OSCE: Exercise Prescription Flashcards
Balance Training (Eyes open or closed)
How would you do this?
- With eyes open, balance on left leg with hands on hips. (May hold onto a stationary object if needed).
- Slowly reach out with right leg as far as possible without touching the floor.
- Continue to repeat with varying directions for right leg.
- Can then repeat exercise with eyes closed.
Quadricpes and Recturs Femoris Stretch
How would you perform this stretch?
Presents as hip flexion somatic dysfunction
- Position as shown with care taken to:
- Keep hip of quads being stretched straight.
- Opposite knee is ideally slightly flexed.
- Contract the gluteus muscles during stretch.
Iliopsoas Stretch
Presents as hip flexion somatic dysfunction.
- Kneel, with the knee on the side of dysfunction on the floor, and the non-dysfunctional leg flexed to 90 degrees.
- Contract your gluteal muscles for 3 deep breaths or 20 seconds.
- Repeat 3-5 times.
- Can repeat on both sides if both are dysfunctional.
Iliopsoas Stretch (Upward Dog)
Presents as hip flexion somatic dysfunction.
- Lay down on your stomach, with your hands at shoulder level on either side of your chest (Figure A)
- Push up, but try to keep the part of your abdomen that is inferior to your belly button on the floor, resulting in the “cobra” posture (Figure B).
- Take 5 deep breaths & slowly lower yourself downward again (Back to Figure A).
- Rest for a breath or 2 & then repeat it again 2-4 more times.
- Alternate stretch: repeat steps 1-4 but with one leg off of table (Figure C).
Lower Extremity Adductor Stretch
How would you perform this stretch?
Presents as hip adduction somatic dysfunction.
- Sit on the floor with your back straight and your gluteal muscles as close to the wall as possible.
- Place your hands on the floor behind your hips & press your hands into the floor.
- Next, arch your back & feel your pelvis rotate anteriorly.
- Hold this position for 20 seconds.
- Repeat this exercise 3 times and then 3 times a day.
Piriformis Stretch
How would you perform this stretch?
Presents as pain/tenderness in gluteal region and posterior leg
For left sided dysfunction:
- Lay supine with left hip flexed and adducted, and knee flexed. Place left foot lateral to right knee.
- Place right hand on lateral aspect of left knee.
- With exhalation, apply gentle pressure to pull knee further to right side of body.
Reverse directions for RIGHT sided dysfunction.
Piriformis Stretch Self MET
How would you perform this stretch?
Presents as pain/tenderness in gluteal region and posterior leg
- Lay on your back with dysfunctional leg crossed over the other, as shown above.
- Grab the table to stabilize your hip against the table.
- Place your other hand on the outside of your thigh or knee. Inhale deeply & gently press your thigh/knee into your hand for 3-5 seconds.
- Then, exhale and relax your leg, allowing your hand to pull your dysfunctional leg further towards the other side (in example, pull left leg towards the right side).
- Repeat steps 3 & 4 another 3-5 times.
Prone Piriformis Self-Stretch
How would you perform this stretch?
Presents as pain/tenderness in gluteal region and posterior leg
- Start off on all fours & bring your involved leg closer to your hands, getting it as close to the horizontal position as possible (Figure A, treating L piriformis in photo).
- Then, lower yourself onto your forearms & slide your other leg further farther behind you, keeping it as straight as possible (Figure B).
- Hold this position for 20 seconds.
- Repeat this 3-5 times & then repeat the whole activity 2-3 times a day.
Tensor Fascia Lata Stretch (Supine)
How would you perform this stretch?
Presents as tightness in the abductors and inability to adduct
- Start lying supine, with your arms out to the sides (abducted to 90 degrees).
- While maintaining a posterior pelvic tilt (tuck the tailbone in), externally rotate the leg to be stretched, while also adducting that leg.
- Allow the pelvis to rotate towards leg to be stretched.
- Hold stretch for 20 seconds.
- To transition to a stretch of the quadratus lumborum:
- Place hands behind head.
- Bend the unaffected leg to 90 degrees, and bend and flex the affected leg to 90 degrees.
Tensor Fascia Lata Stretch (Standing)
How would you perform this stretch?
Presents as tightness in the abductors and inability to adduct
To treat a tight RIGHT tensor fascia lata muscle (as shown in image on R)
- Stand with you legs crossed at the knees, as shown
- Then shift your weight mostly onto the foot of the side you are trying to stretch (shift weight onto R foot, as in photo), allowing your hip to shift toward the affected side (the R side).
