lean your body toward the wall. Then push back to your starting position. Keep the motion smooth and controlled.
 * Repeat 8-12 times


 * Group 1: ** Demonstrate PT intervention for someone with Carpal tunnel syndrome

-Warm patient up on the arm bike -stretch the wrist flexors -Median nerve glide -soft tissue mobilization -strengthen muscles -ROM -Modalities -joint mobilization -Tendon gliding -scapular work -patient education
 * graston- soft tissue mobilization with tools
 * sastm- sound assisted soft tissue mobilization
 * cross fiction massage
 * extension strengthening- reverse curls with eccentric focus
 * -ultrasound- 3 MHz, pulsed, 1.0 intensity for 5-6 minutes
 * ice massage
 * iontophoresis
 * E-stim
 * distraction
 * volar glide
 * things that are going to irritate it
 * things they can do at home to keep it from flaring up/prevent it
 * Example: adjust keyboard placement

Avoid extreme flexion- can strengthen flexors but avoid going to the point of the patient experiencing numbness and tingling

Group 2: Differentiate wrist pain from __neck pain__.

Perform a clearing of the C-Spine.

Palpation of the wrist.

Wrist pain will likely have a clear mechanism of injury

No NT if just wrist and there could be possible swelling and inflammation

If it’s cervical, NT likely

Cervical can have more of an insidious onset

Diagnostic tests

Special tests for cervical:

Compression test (performed in both neutral and in quadrant)

Distraction

Check reflexes and sensation

Ask about their history and any recent traumas

=**Group 3: Demonstrate PT intervention for nondisplaced scaphoid fracture**= (We assumed that we are post immobilization)


 * 1) Day One: Emphasize AROM -- wrist and thumb movements in all planes of motion, including circumduction of the thumb, 50 reps, 3 x day
 * 2) After 2 weeks: emphasize PROM and RROM --
 * move wrist and thumb in all planes of motion
 * thermotherapy -- ultrasound, hot pack, paraffin, or warm whirlpool (in which you could do AROM)
 * radiocarpal joint glides -- volar, dorsal, ulnar, radial, Grades III-IV (3-5 x 45-60 sec)
 * stretches -- wrist extension and flexion, thumb opposition and extension 3 x 30 sec, 3 x day
 * palmar grip and thumb opposition with theraputty, 3 x 20 - 22 reps, 3 x day
 * thumb and finger extension with rubberband, 3 x 20-22 reps, 3 x 3.

> > = Sub-acute = > > =**Group 5: Differentiate between:**= Exercises: resistance mesh theraputty searching through rice to pick things up snake putty: role out and pinch with thumb and index finger (opponens pollicis) resistance bands around with fingers
 * Group 4: Demonstrate exercises for post-op colles fracture (acute and subacute stages) **
 * = Acute: =
 * = Start with PROM =
 * = Bone stimulator =
 * = AROM pain-free range: flexion, extension, UD, RD, pronation/supination, 2x50 =
 * = Hand alphabet 2x26 =
 * = Wrist flexion, extension, prayer stretch 3x30 sec, 2 times/day =
 * = Joint mobs: grade III-IV, 45-60 seconds, 3-5 bouts (flexion, extension, distraction) =
 * = Theraputty x 2 minutes (5 second hold x 15 reps) =
 * = Resisted AROM with weight or soup can/water bottle 2x15, 2xday =
 * = Supination/pronation in GEP =
 * = Bicep curls =
 * = Sub-acute – bone has healed well, WB stretching on table =
 * = Have patient learn to WB through hands, getting up from the floor (grandkids) =
 * = Wall push-ups =
 * = Triceps exercise =
 * = Shoulder IR/ER =
 * = Seated arm flexion on stability ball =
 * = TAS – total arm strengthening =
 * = Addressing different parts of the arm =
 * = Complications like RSD – CRPS =
 * = Pain control at home =
 * FDP- flexion of DIP: can work it independently
 * FDS- flexion of PIP: can work it independently
 * lumbricals:MCP flexion with IP extension
 * interossei:palmar do adduction and dorsal do abduction
 * opponens pollicis: thumb across hand to pinky finger
 * adductor pollicis: bringing thumb back to hand from abducted position
 * adductor pollicis: bringing thumb back to hand from abducted position


