Exercises to Prevent Knee Cap Dislocation: by Gary J. Maguire, PT a physical therapist

Exercises to Prevent Knee Cap Dislocation
Gary J. Maguire, PT


The knee cap, or patella, attaches from the quadriceps muscle and has a ligament attached into the tibia bone. When the knee bends, the patella glides downward; it moves upward when the knee straightens. Patella dislocation happens when the knee cap slips sideways outside of the femur bone's trough. Patella dislocation is often seen in women, and is very painful. It usually occurs after a sudden change in direction when your leg is planted, putting your kneecap under stress, according to MedlinePlus.

Hamstring Stretch

The hamstring muscles on the back of your thigh often shorten with sitting activities. These muscles limit the patella from gliding through its full range of motion. Stretch your hamstring while standing with your leg up on a chair placed in front of you. Lean forward until you feel tension on the hamstring. Do not bounce or force a stretch. Hold the stretch for 1 to 2 minutes to allow the muscle to adaptively lengthen and not return to its shortened resting length. Repeat several times per day. As a variation, lie on your back with your leg straight up and use a towel around your foot to stretch.

Towel Roll

Roll up a towel to about to 3 to 4 inches in diameter. Sitting on the floor with your leg straight, put the towel under your knee. Squish the towel into the floor with your knee while contracting your thigh muscles. Hold as long as you can for up to 1 minute. Repeat the exercise 10 to 12 times. There should be no pain with the gliding of the patella. Slowly relax your thigh muscle.

Straight Leg Raise

Lie on the floor with your leg straight. Bend the other leg up until your foot is flat. Turn your foot out to a 45-degree angle. Raise your leg up to the level of the other leg's knee, or 12 to 14 inches. Hold for 10 to 20 seconds, then lower your leg back to the floor as slowly as you can. Rest and repeat. Start with 10 to 12 repetitions and gradually build to 22 to 30 repetitions.

 

Reference

• MedlinePlus: Kneecap Dislocation [http://www.nlm.nih.gov/medlineplus/ency/article/001070.htm]
• American Academy of Orthopaedic Surgeons: Unstable Kneecap [http://orthoinfo.aaos.org/topic.cfm?topic=A00350]

Resource

• Children's Hospital Boston: Dislocated Patella [http://www.childrenshospital.org/az/Site801/mainpageS801P0.html]

Keywords

• patellar tracking
• knee cap pain
• patellar tracking exercises
• knee cap exercises
• knee cap problems
• Gary J. Maguire, PT
• Physical Therapist
• Physical Therapy
• Vancouver, WA

Choosing a Physical Therapist: Patient Information By Gary Maguire, PT

It's a physical therapy paradox in today's health care market due to insurance reimbursement. Over the past decade, more and more research has demonstrated how manual therapy treatment approaches performed by physical therapists enhance the outcomes for a broad range of conditions.

Physical Therapists utilize manual therapy to treat back pain, shoulder impingement syndrome (e.g. Frozen Shoulder or Rotator Cuff injuries), headaches, Carpal Tunnel Syndrome, neck pain, sports injuries, Fibromyalgia, etc. Over this same span of time, many physical therapy clinics have deemphasized manual therapies, opting to utilize profitable approaches requiring less on-on-one time.

When choosing a physical therapist for your recovery from surgery, a sports related injury or work injury determine if the physical therapist you are referred to or selecting utilizes manual therapy as part of their rehabilitation approach.

What is Manual Therapy?

The term manual therapy performed by a physical therapist refers to a host of approaches wherin the physical therapist uses his or her hands to achieve specific motion in targeted joints and/or soft tissue to improve or restore proper biomechanical motion. A physical therapist who utilizes manual therapy also may include higher velocity thrusts for greater mobilization of a restricted joint due to scar tissue, stiffness or soft tissue restrictions.

Manual therapy also provides the benefit of stimulating mechanoreceptors which are positive nerve stimuli in the joint and assist in reducing nocioceptor information or inappropriate nerve pain stimuli. The mechanical benefits include stretching joint capsule tissue, tendons and ligaments to overcome what is termed hypomobiity (restricted motion).
In general a physical therapist uses manual therapy to focus on healing injured tissue through the effects of motion. WIth manual therapy, a physical therapist can introduce therapeutic motion to tissues or joints much faster than would be possible through voluntary motion alone.

