My Rehab Connection
40 Tulip Tree Common L2S 3Y9 Saint Catharines, ON, Canada

Toes Part 2 Building Flexion The last few posts have been all about the toes. In this post lets continue the theme, but here well shift our focus to improving toe flexion. As discussed in the last post, building the necessary mobility in the toes is important for proper forefoot function as GRF is transferred to the forefoot during the propulsive phase of gait. When the toes dont work well it can lead to a number of local issues (forefoot pain and metatarsalgia), a...s well as issues in the foot and ankle or even up the chain (think plantar fasciitis, tendiopathy, or even mechanical hip and knee pain). When the toes (especially the MPJ) cant flex it goes on our list of targets for treatment/intervention. A great option to improve flexion is a Toe Flexion PAILs exercise targeting the lesser toes (you could also do the same for the bit toe depending on your exam findings). PAILs (Progressive Angular Isometric Loading) are a major component of the @functionalrangeconditioning system which essentially combines stretching with isometric contraction at the end ranges of motion. To perform the exercise begin with the heel and ball of the foot resting on a block or edge of a step - alternatively this could be done with the foot up on a stool if there is difficulty with kneeling. The block allows the toes space to flex while providing some pressure and a fulcrum under the metatarsal heads. Use the hand to push the toes (especially the MPJ) down into flexion. After holding the initial stretch for up to 2 minutes an isometric contraction is added by actively pulling the toes up against the resistance of the hand. Hold this contraction for 10-15s seconds - then relax and push the toes down further to take up the slack and engage the tissue stretch again. Repeat this stretch-contract-stretch sequence 4-5 times. #functionalrangeconditioning #frc #controlyourself #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #jointhealth #stretching #flexibility #foot #footexercise #footrehab #exercise See more

Improving Toe Mobility The toes are one of those forgotten areas, but this is a big problem as limitations here can not only lead to local symptoms (think forefoot pain and metatarsalgia), but also compensatory patterns in the foot and ankle (think plantar fasciitis/ tendiopathy, and mechanical hip and knee pain). In the last post I talked about using CARS as a quick test to screen for toe dysfunctions, so here lets talk about improving toe mobility if problems are u...ncovered. Well start with options for improving extension of the lesser toes (Ill cover flexion in a later post) which requires extensibility of the MPJ joint capsules, FDL, FDB, the deep intrinsic muscles of the forefoot. In addition to using in-office manual therapy therapy to address these tissues, my go-to homework exercise is a Toe Extension PAILs exercise targeting the lesser toes. For anyone who is unfamiliar, PAILs (Progressive Angular Isometric Loading) are a major component of the @functionalrangeconditioning system which essentially combines stretching with isometric contraction at the end ranges of motion. These isometric contractions help to simultaneously expand range and promote tissue adaptation/remodelling in these expanded (i.e stretched) range. To perform the exercise begin with the heel and ball of the foot resting on the floor (alternatively this could be done with the foot up on a stool. Keeping the ball of the foot on the floor the opposite hand pulls the toes up into extension. After holding the initial stretch a PAILs contraction is added by actively pushing the toes down against the resistance of the hand - hold firmly to resist the contraction (this is an isometric contraction so there should be no joint movement). Hold this contraction for 10-15s seconds - then relax and pull the toes further into extension. Repeat this stretch-contract-stretch sequence 3-4 times. #functionalrangeconditioning #frc #controlyourself #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #jointhealth #stretching #flexibility #foot #footexercise #footrehab #exercise See more

Toes are critical for foot health The toes are a critical component of proper foot health. They create a important point with the ground, help to distribute forces through the forefoot, and play a critical role as the body weight is transferred to the forefoot with walking and running. Yet they are often neglected, seldom assessed, and almost never included in exercise programs.... This is a huge mistake. When assessing foot pain patients I assess the toes (in particular the metatarsal-phalangeal joints) the same as I would any other joint I look to if see the joints and surrounding tissue have adequate passive ROM (flexibility), control/coordination (can the patient actively move the joints through the required ranges), and strength required for proper foot function. The video here shows a basic Toe CARS assessment - which gives a great birds eye view of toe function (CARS are Controlled Articular Rotations - they are a part of the @functional_range_conditioning system - I use a lot of their stuff in my clinic - theyve got some great stuff you can check out online if youre not familiar with them). What we are looking for here is the patients ability to 1) actively move the toes through the required ROM, and 2) can they control the 1st toe and 2-5 toes independently (this is important as there are separate sets of muscles that control the 1st and 2-5 toes). If I see issues with this basic task it tells me I need to further assess the toes (for example with PROM testing, RROM testing) and to determine where initial intervention needs to occur. This will tell me if we need to start with passive flexibility to build flexibility in the toe? Or if we need to focus on simply learning to control the toes? Or if basic strength needs to be our focus. I will post some examples of these interventions over the next few posts. #functionalrangeconditioning #frc #controlyourself #mobility #movement #injuryprevention #rehab #chiropractor #jointhealth #footmobility #footexercises #stretching #footstretches #foot #foothealth See more

