The following stretches (many of which are commonly performed) are considered risky (M. Alter uses the term `X'-rated) due to the fact that they have a very high risk of injury for the athlete that performs them. This does not mean that these stretches should never be performed. However, great care should be used when attempting any of these stretches. Unless you are an advanced athlete, you can probably do without them (or find alternative stretching exercises to perform). Each of these stretches is illustrated in detail in the section X-Rated Exercises of M. Alter:
the yoga plough
In this exercise, you lie down on your back and then try to sweep your legs up and over, trying to touch your knees to your ears. This position places excessive stress on the lower back, and on the discs of the spine. Not to mention the fact that it compresses the lungs and heart, and makes it very difficult to breathe. This particular exercise also stretches a region that is frequently flexed as a result of improper posture.
the traditional backbend
In this exercise, your back is maximally arched with the soles of your feet and the palms of your hands both flat on the floor, and your neck tilted back. This position squeezes (compresses) the spinal discs and pinches nerve fibers in your back.
the traditional hurdler's stretch
This exercise has you sit on the ground with one leg straight in front of you, and with the other leg fully flexed (bent) behind you, as you lean back and stretch the quadricep of the flexed leg. The two legged version of this stretch is even worse for you, and involves fully bending both legs behind you on either side. The reason this stretch is harmful is that it stretches the medial ligaments of the knee (remember, stretching ligaments and tendons is bad) and crushes the meniscus. It can also result in slipping of the knee cap from being twisted and compressed.
straight-legged toe touches
In this stretch, your legs are straight (either together or spread apart) and your back is bent over while you attempt to touch your toes or the floor. If you do not have the ability to support much of your weight with your hands when performing this exercise, your knees are likely to hyperextend. This position can also place a great deal of pressure on the vertebrae of the lower lumbar. Furthermore, if you choose to have your legs spread apart, it places more stress on the knees, which can sometimes result in permanent deformity.
Torso twists
Performing sudden, intense twists of the torso, especially with weights, while in an upright (erect) position can tear tissue (by exceeding the momentum absorbing capacity of the stretched tissues) and can strain the ligaments of the knee.
Inverted Stretches
This is any stretch where you "hang upside down". Staying inverted for too long increases your blood pressure and may even rupture blood vessels (particularly in the eyes). Inverted positions are especially discouraged for anyone with spinal problems.
Monday, July 16, 2007
EXERCISES
BENDING THE WRIST TO A TARGET:
Physiotherapist`s aim:
To improve the ability to extend the wrist.
Client`s aim:
To improve your ability to straighten your wrist.
Physiotherapist`s instructions:
Position the patient in sitting with their forearm pronated and resting on a block on a table in front of them.
Place a cup in their hand, a sandbag on their forearm and tape a flexible straw to the dorsal surface of their forearm with the joint of the straw aligned with their wrist joint.
Instruct the patient to extend their wrist to touch the tip of the straw and then relax their wrist back into flexion.
Client`s instructions:
Position yourself sitting with your forearm resting on a block on a table in front of you and your palm facing down.
Place a cup in your hand, a sandbag on your forearm and tape a flexible straw to the top of your forearm so that the bend of the straw is over your wrist.
Practice straightening your wrist so that your hand touches the tip of the straw then relaxing your hand back down again.
Progressions and variations:
Less advanced: 1. Bend the straw down to decrease the range that the wrist needs to move through. 2. Hold a cup with a smaller diameter.
More advanced: 1. Bend the straw up to increase the range that the wrist needs to move through. 2. Hold a cup with a larger diameter. 3. Hold a cup that can deform.
BENDING THE WRIST WHILE HOLDING A CUP:
Physiotherapist`s aim:
To improve the ability to radially deviate the wrist.
Client`s aim:
To improve your ability to bend your wrist.
Physiotherapist`s instructions:
Position the patient in sitting with their hand grasping a cup and hanging over the edge of a table.
Instruct the patient to tilt the cup up by radially deviating their wrist.
Client`s instructions:
Position yourself sitting with your hand grasping a cup and hanging over the edge of a table. Practice tilting the cup up by bending your wrist.
Progressions and variations:
Less advanced: 1. Move the cup through a smaller range of motion. 2. Use a cup with a smaller diameter.
More advanced: 1. Move the cup through a larger range of motion. 2. Use a cup with a larger diameter. 3. Use a cup that can deform. 4. Add water to the cup.
BICEPS ELECTRICAL STIMULATION:
Physiotherapist`s aim:
To strengthen the elbow flexors.
Client`s aim:
To strengthen your biceps.
Physiotherapist`s instructions:
Place the electrodes over the muscle belly of the elbow flexors.
Client`s instructions:
Place the two electrodes over the muscle belly as shown.
Precautions:
1. Perform skin tests.
BILATERAL ANKLE PLANTORFLEXOR STRETCH USING A WEDGE WHILE STANDING AGAINST A WALL:
Physiotherapist`s aim:
To stretch or maintain length of the ankle plantarflexors.
Client`s aim:
To stretch or maintain range in your ankles.
Physiotherapist`s instructions:
Position the patient in standing with their back against a wall and both feet on a wedge.
Ensure that their knees are kept straight and both feet point forwards.
Client`s instructions:
Position yourself standing with your back against a wall and both feet on a wedge.
Ensure that you keep your knees straight and both feet point forwards.
Progressions and variations:
Less advanced: 1. Decrease the angle of the wedge.
More advanced: 1. Increase the angle of the wedge.
Precautions:
1. Impaired or absent sensation of stretch.
BILATERAL ANKLE PLANTORFLEXOR STRETCH USING A WEDGE WHILE STANDING AT A TABLE:
Physiotherapist`s aim:
To stretch or maintain length of the ankle plantarflexors.
Client`s aim:
To stretch or maintain range in your ankles.
Physiotherapist`s instructions:
Position the patient in standing with both feet on a wedge and a table in front.
Ensure that their knees are kept straight and both feet point forwards.