A physical therapist who combines motion manual therapy with therapeutic exercise, functional movment and medical therapeutic equipment on a regular treatment basis will improve and increase a patient's recovery faster than without utilizing this specialized approach.

As you select a physical therapist you should inquire about their level of specialized training and ascertain if they are a skilled manual therapist?

Physical Therapy Research & Guidelines:

Peer review journals and current guidelines show the benefits of manual therapy performed by skilled physical therapists in the treatment of back pain, headaches, sports injuries, carpal tunnel syndrome, Fibromyalgia and more.
One study by Bang et al reported in the 2000 Journal of Orthopaedic and Sports Physical Therapy compared two treatment approaches for shoulder impingement syndrome. The first treatment approach was physical therapy directed strengthening and stretching exercises. The second type of physical therapy provided the same exercises plus passive joint mobilizations involving skilled manual therapy applied by a physical therapist. While both groups showed significant improvements in only three weeks, the group receiving manual therapy reported twice the pain decrease on a visual analog scale and more than twice the improvement on functional ability questionnaires. The researchers demonstrated that even when exercise, stretching and other voluntary movements are effective, manual therapy provided by a physical therapist can significantly shorten a patient's recovery time.

Another good example reported in the 1999 New England Journal of Medicine by researchers Anderson et al., concluded that there was more effectiveness of adding manual therapy to reduce a patient's low back pain. In the study, group one received a standard therapy approach including anti-inflammatory medications, muscle relaxants, ultrasound, heat & cold packs, and electrical stimulation provided by a physcical therapist.

In the second group, patients received the same treatment for low back pain and also received manual therapy techniques provided by a physical therapist. Both groups showed improvement in a reduction of pain, but the patients receiving manual therapy from the physical therapist had less than half the need for pain medication and 75% less muscle relaxant usage.
This study demonstrated that manual therapy provied by a qualified physical therapist can positively affect treatment outcomes even when added to a treatment plan including pharmacological therapies and therapeutic modalities.

In conclusion, when selecting a physical therapist to assist you with recovering from an injury determine their level of clincial expertise and if they have specialized training in manual therapy and the amount of time allowed for its use in your physical therapy appointment.


Gary Maguire, PT


Key words:
gary maguire, pt, physical therapy, physical therapist, manual therapy, low back pain, motor vehicle accident injuries, work-related injury, Fibromyalgia, Myofascial Pain Syndrome, Carpal Tunnel Syndrome, Sports Injuries, ACL, Rotator Cuff, Frozen Shoulder, Knee Pain, Ankle Sprains, Tendonitis, Tendinitis, neck pain, headaches, http://garymaguiremspt.blogspot.com/ , Vancouver, WA, physical, therapist

Gary Maguire, PT An Overview about Fibromyalgia by a Physical Therapist

The following is an overview about Fibromyalgia presented by Gary Maguire, PT a physical therapist .

Fibromyalgia Syndrome (FMS) refers to a complexity of symptoms involving diffuse musculoskeletal pain.  There are also other problems associated with Fibromyalgia such as cognitive impairment, fatigue, sleep disturbance and morning stiffness.

Unfortunately there is currently no diagnostic test for this condition.  Currently health care providers use a standard developed by the American College of Rheumatology (ACR).  Following a patient history about their onset of pain, trauma and emotional state the criteria for a diagnosis is as follows:

There needs to be an unexplained or spontaneous pain present for over 3 months along the spine and in all 4 quadrants of the body.  A quadrant of the body consists of dividing the body in half from head to your feet and across at the naval or waistline.

A clinician then assesses if pain is present by palpation or moderate pressure over 18 designated tender point areas.  To qualify a patient as having Fibromyalgia they have to test positive for 11 out of 18 tender points.

·         The tender points are on both sides in muscles at the base of you skull or what is referred to as the occiput.

·         The next group is at the lower base of our neck area on both sides at the neck and shoulder line or the cervical vertebras of the 5^th to 7^th of the neck.

·          At the level of our upper shoulders over the middle of the trapezius muscles at the middle are the next two points on each side.

·         The shoulder blades or scapula each has a point.  This is located at the middle on the inside edge closest to the spine.  Half way from the top of the scapula to the lower tip.

·         On our front chest on each side are the next two points. These are located where the collar bone meets the sternum at what is called the costochondral junction.

