Upload
shivnair
View
10
Download
0
Embed Size (px)
DESCRIPTION
Spinal Rehab
Citation preview
Lumbar StenosisRehabilitation Using the Resistance Chair
a. Description
Lumbar spinal stenosis is a term used to describe a narrowing of the spinal canal. Thenarrowing leads to compression of the nerves supplying the legs and back, leadingto pain. It is thought to be primarily caused by age-related degenerative changes andis recognized as a common disability in the older adult population. Poor posture andweak core musculature can contribute to symptoms. Exercises to stretch the lower backregion and strengthen the muscles which support the spine can reduce the compressionof the spinal nerves. Symptoms of central spinal stenosis are usually worse when aperson is standing or walking and better when sitting. Therefore, the Resistance Chairis the perfect rehabilitation and exercise tool for patients with lumbar stenosis.
b. Symptoms
People affected by this condition usually describe pain radiating from the low backor buttocks into both legs. Standing or walking for prolonged periods of time oftenexacerbates this condition while sitting or lying down usually relieves this pain. Often,patients report relief of symptoms with forward bending or leaning over something suchas a shopping cart.
c. Diagnosis
The diagnosis of lumbar spinal stenosis requires the presence of typical symptoms asdescribed above along with special imaging studies such as an MRI showing structuralnarrowing of the spinal canal. Electrodiagnostic studies may also be considered toassess possible nerve root damage.
d. Management
Management of lumbar spinal stenosis may involve nonsteroidal anti-inflammatory drugs (such as Ibuprofen) and pain medications, therapy modalities (heat, cold,electrical stimulation, ultrasound), and a specific rehabilitation program. Some patients who do not respond to conservative treatment may be candidates for a steroid injection(epidural) or may require surgical evaluation.Amajority of patients do show considerableimprovement with an exercise based rehabilitation program.
PRODUCTS HELPING PEOPLE HELP THEMSELVES!
Page 1 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
e. The Resistance Chair Solution
Aerobic conditioning, specific strengtheningand stretchingexercisesaremainstaysofconservativetreatmentforlumbarstenosis(1).Onerecentstudyshowedpatientswithstenosistreatedwithanexerciseprogramachievedsignificantimprovementsby6weeks(2).Thegoalsofconditioningareincreasedmuscularstabilization(especiallyinabdominalmusculature)andimprovementofposture.Otherspecifictypesofexercisessuchasbicyclingmayalsohelptorelievesymptomsofspinalstenosis.TheResistanceChairSolutionaddressesallthesefactorsbyincorporatingafocusedexerciseprogramandstationarybicyclingforthemanagementoflumbarspinalstenosis.Thefollowingarespecificexercisestoimprovemobilityandstrengthofthelowerbackandtrunkinordertoreducethesymptomsoflumbarstenosis.TheSolutionalsoenablespatientswith lumbar stenosis to improve upper and lower body strength and endurance insittingwithoutexacerbatingsymptomsoflumbarstenosiswhichareusuallyworsewithstandingandwalking.
References:
1.Rittenberg,JD,Ross,AE.Functionalrehabilitationfordegenerativelumbarstenosis.PhysicalMedicineandRehabilitationClinicsofNorthAmerica2003;14:p111.2.Whitman,JulieM.etal.AComparisonBetweenTwoPhysicalTherapyTreatmentProgramsforPatientsWithLumbarSpinalStenosis:ARandomizedClinicalTrial.Spine2006;31(22),pp2541-2549.
3.Simotas,AlexanderC.etal.NonoperativeTreatmentforLumbarSpinalStenosis:ClinicalandOutcomeResultsanda3-YearSurvivorshipAnalysis.Spine2000;25(2),p197.ntswithlumbarstenosiscanalsostrengthentheirupperbodieswhilesitting.
Trunk Flexion Stretch
Goal:Tostretchthemusclesofthelowerback.