Client`s instructions:
Position yourself standing with both feet on a wedge and a table in front.
Ensure that you keep your knees straight and both feet point forwards.
Progressions and variations:
Less advanced: 1. Decrease the angle of the wedge.
More advanced: 1. Increase the angle of the wedge.
Precautions:
1. Impaired or absent sensation of stretch.
BILATERAL CALF RAISES:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in standing.
Instruct the patient to plantarflex their ankles.
Client`s instructions:
Position yourself standing with your feet together.
Start with your heels on the ground.
Finish with your heels off the ground.
Progressions and variations:
Less advanced: 1. Provide hand support for balance.
More advanced: 1. Progress using strength training principles.
BILATERAL CALF RAISES ON A BLOCK:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in standing on a step with their heels off the edge.
Instruct the patient to plantarflex their ankle.
Client`s instructions:
Position yourself standing on a step with your heels off the edge.
Lift your body weight up onto your toes.
Progressions and variations:
Less advanced: 1. Provide hand support for balance.
More advanced: 1. Wear a backpack with weights in it. 2. Progress using strength training principles.
Physiotherapist`s aim:
To improve the ability to extend the wrist.
Client`s aim:
To improve your ability to straighten your wrist.
Physiotherapist`s instructions:
Position the patient in sitting with their forearm pronated and resting on a block on a table in front of them.
Place a cup in their hand, a sandbag on their forearm and tape a flexible straw to the dorsal surface of their forearm with the joint of the straw aligned with their wrist joint.
Instruct the patient to extend their wrist to touch the tip of the straw and then relax their wrist back into flexion.
Client`s instructions:
Position yourself sitting with your forearm resting on a block on a table in front of you and your palm facing down.
Place a cup in your hand, a sandbag on your forearm and tape a flexible straw to the top of your forearm so that the bend of the straw is over your wrist.
Practice straightening your wrist so that your hand touches the tip of the straw then relaxing your hand back down again.
Progressions and variations:
Less advanced: 1. Bend the straw down to decrease the range that the wrist needs to move through. 2. Hold a cup with a smaller diameter.
More advanced: 1. Bend the straw up to increase the range that the wrist needs to move through. 2. Hold a cup with a larger diameter. 3. Hold a cup that can deform.
BENDING THE WRIST WHILE HOLDING A CUP:
Physiotherapist`s aim:
To improve the ability to radially deviate the wrist.
Client`s aim:
To improve your ability to bend your wrist.
Physiotherapist`s instructions:
Position the patient in sitting with their hand grasping a cup and hanging over the edge of a table.
Instruct the patient to tilt the cup up by radially deviating their wrist.
Client`s instructions:
Position yourself sitting with your hand grasping a cup and hanging over the edge of a table. Practice tilting the cup up by bending your wrist.
Progressions and variations:
Less advanced: 1. Move the cup through a smaller range of motion. 2. Use a cup with a smaller diameter.
More advanced: 1. Move the cup through a larger range of motion. 2. Use a cup with a larger diameter. 3. Use a cup that can deform. 4. Add water to the cup.
BICEPS ELECTRICAL STIMULATION:
Physiotherapist`s aim:
To strengthen the elbow flexors.
Client`s aim:
To strengthen your biceps.
Physiotherapist`s instructions:
Place the electrodes over the muscle belly of the elbow flexors.
Client`s instructions:
Place the two electrodes over the muscle belly as shown.
Precautions:
1. Perform skin tests.
BILATERAL ANKLE PLANTORFLEXOR STRETCH USING A WEDGE WHILE STANDING AGAINST A WALL:
Physiotherapist`s aim:
To stretch or maintain length of the ankle plantarflexors.
Client`s aim:
To stretch or maintain range in your ankles.
Physiotherapist`s instructions:
Position the patient in standing with their back against a wall and both feet on a wedge.
Ensure that their knees are kept straight and both feet point forwards.
Client`s instructions:
Position yourself standing with your back against a wall and both feet on a wedge.
Ensure that you keep your knees straight and both feet point forwards.
Progressions and variations:
Less advanced: 1. Decrease the angle of the wedge.
More advanced: 1. Increase the angle of the wedge.
Precautions:
1. Impaired or absent sensation of stretch.
BILATERAL ANKLE PLANTORFLEXOR STRETCH USING A WEDGE WHILE STANDING AT A TABLE:
Physiotherapist`s aim:
To stretch or maintain length of the ankle plantarflexors.
Client`s aim:
To stretch or maintain range in your ankles.
Physiotherapist`s instructions:
Position the patient in standing with both feet on a wedge and a table in front.
Ensure that their knees are kept straight and both feet point forwards.
Client`s instructions:
Position yourself standing with both feet on a wedge and a table in front.
Ensure that you keep your knees straight and both feet point forwards.
Progressions and variations:
Less advanced: 1. Decrease the angle of the wedge.
More advanced: 1. Increase the angle of the wedge.
Precautions:
1. Impaired or absent sensation of stretch.
BILATERAL CALF RAISES:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in standing.
Instruct the patient to plantarflex their ankles.
Client`s instructions:
Position yourself standing with your feet together.
Start with your heels on the ground.
Finish with your heels off the ground.
Progressions and variations:
Less advanced: 1. Provide hand support for balance.
More advanced: 1. Progress using strength training principles.
BILATERAL CALF RAISES ON A BLOCK:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in standing on a step with their heels off the edge.
Instruct the patient to plantarflex their ankle.
Client`s instructions:
Position yourself standing on a step with your heels off the edge.
Lift your body weight up onto your toes.
Progressions and variations:
Less advanced: 1. Provide hand support for balance.
More advanced: 1. Wear a backpack with weights in it. 2. Progress using strength training principles.
Sunday, July 15, 2007
EXERCISES.
ASCENDING A STEP USING A DOORWAY:
Physiotherapist`s aim:
To improve the ability to ascend a step in a wheelchair.
Client`s aim:
To improve your ability to ascend a step in your wheelchair.