·         Over our elbows where the end of the humerus or upper arm bones are the next points on each side.  The point is 2 cm away from the outside tip of the bone or what is called the epicondyle.

·         The buttock muscles or gluteals each have a point located in the middle and towards the outside.

·         Each thigh bone (femur) at the top closest to the hip or greater trochanter has a point located on the back side.

·         The last points on each side are in the back of the knee joint at the area referred to as the medial fat pads or the half way point where the knee bends.

When examining these tender points to assess Fibromyalgia there are limitations.  This has lead to controversy amongst the medical community surrounding the identification of FMS.  The positive outcome is the recent research into what is referred to as Central Sensitization (CS) and further understanding of pain mechanisms.

Further research is also providing a clearer understanding of connective tissue or fascia tissue and its relationship to the autonomic nervous system.  As musculoskeletal physiology evolves, our clinical ability to accurately identify and diagnose Fibromyalgia will greatly improve.  Recent research studies have lead to the identification of what are called myofascial trigger points or MTrPs. These trigger points or painful tissue points play a specific role in Fibromyalgia.

These myofascial trigger points have been identified in Fibromyalgia patients in recent clinical studies.  A myofascial trigger point is a taut band of skeletal muscle fibers that create a characteristic pain and referral pattern of symptoms when they are palpated or stimulated.

These trigger points can be active and painful.  They also can be quiet and do not cause any discomfort.  When active they can cause spontaneous pain locally and can also refer pain to other areas exhibiting a muscle twitch.  Then they are quiet they only become active and painful when pressure is applied to them causing pain or a tender bruising symptom.

One common characteristic of myofascial trigger points is the presence of spontaneous electrical activity (SEA).  This activity can be measured using medical equipment referred as an electromyography (EMG) while the muscle is at rest.

As a physical therapist who has successfully treated and resolved patient with Fibromyalgia one important component is to engage the patient in a progressive swimming approach.

Due to over arousal of the sympathetic nervous system and its direct influence on the connective tissue and trigger point mechanisms, this approach is aimed at quieting and shutting off this over arousal or derailment of the sympathetic nervous system. 

The sympathetic nervous system is part of our central nervous system (CNS) involved involving the autonomic nervous system.  With progressive swimming a patient can reduce the overall symptoms and with specific treatment techniques applied by a physical therapist this condition can be resolved permanently.

Gary Maguire, PT is a physical therapist who specializes in treating patients with chronic pain.  As a physical therapist for over 20 years I have successfully resolved chronic pain related problems utilizing neurophysiology treatment approaches.

Key Words

Gary Maguire, PT
Physical Therapist
Gary J. Maguire, PT Physical Therapist
Vancouver, WA
PT

Gary Maguire, PT Physical Therapist: Advice for Rotator Cuff Strengthening Exercises

Proprioceptive Exercises for a Rotator Cuff Injury

The rotator cuff muscles provide coordination and movement of the humerus bone in the arm, preventing it from compressing against the top of the scapula bone. In the aging population, mechanical pinching of the rotator cuff tendons occurs from degenerative changes, muscle weakness and stress overload on the tissues. In younger individuals, rotator cuff problems occur with muscle imbalances and abnormal movement patterns. Proprioceptive exercise helps to improve neuromuscular functioning and is a specialized variation of the sense of touch.

Proprioception

Proprioception is important in developing neuromuscular control of the rotator cuff with sports activities, especially throwing or overhead movements. It improves muscle tone, reduces strain on the joints and ligaments of the shoulder and can decrease the vulnerability to injuries. Balance and coordination exercises improve muscle restraint and provide a protective reflex during movement. Muscles that are deconditioned or fatigued have a low muscle tone and move awkwardly. This can lead to injury and wear and tear of tissue.

Proprioceptive Exercise Equipment

Resistance bands, exercise balls and medicine balls are examples of equipment used to develop proprioception. Exercises should start with the arm at your side and progress to overhead movements. Progression is based on the speed of the movement and added tension resistance. All activities should be monitored based on the "shrug sign." When an individual performing an exercise begins to shrug his shoulders, he should stop. This demonstrates lack of rotator cuff control; therefore the exercise should be modified so it is performed without shrugging.

Rhythmic Stabilization

In the March 1994 issue of the “Journal of Athletic training," Nina Partin, MS, ATC states that “rhythmic stabilization” occurs when an individual positions her upper extremity anywhere in its available range of motion and holds an isometric contraction. External resistance is applied by the trainer to cause the individual to react, but not enough to disrupt the isometric contraction. Progression can consist of the length of time, resistance and the amount of contact to the area between the trainer and the individual.

