kin-3015 lab 3 exercise prescription group 4 tyler hyvarinen 0308368 aaron ruberto 0243189 kelly...

Kin-3015 Lab 3 Exercise Prescription

Group 4Tyler Hyvarinen 0308368Aaron Ruberto 0243189Kelly Heikkila 0305975Allison Pruys 0310660

CASE STUDY #1

Flexibility Range ExercisesStrengthening Exercises

Stability ExercisesPlyometric ExercisesFunctional Activities

FLEXIBILITY RANGE EXERCISE #1

CATEGORY EXERCISE DESCRIPTION REPETITIONS FREQUENCY REST EXERCISE MECHANICS

Flexibility Range Assisted Side Reach, after progress by

him/herself (ACSM Fitness Manual)

Patient is in anatomical position with feet together and arms at side.

Patient moves hand/wrist into

neutral position and raises arm above

head (with assistance for case study 1) and looks up in direction of stretch. Fingers

should be extended and palm facing

medially.

1-2 (if there is little to no discomfort) holding stretch for

5-10 seconds

1-2 times a day – if no pain or

discomfort is present, as many times as possible.

As progress is made the patient after consultation

with the kinesiologist may

decrease the frequency of this stretch, though it

can only be beneficial to

continue performing this

stretch daily.

Only if discomfort or pain is

experienced

Helps patient get into the habit of lifting his arm above shoulder

level. This stretch also initiates

muscles involved in abduction of the arm (Deltoid-lateral

fibers, Supraspinatus)



Flexibility Range Posterior Capsule Stretch

(Therapeutic Exercise for

Musculoskeletal Injuries)

Patient positions involved arm at

shoulder level, by laying affected

forearm pronated across opposite shoulder. The

patient grasps the elbow of his

affected arm with his opposite hand. The patient pulls

the arm across the body attempting to place the hand of

the involved shoulder behind the

opposite and the elboe close to the chin. Minimize trunk rotation.


5-10 seconds








stretch daily


experienced

Stretch is used to gain abduction and medial rotation of

arm. Both are important in

abduction of the shoulder joint. The deltoid (lateral and

posterior fibers) and supraspinatus are fully stretched in this exercise.

Both are the major muscles of

abduction of the glenohumeral joint.



Flexibility Range Wall Arm/Chest Stretch (ACSM Fitness Manual)

Patient extends affected arm to shoulder level. Patient places

whole arm on wall (with palm making contact). Patient

faces opposite direction of

extended arm. Stretch intensity is affected by how trunk rotation occurs in the

opposite direction of the affected arm.


5-10 seconds








stretch daily


experienced

This will not stretch the anterior

fibers of the deltoid, the

coracobrachialis, and the pectoralis major (clavicular head). All three

muscles are major flexors at the

shoulder joint. This stretch may

also aid in the pain experienced on the

right side of the neck as this

exercise will also stretch the

sternocleidomastoid and other minor muscles that rotate

the neck.

STRENGTHENING EXERCISE #1CATEGORY EXERCISE DESCRIPTION REPETITIONS FREQUENCY REST EXERCISE

MECHANICS

Strengthening Exercise 1

Isometric Shoulder Flexion

Facing a doorway or a

wall, the patient stands with their

involved arm slightly forward with the radial portion of their hand against the

door frame or wall. The

patient gradually

attempts to move the arm forward while pushing the

hand against the wall or

doorframe.

10 repetitions (each held for 10 seconds)

Several times throughout the

day

30 seconds between

repetitions2-3 hours

between sets

This exercise facilitates muscle contraction in the

movement of shoulder elevation through flexion. Each isometric contraction is

gradually increased to a maximum,

held at the maximum and the

slowly released until the muscle is

relaxed. This exercise mainly

involves the contraction of the anterior deltoid

fibers, coracobrachialis and pectoralis

major.


MECHANICS


Isometric Shoulder

Abduction

Facing a wall or a doorway, the patient stands

with the involved arm in slight abduction with the dorsum

of the hand against the wall or doorframe. Keeping the

elbow extended that patient

pushes the arm against the wall,

attempting to move the arm

into abduction.

10 repetitions (each held for 10 seconds)


day

30 seconds between

repetitions2-3 hours

between sets

This exercise strengthens the

shoulder abductors. The exercise also

facilitates the movement of

shoulder elevation through abduction.