Hip Rotation Mobility Rotation is a critical motion of the hipso restoring rotation often becomes a priority with hip rehabilitation and performance training programs. But what are the best options to help improve hip rotation?... For this post, lets look at some options to help improve flexibility/mobility of the hip. This is typically the starting point (we need to have a range before we can strengthen that range) With respect to hip internal rotation (I will talk about external rotation in a later post) one of my go-to methods is to use PAILS-RAILS exercises. For anyone who is unfamiliar, PAILs and RAILs are a major component of the @functional_range_conditioning system. These exercises essentially combine stretching with isometric loading to simultaneously expand ROM as well as strengthen and promote tissue adaptation at these expanded ranges. While internal rotation can and often is trained from a 90/90 position many of the patients I see have difficulty with this position when this is the case I will have the patient train from a quadruped position using stiff strap for resistance. The idea is to pre-position the hip into internal rotation (rotating the lower leg and ankle outward keeping the thigh vertical). From this stretched position we can then create an isometric contraction in the opposite direction. This is similar to a traditional contract-relax type stretch. But then with the release of this contraction we then actively move the hip farther into internal rotation. This will also act to train the internal rotator group to generate tension from this shortened (ie regressive) position. The idea here is that we are not just trying to improve flexibility but to train the hip to be better able to create muscular force and tissue resiliency and to essentially trust this position. #hippain #hipexercise #hiprehab #exercise #hiphealth #health #hip #stretching #stretch #hipmobility #functionalrangeconditioning #frc #functionalrangerelease #mobility #movement #injuryprevention #rehab #chiropractor #jointhealth See more

Shoulder Rotation Mobility In my last post I started talking about the importance of shoulder rotation. Simple stated, deficiencies in shoulder rotation will lead to problems into almost any other shoulder motion or task as well. This is why restoring rotation typically becomes the priority with shoulder rehabilitation and performance training programs. ... In the last post we focused on shoulder external rotation so here lets talk about internal rotation. With internal rotation deficits I will typically use hands-on manual therapy technique to help work the posterior capsule and surrounding soft tissue, but I will always back that up with home exercise. For Internal rotation one of my go-to methods is to again use PAILS-RAILS exercises. For anyone who is unfamiliar, PAILs and RAILs are a major component of the @functional_range_conditioning system. These exercises essentially combine stretching with isometric loading to simultaneously expand ROM as well as strengthen and promote tissue adaptation at these expanded ranges. The idea is to pre-position the shoulder into internal rotation, then to create an isometric contraction in the external rotators from the stretched position similar to a traditional contract-relax type stretch. With the release of this contraction (which should in part affect the stretch reflex and thus create some tissue slack upon the release) we can then try to actively pull the shoulder farther into internal rotation. This will also act to train the external rotators group to generate tension from this shortened (ie regressive) position. The idea here is that we are not just trying to improve flexibility but to train the shoulder to be better able to create muscular force and tissue resiliency and to essentially trust this position. #shoulderpain #shoulderexercise #shoulderrehab #exercise #shoulderhealth #health #functionalrangeconditioning #frc #functionalrangerelease #mobility #movement #injuryprevention #rehab #chiropractor #jointhealth See more

Better Shoulder Rotation Mobility Shoulder rotation is a critical motion of the shoulder so much so that restoring rotation typically becomes the priority with shoulder rehabilitation and performance training programs. ... But what are the best options to help improve mobility of shoulder rotation? With respect to external rotation (I will talk about internal rotation in a later post) one of my go-to methods to the use PAILS-RAILS exercises. For anyone who is unfamiliar, PAILs and RAILs are a major component of the @functional_range_conditioning system. These exercises essentially combine stretching with isometric loading to simultaneously expand ROM as well as strengthen and promote tissue adaptation at these expanded ranges. With most shoulder pain cases I prefer to start with the elbow supported as shown here. The idea is to pre-position the shoulder into external rotation, then to create an isometric contraction in the internal rotators from the stretched position similar to a traditional contract-relax type stretch. With the release of this contraction (which should in part affect the stretch reflex and thus create some tissue slack upon the release) we can then try to actively pull the shoulder farther into external rotation. I think of this as trying to create some slack in the strap. This will also act to train the external rotators group to generate tension from this shortened (ie regressive) position. The idea here is that we are not just trying to improve flexibility but to train the shoulder to be better able to create muscular force and tissue resiliency and to essentially trust this position. #shoulderpain #shoulderexercise #shoulderrehab #exercise #shoulderhealth #health #functionalrangeconditioning #frc #functionalrangerelease #mobility #movement #injuryprevention #rehab #chiropractor #jointhealth See more

