11/3/2009

Dear Shari and Toby,

EXERCISE - Roy

The biggest mistake I always make when trying to start an exercise routine is doing too much at once. I need to start with a few simple exercises and add to them slowly as I become comfortable with the current loading. I will start with a set of exercises for one area to be done regularly and add to them as I become more proficient. The order of the exercises by need are àneck, wrist, back, shoulders, knees, general. From past experience I have discovered I will not follow through with structured exercise unless I have a tracking chart. This is not from laziness or stupidity but from the difficulty in remembering what the weight and number of repetitions was the last time you performed the exercise. There are many other important things to focus my attention on during the week that are not easily quantified and tracked. An exercise spread sheet is the easiest way to track your progress and remember the exercise order. Diligently marking progress will provide data for later decisions and may help others by example if scanned back into this book. This program will need to be accompanied by a change in diet to provide the proper resources for healing.

TENS will be used for the lower back, wrist and neck to control the pain. I am starting with the neck because there are problems with my thumb which have been diagnosed as a pinched nerve in my neck. It would be difficult to gage the wrist progress with the two problems interacting. As I become fluent with the neck exercises I will add the wrist exercises. At this point I will need to decide on LLLS application. The addition of back exercises when proficient in the two previous exercises should begin to provide general improvement in dexterity. This will be the key to see a chiropractor to align the structure and learn what to do to maintain the alignment. When the pain is gone it will be time to add strengthening exercises for shoulders, knees and general stamina.

EXERCISE DESCRIPTIONS FOR AREAS NEEDING REBUILDING

Neck

Neck Exercises for
Stiff Neck, Neck Pain Relief, Decreased Mobility, Decreased Range of Motion + Strengthening the Neck Muscles

Stretching and Increasing Mobility
Below you will find stretching exercises specifically for the neck. If you suffer from a stiff neck or a pinched nerve in the neck, these exercises with give you pain relief. These are good stretches for your neck and will help you keep your neck flexible and mobile. Keep in mind that if you are having neck pain due to a cervical radiculopathy (pinched nerve in the neck), do these exercises under the guidance of your Dr, your trainer or physical therapist.

More pain and neck stiffness means you will have do these exercises slowly and only to the point that you can feel the stretch- you never want to do them to the point of pain. This is especially important if you suffer with neck arthritis or degeneration in the cervical spine. Keeping the joints moving and flexible is very important for patients with arthritis in the neck. The goal of these neck stretches is to:

• Stretch the Neck Muscles
• Improve flexibility
• Restore the full range of motion in the neck
• Maintain Mobility for patients who have arthritis of degeneration of the cervical spine
• Increase range of motion in the neck.
• Decrease neck stiffness
• Decrease neck pain and inflammation
• Be able to carry out your activities of daily living without a stiff neck, or neck pain- for example- we want you to be able to check your blind spot with out neck pain while driving
• Prevent neck pain and upper back pain at the end of the day when you work on the computer all day

In the cervical spine, we are looking to increase range of motion in

• Flexion (bringing your head and neck forward)
• Extension (bringing your head and neck back- looking up the ceiling)
• Lateral Flexion (right ear to the right shoulder, same on the left)
• Rotation (turning your head and neck from side to side)

*** Always make sure you breathe while doing neck stretches. This is very important as it will help you to relax the neck muscles while taking them through the normal neck range of motion.

1. The first neck exercise is called Cervical Flexion (bringing your chin to your chest) and Cervical Extension (looking up to the ceiling). You want to start by tucking your chin in and gently bringing your head foward and attempting to touch the chin to the chest. Next, gently bend the head backwards as far as it will go. Repeat this exercise 5 times. Forward head flexion is great for those patients who suffer from hypertonic cervical parapinals- which is essentially pain in the back of the neck.
   

2. The next neck exercise is called Lateral Flexion. Bring your right ear to your right shoulder as far as you are able to. Do not rotate or turn your head when you are doing this neck stretch. Then bring your left ear to the left shoulder. Repeat this for 5 times
   
   

3. Next part of the program is called Rotation of the Cervical Spine. In this exercise you want to turn your head to the right as far as you possibly can, trying to bring your chin over your shoulders. When you are doing this neck exercise, do not bring up your shoulders. Hold this position for 3 to 5 seconds. Next do this on the left side of the neck and repeat for 5 times.
   