Physiotherapist`s instructions:
Position the patient in their wheelchair below a step.
Instruct the patient to use the doorway to pull themselves up over the step.
Client`s instructions:
Position yourself in your wheelchair below a step.
Practice using the doorway to pull yourself up over the step.
Progressions and variations:
Less advanced: 1. Decrease the height of the step.
More advanced: 1. Increase the height of the step.
Precautions:
1. Caution required to prevent forward fall from wheelchair.
ATTAINING A WHEELSTAND:
Physiotherapist`s aim:
To improve the ability to attain a wheelstand.
Client`s aim:
To improve your ability to attain a wheelstand.
Physiotherapist`s instructions:
Position the patient in their wheelchair.
Instruct the patient to flip the wheelchair into a wheelstand.
Client`s instructions:
Position yourself in your wheelchair.
Practice flipping your wheelchair into a wheelstand.
Progressions and variations:
Less advanced: 1. Perform the task on a flat surface.
More advanced: 1. Manoeuvre the wheelchair in different directions while maintaining a wheelstand.
2. Perform the task on a slope.
3. Add a weighted bag to the front or back of the wheelchair.
Precautions:
1. Ensure that wheelchair does not flip backwards.
BALANCING ON A BALL:
Physiotherapist`s aim:
To improve the ability to sit unsupported.
Client`s aim:
To improve your ability to sit unsupported.
Physiotherapist`s instructions:
Position the patient in sitting on a large ball that is wedged between two plinths.
Instruct the patient to lift their hands up in the air without falling.
Client`s instructions:
Position yourself sitting on a large ball that is wedged between two plinths.
Practice lifting your hands up in the air without falling.
Progressions and variations:
Less advanced: 1. Sit on a plinth.
More advanced: 1. Change the size of the ball. 2. Add a concurrent task while sitting on the ball.
BALANCING ON A BALL WHILE LIFTING ONE LEG UP AND DOWN:
Physiotherapist`s aim:
To improve the ability to sit unsupported.
Client`s aim:
To improve your ability to sit unsupported.
Physiotherapist`s instructions:
Position the patient in sitting on a large ball with their feet on the floor.
Instruct the patient to lift then lower one leg.
Client`s instructions:
Position yourself sitting on a large ball with your feet on the floor.
Practice lifting one leg up and down.
Progressions and variations:
Less advanced: 1. Provide hand support for balance. 2. Decrease the height that the leg is lifted. More advanced: 1. Increase the height that the leg is lifted. 2. Increase the movement of the raised leg (eg. add knee extension or hip abduction).
BALANCING WHILE SITTING ON A MOVING OBJECT:
Physiotherapist`s aim:
To improve the ability to sit unsupported.
Client`s aim:
To improve your ability to sit unsupported.
Physiotherapist`s instructions:
Position the patient in sitting on a moveable object while holding onto a rope.
Instruct the patient to sit upright while getting towed across the floor.
Client`s instructions:
Position yourself sitting on a moveable object while holding onto a rope.
Practice sitting upright while getting towed across the floor.
Progressions and variations:
Less advanced: 1. Tow the patient in one direction only. 2. Tow at a slow speed.
More advanced: 1. Tow the patient in many directions. 2. Tow at a faster speed.
BEAR WALKING:
Physiotherapist`s aim:
To strengthen the shoulder and hip muscles.
Client`s aim:
To strengthen your shoulder and hip muscles.
Physiotherapist`s instructions:
Position the patient on their hands and feet with their bottom in the air.
Instruct the patient to `bear-walk` forwards along the floor.
Client`s instructions:
Position yourself on your hands and feet with your bottom in the air.
Practice `bear-walking` forwards along the floor.
Progressions and variations:
More advanced: 1. Practice `bear-walking` in different directions. 2. Increase speed of task.
BENCH PRESS:
Physiotherapist`s aim:
To strengthen the shoulder horizontal adductors and elbow extensors.
Client`s aim:
To strengthen the muscles at the front of your shoulder and chest.
Physiotherapist`s instructions:
Position the patient in supine with their shoulders abducted and elbows flexed.
Instruct the patient to lift the weights above their chest until their elbows are straight.
Client`s instructions:
Position yourself lying on your back with your shoulders out to the side and elbows bent.
Lift the weights above your chest until your elbows are straight.
Progressions and variations:
Progress using strength training principles.
BENDING AND STRAIGHTENING THE WRIST TO TARGETS:
Physiotherapist`s aim:
To improve the ability to flex and extend the wrist.
Client`s aim:
To improve your ability to bend and straighten your wrist.
Physiotherapist`s instructions:
Position the patient in sitting with a cylindrical object on a table in front of them and a sandbag on their forearm.
Draw two target lines on the table to serve as targets for wrist movement.
Instruct the patient to flex and then extend their wrist to the target lines while grasping the object.
Ensure that the forearm does not move.
Client`s instructions:
Position yourself sitting with a cylindrical object on a table in front of you and a sandbag on your forearm. :
Practice bending your wrist backwards and forwards to the target lines while grasping the object.
Ensure that your forearm does not move.
Progressions and variations:
Less advanced: 1. Decrease the distance from the wrist to the target lines. 2. Hold an object with a smaller diameter.
More advanced: 1. Increase the distance from the wrist to the target lines. 2. Hold an object with a larger diameter. 3. Hold an object that can deform. 4. Remove the sandbag holding the forearm in place.
BENDING THE KNEE IN SITTING:
Physiotherapist`s aim:
To improve the ability to flex the knee in preparation for standing.
Client`s aim:
To improve your ability to bend your knee in preparation for standing.
Physiotherapist`s instructions:
Position the patient in sitting with their toes on a line in front of their knee.
Instruct the patient to flex their knee so that their heel touches a line behind their knee.
Client`s instructions:
Position yourself sitting with your toes on a line in front of your knee.
Practice sliding your foot back so that your heel touches a line behind your knee.
