Monthly Archives: October 2013

Rehab Exercises

Physical Rehabilitation Exercises

What is rehab and how will it help me?

Physical rehabilitation is the development of exercise protocols and processes that assist the body in returning to a more normal state of health. Whether you are young, old, male, female, big or small, if you are experiencing some form of dis-ease (pain or poor health) then you will benefit from exercises.

The best way to start on the road to health and fitness is to first understand the following

1) It took a long time to get where you are today and it is going to take time to reverse the process.

2) A balanced program needs to include, flexibility, cardiovascular, endurance and strength training and be tailored to your individual needs. Patience and commitment are key.

3) Most people who seek treatment for musculoskeletal pain and injuries suffer from naturally occurring degenerative processes, and it is not always arthritis! We must all continue to fight against the effects of aging, gravity stress and any occupation induced strain and/or postural habits.

How does my body heal?

There are three phases the body goes through to heal any injury.

The first phase is simply INFLAMMATION and occurs within the first 48-72 hour post injury. During this phase the most important thing to do is control the inflammation, usually by using ICE, and avoid further irritation to the area. Sometimes immobilization with a brace is necessary.

The second phase of healing, up until 6 weeks post injury, is when your body begins to REPAIR AND REGENERATE. This is when scar tissue formation occurs. Our muscles and organs are covered with a material much like plastic wrap, that’s called fascia. When injured, the scar tissue turns this area of ‘plastic wrap’ into a material much like ‘wax paper’, inflexible and without circulation. This will cause a weak spot in the tissue that was injured allowing the margin of plastic wrap’ and ‘wax paper’ to be injured again or torn more easily unless it is knitted together properly from the beginning. The most important thing to do during this phase is gentle, pain free range of motion exercises and stretching. By starting motion as early as possible we can stop the scar from becoming too large, and allow the tissue it is healing to regain its flexibility and strength.

The third phase of healing, which can take up to 12 months, is when the tissues REMODEL AND MATURE. The only way that the body can complete this healing process is by the performance of specific exercises prescribed for your individual needs. Exercises geared toward building strength and endurance through safe ranges of joint motion will enable the body to heal with strength, balance and stability and be less prone to re- injury.

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Readiness Position
Perfect neutral posture or the ‘readiness position’, is achieved by:
1) standing erect with feet pointing straight ahead of you accentuating the
arches of the feet by performing a short foot.
2) knees are slightly narrower than shoulder width apart, and are soft. 3) perform slight pelvic tilt and abdominal hollowing 4) elevate chest slightly and bring shoulders back and down. 5) head looking straight forward., chin parallel with floor.

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Short Foot Position
The short foot position is utilized to aid in the restoration of normal foot alignment
as well as to increase proprioceptive outflow. Pronation is a common foot problem
and can cause a chain of events up the leg and spine that can lead to pain and discomfort.
A ‘short foot’ is achieved by:
1) first roll slightly to the outside edge of the foot
2) then try to increase the amount of space under your arch by tightening the muscles of the arch without curling the toes down. [Imagine you are grabbing sand between the heel and ball of the foot.]

Abdominal Breathing
Most people breath into their upper chest. This is termed “paradoxical” breathing. Proper breathing is abdominal breathing, which uses the diaphragm to bring air into the lower lung fields.

To perform, place one hand on top of the other over your belly button. As you inhale, allow the air to enter your lower lung fields. Your belly should rise up first and higher than your chest. As you exhale relax the stomach muscles and repeat.

Performing this alone can help alleviate discomfort in the upper back, lower back and neck areas.

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Abdominal Hollowing
Abdominal hollowing is simply the exhale position of abdominal breathing taken one step further.

As you continue to fully exhale, suck in your lower abdominal muscles (belly button) toward the spine to the point of tightness. As you force air out, you should feel the muscles below the belly button get tight. Practice holding your lower abdominals tight while you breath.

Abdominal hollowing should be performed throughout your activities of daily living. When lifting groceries, children, or shoveling as well as when getting out of bed in the morning and rising from a seated position, suck in the abdominal in order to stabilize and protect your low back.

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Posture
Maintaining proper posture not only allows your joints to move freely through their ranges of motion, it also allows your organs to work more efficiently (i.e.: bowels to function, heart to pump, lungs to fill with air). The importance of good posture can not be overemphasized, so even if you consider yourself to have poor posture, there are always ways to change.

Poor posture is often caused by muscle imbalances. Some muscle are too tight and become shortened, and others become permanently elongated and weakened. This process is termed ‘plastic deformation’. An example of the effects of this process is often experienced by people who work all day in front of a computer. The rounded shoulders (shortened chest muscles and continually elongated mid back muscles) and forward drawn head position (tightness in the back of the neck and lengthening of the muscles in the front of the neck) lead to all sorts of pain patterns and discomfort. The key to changing muscle imbalances, and therefore posture, is through a specific and personalized exercise program geared to lengthening and strengthening appropriate tissues.

