Category Archives for "rehab"

What is PNF Stretching?

Proprioceptive Neuromuscular Facilitation, also known as PNF stretching, is a technique employed to improve muscle elasticity and range of motion. PNF is frequently used by therapists to restore functional range of motion and increase strength capabilities in patients who have sustained soft tissue damage or in post-surgery rehabilitation. It is found that consistent performance of PNF stretching and PNF stretching post-exercise may increase athletic performance by increasing range of motion. It is evident in literature that there are two types of techniques that can be utilized under PNF stretching.

The contract-relax method (CR) includes lengthening the targeted muscle and holding it in that position while the targeted muscle is contracted to its maximum isometrically for a period of time. A short period of relaxation and a passive stretch of the targeted muscle follows this initial contraction phase. The contract-relax-antagonist-contract method (CRAC) begins with the same procedure as the CR method. However, it takes a further step by contracting the antagonist muscle to the targeted muscle instead of passively stretching the targeted muscle.

How to Properly Perform a PNF Stretch:

Contract-Relax (CR) Method:

1) Stretch targeted muscle to the limit of normal range of motion. Contract the targeted muscle group for 5 – 10 seconds while a partner or immovable object such as a band applies sufficient resistance to inhibit movement of the muscle group.

2) Relax the targeted muscle group for 3 – 5 seconds.

3) Have your partner passively stretch the targeted muscle group by applying a controlled, deeper stretch for about 20 – 30 seconds into a greater range of motion.

4) Relax the muscle for approximately 30 seconds before repeating the above process 2 or 3 more times.

Contract-Relax-Antagonist-Contract (CRAC) Method:

1) Stretch targeted muscle to the limit of normal range of motion. Contract the targeted muscle group for 5 – 10 seconds while a partner or immovable object such as a band applies sufficient resistance to inhibit movement of the muscle group.

2) Relax the targeted muscle group for 3 – 5 seconds.

3) Contract the antagonist muscle (opposite to targeted muscle group) for 5 – 10 seconds.

4) After brief period of relaxation, have your partner passively stretch the targeted muscle group by applying a controlled, deeper stretch for about 20 – 30 seconds into a greater range of motion.

5) Relax the muscle for approximately 30 seconds before repeating the above process 2 or 3 more times.

Example of PNF Stretching for the Lower Body: 

Begin by lying on your back with one leg on the floor and the other leg extended and stretched into the limit of your normal range of motion. 

Contract the hamstring of the stretched leg and have your partner resist leg movement. 

Relax the hamstrings then have your partner passively stretch the leg past its normal range of movement.
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How to Improve Flexibility with a Yoga Block

Flexibility is the ability to move a joint through its complete range of motion and is important in carrying out daily activities and in athletic performance. Maintaining flexibility of all joints produce efficient movement and reduces risk of injury. It can be improved in all age groups by regularly engaging in exercises targeting different joints. Joint capsule stiffness, muscle viscosity, ligament and tendon compliance all affect flexibility. Therefore, adequate warm-up and proper stretching is essential in optimizing joint range of motion. Chronic conditions such as lower back pain may arise if an individual has poor lower back and hip flexibility, in conjunction with weak abdominal muscles.

Flexibility exercises are most effective through warm-up exercises or passively through moist heat packs or hot baths to increase the muscle temperature. An effective warm-up is typically 5 to 10 minutes long, but may be longer for older adults or individuals with health conditions. Watch the video below, led by InSync Physio’s Claire McDonald, on how to do a comprehensive warm-up targeting all of the major muscles:

Evidence-Based Recommendations:

Frequency: more than 2-3 days per week with daily being the most effective
Intensity: stretch to the point of feeling tightness or slight discomfort
Time: hold a static stretch for approximately 10-30 seconds, hold for 30-60 seconds for older individuals
Type: static (active or passive), dynamic, ballistic, or proprioceptive neuromuscular facilitation
Volume: a total of 60 seconds of stretching time for each flexibility exercise is recommended
Pattern: repetition of each exercise 2-4 times

Stretching for Beginners: 

Yoga blocks can be very helpful for individuals building their flexibility by reinforcing balance and proper alignment. Use a yoga block for the following positions:

1) Forward Folds for Tight Hamstrings

Place a yoga block flat on the ground and sit directly on top with legs extended forward and feet flexed.