   
   

4. For the last part of the neck stretching exercise you want to stand with you feet shoulder width apart and place your hands behind your head. Bend from side to side, making sure to bend only with the upper back area and not with the waist or hips. Try to reach the upper elbow to the celing. Hold each movement for 3-5 seconds. Now do the same thing with the left side.
5. Standing with your feet apart shoulder length, clasp your hands behind your back, and pull downward toward the floor with your hands. Take a deep breath in and stand on your toes and look at the ceiling while exerting the downward pull. Hold this stance for 3-5 seconds, then exhale slowly. Relax and repeat 5 times.

Remember neck stretches should always be peformed in a slow and smooth fashion. Especially for those patients who suffer from acute neck pain due to a stiff neck, pinched nerve in the neck, cervical radiculopathy or other severe pain- make sure you do the motions slowly. If anytime you feel neck pain or a "twinge" in the neck, stop doing that exercise immediately. Speak to your Dr about a modified exercise that you can do because of specific neck pain. This home neck exercise program is safe to do at home, but always consult with your treating Dr to make sure that you are in the best health possible to do your own exercises at home without supervision. Finally, remember to breathe and relax while doing the neck stretches.

Strengthening the Neck Muscles

Next we want to discuss a system of exercises that will strengthen the neck muscles. These neck exercises will help to make your neck stronger. This includes your cervical paraspinal muscles, and subocciptial muscles. These exercises are called Isometric exercises. Isometric exercise is a type of exercise involving the static contraction of a muscle without any visible movement in the angle of the joint. In simple terms this means that in these exercises the length of the muscle does not change. As you continue to do these strengthening exercises for the cervical spine you will gain strength in your neck. Over time you should be able to increase the force and number of times you are able to perform the exercises.

1. Press your palms against your forehead and push against each other, resisting motion. Hold this position for 5 seconds and repeat this exercise 3 times.
   

2. With this next cervical strengthening exercise place your hand against the side of your head. Try to bring to your ear to your shoulder, resisting the motion. Repeat this exercise on the other side. Hold each position for 5 seconds and when finished relax slowly.
   

3. Cup both hands against the back of your head. Attempt to push your head back, resisting the motion. Hold this position for 5 seconds, and when finished relax slowly.
   
   

4. In the final cervical strengthening exercise, put your right hand against the right temple. Attempt to turn your chin to your right shoulder, resisting the motion. Repeat this on the left side. Hold for 5 seconds, then relax slowly. Do this neck exercise 3 times.

Right wrist

Tendon Gliding Exercises

Nine tendons pass through the carpal tunnel.   Four of the nine tendons bend the tips of the fingers; another four of the nine tendons bend the middle joints of the finger, and  the ninth tendon bends the thumb tip.  The purpose of these exercises is to glide the tendons gently through the carpal tunnel to minimize microscopic adhesions, reduce congestion, and improve lubrication in the tendons.  These are not strength exercises.   Perform the exercises gently or they may cause a pain flare-up.

hook fist - touch your fingers to the top of your palm.  The large knuckles should be pulled back as much as possible.

full fist- touch your fingers to the middle of your palm.  All three finger joints should be bent.

straight fist - touch your fingers to the bottom of your palm.  The tips of the fingers should be straight.

thumb flexion - Start with your thumb pulled back from your palm as if you are hitch-hiking, then move your thumb across your palm and try to touch the tip of the thumb to the bottom of the small finger. 

Nerve Gliding Exercises

The three nerves that supply power and sensation to the hand begin at the spinal cord in the neck.  They have some elasticity, like a rubber-band, and lengthen and shorten as we move our arms.  With repetitive trauma, microscopic adhesions can bind the nerve.  Then, when the nerve over-stretches, we experience sensations such as pain, numbness, tingling, or coldness in the fingers.

If you are experiencing nerve symptoms, these exercises to glide (or slide, or pump) the nerves are critical.  In fact, in one study, the chances of avoiding surgery improved dramatically when nerve glides were added to the therapy program.

