OP Exercises

Question 1

Foam Roller for thoracic Extension

Answer 1

-Place the foam perpendicular to the spine
-Have the client start seated, with foam roller at bottom of the t-spine (lower mid-back)
-Lean back (into thoracic extension), using the foam roller as a pivot point
-The foam roller can be moved along the thoracic spine to change pivot point (targeting mobility along various points of the thoracic spine).

Question 2

Cow

Answer 2

-Start in a four point stance (knee on ground aligned with the hip, arms and hands in line with the shoulders)
-Breathe out, bringing the navel down to the ground (extension-Lumbar spine and PPT) and the head up (cervical extension)
-Often paired with cat as a general ROM activity

Question 3

Cobra

Answer 3

-Lying prone, push self up with arms to extended the spine (+PPT)
-Lower to the ground= more thoracic emphasis
-Higher off the ground= more lumbar emphasis
-Place arms closer/further in front of hips to alter this bias (closer to hips allows more extension- more lumbar emphasis)

Question 4

Cat

Answer 4

-Start in a four point stance (knee on ground aligned with the hip, arms and hands in line with the shoulders)
-Breathe in and pull up towards the ceiling as if there is a string attached to the back, simultaneously bringing the head down
-Tuck “tail” between legs
-Lumbar and thoracic spine-Pulled into flexion and APT, head pulled down (cervical flexion)
-Often paired with cow as a general ROM activity

Question 5

Child’s Pose

Answer 5

-Sit with heels on bum, reaching forwards with arms attempting to bring the forehead to the floor
-Knee position- More open hips (knees wider)= more flexion, and better if have femoral acetabular impingement (indicated via a +ive FADIR)
-May be difficult for people with lower extremity pathology; overstress the area since at end range and putting weight into lower extremities in this position- modify to seated position if needed
Seated child’s pose (modification for people with lower extremity injuries)
-Sit in chair, hug a pillow or jacket- then bend over flexing the spine

Question 6

Seated twist

Answer 6

-Sitting on a chair (or ground?), self hug
-Keeping contact with the chair with bum (look for ischial tuberosities in contact) rotate the torso
-Look the same direction as the rotation of spine (cervical rotation mimics thoracic rotation)

Question 7

Archer

Answer 7

-Lying in a supine position with knees stacked (hold knee), knees staggered at 90-bottom leg straight, open/close torso (one arm up)
-by staggering can get more ROM- hip can rotate more , if ROM is very limited can use roller or foam pad to support leg (place under the leg that is crossed over)

Question 8

Seated lateral Flexion

Answer 8

-Sit in a tall stance using the cue of pulling the rib cage way from the iliac crest.
-Reach laterally (away from the side being stretched)
-Watch for compensation via spinal rotation

Question 9

Banana

Answer 9

-Lying on the floor in supine position
-Cross legs, and bring them to the opposite side that is being stretch
-Keep one arm by side while the other reaches up and overhead towards the other side (away from side being targeted)

Question 10

Cervical Lateral flexion (self)

Answer 10

-Seated in neutral position, bring the ear to shoulder (not shoulder to ear!),
-Look out for: trunk lateral flexion as a cheat
- Can bring same arm up to bring further into flexion as needed

Question 11

Partner assisted cervical lateral flexion

Answer 11

-Client lying on table, with head right at then end
If flexing to the left:
-Place left hand on the nuchal line (on occiput) and begin to bring the client into lateral flexion.
-With the right hand, make a C and place it on the opposite shoulder to prevent it from moving (anchoring the shoulder girdle)
-Use forearm to prevent head from moving back into neutral position
-Ensure to continuously talk to the client and to keep their eyes in your sightline; if you notice nystagmus, dizziness, headache or changes in consciousness stop immediately as these are contraindications (something is going badly with the nervous system- WHAT?)