2) Hip Openers for Tight Hips

Sit on the ground and bring your feet together, then place a yoga block under each knee for support. Remember to sit up straight.

3) Standing Thigh Holds for Posture: 

Standing tall, place a yoga block between the thighs to tilt the pelvis downwards and realign the spine.
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Which is Better for an Injury: Ice or Heat?

Ever wondered whether to use ice or heat for your sore muscles, your healing fracture, or any injury? Both ice and heat have been commonly used to treat an array of injuries, but when to use either one is critical in preventing further damage and promoting faster recovery.

Acute irritation or inflammation of a muscle, ligament, or tendon is typically treated with ice. The cold application reduces inflammation and numbs the pain, especially when the superficial tissues are red, hot, and swollen. The inflammatory response associated with damage to tissues is a defence mechanism in the human body that lasts for the first several days to protect against infection. The response involves immediate changes to blood flow, increased permeability of blood vessels, and flow of white blood cells to the affected site.

ICE APPLICATION

Ice can be used for gout flare-ups, headaches, sprains, and strains. It is crucial to apply ice to the site of injury during the first 48 hours post-injury to minimize swelling. For soft tissue injuries such as muscle strains or ligament sprains, an ice massage involving elevation of the injured body part above the heart and circular movement of an ice pack around the affected area may promote faster recovery of these acute injuries. Apply for 10 minutes at a time, then take a break from icing for another 10 minutes. Repeat this process 3 to 5 times a day. Remember to wrap the ice pack in a dry cloth or towel.

HEAT APPLICATION

Heat can also be used for headaches, sprains, and strains as well as arthritis or tendinosis. Heat causes blood vessels to dilate which increases blood flow and relaxes tight or stiff muscles and joints. Do not use heat during the initial inflammatory response as this will further aggravate the site of injury. For minor injuries, applying heat for 15 to 20 minutes at a time may be sufficient to relieve tension. However, longer periods of heat application such as 30 minutes to an hour may be required for major chronic injuries. Hot baths, steamed towels, or moist heating packs can be used as different heat options.

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How to Recover from Achilles Tendinopathy

The Achilles tendon is the thickest tendon in the human body. It attaches the gastrocnemius and soleus muscles (together known as the triceps surae) as well as the plantaris muscle to the calcaneus bone (heel) of the ankle. These muscles combined allow for plantar flexion at the ankle and flexion of the knee.

Tendinopathy of the Achilles tendon refers to a condition that causes pain, swelling, or stiffness at the tendon connecting the muscles to the bone. Commonly found in athletes such as runners, overuse of the tendon, may result in microtrauma or repeated injuries to the Achilles tendon. Wearing improper footwear, having poor training or exercising techniques, making a sudden change to your training program, or exercising on hard surfaces may also cause minor injuries to this tendon. Pain and stiffness may develop gradually and are typically worse in the morning. Pain is generally worse after exercise, but may potentially arise during training. Overtime, symptoms may be so severe that individuals may be unable to carry out their usual daily activities.

Recovery:

Rehabilitation occurs quickly or over several months depending on the severity of the injury. Although pain may be present, expert clinicians and researchers recommend continuing daily activities within one’s pain tolerance. As complete rest should be avoided as much as possible.

In the early stages of Achilles tendinopathy, a treatment called iontophoresis may be used to reduce soreness and improve function. This treatment involves delivering a medicine (dexamethasone) to the painful area. Ice packs are also effective in reducing swelling. Apply ice pack wrapped in a towel or dry cloth to the affected area for 10 to 30 minutes at a time.

However, researchers have found that Achilles tendinopathy is often successfully treated with strength training guided by a physical therapist. Strength training relies on using one’s body weight with or without additional weight for resistance to load the tendon and associated muscles to strengthen the calf. Do exercises slowly to decrease pain, improve mobility, and return to normal functioning.