With shoulder pain cases one of our first goals of treatment is to introduce tolerated loads back into the shoulder ASAP. Isometric exercises can be one of the most effective ways to do this in the early stages of care because: Intensity of contraction can be adjusted to the tolerance of the patient (ie - start very light for more sensitive cases)... No joint motion therefore reduced joint stress/shear Isometrics can serve as a simple marker of treatment progress (we are looking for ability to contract harder with less sx over time) Isometrics can be easily progressed as tolerance improves by manipulating increasing intensity of contraction and/or joint angle Isometrics can help reduce pain Early introduction of tensile load will help prevent guide tissue healing / fibre deposition and help prevent deconditioning The examples here show an isometric exercise option for shoulder external rotation. The instructions I use with my patients is to SLOWLY pull their hand/forearm outward against the resistance of the strap untilt they feel a mild symptom in their shoulder (mild achy symptoms are typically tolerated well, but I do not have them push into pain). I then have them hold this intensity for 30 seconds, then SLOWLY relax the contraction. I will typically have them perform 5 repetitions 2x/day. I will also have them monitor their symptome response and adjust the dose as needed. The first picture shows the exercises performed from a neutral position. As tolerance improves I will also have patients perform the exercise from a more internally rotated (seconds picture) and externally rotated position (third pic). This will help to train the muscles/joint throughout the range while still keeping the isometric effect. #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #stcatharineschiropractor #niagarachiropractor #jointhealth #shouldermobility #stretching #exercise #shoulderexercises #shoulderstrength #jointmobility #flexibility #shoulder @ St. Catharines See more

Isometrics for Early Shoulder Rehab With shoulder pain cases one of our first goals of treatment is to introduce tolerated loads back into the shoulder ASAP. Isometric exercises can be one of the most effective ways to do this in the early stages of care because: Intensity of contraction can be adjusted to the tolerance of the patient (ie - start very light for more sensitive cases)... No joint motion therefore reduced joint stress/shear Isometrics can serve as a simple marker of treatment progress (we are looking for ability to contract harder with less sx over time) Isometrics can be easily progressed as tolerance improves by manipulating increasing intensity of contraction and/or joint angle Isometrics can help reduce pain Early introduction of tensile load will help prevent guide tissue healing / fibre deposition and help prevent deconditioning The examples here show an isometric exercise option for shoulder external rotation. The instructions I use with my patients is to SLOWLY pull their hand/forearm outward against the resistance of the strap untilt they feel a mild symptom in their shoulder (mild achy symptoms are typically tolerated well, but I do not have them push into pain). I then have them hold this intensity for 30 seconds, then SLOWLY relax the contraction. I will typically have them perform 5 repetitions 2x/day. I will also have them monitor their symptome response and adjust the dose as needed. The first picture shows the exercises performed from a neutral position. As tolerance improves I will also have patients perform the exercise from a more internally rotated (seconds picture) and externally rotated position (third pic). This will help to train the muscles/joint throughout the range while still keeping the isometric effect. #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #stcatharineschiropractor #niagarachiropractor #jointhealth #shouldermobility #stretching #exercise #shoulderexercises #shoulderstrength #jointmobility #flexibility #shoulder @ St. Catharines See more

Exercises for Knee Internal Rotation Knee rotation is a fundamental motion. But despite its critical importance, many knee training and rehab programs fail to address rotation and focus solely on flexion/extension. ... This is a big problem. And its the topic of our most recent article series. In Part 1 reviewed not only the importance of rotation for an healthy and fully functional knee, but also how to assess knee rotation, and some key exercises to help to improve rotational flexibility, control and coordination, and strength. In Part 2 - now posted on our site - the focus is Knee Internal Rotation. To access the article just follow the link in the bio to our site, and go to the blogs section. #functionalrangeconditioning #frc #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #stcatharineschiropractor #niagarachiropractor #jointhealth #kneemobility #stretching #kneestretches #exercise #kneeexercises #knee See more