- Reach the arm on that side over towards the other side (reach arm to the LEFT).
Reverse the position and direction to treat a tight LEFT TFL. Can also hold onto a supportive chair instead of hip.
Quadratus Lumborum Stretch
How would you perform this stretch?
Left Side:
- Stand with your legs a little more than shoulder width apart and reach your arm (on the unaffected side) down your thigh toward your knee, looking at the ceiling (Figure A).
- Then, exhale and look down (Figure B).
- Upon looking down your hand should be able to slide down your leg more.
- Repeat 3-5 times. The whole exercise should be repeated 2-3 times a day.
You can perform on both sides as a treatment option. To treat only a tight RIGHT QL, reverse the directions in the above instructions.
Hamstring Stretch (on floor)
How would you preform this strech?
Presents as restriction to hip flexion (hip extension somatic dysfunction)
- Using a wall or flat table, place your hands upon it. Your feet should be about 6 inches apart.
- The goal is to keep your neck, upper & lower back relatively flat and elongated, putting your feet beneath your lower abdomen.
- Try to straighten your legs so that your gluteal muscles move toward the ceiling.
- Hold this position for 20 seconds. Then, relax and, while keeping your spine straight, bend your knees as if you were going to sit down on something.
- Repeat this exercise 3 times.
5.
Hamstring Stretch (seated)
How would you preform this strech?
Presents as restriction to hip flexion (hip extension somatic dysfunction)
- Start seated on the floor with one leg straight out in front of you & the other bent with your foot against your inner thigh.
- Reach your hands as far down your leg as possible. When you can’t reach your hands any further, try to push your heel through the floor for 20 seconds.
- Rest for 5 seconds & then repeat this stretch 2-3 times on each side.
- Repeat this routine 2-3 times a day.
Gluteus Medius and Abductor/Adductor Strengthening
How would you perform this activity?
Clamshell Exercise (Left Side):
- From a lateral recumbent position, flex hips to 45 degrees and flex knees 90 degrees.
- Keeping feet together, raise left knee ~6 inches (~15 cm) while exhaling.
- Return to starting position during inhalation.
- Repeat 10-15 times per session.
Abdominal Sit-Backs
How would you perform this activity?
- Level 1: Arms extended
- Level 2: Arms folded
- Level: 3: Arms behind head
- Level 4: Obliques
Deep Pressure on Tender Points in Upper Trapezius and Levator Scapula
- Instruct patient to identify any knots in their upper trapezius.
- Apply deep pressure to release muscle tension.
- Hold pressure and allow tender point to melt.
- Follow with self-stretching, if possible.
Levator Scapulae Stretch
How would you perform this stretch?
Presents as pain in base of neck
Left Side:
- Patient grasps back corner of chair seat and leans towards their contralateral knee (if treating LEFT dysfunctional levator scapula, lean towards RIGHT knee).
- Patient places other hand on the back of their head, if able, and stretches slightly further by adding a feather’s edge more weight in direction of contralateral knee.
- Patient contracts their ipsilateral armpit inferiorly for 5 seconds.
- Upon relaxing the contraction, the patient allows themselves to advance closer to their contralateral knee (further stretching the levator scapula).
- .Steps 3 and 4 are repeated 3-5 times, or until there is no more advancement towards the knee upon relaxation of the stretch.
Scalene Stretch
How would you perform this stretch?
Presents as pain in neck.
Left Side:
- Place the hand of the affected side under your gluteal muscles, palm up. Use your other hand to reach over your head and grab just above the ear of the affected side.
- Place your neck into a sidebending stretch toward the unaffected side.
- Take a deep breath feel the tension mount in your head placed hand, upon exhalation follow the relaxation of your neck into further sidebending.
- Repeat this 3-6 times and make sure the other side is stretched equally.
- Do this exercise 3 times a day.
Scalene Stretch (Gravity Stretch)
How would you perform this stretch?
Presents as pain in neck.
- While lying on your unaffected side, lift your head and look away from the table/bed while taking a deep inhalation (Figure A).
- Hold your breath for a count of five and, while exhaling, allow your head to sink back towards the table/bed (Figure B).
- Repeat this exercise 3 times.
- Perform this exercise 3 times a day.
- Can repeat on opposite side to make sure both sides are loose.
Latissimus Dorsi Hypertonicty: Gravity Stretch
How would you perform this stretch?