Try these exercises below:

1) Heel-raise: Stand with your feet a few inches apart. Raise up on to your tiptoes and lift the heels by using both legs. Then lower yourself down using the affected leg. Perform 3 sets of 15 repetitions twice per day. This exercise can also be performed seated in a chair.

2) Calf stretch: Stand a few steps away from a wall and place your hands at about eye level. Place the leg you want to stretch about a step behind the other leg and bend the knee of the front leg until you feel a stretch in the back leg. Remember to keep your heels planted. Hold this position for 15 to 30 seconds. Repeat 3 to 4 times before switching to the other leg. Repeat twice per day.

3) Towel stretch: Sit with both knees straight on the ground and loop a towel around the affected foot. Gently pull on the towel until a comfortable stretch is felt in the calf. Hold position for 15 to 30 seconds. Repeat 3 to 4 times before switching to the other leg. Repeat two to three times per day.

Check out these videos:

Strengthen the Calf Muscles with 1-Legged Squats:
Roll Out Stiff Calves:

Reference: J Orthop Sports Phys Ther 2018;48(5):427. doi:10.2519/jospt.2018.0506
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Strain vs Sprain? How To Recover Optimally

Acute sprains and strains may impede performance and delay return to a sport. Proper management, treatment, and prevention is essential to recovering effectively. An athlete must first understand the definition and recognize the differences between a “sprain” and a “strain.” A sprain is defined as a violent overstretching of one or more ligaments in a joint. A sprain can result in pain, tenderness, swelling or bruising at the joint. A strain is defined as a stress or direct injury to the muscle or tendon. A strain may also cause pain when moving or stretching the injured muscle, but can also cause muscle spasms.

Grades of Strain:

1) Grade I – Mild Strain: slightly pulled muscle with no muscle or tendon tears and no loss of strength and low levels of pain
2) Grade II – Moderate Strain: partial tearing of the muscle or tendon at the bone attachment with reduced strength, moderate pain levels
3) Grade III – Severe Strain: complete rupture of muscle-tendon-bone attachment with separation, substantial loss in strength and high levels of pain

Grades of Sprain:

1) Grade I – Mild Sprain: minor tearing of some ligament, no loss of function
2) Grade II – Moderate Sprain: partial rupture of portion of ligament, moderate loss of function
3) Grade III – Severe Sprain: complete rupture of ligament or separation of ligament from bone, substantial loss of function

Proper RICE Treatment:

1) REST: Do not continue to use the affected muscle or ligament immediately after injury. Use crutches for the lower extremities (i.e. leg or ankle) and splints for the upper extremities (i.e. arm or hand)

2) ICE: Sudden cold may help constrict capillaries and blood vessels to slow or restrict internal bleeding. Place an ice pack between a towel or dry cloth. Apply ice every hour for 10 to 20 minutes at a time.

3) COMPRESS: Compression can help reduce swelling post-injury. Wrap the injured part firmly with an elasticized bandage, compression sleeve, or a cloth. Do NOT wrap the cloth too tightly as it may cut off blood circulation and lead to more swelling.

4) ELEVATE: Elevate the injured part about level of the heart to reduce swelling and pain. Place a soft object such as a pillow or piece of clothing to use as a prop below the body part.

Continued Recovery:

Continue to follow the above RICE method for two to three days post-injury. Daily stretching may help loosen the muscle. Key to prevention is to stretch the tight muscles and strengthen the weak muscles.

Watch the videos below on how to recover from a common ankle sprain or shoulder strain:

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5 Exercises for Stronger Scapulas

Weak scapular muscles can lead to an array of injuries including shoulder impingement, rotator cuff tears, and other shoulder-related pains. Pain may be followed by a restricted range of motion and may severely worsen if left untreated. Strengthening the scapular muscles can provide long-term benefits for rehabilitation and performance. Try the five following exercises below:

LYING DUMBBELL PRESS:

1. Lie down flat on a bench with a light dumbbell in each hand.

2. Hold the dumbbells on either side of your chest with the palms facing away from your shoulders and your elbow at a 90 degree angle.