Question 12

Abdomincal bracing

Answer 12

-Brace is a base skill that builds into other exercises! (do it before any core exercise to teach/remind client of what it is so they can use it in their exercises)
-Cue client to engage their core as if they are getting punched in the stomach - then to let off a bit so can breathe and do exercises

Question 13

Deadbug variations

Answer 13

-Start in a supine position with knee over hips, elbows over shoulders
-For a true deadbug (advanced exercise): Extend shoulder and hip on contralateral sides
Regressions:
-I limb at a time
-Just legs
-Just arms
-Heel taps (decreasing the range of motion)
- Heel side (while crook lying)

Question 14

Chin Tuck

Answer 14

-Upper cervical flexion (head roll) with lower cervical extension
-Base skill that builds into other exercises
-Can be done in supine, seater or tabletop positions
-tuck chin back making biggest double chin possible
-Great for students that sit at a desk all day with a forward head posture

Question 15

Tall sitting

Answer 15

-Done on the floor with legs straight in front but can modify leg position (ie if have tight hamstrings)
-Dowel for guidance- 3 points of contact; occiput, thoracic spine, sacrum- goal is to get pelvis flat but many people can’t do this
-Incorporating chin tuck + sternal lift with wide shoulders
-Look for flaring of the lower ribs (anteriorly) - want to avoid this; keep the finger guns tucked into front pockets
-supine chin tuck is the most regressed, standing
-Most progressed- prone

Question 16

Bird dog

Answer 16

-Brace
-4 point position: shoulders over hands and hips over knees
-Use dowel on spine to ensure proper position (maintain 3 points of contact- occiput, thoracic spine, sacrum) - since some people like to rotate hips
-Cue: Try to be as long as you can- instead of saying reach out (encourages extension of spine)
-Many different variations: 1 arm at a time, 1 leg at a time as regressions
-End goal: lift up opposite arm and leg simultaneously
-Final, most advanced variation is lifting the same arm and leg at the same time

Question 17

Front plank

Answer 17

-Hands or elbow under shoulder, feet or knees as other point of contact
-Engage core and enure body is in straight line- look for sagging at the core
-On Elbow is harder because you are more horizontal
-Can also do variation against the wall or a table to regress or can’t go on the ground
-Can use dowel and 3 points of contact to help with body position cueing

Question 18

Bear Plank

Answer 18

-4 point position: shoulders over hands and knees under hips with toes as point of contact (true 4 point)
-Engage core in brace to hold the position
-Can add shoulder taps to progress this exercise
-Can use dowel and 3 points of contact to help with body position cueing

Question 19

Side Plank

Answer 19

-Lying on side, use hand or elbow as upper support, feet stacked or staggered (whichever is easiest for balance) – regression to use knees as point of contact
-Ensure shoulders and hips are stacked vertically
-Cue pressing bottom shoulder to protracted position (NO SHOULDER TO EAR)
-Lift hips up off the ground and hold
-Add leg lift to increase difficulty
-Modify angle of the body (more horizontal= harder)
-Modify arm and leg contact points with the ground
-Watch for rotation

Question 20

Side bridge

Answer 20

-Lying on side, use hand or elbow as upper support, feet stacked or staggered (whichever is easiest for balance)
-Ensure shoulders and hips are stacked vertically
-Cue pressing bottom shoulder to protracted position (NO SHOULDER TO EAR)
-Lift hips up off the ground repeatedly in a controlled manner
-Modify angle of the body (more horizontal= harder)
-Modify arm and leg contact points with the ground
-Watch for rotation

Question 21

Foam roller anterior thigh

Answer 21

-Ant thigh: lying on foam roller, target leg on foam roller, other leg as stabilizing leg. Roll up and down

Question 22

Foam roller lateral thigh

Answer 22

-Lateral thigh: sidelying (ish) target leg on roller over leg crosses over and foot on floor. Roll up and down

Question 23

Foam roller plantarflexors

Answer 23

-sit on floor with target PF on roller, can stack feet to increase intensity
-Roll up and down

Question 24

Lunge stretch

Answer 24

-Right hip flexor, right hip foot back (ipsilateral leg on airex pad)
- If no external stability, have a wide BOS. start w/ weight on back knee
-Stand really tall, give cue to “Tuck your tail” (PPT) – watch out for apt as it shortens hip flexor and makes stretch less effective
-Coach to shift weight from back knee to front foot
-Targets Rec fem, tfl, psoas (primary target)– Deeper flexion of knee= greater rec fem bias since it crosses both the knee and the hip
-Can also be done on the chair if can’t do on ground
-standing tall, place knee on the seat (foam pad under knee), foot/anterior ankle over the backrest
-If need more stretch, bring knee closer to backrest (increased flexion)
-Watch for thoracic and lumbar extension as a compensation (shows don’t have the emobility)