 * Group 6: ** Differentiate between ulnar vs median nerve entrapment at the wrist joint
 * Median Nerve Entrapment
 * Positive Phalen’s test
 * Positive Tinel’s sign
 * N/T in the thumb and digits 2-3 or loss of sensation


 * Ulnar Nerve Entrapment
 * Positive Froment’s sign
 * N/T in the 4th and 5th digit or loss of sensation
 * Motor loss to hypothenar muscles, adductor pollicis and interossei
 * Atrophy of interosseous spaces and hypothenar eminence

=Elbow Lab - March 28, 2011=

Group 2: How can you differentiate between lateral elbow pain caused by local structures versus referred by cervical spine and how would this affect your exercise prescription?
By Jimmy Wernel

__Cervical Spine__: Local Lateral Elbow pain: Effect on exercise prescription: If the issue was related to the cervical spine we would educate the pt on posture, stretch neck muscles (levator stretch, side bend stretch,..), strengthen neck and scapula muscles (isometrics and scapular squeezes), and do mobilizations (traction). If the issue was a local lateral elbow structure we would establish their pain-free ROM, stretch extensors, work on grip strengthening and hammer exercise once tolerable, strengthen extensors with eccentric exercises first, core and shoulder strengthening will be important to allow proper biomechanics of elbow, activity modification, and posture education.
 * Check mytomes for weakness
 * Check dermatomes for numbness or tingling or decreased sensation
 * Check reflexes
 * Perform cervical spine compression test - checking for increase of symptoms
 * Perform cervical traction - check for decrease of symptoms
 * Do they have pain in the cervical spine or scapula area?
 * Extensor Carpi Radialis Brevis test
 * Mill's test
 * Cozin test
 * Local TTP

**Group 3: Select and demonstrate weight bearing exercises (and progression if appropriate) for a non-irritable elbow.**

 * Early weight bearing**
 * Weight shift with hands on table
 * Progress to quadruped position > tripod > opposite arm/opposite leg raise (this also works core)
 * Can add rhythmic stabilization
 * Progress to**
 * Push-ups: begin with hands on wall, progress to lower levels: table, chair, step, and floor
 * Can decrease difficulty of floor push up by having their knees on the floor
 * Can increase difficulty by changing hand positions (hands together, single arm, clap)
 * Dips: progress from using chair arms to raise body up to lower the body below the edge of the chair.
 * Can increase difficulty by decreasing the amount of weight accepted by the legs (extend the legs out in front, use assisted dip machine if available, hold legs up) then adding weight.
 * High level**
 * From the push up position, walk hands up and over step (from side to side)
 * Can be performed as a plyometric activity by increasing the speed.

Group 4: Demonstrate exercises that will indirectly assist forearm supination and pronation for a subacute elbow patient.

 * Bicep curls- turning from pronation to supination as you curl or vice versa
 * IR/ER of shoulder with arm down by side ( can do with or without holding weight)
 * D1 and D2 Flexion and Extension PNF patterns (with or without resistance/weight)
 * Rows- starting in pronation and turning to supination
 * Twisting door know handle
 * Screwing and unscrewing an object
 * Toy steering wheel
 * Punching- start in supination and rotate to pronation as you punch (with or without weight)
 * Wii balance games with one hand out holding control

Group 5: Demonstrate appropriate exercise reginmen for a 14-year-old male with healed distal humeral fractrue who is lacking elbow flexion and extension.