Standing Pelvic Tilts with Corrective Blocking Pelvic tilt exercises can be a very effective tool in the treatment and rehabilitation of lower back pain. As I have talked about in previous posts pelvic tilt exercises from a quadruped or supine position can be a great way to introduce non-weight bearing motion to the spinal joints and build coordination. But as treatment progresses we will typically want to progress to a more upright/ weight bearing position.... While this seems like a simple task, many patients find it difficult to transfer this movement skill to a standing/upright position and have a lot of trouble isolating movement through their lumbar spine. Patients will typically try to position the pelvis by leaning back instead of using the abdominals to pull the pelvis into posterior rotation. Using a foam roller as shown here can be an effective way to help correct this fault. The foam roller provides more objective feedback as to the success (posterior tilt driven by the abdominals) or failure (the roller falls because they lean back). This feedback is essential to motor learning and ensures the patient is not practicing and thus ingraining an undesired movement pattern. Of course as control and coordination improves we can remove the roller and move on to additional progressions. #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #stcatharineschiropractor #niagarachiropractor #jointhealth #spinemobility #stretching #exercise #backexercises #backpain #jointmobility #flexibility #backstretches #back #spine See more

Lateral Pelvic Tilts When we think about pelvic tilts with typically think of motion in the sagittal plane - flexion and extension. While these can be very effective exercises and exercise progressions for lower back pain patients, we should remember that the spinal joints also allow for frontal plane motion (lateral flexion). When lateral flexion is found to be part of the clinical picture (for example lateral flexion is limited, painful, or poorly controlled) we want... to work towards improving mobility, control, and movement tolerance. In the early stages of care (for example, if the motion is limited and/or symptomatic) I often prescribe ateral pelvic tilts, as demonstrated here. These motions can be an effective way to focus movement at the lower lumbar spine which will act to flush out tissue swelling and edema in and round the joints as well as stimulate connective tissue cells and mechanoreceptors all of which can help to manage pain and guide tissue healing. And it helps teach control and coordination which we can build on in subsequent exercise progressions. The key in the beginning is to limit the movement to what is well tolerated. This means that you may need to limit the overall range of motion, and/or bias the movement towards right or left lateral flexion. I will typically ask my patients to do 10 slow deliberate repetitions, and to repeat this every few hours. As symptoms begin to subside and the patients tolerance to these movements increases we can then progress these movements by incrementally increasing load and control requirements as we progress the patient through treatment and rehabilitation (I will try to post some of these progressions in the next few posts). #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #stcatharineschiropractor #niagarachiropractor #jointhealth #spinemobility #stretching #exercise #backexercises #backpain #jointmobility #flexibility #backstretches #back #spine See more

Knee rotation is a fundamental motion. But despite its critical importance, many knee training and rehab programs fail to address rotation and focus solely on flexion/extension. This is a big problem. So in our latest blog post we review not only the importance of rotation for an healthy and fully functional knee, but also how to assess knee rotation, and some key exercises I often use in my clinic to improve rotational flexibility, control and coordination, and strength.... In Part 1 the focus is Knee External Rotation. Well cover Internal Rotation in part 2 coming soon. https://myrehabconnection.com/knee-rotation-exercises/

Posterior Hip Mobilization Compensatory motion often occurs through the lumbar spine in conjunction with limitations in hip range of motion. When this occurs a goal of care would be to improve hip ROM, which would often include stretching or mobility exercises. However, when prescribing or performing these exercises we want to ensure motion occurs through the hip joint while also preventing excessive motion at the lumbar spine. We dont want to train the pattern we ar...e trying to correct. One of the most common areas where we see this is with restrictions in the posterior-lateral hip group. Limited mobility here will typically limit motion into hip flexion and external rotation, and will force the lumbar spine into compensatory flexion. Here is a beginner mobilization I often use to address restrictions in the posterior/lateral hip. This is essentially a closed-chain figure-4 position. The initial starting position will begin to tension the posterior-lateral hip structures. You (or your patient) can explore the position (ie a little more or less ER, flexion, etc) to set the initial position so there is just a mild, comfortable stretch. From here we can use an anterior and posterior pelvic tilt to increase or decrease the tension on the posterior-lateral hip. This will not only start to create tension through the hip, but will start to build coordination at the lower spine and teach the patient (or you) how the position of the spine has a major impact on the hip. As tolerance is established and the motion becomes more coordinated this base movement can be progressed to include a deeper stretch and/or more advanced mobility work such as PAILS exercises. #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #stcatharineschiropractor #niagarachiropractor #jointhealth #spinemobility #stretching #exercise #backexercises #backpain #jointmobility #flexibility #mobilizations #jointmobility #hip #hipstretches See more