Isometric contraction is

gradually increased to a maximum,

held at the maximum and the slowly released to

full relaxation. The primary

muscles involved are the

supraspinatus and the deltoid (middle

fibers)


MECHANICS

Strengthening Exercise

Theraband Shoulder Flexion and Abduction

Raise

Patient loops theraband around foot on the same side of affected

shoulder. Patient loops the other end

of the theraband around the palm of

the hand of the affected shoulder. Patient extends arm

(not complete – slight bend at the

elbow 5-10 degrees). Patient

then alternates between flexing arm at shoulder

joint (frontal elevation) and

abducting arm at shoulder joint

(lateral elevation)

4 for both flexion and abduction


discomfort is present.






stretch daily

After set for abduction is

complete immediately return

to second set flexion and so on.

This exercise adds resistance against

flexion and abduction

movements at the shoulder. Muscles involved in flexion

and abduction (which are listed in the stretches) are all being worked

with these movements.

STABILITY EXERCISE #1


Stability Swiss-Ball Stabilization

A large Swiss-ball is placed on a table

and the patient stands beside it.

Placing both hands on the ball, patient

applies little weight. Patient

then moves the ball in varying patterns (side to side, front

to back and in circles) while

maintaining weight bearing.

Move through each exercise for 20-30

seconds.


discomfort is present, as many times as possible. As progression in range of motion is made, the patient

increases degree of weight bearing. The patient may

also move the ball to a wall and stand beside it, moving

in varying patterns.


experienced

This exercise uses weight bearing as a method of scapular stabilization. The degree of weight bearing can be

increased according to the patients range of motion and pain.

Some of the muscles worked are: deltiod (all

heads), coracobrachialis, pectoralis major,

supraspinatus, rhombiods and

trapezius.



Stability Rhythmic Stabilization

Patient stands beside a table and places arms on the

surface. With a slight weight

baring position, the therapist offers resistance to the

patient as the patient shifts their weight from one arm to the other.

Approximately 10 per side.

1-2 times a day with the assistance

of therapist.


experienced

This exercise can assist in

reeducating the proprioceptors and

improve kinesthetic

awareness. By having the patient

resist the movements that

the therapist applies, they are using stabilizer muscles of the

scapula (such as the rhombiods,

deltoid, trapezius, supraspinatus and infraspinatus) that may need to be re

trained after injury.



Stability Distal Movement Stabilization

While seated and with correct

scapular position, the patient will outstretch the

injured arm to 60° - 100°. Patient will now draw out the

alphabet with their hand, keeping the arm straight at the elbow and wrist.

Two rounds of the alphabet.

1-2 times a day with the assistance

of therapist.

Approximately one minute between

rounds.


experienced.

This activity involves

movement of the distal extremity which requires

movement control and strength. During the

exercise, proper scapular position

must be maintained in

order to ensure stabilization

muscles are being worked correctly. To increase the difficulty of this

exercise, a weight in the patients

outstretched hand can be added, as well as the height

of the hand.

Plyometric Exercise #1Category Exercise Description Repetitions Frequency Rest Exercise Mechanics

Plyometric exercises

Chin ups The patient hangs onto a chin up bar and extends his shoulders fully over their head. Patient then pulls up on the bar until the chin has reached just over the bar.

3-5 depending on how far the patient is in the recovery stage, and how easily the patient can do a chin up. If possible, perform in sets of 2.

1-2 times daily. If possible for the patient.

A rest of 2-3 minutes between sets should be done, if there is no discomfort for the patient.

Allows patient to lift the arm above shoulder level in flexion while exerting force pulling themselves up using the deltoid (anterior and middle fibers), biceps brachii, and pectoralis major. Also allows them to stabilize themselves on the way down during the chin up using the triceps brachii, Latissimus dorsi, deltoid (posterior fibers) and pectoralis major.

Exercise #1

Plyometric Exercise #2Category Exercise Description Repetitions Frequency Rest Exercise Mechanics

Plyometric exercise

Medicine ball

overhand throw

Standing with one foot in front, the Patient hold a medicine ball overhead and forcefully throws the ball down toward the wall. The weight of the medicine ball can be adjusted according to the patient’s strength.

5-10 times. Doing sets of 2.

1-2 times daily.


This exercise allows the patient to bear weight overhead when the ball is in should flexion using he deltoid (anterior and middle fibers), biceps brachii and pectoralis major. It also allows them to forcefully contract their shoulder extensors on the way down using the triceps brachii, latissimus dorsi, deltoid (posterior fibers) and pectoralis major.

Exercise #2

FUNCTIONAL ACTIVITIES #1 & #2CATEGORY EXERCISE DESCRIPTION REPETITIONS FREQUENCY REST EXERCISE

MECHANICS

Functional Activity 1

Scapulohumeral Rhythm

Patient slowly lifts a light

object (ie. Book) from waist height to an

elevated book shelf. Patient

pregresses from a lower shelf to a higher on as full

ROM is achieved with full extension

through elevation of the

shoulder.