1.Beginsittinguprightinchair.Roundyourbackasyoubendforwardtoreachyourchesttowardsyourthighs.(FigureA)
2.Contractyourabdominalmusclesasyourollbackuptostartingposition.
3.Holdpositionfor20seconds.Repeat3times.
FigureA
Page 2 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
Abdominal Curls
Goal:Toimproveabdominalstrength.
1.Situprightinchair.2.Withupperpulleysextendedoveryour
shoulders,interlockyourfingersinfrontofyourchestbypullingthetwohandlestogether.(FigureA)
3.Contractabdominalmusclesasyoubendforwardatthewaistasfarascomfortablypossiblewhileroundingyourback.(FigureB)
4.Slowlyreturntostartingposition.5.Repeat10timesandperform2sets.
Techniquekey–Makesurethatwhileroundingyourbacktheabdominalmusclesarepullinginward,notpushingoutward.
FigureA FigureB
Chair Squats
Goal:Toimprovelegstrengthandabilitytogetin/outofchair.
1.Sittowardfrontofchairwithhandsonthighs,feetfirmlyonfloor.(FigureA)
2.Leanforward,transferringweighttolegsasyouliftyourbottomoffthechair.(FigureB).
3.Slowlyreturntoseatedposition.4.Repeat10timesandperform2sets.
Techniquekey–Practiceholdingpositionatstable,comfortableheights. FigureA FigureB
Trunk Twist Stretch
Goal:Toincreaserangeofmotionofback.
1.Situptallwhilefacingsidewaysinchair.2.Twistrightandgraspbackofchairwithhands(FigureA).3.Holdposition20secondswhilecontinuingtobreath.4.Repeat2timesoneachside.
Techniquekey–Toincreasestretch:Crossleftlegoverrightwhilestretchingtotheleftandrightlegoverleftwhilestretchingtotheright.(FigureB).
FigureA Page 3 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
Oblique Strengthening
Goal:Toimprovetrunkstrength.
1.Sitonsideofchairasshown.2.Graspuppercablehandleandholdin
frontofsternumwithbothhands(Fig.A).3.Sittallwhiletwistingfromyourwaistaway
fromthepulleyanchor.Keepweightevenlydistributedbetweenrightandleftbuttocksasyoutwist(Fig.B).
4.Slowlyreturntostartingposition.5.Repeat10timesandperform2sets.
Techniquekey–Maintainpulleysdirectlyinfrontofsternumthroughouttwist. FigureA FigureB
Hamstring Stretchwith Sciatic Nerve Glide
Goal:Tostretchbackoflegandincreasemobilityofsciaticnerve.
1. Sittallinchair.2. Extendonelegoutasstraightasyou
canwithoutincreasinglowerbackpain.(FigureA)
3. Pointandflexankle10timesineachdirectionwhilekeepingyourlegextended.(FigureB)
4. Repeat2timeseachside.
Techniquekey–Pointandflexfromankle,nottoes.
FigureA FigureB
Quadricep Stretch
Goal:Tostretchthefrontofthigh.
1.Standatrightsideofchair.Faceawayfromchairandholdbackofchairforbalance
2.Placerightfootonchairseatasshown(FigureA).3.Squeezebuttocksandabdominalstotuckpelvisunder.Keepthighs
together.Feelstretchinfrontofthigh.4.Repeat2timeseachside.5.Holdstretchforatleast20seconds.Recommendholdingfor60-90
seconds,ifpossible.
Techniquekey–Keepthighstogether.
FigureA
Page 4 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
Hip Flexor Stretch
Goal:Toincreaseflexibilityofhipsanddecreasestraintolowerback.
1.SitsidewaysonthechairwithonekneeontheHealthStepandoppositearmholdingthebackofchairforsupport.(FigureA)
2.Squeezebuttocktofeelastretchinfrontofyourkneelinghip.3.Holdstretchforatleast20secondseachside.Recommendholding
for60-90secondsifpossible.4.Repeat2timeseachside.
Techniquekey–Maintainmostofweightonchairandpadunderkneeifneeded.Stretchkneebehindyoutoincreasestretchinfrontofthigh.