Progressions and variations:
Less advanced. 1. Place the lines closer to the heel and toes. 2. Reduce the amount of friction under the foot by using a friction-reducing device (eg. a roller-skate or slidesheet).
More advanced. 1. Place the lines further away from the heel and toes.
BENDING THE KNEE IN SITTING USING A ROLLER SKATE:
Physiotherapist`s aim:
To improve the ability to flex the knee in preparation for standing.
Client`s aim:
To improve your ability to bend your knee in preparation for standing.
Physiotherapist`s instructions:
Position the patient in sitting with one foot strapped into a roller-skate and their other foot on a block.
Instruct the patient to flex and extend their knee so that the roller-skate rolls between the lines on the floor.
Client`s instructions:
Position yourself sitting with one foot strapped into a roller-skate and your other foot on a block. Practice bending and straightening your knee so that the roller-skate rolls between the lines on the floor.
Progressions and variations:
Less advanced. 1. Place the lines closer to the heel and toes.
More advanced. 1. Place the lines further away from the heel and toes.
Physiotherapist`s aim:
To improve the ability to ascend a step in a wheelchair.
Client`s aim:
To improve your ability to ascend a step in your wheelchair.
Physiotherapist`s instructions:
Position the patient in their wheelchair below a step.
Instruct the patient to use the doorway to pull themselves up over the step.
Client`s instructions:
Position yourself in your wheelchair below a step.
Practice using the doorway to pull yourself up over the step.
Progressions and variations:
Less advanced: 1. Decrease the height of the step.
More advanced: 1. Increase the height of the step.
Precautions:
1. Caution required to prevent forward fall from wheelchair.
ATTAINING A WHEELSTAND:
Physiotherapist`s aim:
To improve the ability to attain a wheelstand.
Client`s aim:
To improve your ability to attain a wheelstand.
Physiotherapist`s instructions:
Position the patient in their wheelchair.
Instruct the patient to flip the wheelchair into a wheelstand.
Client`s instructions:
Position yourself in your wheelchair.
Practice flipping your wheelchair into a wheelstand.
Progressions and variations:
Less advanced: 1. Perform the task on a flat surface.
More advanced: 1. Manoeuvre the wheelchair in different directions while maintaining a wheelstand.
2. Perform the task on a slope.
3. Add a weighted bag to the front or back of the wheelchair.
Precautions:
1. Ensure that wheelchair does not flip backwards.
BALANCING ON A BALL:
Physiotherapist`s aim:
To improve the ability to sit unsupported.
Client`s aim:
To improve your ability to sit unsupported.
Physiotherapist`s instructions:
Position the patient in sitting on a large ball that is wedged between two plinths.
Instruct the patient to lift their hands up in the air without falling.
Client`s instructions:
Position yourself sitting on a large ball that is wedged between two plinths.
Practice lifting your hands up in the air without falling.
Progressions and variations:
Less advanced: 1. Sit on a plinth.
More advanced: 1. Change the size of the ball. 2. Add a concurrent task while sitting on the ball.
BALANCING ON A BALL WHILE LIFTING ONE LEG UP AND DOWN:
Physiotherapist`s aim:
To improve the ability to sit unsupported.
Client`s aim:
To improve your ability to sit unsupported.
Physiotherapist`s instructions:
Position the patient in sitting on a large ball with their feet on the floor.
Instruct the patient to lift then lower one leg.
Client`s instructions:
Position yourself sitting on a large ball with your feet on the floor.
Practice lifting one leg up and down.
Progressions and variations:
Less advanced: 1. Provide hand support for balance. 2. Decrease the height that the leg is lifted. More advanced: 1. Increase the height that the leg is lifted. 2. Increase the movement of the raised leg (eg. add knee extension or hip abduction).
BALANCING WHILE SITTING ON A MOVING OBJECT:
Physiotherapist`s aim:
To improve the ability to sit unsupported.
Client`s aim:
To improve your ability to sit unsupported.
Physiotherapist`s instructions:
Position the patient in sitting on a moveable object while holding onto a rope.
Instruct the patient to sit upright while getting towed across the floor.
Client`s instructions:
Position yourself sitting on a moveable object while holding onto a rope.
Practice sitting upright while getting towed across the floor.
Progressions and variations:
Less advanced: 1. Tow the patient in one direction only. 2. Tow at a slow speed.
More advanced: 1. Tow the patient in many directions. 2. Tow at a faster speed.
BEAR WALKING:
Physiotherapist`s aim:
To strengthen the shoulder and hip muscles.
Client`s aim:
To strengthen your shoulder and hip muscles.
Physiotherapist`s instructions:
Position the patient on their hands and feet with their bottom in the air.
Instruct the patient to `bear-walk` forwards along the floor.
Client`s instructions:
Position yourself on your hands and feet with your bottom in the air.
Practice `bear-walking` forwards along the floor.
Progressions and variations:
More advanced: 1. Practice `bear-walking` in different directions. 2. Increase speed of task.
BENCH PRESS:
Physiotherapist`s aim:
To strengthen the shoulder horizontal adductors and elbow extensors.
Client`s aim:
To strengthen the muscles at the front of your shoulder and chest.
Physiotherapist`s instructions:
Position the patient in supine with their shoulders abducted and elbows flexed.
Instruct the patient to lift the weights above their chest until their elbows are straight.
Client`s instructions:
Position yourself lying on your back with your shoulders out to the side and elbows bent.
Lift the weights above your chest until your elbows are straight.
Progressions and variations:
Progress using strength training principles.
BENDING AND STRAIGHTENING THE WRIST TO TARGETS:
Physiotherapist`s aim:
To improve the ability to flex and extend the wrist.
Client`s aim:
To improve your ability to bend and straighten your wrist.
Physiotherapist`s instructions:
Position the patient in sitting with a cylindrical object on a table in front of them and a sandbag on their forearm.
Draw two target lines on the table to serve as targets for wrist movement.
Instruct the patient to flex and then extend their wrist to the target lines while grasping the object.