Exercises for Neck Pain - Part 3 In the past few posts I have reviewed some of my go-to exercises I often prescribe for patients with neck pain. So far I have discussed some options to help mobilize the cervical joints with a more sensitive/acute mechanical neck pain presentation as well as some more advanced options to help improve mobility/ROM. As these findings start to improve and the patient is able to tolerate more stress/load, I will typically progress to more ad...vanced exercises to help further improve the strength and load tolerance of the cervical spine. Shown here is an isometric exercise biased towards cervical flexion. The key here is to focus on rolling/tucking the chin in towards the neck to pre-position the cervical spine in more of a flexed position until you start to feel some tension in the deep muscle along the front of their neck. Hold this position/muscle tension as you start to lift the head slightly off the book. As the head lifts off the book gravity will create an extension moment - which needs to be balanced/resisted but the active contraction of the cervical flexors. Remember, this should be challenging but should not hurt. If there is pain try regressing to a partial lift (lift some of the weight of the head but do not lift fully off the ground) I like to have patients work up to performing 10 repetitions of 10 seconds holds. This gives up a target to shoot for and an easy way to track progress. #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #neck #neckpain #neckrehab #neckexercises #stcatharineschiropractor #niagarachiropractor #jointhealth #spinemobility #stretching #exercise #backexercises #backpain #jointmobility #flexibility See more

Neck Pain Part 2 - Improving Neck Mobility The cervical spine is often associated with neck pain and headaches. This area often becomes restricted as a result of prolonged sitting and computer use which maintains the upper neck in an extended position for long periods. In my previous post I demonstrated a mobilization option for the upper cervical spine that can help create movement biased towards the upper neck, but in many cases we also need to work to expand movemen...t. To create more range and unlock the upper neck. Demonstrated here is a PAILS/RAILS, which are a major component of the @functionalrangeconditioning system. These exercises combine stretching with isometric contraction at the end ranges of motion to improve range and promote tissue adaptation in these expanded ranges. These contractions can also influence the stretch reflex and help to reset muscle tone. Begin on your back with your knees bent and feet flat on the floor. Most people will find it helpful to place a hardcover book under their head - this prevents the head from hyper-extending. Then pull/tuck your chin in towards your neck as you slide the back of your head up along the book. From this retracted position bring your hands up to hold the back of your head. Now look up and extend your head and neck by jutting your chin up towards the ceiling while pulling the back of your head down along the book. BUT as you do this you will RESIST the motion with your hands. In other words, your head should not actually move, but you should feel your neck muscles contract into extension.This is the PAILS portion of the exercise. Hold the contraction for 10-15 seconds, then relax your muscles and look down as you try to create more flexion in your upper neck by pulling/tucking your chin in towards your neck and sliding your head up the book again. This is the RAILS portion. Repeat this contract relax/stretch stretch father cycle 3-4 times. #neckpain #neckexercise #neckrehab #spinehealth #health #functionalrangeconditioning #frc #functionalrangerelease #mobility #movement #injuryprevention #rehab #chiropractor #jointhealth #stcatharineschiropractor See more

Exercises for Acute Neck Pain - Part 1 When patients present with mechanical / non-traumatic neck pain our primary goal is to promote and restore joint mobility and movement tolerance ASAP. However, with pain and the possibility of tissue injury we need to be judicious in prescribing exercises that will help manage symptoms and promote tissue healing while at the same time not exacerbating pain and tissue injury.... My starting point with almost all of these patients is to start with head slides, which act to promote basic flexion-extension of the cervical joints. These are basically the cervical equivalent of pelvic tilts. These motions can be an effective way to create graded and controlled movement through the cervical spine to flush out tissue swelling and edema in and around the joints as well as stimulate connective tissue cells and mechanoreceptors all of which can help to manage pain and guide tissue healing. The key with more acute/painful/sensitive cases here is to limit the movement to what is well tolerated. This means that you may need to limit the overall range of motion, and/or bias the movement towards flexion or extension (this is particularly true if the patient displays a direction preference to motion). Placing a book under the head is often necessary with people with anterior head carriage (this will be a lot of neck pain patients) so the neck does not have to hyper-extend to reach the floor. I will typically ask my patients to do 10 slow deliberate repetitions, and to repeat this every few hours. As symptoms begin to subside and the patients tolerance to these movements increases we can then progress these movements by incrementally increasing load and control requirements as we progress the patient through treatment and rehabilitation (I will try to post some of these progressions in the next few posts). #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #neck #neckpain #neckrehab #neckexercises #stcatharineschiropractor #niagarachiropractor #jointhealth #spinemobility #stretching #exercise #backexercises #backpain #jointmobility #flexibility See more