20 repetitions. As progress is

made, the object can be lifted to a higher shelf to

achieve full ROM at the

glenohumeral joint.


day.

If pain or discomfort

persist. Otherwise 10-20 seconds between consecutive lifts.

The process of elevating ones

shoulder to place an object on a

shelf involves a combination of shoulder flexion

and shoulder abduction. Full

range is achieved when the arm

can be abducted fully with full

extension of the forearm at the

elbow.


Self Care (ie. Bathing, dressing,

hygiene tasks)

Patient moves shoulder through

flexion and abduction in tasks such as

washing one’s upper back,

combing hair, brushing teeth.

As performed throughout the

day


day


day

The pectoralis major is a flexor of the forearm at

the glenohumeral joint (shoulder

flexion). In tasks involving self

care, the shoulder is often

flexed.

CASE STUDY #2

Flexibility Range ExercisesStrengthening Exercises

Stability ExercisesPlyometric ExercisesFunctional Activities



Flexibility Range Triceps Stretch(ACSM Fitness

Manual)

Place affected hand between your

shoulder blades (palm facing in), so elbow is pointing upward. Use the opposite hand to

gently push up and back at your left

elbow.


5-10 seconds – with progress can

be increased to 15-30 seconds


discomfort is present, as many times as possible.Due to the chronic nature of overuse

injuries, the patient should perform

these stretches as much as possible on a daily basis.

Some stretches can be performed while at work while the patient has a free

moment.


experienced

Stretches mainly the triceps (posterior

compartment of the arm). This should help with posterior compartment arm

pain



Flexibility Range Pronated Wrist Extensor Stretch

The patient flexes affected arm at the elbow joint to 90

degrees, pronates at the wrist, and abducts at the

shoulder joint to 90 degrees. The

dorsal side of the affected arm should

be facing the patient and at chest level. The patient uses her opposite

hand and wraps her fingers around the dorsal side of the

affected hand. The patient flexes the

affected wrist. The closer the patient pulls her flexed hand toward her

chest, the more the exercise stretches

the extensor muscles of the

wrist.


5-10 seconds






moment.


experienced

This exercise both pronates and stretches the

extensor muscles of the wrist and

forearm. This stretch will

decrease pain and increase flexibility

among the posterior

compartment of the wrist/forearm

No Picture



Flexibility Range Long Lying Stretch The patient lies on her back. Hands

extended above the head in full

abduction. Legs fully extended.


5-10 seconds






moment.


experienced

This is a good stretch to perform after a hard day of work and/if patient

is feeling weakened. Gives a

good overall extension stretch to many muscles from the shoulders to the toes. May also aid in patient’s chronic lower back pain if previous attempts to stretching were never made. Be

careful with lower back pain and

patient being able to get them selves up from a supine

position.


MECHANICS


Wrist Extension (Theraband or

Light Dumbell)

Dumbbell:With the forearm resting on a tabletop in pronation, the patient grasps a light dumbbell holding the hand over the edge of the table. The patient slowly lifts the dumbbell through full ROM from wrist flexion to wrist extension. The forearm must remain in contact with the table at all times.Theraband:Same procedures as above except patient wraps the band around palm with other end anchored by foot.

20 repetitions 1 set / day (as progression is

made, more sets of 20 repetitions

can be added)

1 minute between sets. Original set of 20 repetitions may be broken

down into 2 sets with 30sec-1min rest in between

if pain or discomfort persists.

This exercise is used to increase the strength of

the wrist extensors. The muscles used primarily in

wrist extension are the extensor

carpi radialis brevis, extensor

carpi radialis longus and

extensor carpi ulnaris. All of these muscles attach on the

lateral epicondyle of the humerus.

Tendons of wrist extension all originate here and as in this case study are

inflamed.


MECHANICS


Wrist Supination

Sitting with the forearm

supported over the end of the

table, the patient holds a light dumbbell in

pronation. The patient rotates the dumbbell

upward until it is in a vertical

position (concentric) and slowly rotates it

back into its original position

(eccentric).

20 repetitions 1 set / day (as progression is

made, more sets of 20 repetitions

can be added)


down into 2 sets with 30sec-1min rest in

between if pain or discomfort

persists.

This exercise is used to

strengthen the muscles of wrist

supination, primarily the

supinator which attaches to the

lateral epicondyle of

the humerus and may also be affected by

lateral epicondylitis.