Ensure that the forearm does not move.
Client`s instructions:
Position yourself sitting with a cylindrical object on a table in front of you and a sandbag on your forearm. :
Practice bending your wrist backwards and forwards to the target lines while grasping the object.
Ensure that your forearm does not move.
Progressions and variations:
Less advanced: 1. Decrease the distance from the wrist to the target lines. 2. Hold an object with a smaller diameter.
More advanced: 1. Increase the distance from the wrist to the target lines. 2. Hold an object with a larger diameter. 3. Hold an object that can deform. 4. Remove the sandbag holding the forearm in place.
BENDING THE KNEE IN SITTING:
Physiotherapist`s aim:
To improve the ability to flex the knee in preparation for standing.
Client`s aim:
To improve your ability to bend your knee in preparation for standing.
Physiotherapist`s instructions:
Position the patient in sitting with their toes on a line in front of their knee.
Instruct the patient to flex their knee so that their heel touches a line behind their knee.
Client`s instructions:
Position yourself sitting with your toes on a line in front of your knee.
Practice sliding your foot back so that your heel touches a line behind your knee.
Progressions and variations:
Less advanced. 1. Place the lines closer to the heel and toes. 2. Reduce the amount of friction under the foot by using a friction-reducing device (eg. a roller-skate or slidesheet).
More advanced. 1. Place the lines further away from the heel and toes.
BENDING THE KNEE IN SITTING USING A ROLLER SKATE:
Physiotherapist`s aim:
To improve the ability to flex the knee in preparation for standing.
Client`s aim:
To improve your ability to bend your knee in preparation for standing.
Physiotherapist`s instructions:
Position the patient in sitting with one foot strapped into a roller-skate and their other foot on a block.
Instruct the patient to flex and extend their knee so that the roller-skate rolls between the lines on the floor.
Client`s instructions:
Position yourself sitting with one foot strapped into a roller-skate and your other foot on a block. Practice bending and straightening your knee so that the roller-skate rolls between the lines on the floor.
Progressions and variations:
Less advanced. 1. Place the lines closer to the heel and toes.
More advanced. 1. Place the lines further away from the heel and toes.
Saturday, July 14, 2007
EXERCISES.
ACTIVE CYCLE FOR UPPER LIMBS:
Physiotherapist`s aim:
To improve fitness.
Client`s aim:
To improve your fitness.
Physiotherapist`s instructions:
Position the patient in their wheelchair with their hands in the paddles of the active cycle. Instruct the patient to cycle with their hands.
Client`s instructions:
Position yourself sitting in your wheelchair with your hands in the paddles of the active cycle. Cycle with your hands.
Progressions and variations:
Less advanced: 1. Decrease the active resistance.
More advanced: 1. Increase the active resistance. 2. Increase duration of exercise.
Precautions:
1. Check for pressure marks in areas where sensation is absent or impaired.
ANKLE DORSIFLEXOR ELECTRICAL STIMULATION:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Place the electrodes over the muscle belly of tibialis anterior.
ANKLE DORSIFLEXOR STRENGTHENING IN LONG SITTING:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in long sitting with a target held above their toes.
Instruct the patient to dorsiflex their ankles to touch the target with their toes.
Client`s instructions:
Position yourself sitting with your legs in front of you and a target held above your toes.
Practice bending your ankles to touch the target with your toes.
Progressions and variations:
Less advanced: 1. Decrease the distance to the target.
More advanced: 1. Increase the distance to the target.
ANKLE DORSIFLEXOR STRENGTHENING IN SITTING USING SANDBAG WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting with a weight attached around their toes.
Instruct the patient to dorsiflex their ankle.
Client`s instructions:
Position yourself sitting with a weight attached around your toes.
Start with your toes on the floor.
Finish with your toes off the floor.
Progressions and variations:
Progress using strength training principles.
ANKLE DORSIFLEXOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their feet flat on the floor and their knees relatively extended. Instruct the patient to dorsiflex the ankles.
Client`s instructions:
Position yourself sitting with your feet together in front of you.
Start with your feet flat on the floor.
Finish with your toes lifted up.
Ensure that you keep your heels on the ground.
Progressions and variations:
Less advanced: 1. Position the feet further forwards. 2. Place a bandage around the knees to hold them together.
More advanced: 1. Position the feet further back.
ANKLE DORSIFLEXOR STRENGTHENING IN STANDING BY KICKING A BALL BACKWARDS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in standing while holding onto a ball.
Instruct the patient to kick the ball over their head.
Ensure that their ankle dorsiflexes.
Client`s instructions:
Position yourself standing while holding onto a ball.
Practice kicking the ball over your head.
Ensure that your foot bends backwards.
Progressions and variations:
Less advanced: 1. Perform the exercise in sitting.
More advanced: 1. Kick the ball further behind.
ANKLE DORSIFLEXOR/PLANTARFLEXOR STRENGTHENING IN SIDELYING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors/plantarflexors.
Client`s aim:
To strengthen your ankle muscles.
Physiotherapist`s instructions:
Position the patient in sidelying.
Instruct the patient to dorsiflex and plantarflex their ankle.
Client`s instructions:
Position yourself lying on your side.
Start with your toes pointing down.
Finish with your toes pointing up.
ANKLE DORSIFLEXOR/PLANTARFLEXOR STRENGTHENING IN SITTING BY DRAWING CIRCLES WITH THE FOOT:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors/plantarflexors.
Client`s aim:
To strengthen your ankle muscles.
Physiotherapist`s instructions:
Position the patient in sitting.
Instruct the patient to draw circles in the air with their toes.
Ensure that only their ankle moves.
Client`s instructions:
Position yourself in sitting.
Practice drawing circles in the air with your toes.
Ensure that only your ankle moves.
Progressions and variations:
Less advanced: 1. Move the ankle up and down only. 2. Make smaller circles.
More advanced: 1. Make larger circles. 2. Vary the ankle movement (eg. write the alpabet).