Rowing Exercises

Rowing exercises provide the capability for training and strengthening the scapular muscles that retract or pull your shoulder blades backward. Rowing exercises involve pulling your arms and shoulders towards you and can be performed with resistance bands, free weights or weight machines. Slow controlled movements are important to facilitate proprioception and muscle activity. Shoulder retraction exercises promote rotator cuff stability and prevent the humerus bone from moving upward and pinching the rotator cuff tendon.

Potential for Injury

Due to its wide freedom of movement, the shoulder is susceptible to injury.The shoulder joint is the most frequently dislocated major joint of the body. It is easily injured because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by its muscles, tendons, and ligaments, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Proprioception exercises improve stability and function.

Keywords

• rotator cuff exercises
• proprioception shoulder exercises
• rotator cuff strengthening
• shoulder exercises
• rotator cuff proprioception
• rotator cuff injuries
• Gary J. Maguire, PT Physical Therapist
• Gary Maguire, PT Physical Therapist
• Gary Maguire, PT Physical Therapist
• Physical Therapist
• Physical Therapy
• Vancouver, WA

Reference

• National Institute of Arthritis and Musculoskeletal and Skin Diseases: Questions and Answers about Shoulder Problems [http://www.niams.nih.gov/Health_Info/Shoulder_Problems/default.asp]
• "Journal of Athletic Training"; Upper Extremity Proprioceptive Training; Nina B. Partin, MS, ATC et al; March; 1994 [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317754/]
• MayoClinic.com; Rotator Cuff Injuries [http://www.mayoclinic.com/health/rotator-cuff-injury/DS00192]

Gary Maguire, PT Physical Therapist

Exercises to Help Reduce Low Back Pain

Rehabilitation exercises for the lumbar spine need to be performed pain free with an emphasis on proper technique. Always start each exercise at a safe tolerance. If straining occurs, it is probably too difficult and should be simplified. If you experience fatigue, do not push to the point of straining the muscles. Warm up with gentle stretches or a 10 to 15 minute walk. Progress from low repetitions to high repetitions to target improved strength and endurance.

Exercise Balls

Using an exercise ball regularly can help stretch tight muscles and strengthen the postural muscles of the spine. Increase muscle tone by lying on your back on the ball and performing abdominal exercises. Progressive push-ups can be performed with the ball under your hips, knees and eventually your feet. Squatting exercises consist of using the ball between your back and a wall and moving up and down in a controlled movement. A variety of ball exercises help to provide spinal stability and improve posture.

Progressive Swimming

Progressive swimming provides an effective exercise environment for lumbar spine rehabilitation. In the water, you are only 10 percent of your body weight. Swimming allows the discs, joints and ligaments of the spine to be unloaded, reduce stress on these tissues and improves overall healing capabilities. When swimming the deep postural muscles of the spine are exercised and stretched which improves weight-bearing tolerances, posture and overall core muscle strength.

Core Muscle Exercises

Any exercise that uses the trunk of your body without support counts as a core exercise. Abdominal crunches are a classic core exercise, according to the Mayo Clinic. The focus is on improving pelvic, abdominal and spinal muscles. These exercises can be performed without weights or exercise equipment. By improving core strength, you provide protection to injured vertebral discs, joints and ligaments. Core exercises improve posture, help prevent lifting injuries and reduce stress on the lumbar spine.

Walking

Walking is an effective means to increase lumbar strength. Consistent daily walking reduces body weight, which can place unnecessary strain on the ligaments and discs of the spine. Walking improves muscle tone, overall circulation and coordination. A progressive exercise routine can consist of alternatively walking for one to two minutes and then jogging one to two minutes. Use shoes that have a wide base of support and cushion to reduce excessive loading tolerances on the spine.