3. Push your arms upwards and feel your shoulder blades separate. Remember to keep the dumbbells parallel to each other until the very top of the press.

3. Inhale and slowly bring down both dumbbells to the sides of your chest until you reach the 90 degree angle at the elbow. Breathe out on your next rep. Perform 3 sets of 10 reps.

WALL PUSHUP:

1. Stand a few steps away from a wall, then place your hands on the wall so that they are slightly more than shoulder-width apart and arms are locked out.

2. Maintain a neutral back and neck, then slowly lean towards the wall by bending your elbow.

3. Squeeze your shoulder blades together as you lower yourself and hold this forward position for 2-3 seconds.

4. Slowly straighten your arm and relax your shoulder blades. Repeat 10 times.

BAND PULL APARTS:

1. In a comfortable standing position, hold a light band in between both hands about shoulder-width apart.

2. Pull the band as wide as you can, then slowly bring the arms back to the starting position. Perform 3 sets of 10 reps.

Y-RAISES:

1. Lie on your stomach on a bench or Swiss ball with a light dumbbell in each hand.

2. Straighten your arms so that the dumbbell is in front of your head.

3. Lift the dumbbells up, keeping your arms straight, to make a “Y” shape with your torso.

4. Slowly lower them down. Perform 3 sets of 10 reps.

ISOMETRIC DUMBBELL HOLDS:

1. Hold a very light dumbbell straight in front of you at approximately 45 degree angle.

2. Maintain this position for about 10 seconds.

3. Then, slowly lower the dumbbell to the side of your body. Perform 10 holds on each side.

BONUS: Watch this video to learn an extra exercise for the scapula muscles!

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How to Squat Properly

Squats are an excellent way to target the full body and to build significant strength. It heavily relies on your thighs, calves, lower back, arms, and abs. Some key benefits include building muscle, burning fat, increasing endurance, and improving proprioception. However, proper form is needed to avoid back or knee pain.  
HOW TO SQUAT WITH A BARBELL:
Starting Position
1.      Stand with feet approximately shoulder-width apart, toes pointing straight ahead, and knees aligned over second and third toes.
         As much as 5-8° of external foot rotation is allowed in the starting position, some consider this normal anatomical position.
2.      To perform the high-bar back squat, rest the barbell on the shoulders, behind the neck, with hands grasping the bar wider than shoulder-width apart.

3.      To perform the low-bar back squat, rest the barbell on the middle trapezius region with hands grasping the bar wider than shoulder-width apart.
         It is important to note adequate shoulder mobility (external rotation) is required to hold the bar securely.
Movement Pattern
1.      Slowly begin to squat down by hinging at the hips and then flexing at the knees.  
2.      Allow glutes to “stick” out behind the body as if sitting into a chair.
3.      Keep the chest up and the cervical spine in a neutral position. Avoid excessive cervical flexion, extension, or anterior translation (jutting the head forward).
4.      Squat to a depth that can be safely controlled with no movement compensations.
         Common movement compensations include knee valgus (knock knees), rounding or arching of the low-back, an excessive forward lean of the torso, and overly externally rotating or pronating the feet.
5.      To rise back up, contract the gluteals and place pressure through the heels as the knees and hips are extended.
6.      Stand up straight until hips and legs are fully extended. Fully contract the gluteals in the standing position for maximal muscle recruitment.

FOR BEGINNERS:

1. Place the big ball up against the wall and have your lower back against the ball
2. Roll up a towel, place it between your knees and shimmy your feet out slightly in front of you.
3. Make sure your knee is in line with your second toe, squeeze the towel and keep your core engaged.
4. Squat down until your knees are at 90 degrees and hold that for 10 seconds.
5. Do 3 sets of 10. Rest for 5 seconds between each rep.

For reference:
http://www.ptonthenet.com/articles/biomechanics-of-the-squat-4016

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.