Presents as midthoracic back pain.
- Start by lying on your unaffected side.
- Raise your affected arm over and behind your head (Figure A).
- Allow gravity to stretch the muscle into a more relaxed position (Figure B).
- Taking a few deep breaths and breathing through the tension may be very helpful.
- Perform this stretch at least 3 times a day as needed.
Latissimus Dorsi Prayer Stretch
How would you perform this stretch?
Presents as midthoracic back pain.
- Starting on your knees with you elbows together and planted on the seat of a chair, lower yourself into the position of the image to the right.
- Drop your chest and sit back towards your heels.
- A stretch should be felt in the upper back.
- Increasing the curve in your lower back should increase the stretch.
- Hold this stretch for 5-6 deep breaths.
- After the 5-6 breaths relax and take the pressure off the back muscles. Repeat this stretch again.
- Perform this at least twice a day and after any exercise, especially when the exercise involves rotating your trunk.
Subscapularis Gravity Self-Stretch
How would you perform this stretch?
Presents as internally rotated SD
- Start lying supine. Raise the affected arm midway in the palm-up position (Figure A).
- Allow gravity to stretch the muscle to a more relaxed position (Figure B).
- Taking a few deep breaths and breathing through the tension may be very helpful.
- Perform this stretch at least 3 times a day as needed.
Subscapularis Resistance Self MET
How would you perform this stretch?
Presents as internally rotated SD
- Start by lying on the side of the affected arm, with your arm flexed (Figure A).
- Allow the back of your wrist to drop as close to the bed/floor as possible (Figure A).
- Press your unaffected hand into the wrist of the affected arm with a gentle pressure (only to the feather’s edge of discomfort). Push your affected arm into your unaffected wrist for 3 deep breaths (Figure B).
- After the 3 breaths relax and take the pressure off. Repeat this stretch again.
- Perform this at least twice a day, and before and after any exercise, especially when the exercise involves rotating your arm.
Pectoralis Major and Minor Stretch
How would you perform this stretch?
- Stretch for 20 seconds, and repeat 2-3 times.
- Repeat 2-3 times/day.
- Remember to take deep breaths and go only to the feather’s edge of discomfort.
Arm Wheels: Shoulder Stretch
- Start by lying down on your side with a pillow between your neck & shoulder
- Reach your free arm straight out in front of you & rotate it at your shoulder in a circular fashion, like a wheel, while keeping your hand as close as possible to the surface upon which you are lying.
- At the top of your stretch, when your arm is closest to your head, rotate your hand around to face the ceiling
- When you get to the point indicated above (180 degrees from the starting position), rotate back to the start position by going in the opposite direction.
Retraining Scapular Stabilization
Presents as weakness in the rhomboids
- Stand at arms length from a wall, and place your hands on the wall about shoulder width apart while looking at the ground (Figure A).
- Push the wall away, allowing your shoulder blades to spread apart and drift forwards towards the wall (this protracts the scapula).
- Slowly, allow your body to go forward toward the wall and at the same time uncurl your neck starting at the lowest portion first so that you eventually end with your nose near touching the wall and your shoulder blades squeezing close together (this retracts the scapula) (Figure B).
- Then, push away from the wall allowing your neck to bend forward from the top vertebra down to your shoulders maximally pushing away from the wall
- Your neck should ideally be fully bent with your chin on your chest to return to the Figure A position.
- Hold that position for 2 deep breaths and then return to the start position. Repeat the retraining exercise 8-12 times and then do this 2-3 times a day.
Scapular Retraining
- Push elbows posteriorly and squeeze scapulae together (can also add chin tuck)
- Inhale while contracting; Exhale and relax.
Standing Posture
Stand with your feet about 4 inches apart, arms at your sides and with your thumbs pointing forwards (Figure A).
- Tighten your gluteal muscles.
- Rotate your arms and shoulders out and back while inhaling (make sure to feel your shoulder blades squeeze together in your back); your thumbs rotate outwards.
- Maintain this position while pulling your shoulder down and exhaling (Figure B).
- Hold this position while breathing normally and correcting the head posture (pretend you are suspended by a Unicorn horn at a 60 degree angle from the ceiling).
Seated Posture & Retraining
- Fully extend, fully slouch…then find the middle.
- The middle is probably where you need to retrain your body to be comfortable.
- Practice sitting in the middle each time you sit. When your muscles fatigue, you can let go of the posture.
- It may take a year to become capable of maintaining this posture.