FigureA
Hip Flexor Stretch - Alternate Technique
1.StandfacingbackofchairwithhandsonBalanceBarforsupport.
2.Steponefootbackwardsapproximately12inches.3.Maintaininguprightposture,tuckpelvisunderwhile
squeezingbuttockmusclestofeelastretchinfrontofyourhip(FigureA).
4.Toincreasestretchgentlylungeweightforwardontofrontleg.
FigureA
Page 5 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
Symptomsoflumbarstenosisareusuallyexacerbatedwithstandingorwalking.TheResistanceChairoffersthesepatientsanexcellentwaytoconditiontheirbodieswhilesittingwithoutpain.Thefollowingaresomesuggestedupperbodyexercises.
Additional Upper Body Exercises
Chest Press
Goal:Toimprovestrengthofchestandshouldermuscles
1.Sitinchair.2.Graspuppercablesatchestlevel.(Fig.A)3.Pusharmsforward,returnslowly.(Fig.B)4.Repeat10timesandperform2sets
Techniquekey–Keepwristsstraightthroughoutexerciseandshouldersrelaxed,awayfromears.
FigureA FigureB
Forward Raises
Goal:Toincreasestrengthoffrontofshoulders.
1.Sitinchair.2.Grasplowercablesineachhandas
shown.(FigureA)3.Withthumbspointingupward,palmsfacing
inward,raisebotharmsinfronttoshoulderlevel,lowerslowly.(FigureB)
4.Repeat10timesandperform2sets.
Techniquekey–Maintainshouldersrelaxed,downawayfromears,asyouraiseyourarms.Keepwristsstraight.Exhaleasyouraisearmsinhaleasyoulowerarms.
FigureA FigureB
Page 6 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
Side Raises
Goal:Toincreasestrengthofsidesofshoulders.
1.Sitinchair.2.Grasplowercablesineachhand.(Fig.A)3.Raisebotharmsouttosideasshown.
Lowerslowly.(Fig.B)4.Repeat10timesandperform2sets.
*Caution:Donotraisehigherthanshoulderlevel.
Techniquekey–Maintainshouldersrelaxeddownawayfromearsasyouraiseyourarms.Keepwristsstraight.Exhaleasyouraisearms,inhaleasyoulowerarms.
FigureA FigureB
Combined Forward/Side Raises
Goal:Toincreasestrengthofrotatorcuffandshoulders.
1. Sitinchair.2. Grasplowercablesineachhand.(Fig.A)3. Withthumbspointingupward,palmsfac-
ingtogetherraisearmstoshoulderlevelasshown.Lowerslowly.(Fig.B)
3. Repeat10timesandperform2sets.
Techniquekey–Maintainshouldersrelaxeddownawayfromearsasyouraiseyourarms.Keepwristsstraight.Exhaleasyouraisearms,inhaleasyoulowerarms.
FigureA FigureB
Bent-Over Reverse Flys
Goal:Tostrengthenupperbackmusclesforpostureandshoulderalignment.
1.SitinChair,foldforwardsochestrestsonthighs,handsreachtowardfloor.(Fig.A)
2.Squeezeshoulderbladestogetherasyouraisearmsouttothesides.
3.Hold5seconds.(Fig.B)4.Relaxarmstofloor.5.Repeat12times.
Techniquekey–Lookdowntomaintainneutralpositionofyourneck(neckstraight).
FigureA FigureB
Page 7 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
Bicep Curl
Goal:Toincreasestrengthoffrontofarms.
1.Sitinchair.2.Grasplowercablesineachhand,palms
facingforward.(Fig.A)3.Bendelbowsandslowlystraighten.(Fig.B)4.Repeat10timesandperform2sets.
Techniquekey–Keepshouldersstableasyoubendelbows.
FigureA FigureB
Tricep Pulldown
Goal:Toincreasestrengthofbackofarms.