Keywords

• back pain
• back exercises
• back strengthening exercises
• lumbar exercises
• low back pain
• core strengthening exercises
• gary maguire, pt physical therapist
• physical therapist
• gary j. maguire, pt
• gary maguire
• physical therapist

Reference

• MayoClinic.com: Core exercises: 7 reasons to strengthen your core muscles [http://www.mayoclinic.com/health/core-exercises/SM00071]

Resource

• American Academy of Orthopaedic Surgeons; Low Back Pain Exercise Guide [http://orthoinfo.aaos.org/topic.cfm?topic=A00302]

Gary J. Maguire, PT

Ankle-strengthening Exercises

Ankle-strengthening exercises are necessary to recover from injuries, such as sprains or fractures, and beneficial to prevent injuries and improve athletic performance. Thera-Bands, resistance bands, sport cords or medicords are elastic materials that vary in density to provide sufficient resistance to stimulate muscle strengthening or endurance. They are inexpensive, easy to use and portable. Thera-Bands are also versatile, allowing a variety of different exercises for different individual or muscle groups to be performed.

Reinjury

According to the American Academy of Orthopaedic Surgeons, possible complications from ankle sprains and surgery include abnormal proprioception. Lack of proprioception or coordination can lead to imbalance and muscle weakness that can cause reinjury. Repetitive reinjury creates a chronic situation establishing instability or a sense of the ankle giving way and chronic pain. This often happens if you return to work, sports or other activities without letting the ankle heal and become rehabilitated.

Strengthening the Ankle

Most functional movements and physical demand on the ankle and foot occur whenever you are in a weight-bearing posture. Emphasis for strengthening the ankle and foot should involve focus on closed chain activities, which involves keeping your foot in contact with a surface at all times. This can be a smooth surface, an unstable surface, such as a foam pad or even riding a bicycle. Always exercise without pain. Attention should be on the quality of the exercise and not just repetitions.

Thera-Band Properties and Strengthening

The characteristic of elastic resistance bands is that the material undergoes a change in resistance while it is being stretched or when it is returning to its resting length. This provides a special property for challenging muscles during strengthening exercises. Another consideration is that when strength training, muscle contractions require an overload principle. Muscle contractions need to be applied consistently so that it will respond and adapt to greater loads of resistance. This requires progressively increasing the thickness of the Thera-Band. Most have a color-coding system.

Benefits to the Ankle

In the Winter 1993 "Journal of Athletic Training," Phillip A. Page, M.S., A.T.C., E.M.T., L.A.T., states that a 19 percent increase in eccentric deceleration strength was demonstrated in athletes who used elastic resistance bands. An example of eccentric deceleration would be the muscles contracting to slow down, and absorbing the force of the ground when the foot is coming in contact during running. Training with elastic resistance would then benefit improved ankle foot strength and help reduce a potential injury or improve performance.

Considerations

Many different types of exercises may be performed with Thera-Band to strengthen, improve endurance and increase coordination of the ankle and foot. Thera-Band is widely used in rehabilitation settings, fitness centers and athletic training. Consideration needs to be given when using resistance bands to determine the optimal dose with intensity, frequency and duration of each exercise. Prior to engaging in a strenuous exercise program, it is important to receive medical clearance from a trained health care professional to prevent injury and learn proper technique.

Reference

·    American Academy of Orthopaedic Surgeons: Sprained Ankle [http://orthoinfo.aaos.org/topic.cfm?topic=A00150&return_link=0]

·    "Journal of Athletic Training"; Posterior Rotator Cuff Strengthening Using Thera-Band in a Functional Diagonal Pattern in Collegiate Baseball Pitchers; Phillip A. Page, M.S., A.T.C., E.M.T., L.A.T., et al; Winter 1993 [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317739/]

Resource

·    Cleveland Clinic: Rehabilitation for Foot and Ankle Overuse and Traumatic Injuries [http://my.clevelandclinic.org/disorders/plantar_fasciitis/hic_rehabilitation_for_foot_and_ankle_overuse_and_traumatic_injuries.aspx]

Keywords

·    ankle sprains

·    ankle strengthening exercises

·    ankle resistance exercises

·    resistance band exercises

·    ankle resistance bands

·    ankle exercises

·    Gary J. Maguire, M.S., P.T.

·    Gary J. Maguire, PT

·    Gary Maguire

·    Gary Maguire, Physical Therapist

Exercises to Prevent Knee Cap Dislocation

The knee cap, or patella, attaches from the quadriceps muscle and has a ligament attached into the tibia bone. When the knee bends, the patella glides downward; it moves upward when the knee straightens. Patella dislocation happens when the knee cap slips sideways outside of the femur bone's trough. Patella dislocation is often seen in women, and is very painful. It usually occurs after a sudden change in direction when your leg is planted, putting your kneecap under stress, according to Medline Plus.