Question 25

Straight Leg Raise

Answer 25

-Wrap the band (non-stretchy) around the midfoot, lay back and bring the straight knee leg into hip flexion to stretch hamstrings. -Bringing the foot higher provides a more intense stretch -Can have straight or bent elbows- straight is less work -Adding plantar flexion allows for more stretch of hamstring by stretching the sciatic nerve extra hard (might feel it as pain at the back of the knee) -Targets the semimembranosus, semitendinosus and bicep femoris

Question 26

Pyramid

Answer 26

-If targeting the right hamstring, bring the right foot back -lean forward with a straight back, arms straight down -Look for compensation at the hips- want them to be squared. If they aren’t then the person is going too far for the length they have -Can add block in front to help with balance/ add support if can’t go all the way down

Question 27

Figure 4/ pretzel

Answer 27

-Targets deep gluteal muscles (ie piriformis) Supine: -Lay on back - Grab posterior thigh (often more comfortable, especially if have a knee pathology) or tib tube (adds extra pressure on the knee) and put contralateral ankle on ipsilateral knee -Let that sink in Half seated: -bring heel to bum, rather than bringing thigh up Seated: -Sit in figure 4 position -Bring belly button forward to the calf

Question 28

Adductor rock back

Answer 28

-If on right knee, targeting left adductor (CL) -Foot flat on the ground- bum to heel (Rock back) -Chair variation: bring the leg up and out 45 deg. Toe up prevents compensation via internal rotation

Question 29

Gate stretch

Answer 29

-right side, right leg out (IL) -Reach towards same side as leg out -prescribed less often since lots of joints going on (lots of room for compensation/target other tight areas that aren't the adductors )

Question 30

SAQ over foam roller

Answer 30

SAQ (short arc quadriceps: -Place foam roller under the knee -Bring knee into extension -Good for post op/early rehab (good for non weight bearing) -Very low resistance

Question 31

TKE with a band

Answer 31

-Once at a weight bearing stage -Band around a stable structure (ie pole) -Start w/ knee slightly flexed, and then contract against the band into full extension -Watch for knee going into varus and/or valgus through the movement -Targets getting back into full ROM, for functional activities

Question 32

BW squat

Answer 32

-Dowel w/ 3pt contact (occiput, thoracic, sacrum) -Feet neutral/ext rotated -Stance- hip to shoulder width apart- wider stance for FAI so have more space in hip flexion -Watch for knee/hip dominant squats (which joint moves more); knee dominant will see lots of anterior translation of the knee, hip dominant will see lots of hinge at the hips- chest down - Watch for weight through midfoot- see where the weight is distributed (not too far forward or back) -watch for varus and valgus at knee

Question 33

Split squat

Answer 33

-Unlike in lunge, weight is not evenly distributed front vs back; most of the weight is on the front leg (makes it more unilateral bias) -Progress with the other hip going into more extension– elevating the back foot- driving the knee down further (get more flexion)

Question 34

Step up and down

Answer 34

-Stand on one foot on an elevate surface- step up and down very controlled -Focus on eccentrics -Good progression towards single leg exercises since can modify many variables such as height, just CON, ECC, ect -Useful for people that need to traverse stairs

Question 35

Prone hamstring curl

Answer 35

-With or without resistance band -Non weight bearing -Band over midfoot on one leg, rotate it at least 90 deg (180 is great), then loop it over the other ankle -Flip into prone position -Foot with band around midfoot stays anchored, other leg is curling -Can add foam roller under hips to decrease stretch on muscle my creating hip flexion- makes the actin and myosin of the muscle overlap in a more ideal position and therefore get a better/stronger pull (more strength in this position -May see hip flexion as a compensation if don’t place the foam roller/towel under

Question 36

Glute bridge

Answer 36

-feet flat on table, hip or shoulder width apart -Can alter amount of knee flexion ( more flexion= more glute, less= more hamstrings) -Lift to form a straight line from shoulder, hip and knee -Count of 3 up and down (slow controlled motion)

Question 37

Hip hinge

Answer 37

-Start with 3 points of contact on dowel (occiput, thoracic spine, sacrum) -have a soft bend in the knee -Hinge at the hip by driving the bum back -Coaching cueL reach bum back throughout the range (close the car door)