 * Pulley
 * AROM bicep curls
 * Gravity assisted or Gravity eliminated.
 * Patient can also give over pressure to themselves into end range of flexion and extension.
 * AROM pronation and supination
 * Patient can also give over pressure to themselves into end range of pronation and supination.
 * Elbow Towel Prop - Stretch for extension (low load, long duration)
 * Wall push-ups

Group 6: Demonstrate exercises that incorporate the shoulder but indirectly assist elbow extension

 * Pulleys
 * Pendulums
 * Prone shoulder extension (can do with or without holding weight)
 * Standing shoulder extension (can do with or without holding weight)
 * D2 extension (can do with or without holding weight)
 * Triceps Kickbacks
 * Push-ups
 * Can progress from wall, counter-top, hi-lo table, step, floor
 * Can increase difficulty by going from push-ups with knees on ground to feet on ground
 * Shoulder Press
 * Ball Circles on the wall (can add rhythmic stabilization)
 * Overhead ball dribble (can increase size or weight of ball to make more difficult)
 * Body Blade (flexion, abduction, D2 extension pattern)

=**Ther Ex with Dorothy (take away points) April 6th, 2012**=


 * Kate Wiens**
 * every movement involves all 3 planes to some degree
 * Suggestion for HEP: give your patients a set of 9 exercises but let them pick 1 from mobility, 1 from strength, 1 from endurance (totally 3). Have them pick 3 new ones the next time they do it. It shouldn't take them more than 10 minutes to do a set
 * MMT isn't always a good way to assess function
 * Radiation tightens connective tissue. Ex. If patient has a shoulder injury and but has a history of cancer: they could be related
 * 17 muscles attach to the scapula! don't forget the omohyoid
 * Pulleys are now considered active-assisted.
 * You can do thoracic movements if shoulder is immobilized. Have them relax shoulder when they are moving other body parts. It's a simple concept but a lot of people are very guarded no matter how they are moving.
 * balance: your ability to keep upright in your personal environment
 * stability: when something acts on you, ability to maintain position

Squatting Specifics- Amanda Young
 * There are 27 common stances for squats in ther ex
 * Each squat is named in three planes
 * Sagittal
 * Frontal
 * Transverse
 * The "normal" squat is considered to be XXX
 * Sagittal X, Frontal X, Transverse X
 * Sagittal
 * X (In line feet), R (right forward), L (Left Forward)
 * Frontal
 * X (shoulder width), W (wide), N (narrow)
 * Transverse
 * X (neutral foot), I (internally rotated), E (externally rotated)

Rotator Cuff- Christine Chollet
 * At what point during a RC repair can you start putting resistance on the shoulder?
 * 10-12 weeks
 * Small tear might be able to start at 8 weeks
 * Really big tear may be up to 14 weeks
 * 30 degrees abduction to get optimum blood flow
 * 1ststage: no resistance (if you can’t do the simple…will probably mess up the complex)
 * 1 week: can start proprioception/feeding/ROM flow to RC using sternal movement side to side, thoracic flexion/extension (have them relax!)
 * 2 week: increase range of movement of week 1 movements, have them look down and up, move arm on the other side up and down; no strengthening
 * 4 weeks: same exercises, bigger range so arm next to them on the table
 * 6 weeks: same exercises, bigger range so other arm moving while lunging
 * If you ask “why am I doing this?” then you will know the next progression
 * 2ndstage: AAROM and AROM
 * Neuromuscular re-education
 * Want active motion and passive motion to be as close together as possible
 * Do pulley’s and wall walks with shorter lever arm
 * Don’t limit AROM to just straight planes (do different angles and rotations)
 * 3rdstage: resistance/strengthening
 * If they still have compensation patterns, you haven’t done your job
 * Push-ups
 * Wall (can do squat matrix)
 * Edge of table
 * Step back or scoot feet forward
 * Wide/narrow hand placement
 * Take away a point of balance
 * Angle shoulder toward other elbow
 * Floor
 * Pelvis toward floor and all the way up
 * Hips side to side
 * Lay on side, hips down and up
 * Reach down and across while rotating through thoracic spine
 * Medicine balls
 * Down up
 * Rotation
 * Higher: Transverse Spine
 * Lower: Lumbar Spine
 * Work as many angles as you can: want to connect hips to shoulders through the thoracic spine

Exercises to Increase Serratus Anterior strength to prevent scapular winging. By: Luke Giefer
We have talked multiple times, and have even observed many of us have scapular winging, most likely due to weakness of the serratus anterior. Scapular winging is classified as types: Type 1 indicates inferior border winging, Type 2 indicates medial border winging, Type 3 indicates superior angle winging.