It is very important not to over-stretch the nerve while exercising or you will create symptoms.  Perform these exercises at a quiet time when you can pay close attention to the signals from your body.  Feeling some tension is good but do not stretch to the point that you feel pain or numbness.  You may feel tension anywhere along the nerve pathway, sometimes at quite a distance from the site of pain.  I've had clients feel tension in their arms, shoulders, neck, even chest and back!

I teach clients to gently "pump" the nerve so that it is carefully teased out of adhesions.  Some therapists instruct their clients in a sustained hold of 10 seconds.  Try it both ways and see which feels better for you.

Median Nerve Glide (the carpal tunnel nerve)

1.  Sweep your arm out to the side until it is slightly behind you, palm facing forward, elbow gently straight

Pull your wrist back until you feel a gently tension somewhere in the arm

Relax the wrist forward until tension is relieved

Repeat 10 times

2. Ease the tension on the wrist to about half

Holding this position, gently raise your arm until you feel tension (stay below shoulder height)

Lower the arm until tension is relieved

Repeat 10 times

3. Ease the tension on the arm to about half

Tilt your head (bring opposite ear towards opposite shoulder) until you feel tension

Straighten the neck until tension is relieved

Repeat 10 times

4. Ulnar Nerve Glide (the funny bone nerve)

Place your arm out to your side with the wrist pulled back as if you are saying "stop"

Bring your fingers toward your ear as if to cup the ear with the palm, fingers pointing to the shoulder.  Stop when you feel a gentle tension.

Bring your hand back out to the side until tension is relieved

Repeat 10 times.

As an alternative:

Hold your arm out to the side, elbow straight, fingers gently curved but not in a fist

Rotate your arm fully until the palm is up.

Gently tilt your head (bring opposite ear towards opposite shoulder) until you feel tension

Straighten the neck until tension is relieved

Repeat 10 times

5. Radial Nerve Glide (the back of the hand nerve)

Place your hand at your side with the back of the hand facing forward

Push your shoulder down towards the floor (the movement comes from the shoulder, do not lean)

Bend your wrist toward the palm until you are in the "waiter's tip" position (as if you are a waiter unobtrusively taking a tip)

Move your arm back behind you and up at a slight angle to the side until you feel tension

If you feel as if you need more stretch, gently tilt your head (bring oppositie ear towards opposite shoulder) until you feel tension

Straight the head or move the arm back down until tension is relieved

Repeat 10 times

These nerve glides deserve a repeat of the previous cautions.  Stretch only until you feel a gentle tension.  Avoid pain.  Perform in a quiet environment and listen carefully to your body's feedback while performing.

Finger & Thumb Stretches

Finger abduction and adduction (Spread the fingers apart widely then bring them back together)- This is an exercise that just feels good and can help reduce swelling in the fingers.  It also stretches the hand out of the position it is held in for most of the day.

Thumb stretch - Using your other hand, pull the thumb back into the hitch-hike position.  You should feel a nice stretch in the muscles at the base of the thumb.  Push from the base of the thumb where it meets the palm.  Do not pull from the thumb tip.  This can hyper-extend the tip or the middle thumb joint.  This is an important stretch to perform if you use a blackberry or text-message frequently.

Wrist stretches & Forearm Muscle Stretches

These are great stretches for elbow pain or forearm tightness.  Make sure to keep your shoulders relaxed.  The muscles of the arm being stretched should be relaxed - do not activate the muscles.  The other hand is doing all the work to provide the stretch.  If necessary, start the stretch with the elbow tucked in to your side and then gradually straighten the elbow while you maintain the stretch with the other hand until you feel a good stretch.   Do not hyperextend your elbow.  If performing these stretches with your arm held at shoulder height is uncomfortable, you can relax the shoulder and arm so that it is half-way between the shoulder and the side of your body.  These stretches should not hurt; however, it is okay to feel a gentle "good pain".  Hold for 30-40 seconds.  Perform 2-3 stretches before and after strenuous activity and every 1-2 hours or so during non-strenuous activity.

Forearm Extensor Stretch:  Place your hand in front of your body with the elbow straight and the palm down. Let gravity bend the wrist forward.  With your other hand, gently push the wrist further until you feel a good stretch.  Hold for 30-40 seconds.  Close your fingers gently to increase the stretching sensation.