Question 38

RDL

Answer 38

-builds off the hip hinge base -Kickstand/stagger option to bias single leg

Question 39

Clamshell

Answer 39

-Hip motion, not lumbo-pelvic -side lying -Knees bent at 90 deg -Feet in line with torso (shoulders, hips, ankles) -Hips are stacked -Point top knee to ceiling -Look for compensation: rolling through the hips, abduction

Question 40

Side leg raise

Answer 40

-Hip motion, not pelvis -side lying -Knees bent at 90 deg -Feet in line with torso (shoulders, hips, ankles) -Hips are stacked -Top leg straight out- can lead with heel or toe (IR vs ER- bias glutes vs TLF? muscles) -Lift lop leg via abduction -Watch for hip flexion as a compensation

Question 41

Pelvic drop and Hike

Answer 41

-ASIS dip and back up to normal -If don’t have elevated surface- sub for a curtsey squat; bring back leg posterior- reach as far back as possible- requires the ASIS to hike back

Question 42

Balance skills- Lower Extremity

Answer 42

-How wide is the BOS -Single and double leg -Stable vs unstable surface -modify visual input (eyes closed, turn head- vestibular too)

Question 43

Dowel Flexion

Answer 43

-Flexion: affected thumb on top of dowel, use unaffected arm to push further, should look like canoeing (reverse?) -Can be done in supine or upright position

Question 44

Dowel Extension

Answer 44

-Can be done in supine or upright position

Question 45

Dowel External rotation

Answer 45

-For ER and IR, have client hold something in tennis balls to their ribs using their elbow to prevent movement of the elbow away from the body (helps isolate the movement) -Can be done in supine or upright position

Question 46

Dowel internal rotation

Answer 46

-For ER and IR, have client hold something in tennis balls to their ribs using their elbow to prevent movement of the elbow away from the body (helps isolate the movement) -Can be done in supine or upright position

Question 47

Dowel Abduction

Answer 47

-Can be done in supine or upright position

Question 48

Cross body stretch

Answer 48

-Key: cross-flexion at GH joint, not protraction of the shoulder girdle

Question 49

Cross body ball SMR

Answer 49

-Combine with cross body stretch SMR: lacrosse ball -Lacrosse ball used to apply pressure to muscles below the spine of the scapula (found by palpating). -Put ball bw body and wall, and cross flex, then roll around -Opens up posterior aspect of the shoulder

Question 50

Foam roller lat dorsi

Answer 50

-Place foam roller perpendicular to torso -Thumbs up to integrate some ER to open up further as lat dorsi is a medial rotator -Apply force through the posterior axillary wall, and then just roll er out (along the margin of the lat) -Contralateral foot planted on the floor to provide stability through the position

Question 51

Child's pose + reach

Answer 51

-Modify child’s pose: add lateral flexion -Chair, table (hips stay high) or wall stretch into flexion -Thumbs up to integrate some ER to open up further as lat dorsi is a medial rotator -Can reach more through right/left to bias- contralateral reach -Cue chest/sternum to the ground to bias the GH joint ROM -Good for students/OH athletes

Question 52

Pectoral stretching over foam roller

Answer 52

-Caution for those with GH instability (ask if have history of shoulder dislocation first) Foam roller chest opener: -Supine along length of foam roller, with sacrum and occiput supported for maximum comfort (just occiput if roller is smaller) -Foam roller should be parallel to the spine -Let arms hang into cross extension -Widen BOS by increasing distance between feet if need more stability

Question 53

Pectoral SMR with ball

Answer 53

-Can also do lacrosse ball on the wall: -Ideally use corner so head has somewhere to go; place ball on pec and roll it out

Question 54

Executive stretch

Answer 54

-Can be done in supine or sitting -Check which side is more restricted -Therapist assisted can help add tension: Hip into back as an anchor to create more of a stretch, using the hips as leverage

Question 55

L wall stretch

Answer 55

-Make and L with fingers to force into pronated position -Place L on the wall- Rotate away (with elbow staying in contact with the wall), shoulder can lift off

Question 56

Scootch stretch

Answer 56

-Seated Stretch - sit as if would scootch across the floor -Point fingers posteriorly (change ant vs post for pronated vs supinated position to get even more targeted stretch) -Lift sternum (push it forward)- extension of elbow -Externally rotate GH -Scootch your hips forward along floor to deepen stretch (lift bum to feet)- extension of GH joint -Bicep is responsible for shoulder and elbow flexion, forearm supination- need to consider all these movements

