Therapeutic Exercise Program

 

Therapeutic Exercise Program

First and foremost - do not push into pain with any of the exercises.

Prior to exercise, take your resting heart rate, blood pressure, and oxygen saturation. If these numbers are outside of the safe range, see a medical doctor and do not attempt exercise.

Safe Range of Resting Vitals for Exercise
heart rate	50-100 beats per minute
blood pressure	90/50 to 170/110 mmHg
oxygen saturation	90% or above

When choosing how many reps and sets, I suggest 4 sets of 12 reps 3 times per week for most of the muscle groups. With your glute muscles, it’s hard to completely isolate the gluteus medius from gluteus maximus so I suggest 2 sets of 12 reps for each specific gluteal muscle. Otherwise 4 sets of 12 reps per muscle group should achieve the best strength gains and therapeutic benefit.

Everyday:

Psoas stretch: Split your stance until you feel a stretch on the front of your back leg. This stretches your rectus femoris muscle. Next—with the hand on the same side of the back leg, punch your fist into the air and tilt your torso back. This stretches your psoas muscle. A tight psoas can cause back, hip, and knee issues so this is an important stretch. Hold for 30 seconds to 4 minutes after which there is a diminishing return. 

Hamstring stretch: Lay on your back and use a belt or strap to elevate one leg. Keep a slight bend in the knee to avoid stretching the sciatic nerve. The goal is to isolate the hamstring. Hold for 30 seconds to 4 minutes after which there is a diminishing return. Please note that bending over to touch your toes while standing may stretch the hamstring muscles, but it is also a mechanism of injury for ruptured discs so laying on the back is the preferred method. 

Mini curl up (abdominals): Lay on your back with your hands under your low back and one leg bent. Raise head, shoulders, and chest off the ground just high enough to slide a piece of paper under your head and no higher than that. Feel the contraction in your abs. Hold each rep for 8 seconds, no more or you’ll cause a muscle spasm. Relax for a full second in between each rep. Switch the bent leg after each rep and repeat the exercise.

Side bridge (obliques): Lay on your side with knees bent. Thrust hips up and forward while resting on forearm. Feel the contraction in your obliques. Hold each rep for 8 seconds, no more or you’ll cause a muscle spasm. Relax for a full second in between each rep.

Birddog (paraspinals): Assume a quadruped position on hands and knees. Drive a fist forward and drive the heel of the opposite foot back. Create tension in the body from your fist to your heel. Hold each rep for 8 seconds, no more or you’ll cause a muscle spasm. Relax for a full second in between each rep.

Monday, Wednesday, Friday:

1. Supine elbow elevation (anterior deltoid): Lay on your back, bend your elbow, and slowly raise your elbow to 90° without surpassing the height of your shoulder. Then slowly lower your elbow to the starting position.

2. Supine arm elevation (anterior deltoid): Lay on your back. With your thumb pointed up, slowly raise your arm to 90° without surpassing the height of your shoulder. Then slowly lower your arm to the starting position.

3. Supine arm elevation with theraband (anterior deltoid): Lay on you back and place a theraband under both legs with the knees bent. Grab the theraband with both hands. With your thumbs pointed up, slowly raise your arms to 90° without surpassing the height of your shoulders. Then slowly lower your arms to the starting position.

4. Serratus punch (serratus anterior): Lay on your back. Hold dumbbells above your chest with your arms straight. Now thrust your shoulders forward and concentrate the contraction in your upper back. Then lower your shoulders back down. Your arms should remain straight the entire time. Your shoulders and shoulder blades create the movement.

5. Serratus punch against wall (serratus anterior): Lean into a wall with your forearms. Now thrust your shoulders towards the wall and concentrate the contraction in your upper back. Then draw your shoulders back, pinching your shoulder blades together. Your elbows should not move the entire time. Your shoulders and shoulder blades create the movement.

6. Serratus punch in plank (serratus anterior): Assume a plank position on your forearms. Now thrust your shoulders towards the floor and concentrate the contraction in your upper back. Then draw your shoulders back, pinching your shoulder blades together. Your elbows should not move the entire time. Your shoulders and shoulder blades create the movement. A “pushup plus” is the more advanced version of this exercise.

7. Short arc quads (quadriceps): Lay on your back or sit up in bed. Place a pillow or bolster under your knee so that your knee rests with a slight degree of bend. Now fully straighten your knee while contracting the muscle on the front of your thigh. Then slowly lower to the starting position. You may use an ankle weight for added resistance as safely tolerated.

8. Mini squats (quadriceps): Sit in front of a grab bar, counter, or walker for safety. Stand up with the chair seat touching the backs of your knees and grab ahold of the grab bar, counter, or walker. Now very slowly descend part of the way down. Go slow, not low on the way down and come back up at a normal speed. The lower you go, the more compression you place on your knee joints, so you should not descend all the way. Instead, go slow on the way down which will stress the muscle metabolically and focus more contraction on the vastus medialis which is the most therapeutically beneficial quadriceps muscle.