ANKLE DORSIFLEXOR/PLANTARFLEXOR STRENGTHENING IN SUPINE WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors/plantarflexors.
Client`s aim:
To strengthen your ankle muscles.
Physiotherapist`s instructions:
Position the patient in supine.
Instruct the patient to dorsiflex and plantarflex their ankle.
Client`s instructions:
Position yourself lying on your back.
Start with your toes pointing down.
Finish with your toes pointing up.
Progressions and variations:
Progress using strength training principles.
ANKLE EVERTOR STRENGTHENING IN SITTING WITH ASSISTANCE:
Physiotherapist`s aim:
To strengthen the ankle evertors.
Client`s aim:
To strengthen the muscles on the outside of the ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the patient to evert their ankle and bring their toes to touch a target object.
Client`s instructions:
Position the child in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the child to move their toes outwards and upwards to touch an object with the outside border of their foot.
Progressions and variations:
Less advanced: 1. Position the target object closer to the toes.
More advanced: 1. Position the target object further away from the toes.
ANKLE EVERTOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle evertors.
Client`s aim:
To strengthen the muscles at the outside of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their knees together and ankles slightly apart.
Instruct the patient to evert their ankles and bring the medial malleoli to touch together.
Ensure that the knees are kept still.
Client`s instructions:
Position yourself sitting with your knees together and ankles slightly apart.
Start with your feet flat on the floor.
Finish with outside of your soles lifted off the floor and the inside part of your ankles touching together.
Ensure that your knees are kept still.
Progressions and variations:
Less advanced: 1. Place a bandage around the knees to hold them together.
More advanced: 1. Perform the exercise in standing.
ANKLE INVERTOR STRENGTHENING IN SITTING WITH ASSISTANCE:
Physiotherapist`s aim:
To strengthen the ankle invertors.
Client`s aim:
To strengthen the muscles on the inside of the ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the patient to invert their ankle and bring their toes to touch a target object.
Client`s instructions:
Position the child in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the child to move their toes inwards and upwards to touch a target object with the inside border of their foot.
Progressions and variations:
Less advanced: 1. Position the target object closer to the toes.
More advanced: 1. Position the target object further away from the toes.
ANKLE INVERTOR/EVERTOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle invertors and evertors.
Client`s aim:
To strengthen the muscles on the inside and outside of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting.
Instruct the patient to invert and evert their ankle.
Client`s instructions:
Position yourself sitting with your feet on the floor.
Start with the soles of your feet facing in.
Finish with the soles of your feet facing out.
Ensure that your knees are kept still.
Progressions and variations:
Progress using strength training principles.
ANKLE PLANTARFLEXOR STRENGTHENING IN SITTING USING SANDBAG WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in sitting with a weight attached to the top of their knee.
Instruct the patient to lift their heel off the floor by plantarflexing their ankle.
Client`s instructions:
Position yourself sitting with a weight attached to the top of your knee.
Start with your feet flat on the floor.
Finish with your heel off the floor.
Ensure that you keep your toes on the floor.
Progressions and variations:
Progress using strength training principles.
ANKLE PLANTORFLEXOR STRENGTHENING IN SITTING USING THERABAND:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions
Position the patient in sitting with their foot on a wedge and some theraband attached under the wedge and over the top of their knee.
Instruct the patient to lift their heel off the wedge by plantarflexing the ankle.
Client`s instructions:
Position yourself sitting with your foot on a wedge and some theraband attached under the wedge and over the top of your knee.
Start with your foot flat on the wedge.
Finish with your heel off the wedge.
Ensure that you keep your toes on the wedge.
Progressions and variations:
Less advanced: 1. Downgrade the colour of the theraband.
More advanced: 1. Upgrade the colour of the theraband.
ANKLE PLANTORFLEXOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in sitting with their knees together.
Instruct the patient to lift their heels off the floor by plantarflexing the ankles.
Client`s instructions:
Position yourself sitting with your knees together.
Start with your feet flat on the floor.
Finish with your heels lifted off the floor.
Ensure that you keep your toes on the floor.
Progressions and variations:
Less advanced: 1. Place a bandage around the knees to hold them together.
More advanced: 1. Place a weight over the knees.
ANKLE PLANTORFLEXOR STRENGTENING IN STANDING USING A WEDGE:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in standing against a wall with their foot on a wedge and their other foot resting on a stool in front of them.
Instruct the patient to lift their heel off the wedge by plantarflexing their ankle.
Ensure that most of the weight is borne through the leg on the wedge, the knee is kept straight and the back remains against the wall.
Client`s instructions:
Position yourself standing against a wall with your foot on a wedge and your other foot resting on a stool in front of you.
Start with your foot flat on the wedge.
Finish with your heel lifted off the wedge and standing on your toes.
Ensure that most of your weight is borne through the leg on the wedge, your knee is kept straight and your back remains against the wall.
Progressions and variations:
Less advanced: 1. Move the stool closer. 2. Provide hand support for balance.
More advanced: 1. Move the stool further away.
ANKLE PLANTARFLEXOR STRETCH BY WALKING UP A STEEP SLOPE:
Physiotherapist`s aim:
To stretch or maintain length of the ankle plantarflexors.
Client`s aim:
To stretch or maintain range in your ankles.
Physiotherapist`s instructions:
Position the patient in standing on a steep slope such as a slippery slide.
Instruct the patient to walk slowly up the slope.
Ensure that the back heel remains down and the back leg is kept as straight as possible.
Client`s instructions:
Position yourself standing on a steep slope such as a slippery slide.
Practice walking slowly up the slope.
Ensure that your back heel remains down and your back leg is kept as straight as possible.
Progressions and variations:
Less advanced: 1. Decrease the incline of the slope. 2. Provide hand support for balance.
More advanced: 1. Increase the incline of the slope.
Precautions:
1. Impaired or absent sensation of stretch.
ANKLE PLANTORFLEXOR STRETCH IN STANDING:
Physiotherapist`s aim:
To stretch or maintain length of the ankle plantarflexors.