MECHANICS


Bicep Curl (Forearm Flexion)

The patient stands with the

uninvolved hand behind the

involved distal arm just above the elbow. This

stabilizes the joint throughout

the motion. Using a

theraband, the ends are

anchored low to the ground. The patient grasps

the other end of the band with the wrist in a

neutral position, and moves the

arm into flexion (concentric) and back to the start

position (eccentric)

20 Repetitions 1 set / day (as progression is made, more sets of 20

repetitions can be added)


down into 2 sets with

30sec-1min rest in between if

pain or discomfort persists.

The biceps brachii is involved in

forearm flexion as well as supination. The muscle crosses the elbow joint and

inserts on the posterior aspect of

the radial tuberosity (proximal end). This adds to the stability of the

elbow joint, and thus stabilizing the lateral epicondyle

in wrist extension.



Stability Exercise

Distal Radioulnar Joint – Longitudinal Traction

The patient will lie down in the

supine position. The therapist will place a

stabilizing hand proximal to the elbow and the

mobilizing hand around the

anterior side of the wrist.

Patient flexes the arm to 90 degrees. The therapist pulls the mobilizing

arm at the wrist.

4 2-3 times per week with

assistance from therapist.

This exercise will help the

wrist stabilizers by stretching the soft tissue. Once the soft tissue is taken up, either an oscillating

longitudinal pull or a sustaining

traction is applied.



Stability Exercise

The Side-plank (*This exercise was chosen because the patient also has complaints of lower back pain)

Patient will lie on one side,

making sure the hips are stacked on one another. Pushing up on

the exercise ball, balance on

the feet and arm. Making sure the lower

back and abdominals are supported, hold

the proper position.

Two to Three sets of 20-40

seconds.

2-3 times per week with

assistance from therapist.

Rest 30sec-1min between sets.

This exercise requires

strength and stability of the abdominals,

obliques, quadratus

lumborum and transversus abdominus.

While supporting the body in proper position, these

stabilizing muscles are activated.



Stability Exercise

The Superman / Bird Dog exercise (*This exercise was chosen because the patient also has complaints of lower back pain)

Starting on the hands and

knees (hands below the

shoulders), raise one leg

and the opposite arm to

an extended position. Ensure the lower back is supported by the abdominals.

5-10 repetitions per side

2-3 times per day.

Rest one minute between each

side.

This exercise is an effective

exercise for the lumbar and

thoracic portions of the erector spinae

muscles. It also requires co-

contraction of the abdominal wall muscles.

PLYOMETRIC EXERCISE #1Category Exercise Description Repetitions Frequency Rest Exercise Mechanics

Plyometric Exercises

Ball Squeeze

Have the patient hold and tennis ball in their hand and squeeze the ball repeatedly. If pain is reproduced a sponge can be used.

Squeeze the ball 25 times, doing 3 repetitions.

Exercise can be done 3-5 times daily, to the patient’s desire. If any pain emerges the exercise should be stopped.


This exercise allows the patient to contract all the muscles of the forearm simultaneously. It allows the muscles of wrist extension to contract and relax, thus strengthening them.

PLYOMETRIC EXERCISE #2Category Exercise Description Repetitions Frequency Rest Exercise Mechanics

Plyometric Exercise

Finger Extensio

n

Have the patient place a rubber band around their five fingertips. Spread the finger into extension.

Spread fingers 25 times, doing 3 repetitions.

Exercise can be done 3-5 times daily, to the patient’s desire. If any pain emerges the exercise should be stopped.


This exercise allows the patient to use the extensors of the hand including the extensor digitorum and extensor digiti minimi. It also allows the patient to contract the extensors of the forearm to strength them.

FUNCTIONAL ACTIVITIES #1 & #2CATEGO

RYEXERCISE DESCRIPTI

ONREPETITIO

NSFREQUEN

CYREST EXERCISE MECHANICS


Turning door handle

Patient grasps door handle with

affected hand and

supinates at the forearm

to turn handle

10-15 As it occurs throughout

the day

As it occurs

throughout the day

By turning the handle the supinator muscle is activated.


Lifting boxes from waist height and

above – focusing on proper form

(as instructed by the

kinesiologist)

Patient lifts a common household

object, such as a laundry basket from waist height and higher

5-10 As it occurs throughout

the day

As it occurs

throughout the day

By focusing on proper form while lifting common household objects the patient can buildup functionality for

such activities in the workplace.

kin-3015 lab 3 exercise prescription group 4 tyler hyvarinen 0308368 aaron ruberto 0243189 kelly...

Documents

affected arm

direction of stretch

stretch dailyonly

opposite shoulder

medial rotation of arm

patient places

experiencedhelps patient

shoulder level