Exercises to target strengthening the serratus anterior include:
 * Cat/Camel backs-this is performed with the patient in all fours, and creating an arch and then a dip in the back. Patients should hold the arch back for 5-8 seconds.
 * Serratus Wall Slide-Performed with patients forearms pressing against a wall starting at sholder height, with arms neutrally positioned with palms facing each other. The patient is advised to press into the wall with 10 lbs of pressure and slowly slide their palms up the wall as high as they can, at which point they should hold at the top for 10 seconds, then relax and slide hands back down. Repeat 5-10 times.
 * Serratus punches-Patient lies in supine, using weight or no weight. Patient arm is flexed to 90 with elbow extended and perform a "punch" by raising arm up, and raising scapula off the table.
 * Wall pushups-performed at varying levels of incline


 * Functional Evaluation and Treatment- Focusing on Lower Extremity (April 6 lab)- Madeline McCann**


 * have baselines and re-check them __all the time__
 * understand gravity and its interaction with the body
 * lower extremity works to control gravity- responds to gravity
 * upper extremity works to overcome gravity
 * understand neuro feedback
 * three planes of motion
 * momentum
 * does it act on you or do you have to create it?
 * Difference between balance and stability
 * Balance: Persons ability to stay upright in their environment
 * Stability is the ability to keep upright when something is pushing on them
 * Develop strategy and plan exercises that specifically work on strategy
 * Every movement involves all three planes of motion (some more than others)
 * can move into sagittal plane movements by doing other planes of movement
 * if sagittal plane hurts
 * move from lateral lunge with trunk rotation to lateral lunge to squat
 * slowly add in saggital plane
 * when deciding if exercise is functional consider what the person has to get back to
 * everything not in standing is less functional than things in standing
 * the less rigid the exercise the more functional it is
 * hamstring curl machine is not functional
 * someone who can’t control pronation: turn feet in with squat
 * choose pain free range with variations
 * squat- heels on ground, working on df; heels can come off ground if working on weight shifting
 * Load a muscle by lengthening it
 * Adduction with swing leg loads abductors in stance leg
 * Lunge with reach for back, gluts
 * Lunge with arms overhead works abs, quads

Balance Exercises from April 6th - Brandon Walker
 * A few useful definitions:
 * Points of balance - The number of body parts that are in contact with a stable surface. (e.g. standing on one leg with both hands on the wall equals 3 points of contact).
 * Driver - Anything that is use to achieve a desired motion. (e.g. reaching horizontally with the arms to achieve IR and ER at the hip)
 * Balance exercises can be established and modified by changing the drivers, points of balance, range, speed, and angulation of the movements to achieve the desired movement.
 * How changing the movement of different drivers affects the hip. (All of these exercises are in single leg stance with no UE support)
 * LE driver
 * Moving foot straight anterior and posterior - hip flexion and extension
 * Moving foot straight lateral and medial - hip abduction and adduction
 * Moving foot from anterior/medial to posterior lateral and back (allowing pelvis to move with swinging leg) - hip IR and ER
 * UE drivers
 * Reaching horizontally left and right - hip IR and ER
 * Reaching straight down anteriorly and straight overhead - hip flexion and extension
 * Reaching left and right keeping arms straight overhead - hip abduction and adduction
 * Techniques can be combined to facilitate more complex motions
 * You can increase the intensity of the exercise by having the pt increase the speed of movement and/or the range that they are reaching.
 * You can also add external forces such as resistance band and free weight to progress the exercises.