Client`s aim:
To stretch or maintain range in your ankle.
Physiotherapist`s instructions:
Position the patient in standing with one leg in front of the other and their hands resting on a wall.
Instruct the patient to lean forwards while keeping the back leg straight.
Ensure that both feet point forwards and the back heel remains on the ground.
Client`s instructions:
Position yourself standing with one leg in front of the other and your hands resting on a wall. Lean forwards while keeping your back leg straight.
Ensure that both feet point forwards and your back heel remains on the ground.
Progressions and variations:
Less advanced: 1. Decrease forwards lean.
More advanced: 1. Increase forwards lean.
Precautions:
1. Impaired or absent sensation of stretch.
ANTERIOR DELTOID ELECTRICAL STIMULATION:
Physiotherapist`s aim:
To strengthen the shoulder flexors.
Client`s aim:
To strengthen the muscles at the front of your shoulder.
Physiotherapist`s instructions:
Place the electrodes over the muscle belly of the anterior deltoid.
Client`s instructions:
Place the two electrodes over the muscle belly as shown.
Precautions:
Perform skin tests.
Physiotherapist`s aim:
To improve fitness.
Client`s aim:
To improve your fitness.
Physiotherapist`s instructions:
Position the patient in their wheelchair with their hands in the paddles of the active cycle. Instruct the patient to cycle with their hands.
Client`s instructions:
Position yourself sitting in your wheelchair with your hands in the paddles of the active cycle. Cycle with your hands.
Progressions and variations:
Less advanced: 1. Decrease the active resistance.
More advanced: 1. Increase the active resistance. 2. Increase duration of exercise.
Precautions:
1. Check for pressure marks in areas where sensation is absent or impaired.
ANKLE DORSIFLEXOR ELECTRICAL STIMULATION:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Place the electrodes over the muscle belly of tibialis anterior.
ANKLE DORSIFLEXOR STRENGTHENING IN LONG SITTING:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in long sitting with a target held above their toes.
Instruct the patient to dorsiflex their ankles to touch the target with their toes.
Client`s instructions:
Position yourself sitting with your legs in front of you and a target held above your toes.
Practice bending your ankles to touch the target with your toes.
Progressions and variations:
Less advanced: 1. Decrease the distance to the target.
More advanced: 1. Increase the distance to the target.
ANKLE DORSIFLEXOR STRENGTHENING IN SITTING USING SANDBAG WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting with a weight attached around their toes.
Instruct the patient to dorsiflex their ankle.
Client`s instructions:
Position yourself sitting with a weight attached around your toes.
Start with your toes on the floor.
Finish with your toes off the floor.
Progressions and variations:
Progress using strength training principles.
ANKLE DORSIFLEXOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their feet flat on the floor and their knees relatively extended. Instruct the patient to dorsiflex the ankles.
Client`s instructions:
Position yourself sitting with your feet together in front of you.
Start with your feet flat on the floor.
Finish with your toes lifted up.
Ensure that you keep your heels on the ground.
Progressions and variations:
Less advanced: 1. Position the feet further forwards. 2. Place a bandage around the knees to hold them together.
More advanced: 1. Position the feet further back.
ANKLE DORSIFLEXOR STRENGTHENING IN STANDING BY KICKING A BALL BACKWARDS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in standing while holding onto a ball.
Instruct the patient to kick the ball over their head.
Ensure that their ankle dorsiflexes.
Client`s instructions:
Position yourself standing while holding onto a ball.
Practice kicking the ball over your head.
Ensure that your foot bends backwards.
Progressions and variations:
Less advanced: 1. Perform the exercise in sitting.
More advanced: 1. Kick the ball further behind.
ANKLE DORSIFLEXOR/PLANTARFLEXOR STRENGTHENING IN SIDELYING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors/plantarflexors.
Client`s aim:
To strengthen your ankle muscles.
Physiotherapist`s instructions:
Position the patient in sidelying.
Instruct the patient to dorsiflex and plantarflex their ankle.
Client`s instructions:
Position yourself lying on your side.
Start with your toes pointing down.
Finish with your toes pointing up.
ANKLE DORSIFLEXOR/PLANTARFLEXOR STRENGTHENING IN SITTING BY DRAWING CIRCLES WITH THE FOOT:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors/plantarflexors.
Client`s aim:
To strengthen your ankle muscles.
Physiotherapist`s instructions:
Position the patient in sitting.
Instruct the patient to draw circles in the air with their toes.
Ensure that only their ankle moves.
Client`s instructions:
Position yourself in sitting.
Practice drawing circles in the air with your toes.
Ensure that only your ankle moves.
Progressions and variations:
Less advanced: 1. Move the ankle up and down only. 2. Make smaller circles.
More advanced: 1. Make larger circles. 2. Vary the ankle movement (eg. write the alpabet).
ANKLE DORSIFLEXOR/PLANTARFLEXOR STRENGTHENING IN SUPINE WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors/plantarflexors.
Client`s aim:
To strengthen your ankle muscles.
Physiotherapist`s instructions:
Position the patient in supine.
Instruct the patient to dorsiflex and plantarflex their ankle.
Client`s instructions:
Position yourself lying on your back.
Start with your toes pointing down.
Finish with your toes pointing up.
Progressions and variations:
Progress using strength training principles.
ANKLE EVERTOR STRENGTHENING IN SITTING WITH ASSISTANCE:
Physiotherapist`s aim:
To strengthen the ankle evertors.
Client`s aim:
To strengthen the muscles on the outside of the ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the patient to evert their ankle and bring their toes to touch a target object.
Client`s instructions:
Position the child in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the child to move their toes outwards and upwards to touch an object with the outside border of their foot.
Progressions and variations:
Less advanced: 1. Position the target object closer to the toes.
More advanced: 1. Position the target object further away from the toes.
ANKLE EVERTOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle evertors.
Client`s aim:
To strengthen the muscles at the outside of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their knees together and ankles slightly apart.