9. Single leg squats (quadriceps): Grab ahold of a chair, grab bar, counter, or walker. Kick one leg back in a straight line with your spine. While standing on the other leg, very slowly descend part of the way down. Go slow, not low on the way down and come back up at a normal speed. The lower you go, the more compression you place on your knee joints, so you should not descend all the way. Instead, go slow on the way down which will stress the muscle metabolically and focus more contraction on the vastus medialis which is the most therapeutically beneficial quadriceps muscle. You may use a theraband behind the knee for added resistance as safely tolerated.

Tuesday, Thursday, Saturday:

10. Supine band pull aparts (middle and lower trapezius): Lay on your back. Hold a taunt theraband above your chest with your arms straight and your thumbs pointed up. While maintaining straight arms, pull the band apart across your chest and concentrate the contraction in your upper back by pinching your shoulder blades together. Then slowly return to the starting position. Your arms should remain straight the entire time. Your shoulders and shoulder blades create the movement.

11. Side lying external rotation (teres minor): Lay on your side. With your elbow maintaining a 90° bend, rotate your shoulder outward so that your hand rises into the air. Your elbow should remain pressed to your body and act as the hinge of a door. The movement occurs in the shoulder and should mimic a door opening and closing. Focus the contraction towards the back part of your shoulder. You may use a light dumbbell no greater than 5 lbs for added resistance as safely tolerated. You may place a towel roll between your elbow and body for added comfort as needed.

12. Supine external rotation (teres minor): Lay on your back. With your elbows maintaining a 90° bend, rotate both shoulders outward so that your hands move towards the floor. Your elbows should remain pressed to your body and act as the hinge of a door. The movement occurs in the shoulders and should mimic a door opening and closing. Focus the contraction towards the back parts of your shoulders. You may use a theraband for added resistance as safely tolerated. You may place a towel roll between your elbows and body for added comfort as needed.

13. Bridges (gluteus maximus): Lay on your back with your knees bent and your knees and feet apart. Tighten your buttocks muscle and make that muscle carry you through the movement as you raise your hips up into the air. Hold it there for a second, then return to the starting position, relax for a second, and repeat. You may use a weight atop your hips for added resistance as safely tolerated.

14. Hip extensions (gluteus maximus): Stand with both hands securely holding onto a chair, grab bar, counter, or walker. Tighten your buttocks muscle and make that muscle carry you through the movement as you kick one leg back. Attempt to keep the leg straight as you kick it back. Hold it there for a second, then return to the starting position, relax for a second, and repeat. You may use an ankle weight or theraband around both ankles for added resistance as safely tolerated.

15. Front plank with hip extension (gluteus maximus): Assume a plank position on your forearms. Tighten your buttocks muscle and make that muscle carry you through the movement as you kick one leg up into the air. Attempt to keep the leg straight as you kick it up. Hold it there for a second, then return to the starting position, relax for a second, and repeat. You may use an ankle weight or theraband around both ankles for added resistance as safely tolerated.

16. Bilateral hip abductions (gluteus medius): Lay on your back with your legs straight. Tighten your buttocks muscle and make that muscle carry you through the movement as you slide your legs apart like windshield wipers. Hold it there for a second, then return to the starting position, relax for a second, and repeat. It is important to keep your toes pointed straight or slightly inward throughout the movement. Do not allow your toes to point out. You may use ankle weights or a theraband around both ankles for added resistance as safely tolerated.

17. Hip abductions (gluteus medius): Stand with both hands securely holding onto a chair, grab bar, counter, or walker. Tighten your buttocks muscle and make that muscle carry you through the movement as you kick one out to the side. Attempt to keep the leg straight as you kick it out. slide your legs apart like windshield wipers. Hold it there for a second, then return to the starting position, relax for a second, and repeat. It is important to keep your toes pointed straight or slightly inward throughout the movement. Do not allow your toes to point out. You may use ankle weights or a theraband around both ankles for added resistance as safely tolerated.

18. Side bridge with hip abduction (gluteus medius): Assume a side bridge position. Thrust your hips up and forward while resting your weight on your forearm and feet. Tighten your buttocks muscle and make that muscle carry you through the movement as you kick your top leg up into the air with a straight leg. Hold it there for a second, then return to the starting position, relax for a second, and repeat. It is important to keep your toes pointed straight or slightly inward throughout the movement. Do not allow your toes to point out. You may use ankle weights or a theraband around both ankles for added resistance as safely tolerated.

5-7 days per week:

Balance and cardio: Sit in a chair with armrests so that there is no risk of falling. Tap the balls of your feet on the ground in unison so that your feet tap together and then apart, back and forth in this pattern for up to 20 minutes as safely tolerated without pain. To further challenge your balance and vestibular system, you can simultaneously turn your head left and right with your eyes open or closed for increased difficulty. Make sure to hold onto the arms of the chair because this exercise challenges balance. Be sure to work no harder than you are able to comfortably speak to ensure a proper intensity level for ideal cardiovascular benefit. Pace yourself with this exercise and take breaks as needed.

References

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