Forearm Extensor Stretch with Full Pronation:  Same as above but rotate the palm outwards as if you are swinging the small finger up towards the ceiling.  Hold for another 30-40 seconds.  Close your fingers gently to increase the stretching sensation.

Forearm Flexor Stretch with Pronation:  Place your hand in front of your body with the elbow straight as if you are saying "stop".  Support the hand being stretched with the other hand.  Relax the muscles of the arm being stretched so they are not activated.  Gently push the wrist further with the other hand until you feel a good stretch.  Hold for 30-40 seconds.

Forearm Flexor Stretch with Supination:  Begin from the "stop" position with the fingers pointing up towards the ceiling.  Swing your fingers out and rotate your arm until the fingers are now pointing to the floor.  Make sure the muscles are relaxed and not pulling the wrist back actively.  Gently push the wrist further with the other hand until you feel a good stretch.  Hold for 30-40 seconds.  This forearm stretch is often the most uncomfortable for people to perform.  If necessary, bend the elbow to make this stretch more comfortable.

Computer stretches

It is important to stretch frequently throughout the day.  Every 30-60 minutes or so, take 30 seconds to stretch out of the position you have been in.  For example, if seated at a computer, stand up, stretch your back, pull your shoulder blades together, open your arms, turn  your palms up, straighten  your elbows, look up at the ceiling.  Then choose 2 or 3 of the following.  Alternate these throughout the day, so that by the end of the day, you will have performed 2-3 repetitions of all.

Stretches should feel good, not painful.

Occasionally you may feel a "good pain".  This is okay.

Perform stretches smoothly and slowly.

Hold the stretch gently.  Do not bounce.

Breathe slowly, deeply and naturally.

supination

triceps- overhead

triceps - across shoulder

biceps - behind back

shoulder circles - emphasize scap retraction, depression

hands behind head

neck side-bend- neutral, up, down

neck rotation- neutral, up, down

neck retraction- neutral, flexion

Wrist strengthening

flexion -  (wrist curl)

place  the back of your forearm on a padded chair arm with the palm facing up. 

Keep your shoulders relaxed.  Your elbow, shoulder and ear should all line up.

Holding a comfortable amount of weight (a juice can, soup can, water bottle, small weight , 1-5 pounds depending up your conditioning and symptoms) bend the wrist forward for a count of 4, pause briefly, then release for a count of 4. 

Do not snap the wrist forward. 

Control the release.  I

If you have an injury, do not start the movement from an extreme position of wrist extension and do not let the weight roll out to the tips of the fingers.

extension - (reverse wrist curl)

place your forearm on a padded arm chair with the palm facing down.

Keep your shoulders relaxed.  Your elbow, shoulder and ear should all line up.

Holding a comfortable amount of weight (a juice can, soup can, water bottle, small weight , 1-5 pounds depending up your conditioning and symptoms). pull the wrist back for a count of 4, pause briefly, then release for a count of 4. 

Do not snap the wrist back. 

Control the release. 

If you have an injury, do not start the movement from an extreme position of wrist bend.

radial deviation (hammer curl) 

place the small finger edge of the forearm on a padded chair arm with the thumb side of the hand up. 

Keep your shoulders relaxed.  Your elbow, shoulder and ear should all line up.

Holding a comfortable amount of weight (a juice can, soup can, water bottle, small weight , 1-5 pounds depending up your conditioning and symptoms) gently bend the wrist up towards the thumb then down towards the small finger as if you are slowly using a hammer. 

Do not snap the wrist. 

Control the release.

supination & pronation - (forearm rotation)

tuck your elbow gently in at your side. 

Keep your shoulders relaxed.  Your elbow, shoulder and ear should all line up.

Holding a comfortable amount of weight (a juice can, soup can, water bottle, small weight, 1-5 pounds depending up your conditioning and symptoms) slowly rotate your palm up for a count of 4, then rotate your palm down for a count of four. 

All the movement should come from the forearm.  Do not let the elbow move in towards the body or out away from the body.