Instruct the patient to evert their ankles and bring the medial malleoli to touch together.
Ensure that the knees are kept still.
Client`s instructions:
Position yourself sitting with your knees together and ankles slightly apart.
Start with your feet flat on the floor.
Finish with outside of your soles lifted off the floor and the inside part of your ankles touching together.
Ensure that your knees are kept still.
Progressions and variations:
Less advanced: 1. Place a bandage around the knees to hold them together.
More advanced: 1. Perform the exercise in standing.
ANKLE INVERTOR STRENGTHENING IN SITTING WITH ASSISTANCE:
Physiotherapist`s aim:
To strengthen the ankle invertors.
Client`s aim:
To strengthen the muscles on the inside of the ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the patient to invert their ankle and bring their toes to touch a target object.
Client`s instructions:
Position the child in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the child to move their toes inwards and upwards to touch a target object with the inside border of their foot.
Progressions and variations:
Less advanced: 1. Position the target object closer to the toes.
More advanced: 1. Position the target object further away from the toes.
ANKLE INVERTOR/EVERTOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle invertors and evertors.
Client`s aim:
To strengthen the muscles on the inside and outside of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting.
Instruct the patient to invert and evert their ankle.
Client`s instructions:
Position yourself sitting with your feet on the floor.
Start with the soles of your feet facing in.
Finish with the soles of your feet facing out.
Ensure that your knees are kept still.
Progressions and variations:
Progress using strength training principles.
ANKLE PLANTARFLEXOR STRENGTHENING IN SITTING USING SANDBAG WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in sitting with a weight attached to the top of their knee.
Instruct the patient to lift their heel off the floor by plantarflexing their ankle.
Client`s instructions:
Position yourself sitting with a weight attached to the top of your knee.
Start with your feet flat on the floor.
Finish with your heel off the floor.
Ensure that you keep your toes on the floor.
Progressions and variations:
Progress using strength training principles.
ANKLE PLANTORFLEXOR STRENGTHENING IN SITTING USING THERABAND:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions
Position the patient in sitting with their foot on a wedge and some theraband attached under the wedge and over the top of their knee.
Instruct the patient to lift their heel off the wedge by plantarflexing the ankle.
Client`s instructions:
Position yourself sitting with your foot on a wedge and some theraband attached under the wedge and over the top of your knee.
Start with your foot flat on the wedge.
Finish with your heel off the wedge.
Ensure that you keep your toes on the wedge.
Progressions and variations:
Less advanced: 1. Downgrade the colour of the theraband.
More advanced: 1. Upgrade the colour of the theraband.
ANKLE PLANTORFLEXOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in sitting with their knees together.
Instruct the patient to lift their heels off the floor by plantarflexing the ankles.
Client`s instructions:
Position yourself sitting with your knees together.
Start with your feet flat on the floor.
Finish with your heels lifted off the floor.
Ensure that you keep your toes on the floor.
Progressions and variations:
Less advanced: 1. Place a bandage around the knees to hold them together.
More advanced: 1. Place a weight over the knees.
ANKLE PLANTORFLEXOR STRENGTENING IN STANDING USING A WEDGE:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in standing against a wall with their foot on a wedge and their other foot resting on a stool in front of them.
Instruct the patient to lift their heel off the wedge by plantarflexing their ankle.
Ensure that most of the weight is borne through the leg on the wedge, the knee is kept straight and the back remains against the wall.
Client`s instructions:
Position yourself standing against a wall with your foot on a wedge and your other foot resting on a stool in front of you.
Start with your foot flat on the wedge.
Finish with your heel lifted off the wedge and standing on your toes.
Ensure that most of your weight is borne through the leg on the wedge, your knee is kept straight and your back remains against the wall.
Progressions and variations:
Less advanced: 1. Move the stool closer. 2. Provide hand support for balance.
More advanced: 1. Move the stool further away.
ANKLE PLANTARFLEXOR STRETCH BY WALKING UP A STEEP SLOPE:
Physiotherapist`s aim:
To stretch or maintain length of the ankle plantarflexors.
Client`s aim:
To stretch or maintain range in your ankles.
Physiotherapist`s instructions:
Position the patient in standing on a steep slope such as a slippery slide.
Instruct the patient to walk slowly up the slope.
Ensure that the back heel remains down and the back leg is kept as straight as possible.
Client`s instructions:
Position yourself standing on a steep slope such as a slippery slide.
Practice walking slowly up the slope.
Ensure that your back heel remains down and your back leg is kept as straight as possible.
Progressions and variations:
Less advanced: 1. Decrease the incline of the slope. 2. Provide hand support for balance.
More advanced: 1. Increase the incline of the slope.
Precautions:
1. Impaired or absent sensation of stretch.
ANKLE PLANTORFLEXOR STRETCH IN STANDING:
Physiotherapist`s aim:
To stretch or maintain length of the ankle plantarflexors.
Client`s aim:
To stretch or maintain range in your ankle.
Physiotherapist`s instructions:
Position the patient in standing with one leg in front of the other and their hands resting on a wall.
Instruct the patient to lean forwards while keeping the back leg straight.
Ensure that both feet point forwards and the back heel remains on the ground.
Client`s instructions:
Position yourself standing with one leg in front of the other and your hands resting on a wall. Lean forwards while keeping your back leg straight.
Ensure that both feet point forwards and your back heel remains on the ground.
Progressions and variations:
Less advanced: 1. Decrease forwards lean.
More advanced: 1. Increase forwards lean.
Precautions:
1. Impaired or absent sensation of stretch.
ANTERIOR DELTOID ELECTRICAL STIMULATION:
Physiotherapist`s aim:
To strengthen the shoulder flexors.
Client`s aim:
To strengthen the muscles at the front of your shoulder.
Physiotherapist`s instructions:
Place the electrodes over the muscle belly of the anterior deltoid.
Client`s instructions:
Place the two electrodes over the muscle belly as shown.
Precautions:
Perform skin tests.
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