Better Rotator Cuff Exercises Traditional rotator cuff exercises typically use cables, bands, or dumbbells. The issue with this is that it tends to bias the load towards specific joint angles. For example, in an upright posture shoulder external rotation exercises using a band will create maximal load with the forearm horizontal, and little to no load with the forearm vertical. The opposite will occur when using a dumbell. ... This is fine if we are trying to bias the load towards one of these angles, but if we are trying to load joint/muscles through an entire range an effective option can be to combine the use of bands and dumbells in an effort to create load throughout the range. Shown here is an example of how to do this with shoulder external rotation, but similar strategies can be used for other directions as well. #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #stcatharineschiropractor #niagarachiropractor #jointhealth #shouldermobility #stretching #exercise #shoulderexercises #shoulderpain #jointmobility #flexibility #shoulder #rehab #rehabilitation See more

Shoulder Isometrics for Improved Pain and Load Tolerance When treating soft tissue injuries such as shoulder tendinopathies one of the first goals is to work towards reducing pain and improving the patients ability to tolerate load across the shoulder joint. This not only helps from a symptom management perspective, but also helps to set up more later stages of rehabilitation. Utilizing isometric exercises is one of the best ways to start introducing contraction an...d load in these cases. Isometrics work well because they are very scalable. With more load-sensitive presentations we can start with low-level contraction intensities that are more readily tolerated. These contractions can help reduce pain and tissue edema, and will start to guide the healing process by communicating with the affected tissues on a cellular level. Because there is no movement it is also a simpler task for the patient to perform. So the focus can be on loading the tissue through muscle contraction. In these initial stages I will typically instruct my patients to contract as firmly as they can but not into pain (usually a mild 3-4 out of 10 symptom is OK, but it should be mild and tolerable) and hold for 30 seconds for 5 repetitions. They can perform this sequence 2-3x/day. As symptoms and contraction/load tolerance improves the intensity of contraction can be increased. When they can contract firmly without pain they are usually ready to progress to higher load dynamic exercises. #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #stcatharineschiropractor #niagarachiropractor #jointhealth #shouldermobility #stretching #exercise #shoulderexercises #shoulderpain #jointmobility #flexibility #shoulder #rehab #rehabilitation See more

Thoracic Spine Mobilizations With typical thoracic pain presentations we want to promote joint mobility and movement ASAP. Thoracic mobilizations can be an effective way to do this. These motions can not only help improve mobility, but they can also be an effective way to flush out tissue swelling and edema in and around the joints as well as stimulate connective tissue cells and mechanoreceptors all of which can help to manage pain and guide tissue healing.... The key is to find a way to focus (or at least bias) movement to the affected areas. Shown here is an exercise option that I often prescribe. Similar to a traditional cat/camel exercise, we are focusing on promoting flexion-extension of the spinal joints - but now at the thoracic as opposed to the lumbar spine. For the flexion phase we are trying to push/round the thoracic spine, and for the extension phase we are trying to arch/pull the thoracic spine more inwards. The key here to to actively contract the paraspinal muscles to help pull or guide the joints into extension. Remember, with a painful or sensitive spine you will need to limit the movement to what is well tolerated. This means that you may need to limit the overall range of motion, and/or bias the movement towards flexion or extension (this is particularly true if the patient displays a direction preference to motion). Performing this motion from this kneeling position helps to limit the motion through the lumbar spine. Using the band helps provide some tactile sensation to help the patient try to focus on the main area that we are trying to mobilize (of course, the exercise can also be done without the band if the band is not tolerated well or if a band is not available) . I will typically ask my patients to do 10 slow deliberate repetitions, and to repeat this every few hours. #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #stcatharineschiropractor #niagarachiropractor #jointhealth #spinemobility #stretching #exercise #backexercises #backpain #jointmobility #flexibility #mobilizations #jointmobility See more

Exercise Rx for Acute Knee Pain Movement is essential when dealing with injured tissue... but we also want to be careful to respect tissue pathology and not exacerbate symptoms or healing mechanisms. These Knee Slides are often an effective movement option to prescribe when motion is limited because of pain and swelling.... The key is to slide the foot to limit the intensity of contraction... and be sure to move only as far as symptoms allow (ie dont push into symptoms). The motion will provide some mechanoreception and affect pressure gradients within and around the knee which acts to milk or flush some of the fluid and its irritating chemicals out of the area. This can be performed many times through the day to help manage symptoms and start to guide healing. See more