1.Sitinchair.2.Graspoverheadcablesandpulldownto
startingpositionasshown;elbowsatsidesandbentto90degrees.(Fig.A)
3.Pushcablesdowntosidestostraightenarms.(Fig.B)
4.Slowlybendelbowsto90degrees.5.Repeat10timesandperform2sets.
Techniquekey:Keepelbowsclosetosidesofribs(orsidesofbody),andkeepwristsstraight.
Techniquekey–Keepelbowsclosetosidesofbody.
FigureA FigureB
Page 8 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
Advanced Upper Body Exercises
Bent Over Reverse Flys with Pulleys
Goal:ToStrengthenupperbackmusclesforpostureandshoulderalignment.
1. SitinChair,foldforwardsochestrestsonthighs,handsgrasplowerpulleys.(Fig.A)
2. Squeezeshoulderbladestogetherasyouraisepulleysouttothesides.(Fig.B)
3. Hold5seconds.4. Relaxarmstofloor.5. Repeat12timesandperform2sets.
Techniquekey–Lookdowntomaintainneutralpositionofyourneck(neckstraight).
FigureA FigureB
Bent-Over Row (One Arm Row)
Goal:Strengthenupperbackandshouldermuscles.
1. Beginexercisebybendingoverandsup-portingyourselfwithonehandandonekneeonthechairseat.
2. Graspthelowercablewithyourarmreachingdownstraight.(FigureA)
3. Pullthecablestraightupsothatyourhandendsupnearyourchestwithyourelbowbentandpointingupwardsasshown.(FigureB)
4. Repeat12times;perform2setseacharm.
TechniqueKey:Keepyourabdominalscontractedasyouperformtheexerciseandlookdowntomaintainneutralpositionofyourneck(neckstraight).
FigureA FigureB
Page 9 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
Exercises with the Freedom Flex
Abdominal Crunches
Goal:Toincreaseabdominalandcorestrength.
1. PositiontheSaddleHooksothattheresistancecablesarewithinarmsreachwhileyouaresittinginthechair.
2. Grasptheoverheadresistancecablesineachhand.(FigureA)
3. Pullthecablesasyoucurlforwardfromyourwaistandtightenyourabdominalmuscles.Exhaleduringthisphaseoftheexercise.(FigureB)Thehandlesremaininfrontofyourforeheadthroughouttheexercise.
4.Inhaleasyoureleasethecontractionandreturntotheuprightsittingposition.
5. Repeat12times.
FigureA FigureB
Abdominal Crunch with Single Leg Lift
Goal:Toincreaseabdominalandcorestrength.
1. PositiontheSaddleHooksothattheresistancecablesarewithinarmsreachwhileyouaresittinginthechair.
2. Grasptheoverheadresistancecablesineachhand.(FigureA)
3. Simultaneouslyliftyourleftkneeasyoupullthecablesandcurlforwardfromyourwaist.Tightenyourabdominalmusclesandexhaleduringthisphaseoftheexercise.(FigureB).
4. Inhaleasyoureleasethecontraction,loweringyourlegandreturningtotheuprightsittingposition.
5. Repeat12timeswitheachleg.
TechniqueKey:Roundyourbackasyoucurlforward.
FigureA FigureB
Page 10 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
Latissimus Pulldown
Goal:Toincreasestrengthofbackmuscles.
1. PositiontheSaddleHooksothattheresistancecablesarejustwithinarms’reachwhileyouaresittinginthechairwithyourarmsextendedaboveyourhead.(FigureA).
2. Sittallasyoupullthecablesdowntowardsyourshoulders,elbowstothesides.(FigureB).
3. Slowlyextendyourarmsupwardtothestartingposition.
4. Repeat12timesandperform2sets.
FigureA FigureB
Front Pulldown
Goal:Toincreasestrengthofthebackandarmmuscles.
1. PositiontheSaddleHooksothattheresistancecablesarejustwithinarmsreachwhileyouaresittinginthechairwithyourarmsextendedaboveyourhead.(FigureA).