Hamstring Stretch

The hamstring muscles on the back of your thigh often shorten with sitting activities. These muscles limit the patella from gliding through its full range of motion. Stretch your hamstring while standing with your leg up on a chair placed in front of you. Lean forward until you feel tension on the hamstring. Do not bounce or force a stretch. Hold the stretch for 1 to 2 minutes to allow the muscle to adaptively lengthen and not return to its shortened resting length. Repeat several times per day. As a variation, lie on your back with your leg straight up and use a towel around your foot to stretch.

Towel Roll

Roll up a towel to about to 3 to 4 inches in diameter. Sitting on the floor with your leg straight, put the towel under your knee. Squish the towel into the floor with your knee while contracting your thigh muscles. Hold as long as you can for up to 1 minute. Repeat the exercise 10 to 12 times. There should be no pain with the gliding of the patella. Slowly relax your thigh muscle.

Straight Leg Raise

Lie on the floor with your leg straight. Bend the other leg up until your foot is flat. Turn your foot out to a 45-degree angle. Raise your leg up to the level of the other leg's knee, or 12 to 14 inches. Hold for 10 to 20 seconds, then lower your leg back to the floor as slowly as you can. Rest and repeat. Start with 10 to 12 repetitions and gradually build to 22 to 30 repetitions.

Reference

·    Medline Plus: Kneecap Dislocation [http://www.nlm.nih.gov/medlineplus/ency/article/001070.htm]

·    American Academy of Orthopaedic Surgeons: Unstable Kneecap [http://orthoinfo.aaos.org/topic.cfm?topic=A00350]

Resource

·    Children's Hospital Boston: Dislocated Patella [http://www.childrenshospital.org/az/Site801/mainpageS801P0.html]

Keywords

·    patellar tracking

·    knee cap pain

·    patellar tracking exercises

·    knee cap exercises

·    knee cap problems

·    Gary Maguire

·    Gary J. Maguire, MS, PT

·    Gary Maguire, PT

Proprioceptive Exercises for a Rotator Cuff Injury-- Gary J. Maguire, MS, PT

The rotator cuff muscles provide coordination and movement of the humerus bone in the arm, preventing it from compressing against the top of the scapula bone. In the aging population, mechanical pinching of the rotator cuff tendons occurs from degenerative changes, muscle weakness and stress overload on the tissues. In younger individuals, rotator cuff problems occur with muscle imbalances and abnormal movement patterns. Proprioceptive exercise helps to improve neuromuscular functioning and is a specialized variation of the sense of touch.

Proprioception

Proprioception is important in developing neuromuscular control of the rotator cuff with sports activities, especially throwing or overhead movements. It improves muscle tone, reduces strain on the joints and ligaments of the shoulder and can decrease the vulnerability to injuries. Balance and coordination exercises improve muscle restraint and provide a protective reflex during movement. Muscles that are deconditioned or fatigued have a low muscle tone and move awkwardly. This can lead to injury and wear and tear of tissue.

Proprioceptive Exercise Equipment

Resistance bands, exercise balls and medicine balls are examples of equipment used to develop proprioception. Exercises should start with the arm at your side and progress to overhead movements. Progression is based on the speed of the movement and added tension resistance. All activities should be monitored based on the "shrug sign." When an individual performing an exercise begins to shrug his shoulders, he should stop. This demonstrates lack of rotator cuff control; therefore the exercise should be modified so it is performed without shrugging.

Rhythmic Stabilization

In the March 1994 issue of the “Journal of Athletic Training," Nina Partin, MS, ATC states that “rhythmic stabilization” occurs when an individual positions her upper extremity anywhere in its available range of motion and holds an isometric contraction. External resistance is applied by the trainer to cause the individual to react, but not enough to disrupt the isometric contraction. Progression can consist of the length of time, resistance and the amount of contact to the area between the trainer and the individual.

Rowing Exercises

Rowing exercises provide the capability for training and strengthening the scapular muscles that retract or pull your shoulder blades backward. Rowing exercises involve pulling your arms and shoulders towards you and can be performed with resistance bands, free weights or weight machines. Slow controlled movements are important to facilitate proprioception and muscle activity. Shoulder retraction exercises promote rotator cuff stability and prevent the humerus bone from moving upward and pinching the rotator cuff tendon.