Posture tips:
• When sitting, make sure both feet touch flat on the floor, knees should be slightly higher than the hips and spinal curvatures maintained. Use a pillow or towel behind the low back if necessary.
• Use the arm rests on your office chair to take stress off the shoulders.
• Avoid holding the phone between the shoulder and ear. Use a headset if a large part of your day is spent on the phone.
• For desk work, bring documents up to eye level to avoid hunching over with the head looking down for long periods of time.
• Take regular breaks during the day to move joints and stretch.
• Have your work station ergonomically assessed.
• The back support of your chair is only beneficial if you sit against it .
• When standing, keep one foot elevated on a box or step.
• Maintain abdominal hollow and pelvic tilt to support the low back.
• Wear supportive footwear.
• When sleeping, the use of an orthopedic pillow may be beneficial to help rest the neck and shoulder musculature.
• Do not use more than one pillow and avoid sleeping on your stomach.
• A pillow between the knees when side lying, helps minimize pelvic rotation.

Fit VS Fat
Increasing ones lean body mass i.e.: decreasing ones percentage body fat, is more complex than simple weight loss. Body fat does not just end up in your thighs, belly or face, it also builds up around all your organs and muscles. The leaner your muscle tissue becomes, the less stress it puts on the heart and joints. Muscles then do not need to work as hard to do their job and energy is spent more efficiently. It is important to realize that muscle weigh more than fat and has a higher Basal Metabolic Rate, therefore, as you continue to exercise you may not notice drastic changes on the scales but your body will be functioning more efficiently and will be healthier for it.

In order to decrease your percentage body fat it is important to find out your ‘Optimal Fat Burning Rate’ (OFBR). This will enable you to perform cardio training at your anaerobic threshold. This is the level of work that allows you to burn fat most efficiently during your workout. The OFBR can be calculated by your rehab care provider and the results from this test will tell you how lone and how hard you can push yourself safely.

Helping Yourself
It is important to remember that you are ultimately responsible for your own health. Doctors, specialists, trainers, and so called experts can only guide you to your goal. You must take on the responsibility to become, and stay, healthy. Take small steps, graduate slowly, and reward yourself regularly. Be patient. To see changes in your body takes time.

To decrease pain and increase health, a balanced program of fitness needs to be achieved. Flexibility, strength, endurance, hobbies, sleeping and eating habits are all part of achieving your goals. Attention to postural changes and the control of daily stress is a good start. Remember, if you keep doing what you are doing, your body is going to keep responding the way it is responding
Stay positive and keep smiling!

Tips for stretching
• perform a 5-10 minute general full body warm up first (walking stairs, marching)
• get into stretch position carefully and gently take up muscle slack until a stretch is felt
• pay close attention to posture and body alignment, only stretching one specific muscle at a time
hold stretch and take out slack as muscle relaxes. Do NOT bounce while stretching. Simply hold and breath deep to encourage relaxation.
• use a chair or wall for support if necessary
• stretches should be performed 1 x and performed at least 2x/day in order to achieve optimal increases in range of motion.
• stretches should be performed both before and after activity. Stretches before activity (either occupational or sport) can be specific to the muscles to be used in the activity. Stretching for general permanent elongation of tissue can be performed after activity when the core body temperature is higher

Tips for floor exercises
• The purpose of floor exercises is to educate muscles for spinal stabilization, therefore; perform all movements slowly and with control, paying attention to body positioning.
• perform exercises on a carpeted surface or a gym mat
• only exercise within your pain free range of motion
• hold exercise at your ‘end point’ for 4-10 seconds, stop the motion and allow muscle to fully contract
• maintain readiness position and abdominal hollowing throughout exercises.
• to educate proper joint motion and muscle function, proper postural alignment is key.

Tips for gym ball use
• take time to become familiar with the ball. Achieve both balance and confidence.
• ball should be comfortable to sit on, you should just slightly sink into it and knees should be bent 90 -100°
• choose a room with plenty of space to exercise in. Gym ball exercises must be performed on a carpeted surface .
wear running shoes
• a slightly under inflated ball is easier to start with. Inflate the ball further to make the exercises more challenging.
• continual attention must be given to the maintenance of readiness position and abdominal hollowing while exercising on the gym ball.
• only exercise within your pain free zone and maintain control.
• to educate proper joint motion and muscle function, proper postural alignment is key.

Tips for proprio training
• use rocker or wobble board on a carpeted surface.
• perform exercises close to a wall or corner for assistance with balance if need be.
stretch before performing proprio exercises
• always perform proprio exercises in bare feet maintaining a short foot.
• maintaining readiness position throughout the exercise is imperative.
• always maintain control

Tips for tubing exercises
• tubing can be tied to a door handle, a table or sofa leg or a banister in order to perform the exercises. For some exercises simply attach to the chair leg, if seated, or step on it.
• always warm up before exercising. This can consist of 5-10 minutes of light cardio (march, dance, walk stairs) followed by gentle stretching.
• all exercises should be performed maintaining readiness position. Pay attention to body position and posture when exercising.
• it is the QUALITY of movement NOT QUANTITY. If, for example, you can only do 8 reps with perfect form, that’s more effective than doing 12 reps with the last few reps improperly performed.
• perform exercises with slow, controlled movement focusing on the muscle that is working. Only the area or joint that is being exercised should move. ISOLATE
hold any exercise at the end point for 1-2 seconds. i.e.: stop the motion before releasing the resistance, then release with control.
• reps are given in a range i.e.: 15-20. Which means to perform at least 15, and at most 20. If you can perform more than 20 reps, it may be time to increase the resistance. If you can only perform 14 reps, than you must decrease the resistance to be able to perform the target number of reps for your particular program. Listen to your body each day.

TRAIN, DON’T STRAIN!

01 Oct 2013