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.
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