segunda-feira, 22 de Agosto de 2011

Patellofemural Pain Syndrome Home exercises

Before starting any of the exercises mentioned below, search advice from your physical therapist, for he is the only one that really knows your actual condition and what you shouldn’t do or should do.
In order to achieve proper rehabilitation of your injury it is important to ensure the exercises are performed with good technique, for poor practice leads to poor performance and potential strain on your injury. To avoid that, it is important the presence of a physical therapist.
If at any time you feel pain or discomfort, stop the exercises and consult your physical therapist.

Warm up

When injured it is particularly important that you warm up with a fast walk (at a pain free pace) for 3-4 minutes before you start your exercises. This increases your circulation and helps prepare your muscles. 

Quadriceps sets

1.    Sit with your affected leg straight and supported on the floor or a firm bed. Place a small, rolled-up towel under your affected knee. Your other leg should be bent, with that foot on the floor.
2.    Tighten the thigh muscles of your affected leg by pressing the back of your knee down into a towel. Hold for about 6 seconds, and then rest for up to 10 seconds.
3.    Repeat 8 to 12 times.

Straight-leg raises to the front

1.    Lie on your back with your good knee bent so that your foot rests flat on the floor. Your affected leg should be straight. Make sure that your low back has a normal curve. You should be able to slip your hand in between the floor and your back, with your palm touching the floor and the back of your hand touching your back.
2.    Tighten the thigh muscles in your affected leg by pressing the back of your knee flat down to the floor. Hold your knee straight.
3.    Keeping the thigh muscles thigh and your leg straight, lift your affected leg up so that your heel is about 12 inches off the floor.
4.    Hold for about 6 seconds, and then lower your leg slowly. Rest for up to 10 seconds between repetitions.
5.    Repeat 8 to 12 times.

Wall slide with ball squeeze

1.    Stand with your back against a wall and with your feet about shoulder-width apart. Your feet should be about 12 inches away from the wall.
2.    Put a ball about the size of a soccer ball between your knees. Then slowly slide down the wall until your knees are bent about 20 to 30 degrees.
3.    Tighten your thigh muscles by squeezing the ball between your knees. Hold that position for about 10 seconds, and then stop squeezing. Rest for up to 10 seconds between repetitions.
4.    Repeat 8 to 12 times.

After being able to perform well the exercises mentioned above (not only being able to do the exercise, but to do it correctly, with appropriate control), there is an exercise program to stretch thigh muscles, strengthen the quadriceps and correct lower limb alignment in order to improve the tracking of your patella. 
     Static squat against wall.

2.    Mini-squat on both legs with support (on a chair, for example)

3.    Mini-squat on both legs without support

4.    Mini-squat on both legs with weights (start with 0.5 Kg in each hand)

5.    One leg mini-squat with support

6.    One leg mini-squat without support

7.    One leg mini-squat with weight (start with 0.5 Kg in each hand)

8.    Step up

9.    Step up with weight (start with 0.5 Kg in each hand)
1   Step down

11. Step down with weight (start with 0.5 Kg in each hand)

12. Step to (side-side)

13. Hop

Calf wall stretch

1.    Stand facing a wall with your hands on the wall at about eye level. Put your affected leg about a step behind your other leg.
2.    Keeping your back leg straight and your back heel on the floor bend your front knee and gently bring your hip and chest toward the wall until you feel a stretch in the calf of your back leg.
3.    Hold the stretch for at least 15 to 30 seconds.
4.    Repeat 2 to 4 times.
5.    Repeat steps 1 through 4, but this time keep your back knee bent.

Quadriceps stretch

1.    If you are not steady on your feet, hold on to a chair, counter, or wall.
2.    Bend your affected leg, and reach behind you to grab the front of your foot or ankle with the hand on the same side. For example, if you are stretching your right leg, use your right hand.
3.    Keeping your knees next to each other, pull your foot toward your buttocks until you feel a gentle stretch across the front of your hip and down the front of your thigh. Your knee should be pointed directly to the ground, and not out to the side.
4.    Hold the stretch for at least 15 to 30 seconds.
5.    Repeat 2 to 4 times.

Hamstring wall stretch

1.    Lie on your back in a doorway, with your good leg through the open door.
2.    Slide your affected leg up the wall to straighten your knee. You should feel a gentle stretch down the back of your leg.
a.    Do not arch your back.
b.    Do not bend the knee.
c.    Keep one heel touching the floor and the other heel touching the wall. Do not point your toes.
3.    Hold the stretch for at least 1 minute. Then over time, try to lengthen the time you hold the stretch to as long as 6 minutes.
4.    Repeat 2 to 4 times.