Adam Mathers - Transient Brachial Plexopathy/Stinger/Burner cervical cord neuropraxia (transient quadriparesis), stable cervical sprain, nerve root - brachial plexus axonotmesis, intervertebral disk herniation, unstable / stable cervical fractures, clavicle fracture, AC separation, peripheral nerve injury, scapula fracture, rotator cuff tear
 * ** Brachial plexus injury that is common when tackling in football **
 * ** MOI **
 * ** brachial plexus stretch most often involving C5 and C6 nerve roots **
 * ** direct blow causing contralateral neck flexion and ipsilateral shoulder depression **
 * ** Temoporary burning sensation radiates from the shoulder to the hand. May last hours, days, weeks. No complaints of neck pain associated. **
 * ** Symptoms typically resolve without intervention **
 * ** Occurs in 65% of collegiate players during a 4 year career **
 * ** Exam findings – weakness of shoulder abductors, external rotators, and biceps **
 * ** Differential Diagnosis **
 * Referenced from Wheeless’ online textbook. [] **

** Exercise and Phase of Healing (From TherEx Progression Lab) **
--Lauren Mulsow
 * Acute
 * ACL Reconstruction Example
 * Increase ROM, Decrease swelling & pain, normalize gait, activate quads for beginning strength
 * Heel slides, knee extension, Quad sets, SLR, heel raises, SL Abd, bike, gait training
 * Sub-Acute
 * Progress strength, stability and balance, steps, sit-stand
 * bilateral leg press, squats, miniband walks, step-ups (forward and sideways), single plane lunges
 * Maturation/Strengthening
 * Return to normal activities/sport
 * Multiplane lunges, chops, trunk rotations, step-downs, ladder drills, alternating dynamic lunges
 * Wait for Dr's permission to begin running and jumping

__Home Exercises for Adhesive Capsulitis__
Bend over at the waist so that the arm falls away from the body and dangles in a relaxed way. Use your body to initiate a circular motion. Make small circles while keeping the shoulder relaxed. Do this for 2 to 3 minutes at a time.
 * __Pendulum Exercise__**

Sit in a chair adjacent to a smooth table top. Lift the involved arm with the uninvolved arm and place the hand and forearm on the table. Bend forward at the waist allowing the hand and arm to slide forward. Do **10** repetitions.
 * __Table-top Arm Slides__**

Lie on your back. Using the strength of the uninvolved arm. Raise the involved arm up and then backward (as if to reach overhead) Do 10 repetitions.
 * __Supine Passive Forward Flexion__**

Stand facing a wall; place the hand of the affected arm on the wall. Slide the hand up the wall, allowing the hand and arm to go upward. As you are able to stretch the hand and arm higher, you should move your body closer to the wall. Hold the stretch for 15 to 20 seconds. Do 10 repetitions.
 * __Wall Climb Stretch__**

Sitting in a chair or standing, place the hand of the affected arm behind your back at the waistline. Use your opposite hand to help the other hand higher toward the shoulder blade of the opposite shoulder. Do 10 repetitions.
 * __Internal Rotation: Behind-the-Back Stretch__**

Lying on your back, hold the elbow of the affected arm with your opposite hand. Gently stretch the, elbow toward the opposite shoulder. Do 10 repetitions.
 * __Horizontal Adduction Stretch__**

Hold a door frame with the hand of the involved arm. While keeping the involved arm firmly against your side and the elbow at a right (90 degree) angle, rotate your body away from the door to produce outward rotation at the shoulder. Do 10 repetitions.
 * __Standing Neutral External Rotation__**

Standing facing a corner, position the arms with the elbows at shoulder level. Lean your body gently forward toward the comer until a stretch is felt. Hold this position gently for15 to 20 seconds. Repeat 10 times.
 * __External Rotation in Corner__**

Shrug shoulders upward and pinch shoulder blades backward and together. Do 10 repetitions.
 * __Shoulder Shrugs and Scapular Retraction__**


 * -Andrew Towell**