1. Downward Therapy Dog-to get proper overhead shoulder range of
motion the muscles of the shoulder girdle and glenohumeral joint need to
be well balanced. Often times rehabilitation exercises for the shoulder
patient are done individually and are performed in isolation.
Unfortunately, the shoulder muscles work as a coordinated unit. The
downward facing dog yoga exercise is a great way to facilitate the lower
scapular muscles while inhibiting the often over dominant upper scapular
muscles resulting in smooth scapulohumeral rhythm. The downward therapy
dog (as I have named it) will also improve thoracic spine and latissimus dorsi mobility and facilitate the deep core
musculature that is required to get the arm overhead in an efficient
manner.
2. Total Hip Replacement patients often have tightness of
their hip flexor due to the adaptive shortening that occurs when the
patient has had pain and thus restricts the normal hip range of motion.
When the hip flexor gets tight it inhibits the gluteus muscles. Hip
replacement surgery can further comprise the strength of the gluteus
muscles and if the hip flexor muscle is not stretched appropriately then
the patient's gluteus muscles with not control the femur eccentrically
at initial contact through the stance phase of gait and result in a
functional deficit with ambulation.
3. Joint Replacement Quadricep Facilitation Exercise-"The Church Pew": it has been
documented in the literature that prior to a knee replacement surgery
the patient can have at least a 20% quadricep deficit. This deficit
persists following a total knee replacement. Traditional knee
replacement exercises do not specifically address the neural inhibition
that occurs in the quadricep muscle. The persistent inhibition of the
quadricep muscle affects a total knee replacement patient’s walking and
stair climbing abilities. The "church pew" exercise facilitates the
quadricep by causing an involuntary muscle contraction, just the way the
quadricep muscle functions during the gait cycle. Traditional quadricep
exercises are volitional contractions and thus do not stimulate the
muscle functionally. The "church pew" exercise is a great way to get
that neurological-re-education and augment the traditional exercises.
The church pew exercise is for neuromuscular re-education of the
quadricep and augments all the other traditional quadricep exercises. I
recommend that you assess your patients gait before and after the
exercise and document the change in stance time, speed and the patients
subjective comments post exercise.
4. Joint Replacement Knee range of motion-bike tips: loss of range of motion can
result following knee replacement surgery. Pedaling backwards on a
stationary bike is a great way to achieve range of motion into flexion.
This occurs because the backward pedaling motion results in a hip
flexion moment first, then a knee flexion moment. This sequence is
opposite of traditional cycling. I like having the patient start by
placing their heel on the pedal first and then pedal backwards. Once
they loosen up I have them put their foot in the traditional position
and then at their toe to get extra flexion. Once this is accomplished
the patient can ride the bike for range of motion in the forward method
but they start on their heel first and then progress to their toe. The
patients seat is also moved back and the forward during this exercise.