Back

Initial Exercise Program

Ankle Pumps

1. Lie on your back.

2. Move ankles up and down. Repeat 10 times.

3. Repeat 10 times.

Heel Slides

1. Lie on your back.

2. Slowly bend and straighten knee.

3. Repeat 10 times.

Abdominal Contraction

1. Lie on your back with knees bent and hands resting below ribs.

2. Tighten abdominal muscles to squeeze ribs down toward back.

3. Be sure not to hold breath.

4. Hold 5 seconds.

5. Relax.

6. Repeat 10 times.

Wall Squats

1. Stand with back leaning against wall.

2. Walk feet 12 inches in front of body.

3. Keep abdominal muscles tight while slowly bending both knees 45 degrees.

4. Hold 5 seconds.

5. Slowly return to upright position.

6. Repeat 10 times.

Heel Raises

1. Stand with weight even on both feet.

2. Slowly raise heels up and down.

3. Repeat 10 times.

Straight Leg Raises

1. Lie on your back with one leg straight and one knee bent.

2. Tighten abdominal muscles to stabilize low back.

3. Slowly lift leg straight up about 6 to 12 inches and hold 1 to 5 seconds.

4. Lower leg slowly.

5. Repeat 10 times.

Top of page

Intermediate Exercise Program

Single Knee to Chest Stretch

1. Lie on your back with both knees bent.

2. Hold thigh behind knee and bring one knee up to chest.

3. Hold 20 seconds.

4. Relax.

5. Repeat 5 times on each side.

Hamstring Stretch

1. Lie on your back with legs bent.

2. Hold one thigh behind knee.

3. Slowly straighten knee until a stretch is felt in back of thigh.

4. Hold 20 seconds.

5. Relax.

6. Repeat 5 times on each side.

Lumbar Stabilization Exercises With Swiss Ball

Abdominal muscles must remain contracted during each exercise (see Abdominal Contraction). Perform each exercise for 60 seconds. The farther the ball is from your body, the harder the exercise.

Lying on Floor

1. Lie on your back with knees bent and calves resting on ball.

2. Slowly raise arm over head and lower arm, alternating right and left sides.

3. Slowly straighten one knee and relax, alternating right and left sides.

4. Slowly straighten one knee and raise opposite arm over head. Alternate opposite arms and legs.

5. Slowly "walk" ball forward and backward with legs.

Sitting on Ball

1. Sit on ball with hips and knees bent 90°and feet resting on floor.

2. Slowly raise arm over head and lower arm, alternating right and left sides.

3. Slowly raise and lower heel, alternating right and left sides.

4. Slowly raise one heel and raise opposite arm over head. Alternate opposite arm and heel.

5. Marching: Slowly raise one foot 2 inches from floor, alternating right and left sides.

Standing

1. Stand with ball between your low back and wall.

2. Slowly bend knees 45 ° to 90 ° . Hold 5 seconds. Straighten knees.

3. Slowly bend knees 45 ° to 90 ° while raising both arms over head.

Lying on Ball

1. Lie on your stomach over ball

2. Slowly raise alternate arms over head.

3. Slowly raise alternate legs 2 to 4 inches from floor.

4. Combine 1 and 2, alternating opposite arms and legs.

5. Bend one knee. Slowly lift this leg up, alternating right and left legs.

NOTE: Be careful not to arch your low back!

Advanced Exercise Program

Hip Flexor Stretch

1. Lie on your back near edge of bed, holding knees to chest.

2. Slowly lower one leg down, keeping knee bent, until a stretch is felt across top of the hip/thigh.

3. Hold 20 seconds.

4. Relax.

5. Repeat 5 times on each side.

Piriformis Stretch

1. Lie on back with both knees bent.

2. Cross one leg on top of the other.

3. Pull opposite knee to chest until a stretch is felt in the buttock/hip area.

4. Hold 20 seconds.

5. Relax.

6. Repeat 5 times each side.

Lumbar Stabilization Exercise With Swiss Ball

1. Lie on stomach over ball.

2. " Walk " hands out in front of ball until ball is under legs. Reverse to starting position.

3. " Walk " hands out in front of ball until ball is under legs and slowly raise alternating arms over head.

4. " Walk " hands out in front of ball and slowly perform push-ups.

Shoulders

Knees

General Stamina

 EXERCISE.HTM