Potential for Injury

Due to its wide freedom of movement, the shoulder is susceptible to injury.The shoulder joint is the most frequently dislocated major joint of the body. It is easily injured because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by its muscles, tendons, and ligaments, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Proprioception exercises improve stability and function.

Reference

·    National Institute of Arthritis and Musculoskeletal and Skin Diseases: Questions and Answers about Shoulder Problems [http://www.niams.nih.gov/Health_Info/Shoulder_Problems/default.asp]

·    "Journal of Athletic Training"; Upper Extremity Proprioceptive Training; Nina B. Partin, MS, ATC et al; March; 1994 [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317754/]

·    MayoClinic.com; Rotator Cuff Injuries [http://www.mayoclinic.com/health/rotator-cuff-injury/DS00192]

Reactive Neuromuscular Training

Why do patients benefit with this specialized rehabilitation approach?

The interaction between the static and dynamic components of functional stability is mediated by the neuromuscular system.  Functional stability is defined as possessing adequate stability to perform functional activity and results from the interaction between these static and dynamic components.

Patients are prone to re-injury if they have not been prepared to meet the total demands of the activities that they are going to return to (e.g. reoccurring ankle sprains in sports or running).

A successful rehabilitation program must be based upon the specific demands of each individual. Remember the S.A.I.D. Principle (Specific Adaptation to Imposed Demands).

Proprioception:  In the classic sense, proprioception refers to position sense and movement sense arising from the mechanoreceptors.  Proprioception signals are transmitted to the spinal cord via afferent (sensory) pathways.  The relay information about the articular structures involving: static vs. dynamic conditions, static & dynamic joint angle, equilibrium vs disequilibrium, direction & speed of motion and biomechanical stress/strain.

Neuromuscular Control:  The efferent (motor) response is the sensory information termed neuromuscular control.  Proprioceptive information is then capable of influencing: muscle tone, motor execution programs, cognitive somatic perceptions and reflex joint stabilization.

Neurophysiology of Proprioception (the foundation of motor control):  Mechanoreceptors are specialized receptors in the articular, muscular, and cutaneous structures.  They provide input into the proprioceptive system.  There are several types of different types of receptors found around the joint structures.  Each receptor has a role in signaling information regarding deformations that occur in the tissues they inhabit.  The roles are dependent on the way the receptor responds to deformation (tension-compression-shear).

Gary J. Maguire, MS, PT

Tired of low back pain?  Had enough of poor sleeping or can't tolerate sitting at your work station or pain while commuting?

The answer to resolve many of these strains, aches and pains is to take up a progressive swimming program.  When we are in the water we are only 10% of or body weight.  We effectively eliminate gravity and the strain it places on ligaments, joints and discs within the spine.

This allows those damaged, degenerative tissues to be unweighted and recovery while the muscular system can adapt and become stronger and healthier. 

Over time the ability to tolerate more postural tolerances with sitting, work demands or sports increases.

Swimming is also the only physical activity where you can exercise opposing muscle groups at the same time.  For example think of your biceps and triceps, your quadriceps and hamstrings, your abdominal muscles and your back muscles.

If you are riding a bike, walking, lifting weights, etc. only one muscle of these groups can contract while the opposite muscle has to lengthen and relax.

The other benefit of swimming is that you increase the individual motion of the segments of the spine.

If over time you have been injured or sit for extensive periods of time we lose the ability to move each individual segment of the spine.

For example, think of a bicycle chain that is rusty.  Instead of every link in the chain moving seperately they move as groups or segments.  So think of 3-4 links moving as one and then one moving by itself and say 2 moving as one.

When each link or the joint within the spine doesn't move than it begins to degenerate.  This is called degenerative joint or degenerative disc disease, better know as "ARTHRITIS".

So with swimming you force the spine to have to move from its rigid state and readapt to moving all the individual segments of the spine.  This leads to a healthier spine, reduces arthritis, improves your sitting and activity tolerances.

Try swimming for 30-40 minutes.  Try 2 times per week.  If you are not the most proficient swimmer use 2 kickboards on top of each other and hold on and kick.  You can also use swim fins to improve your propulsion in the water.

Over time you should improve your lifestyle, reduce pain, increase your mobility and improve your ability to sleep.

Consider swimming for those with chronic low back pain, aching, nagging injuries and all of you computer programmers!

Stay tuned for more ways to improve your lifestyle.

Gary J. Maguire, MS, PT