2.Witharmsinfrontofyou,elbowsfacingforward,palmsfacingyou,pullcablestowardyourwaist(FigureB).
3. Slowlyextendarmstowardthestartingposition.
4. Repeat12timesandperform2sets.
FigureA FigureB
Page 11 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
NOTES
•Engageabdominalswithallexercises.•Remembertobreathewitheachrepetition.•Start rehabilitationprogramslowly, onlyworking throughminimaldiscomfort levels. If
painincreases,decreaseresistanceleveland/orrepetitions.• Consult your physician if you experience increased pain, weakness, numbness,
palpitationsorsevereshortnessofbreath.
CAUTION:Beforebeginninganyexerciseprogrampleaseconsultahealthcareproviderforappropriateexerciseinstructionsandsafetyprecautions.
LUMBAR STENOSIS PROFESSIONAL NOTES
1. Seatpatientinchair.Usefootrestifneededtostabilizepatient.
2. Use posture support unless patient has long legs, as this will place them too farforwardinchair.
3. Startwith trunk flexion stretch to open vertebral canal and stretch posterior trunkmuscles.
4. Ifthepatienthasmoderatetosevereosteoporosis,avoidexcessivetrunkflexion.
5. Seatedabdominalcurlsareanexcellentwaytoincreaseabdominalmusclestrengthwithoutstressingtheneck.Cuethepatienttofirstcontractthetransversusabdominusmuscleandtoexhaleandpullthebellyinwhilecurlingforward.Makesuretheyareperforming themovementbyflexing the trunk,notbypulling thecableswith theirarms.
6. Chairsquats:Instructpatienttosittowardthefrontofthechairwithbothfeetfirmlyplantedonthefloor.Havethepatientpracticeshiftingtheirweightforwardontotheirfeetwhileliftingtheirbuttocksoffoftheseat.Makesurethepatientmaintainsneutrallowerextremityalignmentwiththekneespointingdirectlyoverthefeet.Forsafety,cuethepatienttofeeltheseatofthechairbehindtheirlegspriortoreturningtotheseatedposition.
Page 12 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com
7. TrunkTwist:Havethepatientsittallandmaintainuprightpostureastheytwist.Usecautionorexcludethisexerciseifthepatienthasmoderatetosevereosteoporosis.Ifthepatienthasforaminalstenosis,avoidrotationifitreproducesradicularsymptoms.
8. Obliquestrengthening:Thisexerciseisextremelyeffectivewhendoneproperly.Themovementisverysmallandisinitiatedbycontractionoftheobliquemuscles.Makesurethemovementcomesfromthetrunktwistingandnotfrompullingwiththearms.Thecablehandlesshouldremaininfrontofthecenterofthepatient’sbodythroughoutthemovement.
9. HamstringStretchwithSciaticNerveGlide:Exclude thisexercise if itelicits lowerbackpain,numbnessortingling.
10. Quadriceps and Hip flexor stretches: Tight rectus femoris and iliopsoas musclescauseincreasedlumbarlordosisandanteriorpelvictilt.Therefore,stretchingthesemuscles isaneffectiveway to reduce the lumbarextensionmoment to thespine.Cuethepatienttofocusonperformingaposteriorpelvictiltinthestretchingposition.Ifthesemusclesareverytightsuchthatthepatientisunabletoattainneutralpelvicposition,thisstretchmaybetoodifficultforthepatienttoperformwithoutaggravatingsymptomsoflumbarstenosis.
11. AdditionalUpperBodyExercises:Manypatientswithlumbarstenosishavelimited
tolerance to standing and walking. Therefore, exercises in sitting are a safe andeffectivewayforthesepatientstostrengthentheirupperbody.RemovethePostureProp back support if it puts the patient in too much extension.The Posture Propisbeneficialtoassureimprovedscapulohumeralpositioningforasaferupperbodyworkout.Cuethepatienttoexhaleuponexertionandtocontractabdominalmusclesforincreasedtrunksupport.
Page 13 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com