Improving Wrist Flexion (with PAILS) The hand and wrist seem to be one of those forgotten areas that few of us spend any deliberate time working on. This can be a big problem as limitations here can not only lead to local symptoms but will also lead to compensatory patterns in the elbow and shoulder (just like a foot problem can create abnormal motion of the knee and hip). When checking the wrist we want to be sure the wrist moves in the sagittal (flexion/extension) an...d frontal (radial / ulnar deviation) planes. In this post well talk about flexion, which requires extensibility of the posterior forearm group as well as movement and sliding of the carpals. While there are several exercise options than can be done to target wrist flexion an exercise I often prescribe is a supported Wrist Flexion PAILS exercise. For anyone who is unfamiliar, PAILs (Progressive Angular Isometric Loading) are a major component of the @functionalrangeconditioning system which essentially combines stretching with isometric contraction at the end ranges of motion. These isometric contractions help to simultaneously expand range and promote tissue adaptation/remodelling in these expanded (i.e stretched) ranges.. and in addition to affecting the passive components PAILs have the added benefit of also affecting neurological components (stretch reflex / spindle sensitivity). This is critical as it is ultimately the nervous system that dictates how far a muscles is allowed to stretch. To perform the exercise begin with the forearm supported and the wrist flexed. Use your opposite hand to pull the hand/wrist further into flexion. Hold this initial stretch for 1-2 minutes. After holding the initial stretch position a PAILs contraction is added by actively pulling the hand up into the opposite hand - hold firmly to resist the contraction (this is an isometric contraction so there should be no joint movement). Hold this contraction for 10-30s seconds - then relax and pull the wrist further into flexion if your able and the tissue allows. Repeat this stretch-contract-stretch sequence 3-4 times. #functionalrangeconditioning #frc #controlyourself #mobility # See more

Hip Internal Rotation PAILS with Stick Being a ball-and-socket joint, the hip should be able to rotate internally and externally. So building and maintaining these motions is critical to improve the health and overall functional capacity of the hip. While there are several exercise options than can be done to target hip rotation, an exercise I often prescribe is a Seated 90/90 Hip IR PAILS using a mobility stick (often I will prescribe this in conjunction with a 90/90 ...stretch on the floor). (For anyone who is unfamiliar, PAILs (Progressive Angular Isometric Loading) are a major component of the @functionalrangeconditioning system which essentially combines stretching with isometric contraction at the end ranges of motion. These isometric contractions help to simultaneously expand range and promote tissue adaptation/remodelling in these expanded (i.e stretched) ranges.. and in addition to affecting the passive components PAILs have the added benefit of also affecting neurological components (stretch reflex / spindle sensitivity). This is critical as it is ultimately the nervous system that dictates how far a muscles is allowed to stretch. To perform the exercise begin seated on a tall box so that your legs are freely hanging. Then slide a stick / dowel along the outside of your thigh and hook the inside of your foot. If you pull the stick inward you it will act to pull your foot outward - which occurs through internal rotation of your hip. After holding the initial stretch position a PAILs contraction is added by actively pulling the foot back inwards into the stick - hold the stick firmly to resist the contraction. Hold this contraction for 10-30s seconds - then relax and pull the hip further into internal rotation. Repeat this stretch-contract-stretch sequence 3-4 times. #functionalrangeconditioning #frc #controlyourself #mobility #movement #movebetter #injuryprevention #rehab #chiropractor #jointhealth #hipmobility #stretching #hipstretches #flexibility #hipflexibility See more

Lumbar Extension PAILS-RAILS In my last post I reviewed a PAILs/RAILs exercise to help improve lumbar flexion range/mobility when motion is limited. Today lets talk about the same thing but this time for lumbar extension. For anyone who is unfamiliar, PAILs and RAILs are a major component of the @functionalrangeconditioning / @functionalrangerelease system. These exercises essentially combine stretching with isometric loading to simultaneously expand ROM as well as st...rengthen and promote tissue adaptation in at these expanded ranges. To target lumbar extension, with the spine extended at the bottom of the cat/camel we can create a contraction in the flexors by pulling the hands and knees towards from each other. I A good que to use with patients/clients is to squeeze the floor. Hold this for 10-30s. As we release this contraction we can then use our lumbar extensors to arch the lower back further into extension towards the floor (remember - there should be no pain or pincing in the lower back with this). Hold this for 10-30s We can alternate between these PAILs and RAILs contractions for 3-4 repetitions. #backpain #backexercise #backrehab #coreexercise #spinehealth #health #functionalrangeconditioning #frc #functionalrangerelease #mobility #movement #injuryprevention #rehab #chiropractor #jointhealth See more

