GETTING STARTED

3 Points of Improve Functon

EXERCISE ADHERENCE

Source: Nurs Res, 2002 - Adherence is fundamental to improved well being, function and QOL

Source: Manual Therapy, 2010 - Poor adherence can have negative effects on outcomes

Source: PTJ, 2008 (knee OA) 96% completed the aquatic exercise program• 81% completed the land exercise programSource: PTJ, 2012 (hip and knee OA) - At follow

up 84% of participants continued the program

INCREASING ADHERENCE

Reducing barriers for success: Provides social support Decreases depression Decreases anxiety Improves self efficacySource: Jack, McLean, Manual Therapy, 2010

THREE STEPS TO IMPROVE FUNCTION

1. Improve Alignment

2. Improve Balance

3. Decrease Pain

ALIGNMENT / EXTENSION

It’s only taken about 100 years of desk work, computers, driving, backpacks, TV and, sometimes, biking to make us lean forward

WHY FOCUS ON EXTENSION

Better balance Deeper ventilation Better organ function Less pain

EXTENSION IS ANATOMICAL POSITION

Practice anatomical position Practice moving backwards first Practice extension

In seated position In standing position While walking

TEACHING EXTENSION

Head positioning – chin back and up, head lifted, muscles working, then relax and repeat – then add…

Scapulae depressed – press the shoulder blades down, while head lifts, then relax and repeat – then add…

Breathe – inhale during scapulae depression and head lift, then relax exhale, and repeat – then add…  

TEACHING CONTINUED

External shoulder rotation – point thumbs back during inhalation and all above, then relax and repeat – then add…

Rib cage – lift upper trunk off the spine and pelvis, muscles working, during extension, then relax and repeat

START SMALL

Teach only the head first. It tends to lift the rest of the Upper Quadrant with it.

Head positioning goes well with the scapular depression so you may want to combine those.

Try the others individually with the breath. Holding extension without rest increases pain

levels.

FOR UPPER EXTREMITY ONLY – ADD…

Elbows extend during extension listed above (with relax between extension), then add…

Wrists extended beyond neutral, then add …

Fingers extended with thumb still pointing back

FOR HIPS AND BACKS ONLY TRY …

Walk backwards with perfect alignment, then add …

Point toes out about 45 degrees (just to feel the external rotators activate)

Lead with toe (toe strike walking; toe hits first)

FOR KNEES TRY …

Walk backwards with perfect alignment

Lead with heel (heel strike during walk backwards) without changing alignment