Iliotibial muscle stretch

1.    Stand side on to a wall with the affected leg closest to the wall.
2.    Place your arm on the wall for support and cross the affected leg behind the other.
3.    Lean your hips towards the wall. Keep your spine and pelvis in a neutral position.
4.    Hold the stretch for at least 1 minute.
5.    Repeat 2 to 4 times.

domingo, 7 de Agosto de 2011

Thoracic Outlet Syndrome (TOS) home exercises

A person suffering from Thoracic Outlet Syndrome (TOS) should have various precautions, like taking care of his posture and ergonomics. There are certain postures and activities that aggravate TOS symptoms and others that reduce the symptoms. The head-forward posture aggravates TOS symptoms, which combines rounded spine and forward head with protracted shoulders, commonly referred to as “slouching”. 

Activities that aggravate TOS symptoms are reaching above shoulder level and carrying heavy weights. Good posture alleviates symptoms and is as follows: Bring shoulders back to a relaxed but retracted position; head should glide back automatically when shoulders are in correct position, weight should be distributed equally on both feet and low back should retain its normal lordosis. The patient can attempt a rigid military stance and then relax the position to improve comfort and compliance. Proper posture should be maintained when sitting, standing, or walking.
The exercises most commonly given to patients to relax the shoulder girdle and upper trapezius musculature, stretch the scalene and pectoral muscles and strength the cervical extensors, scapular adductors, and shoulder retractors.
Before starting any of these exercises be sure to get advise from your physical therapist, for he is the only one that knows what types of exercises you can or cannot start doing!

Neck (the patient is to sit with the arms resting on pillows, back straight and low back supported)

·         Neck side bending – this exercise stretches the trapezius muscles. Bring the ear of your affected side towards the shoulder of the same side without shrugging the shoulders and hold for 5 seconds.

·         Neck rotation – this stretches the cervical muscles and improves neck rotation. Turn head to side and look over to your unaffected shoulder while keeping the body facing forward; hold for 5 seconds and repeat 5 times.

·         Neck extension – this exercise stretches the scalene muscles and the flexors. Bend the neck backwards to the back and hold for 5 seconds then return the head to it neutral position. Repeat 5 times.

·         Neck flexion – this exercise stretches the cervical extensors and upper trapezius muscles. Bend the neck forward to chest and hold for 5 seconds then return the head to the neutral position. Repeat 5 times. 

·         Chin tucks – this exercise stretches the cervical extensors and strengthens the paraspinal muscles. Try to make a double chin, feeling a stretch behind the neck and hold for 5 seconds. Repeat 5 times, relaxing between efforts. 

·         Neck half-circles – this exercise combines all the neck exercises and improve the Range of Motion (ROM). Roll the head slowly from one ear to the same side shoulder, then the chin to the chest and then the other ear to the other shoulder slowly 5 times in each direction.  

Shoulder (these exercises are done standing up)

·         Pendulum exercises – First do this exercise with 1-lb weight for 1-2 minutes. This exercise loosens the shoulder girdle by putting gentle traction on the upper quadrant. Do this exercise near to a table. Place the hand of your unaffected side on the table and bend your body in a 45º degree angle and relax your affected arm perpendicular to your body, aiming to the floor. Do a pendulum movement with your affected arm.  

·         Shoulder shrugs – elevate shoulders up to ears and then slowly lower, repeating five times. This exercise strengthens and relaxes the upper trapezius muscles and encourages scapular retraction and cervical extension.

Sh Shoulder circles – roll shoulders forward five times then backward five times. This exercise alternately strengthens and stretched the entire shoulder girdle.

·         Elbow pinches – place hands on the waist and move the elbows behind your back attempting to touch the elbows together. Hold for 5 seconds, then relax and repeat 5 times. This stretches the pectoral musculature and strengthens the scapular adductors.

·         Corner stretch – stand in a corner or a doorway and put one hand on each wall or doorframe and then slowly let the upper part of the body lean forward into the corner or doorway. Though standing, the body’s position resembles a push-up and stretches the pectoral muscles while strengthening the scapular muscles. 

·         High swings – as a cool-down exercise, stand with arms to side, swinging both arms forward and backward as a pendulum as high as possible in each direction. Repeat five times. 

·         Side swings – swing arms forward crossing each other at shoulder level and then swing the arms back and try to make your shoulder blades to touch. Repeat five times. This loosens the shoulder girdle. 

Crosby, C.A., Marwan, A.W. (2004). Conservative treatment for Thoracic Outlet Syndrome. Hand Clinics (20): 43-49