Question 57

Pec foam roller

Answer 57

-Place foam roller across the chest (pec) -Bring out CL leg for ease of mobility and increased stability -Add in ER for increased stretching -Start motion at anterior axillary wall and roll down muscle

Question 58

Banded Internal roation

Answer 58

-Check for shoulder instability first -Hold lax ball at elbow against the torso to ensure proper position -Can be done in supine, side-lying, seated (consider mobility and stability) -Arm at side (0deg ABD) OR w/ GH ADB (45… 90 deg)- increasing ABD progresses the exercise -90 deg abduction- position is riskier for a sublux (consider history of instability) -Try with resistance bands for increased challenge -Band placement: for 45deg: hold band at contralateral ASIS; 90deg: sternum

Question 59

Banded External rotation

Answer 59

-Check for shoulder instability first -Hold lax ball at elbow against the torso to ensure proper position -Can be done in supine, side-lying, seated (consider mobility and stability) -Arm at side (0deg ABD) OR w/ GH ADB (45… 90 deg)- increasing ABD progresses the exercise -90 deg abduction- position is riskier for a sublux (consider history of instability) -Try with resistance bands for increased challenge -Band placement: for 45deg: hold band at contralateral ASIS; 90deg: sternum

Question 60

Scaption

Answer 60

-Emphasis on supraspinatus -Abduction of the GH joint, following the plane of the scapula (POS) in “full can” position. -POS: 30-40 deg anterior to frontal plane -In POS align the supraspinatus with the humerus, allowing for bias of supraspinatus -No higher than 90 deg ABD - or else will bias scapulothoracic movement (don’t want to move the origin) -Try with resistance bands -Step on band with contralateral foot? and abd with thumb up

Question 61

W retractions

Answer 61

-Seated or prone (prone is harder) -W position: 45 deg of ABD; targets rhomboids -Neutral through spine; watch for rotation when doing single arm -Good for students, students, students, OH athletes, anyone hunched

Question 62

T retractions

Answer 62

-T position: 90 deg of ABD; targets middle -Neutral through spine; watch for rotation when doing single arm -Good for students, students, students, OH athletes, anyone hunched -Seated or prone (prone is harder)

Question 63

Y lifts

Answer 63

-Y position: ~120-150 deg ABD; targets lower fibers of trapezius -Emphasis on posterior tilt and retraction while in a superiorly rotated position (scapula) -Upright from kneeling , or prone (parne= most advanced) -Extended elbow position or hands placed gently on the back of the head with elbows flexed

Question 64

Forearm wall slides

Answer 64

-Targets serratus anterior (superior rotation + posterior tilt through flexion) -Superior rotation + posterior tilt through flexion -Stand facing wall, place the ulnar side of forearms/ hands against the wall… or a foam roller -Start at wrist to get most of the range possible out of it -elbows start flexed, become extended as arms move up the wall -Lean into arms; push into the wall to support your body weight -Slide hands up the wall by “spinning” the scapulae, aiming for full flexion or the Y position -A towel of long sleeves can reduce friction between your forearms and the wall

Question 65

Wall angels

Answer 65

-Head and back to the wall (or closest fit)-Stand w/ back to wall, 3 points of wall contact, heels are not. -Partial squat -elbows 90 deg, GH joints ABD ~45-60 deg -Retract scapulae and laterally rotate GH joints -Attempt to bring elbows and back of hands towards the wall (you might not make it all the way up) -Spin the scapula superiorly while abducting the arm at through the angel-wing motion -Scapulae will not rotate if you retract excessively -Targets upper and middle and lower traps

Question 66

Shoulder press

Answer 66

-To the front: flexion -To the side: Abduction -Seated - half kneel - standing (introduce more joints = progression) -Modify how high… 45 deg, 90 deg, 120 deg full ROM -Try with resistance band -For oh work, keep wrist over elbow, spot at wrists to watch for them doming themselves w the weights

Question 67

Neuromuscular skills- Upper Extremity

Answer 67

-Four-point-kneeling on foam, add shoulder taps -Tripod hold; target arms on the ground -Full plank, add shoulder taps? -Visual input or not -Try each position with neck rotated -Four point kneel w/ arms/hands on airex pad, promoting stability by training on unstable surface (aka airex pad)