Lumbar Flexion PAILS-RAILS In my last post I briefly discussed the challenge of targeting the lower back joints with the Cat/Camel exercise. To expand on this lets talk about an option to help improve range/mobility of lumbar flexion when motion is limited. ... For this we can add a PAILs/RAILs contraction to the traditional cat/camel exercise. For anyone who is unfamiliar, PAILs and RAILs are a major component of the @functionalrangeconditioning / @functionalrangerelease system. These exercises essentially combine stretching with isometric loading to simultaneously expand ROM as well as strengthen and promote tissue adaptation in at these expanded ranges. To target lumbar flexion, with the spine flexed at the top of the cat/camel we can create a contraction in the lumbar extensors but pushing the hands and knees away from each other as if we are trying to spread the floor apart. We can hold this for 10-30s. As we release this contraction we can then use our abdominal muscles to press the lower back further into flexion towards the ceiling. We can then hold this for 10-30s We can alternate between these PAILs and RAILs contractions for 3-4 repetitions. #backpain #backexercise #backrehab #coreexercise #spinehealth #health #functionalrangeconditioning #frc #functionalrangerelease #mobility #movement #injuryprevention #rehab #chiropractor #jointhealth See more

Thoracic Locked Cat/Camel The Cat/Camel can be a great exercise to promote mobility and control of spinal joint motion. But the challenge with the traditional cat/camel (ie from full quadruped hands and knees position) is that it allows the entire spine to move. This is not necessarily a bad thing if all of the joints are moving well and the goal is full spine motion, but if there are specific area of restriction and the goal to to build movement at those specific areas... we can modify the exercise in an attempt to focus movement at the desired area. Shown here is an example of a Thoracic Locked Cat/Camel variation. By moving onto the elbows and tucking the head down it creates tension in the upper spine and thus limits motion through these joints. This allows motion to be focused at the lumbar spine. #backpain #backexercise #backrehab #coreexercise #chiropractor #spinehealth #health #functionalrangeconditioning #frc #functionalrangerelease #mobility #movement #injuryprevention #rehab #chiropractor #jointhealth See more

Nerve Entrapment and Anterior Knee Pain The skin over the anterior/ anterior-medial knee is innervated by the infrapatellar branch of the saphenous nerve (IPBSN), and entrapment or irritation of should be considered in the diagnosis of symptoms in the area. Clinically the nerve can become irritated in conjunction with stress/soft tissue restriction at the medial knee due to its intimate relationship with the sartorius muscle and fascia.The nerve is often palpably tende...r and a Tinels sign may be present when the IPBSN is involved. Relevant Anatomy... The IPBSN is the posterior branch of the saphenous nerve. It typically emerges along the distal sartorius, however like most nerves there is considerable variability. According Kalthur et al. (2015) the nerve may emerge anterior to sartorius (68.7%), through the sartorius (28.1%), or less commonly posterior to the sartorius (3.1%). From here the IPBSN pierces the fascia lata to become subcutaneous, supplying the skin of the anterior and medial aspect of the knee. In 75% of the population the IPBSN consists of more than one branch. This branching typically occurs more distally after it passes beyond the sartorius (See Image 2 - note the subcutaneous location of the distal branches). The first image shows the IPBSN (*) passing thorugh the sartorius muscle - right leg - image from Natsis et. al (2016). #functionalrangeconditioning #functionalrangerelease #anatomy #knee #kneepain #kneeinjury #sportsmedicine #chiropractor #chiropractic #softtissue #rehab #stcatharineschiropractor #jointhealth #manualtherapy @ St. Catharines

When were in pain after an accident or trauma at least it makes sense not that were happy about it, but at least theres no mystery as to why we hurt. But other times we can hurt and become injured even though it seems like we didnt do anything in particular to cause any damage or injury. Or in some cases pain develops after doing some routine activity that we have done hundreds of times before. These conditions are often the result of tissue damage that can build up ove...r time. This micro-damage will reduce the tissues ability to tolerate stress (and by tissue I mean muscle, tendon, ligament, bone, or even nerve). If this process continues at some point the tissue will yield, at which point symptoms will develop and/or escalate. This injury process - commonly referred to as Repetitive Strain Injuries is the topic of my most recent blog post - click on the the link below to read more. https://myrehabconnection.com/i-hurt-but-didnt-do-anything/

Isometric Loading For Medial Knee Pain Isometric loading can be an important initial intervention in the early stages of injury. Some of the benefits of isometrics include: Reduce pain (Rio et al, 2015)... Guides tissue healing and remodelling (stimulates collagen deposition along these lines of stress) Intensity can be easily graded for patient/tissue tolerance Acts as an early progression to higher level/load exercises Anatomic structures at the medial knee include the medial meniscus, meniscotibial ligaments, knee capsule, MCL, pes anserine tendons, and medial fascia. These structures are generally stressed/loaded with a valgus/abduction force - so we can use isometrics in this direction to start to progressively load these tissues. While there is no set loading parameters these should typically be done to well within symptom tolerance - usually my instructions to patients are to slowly increase muscular effort until they feel a very mild symptom increase - they then hold this contraction for 30-45 seconds and repeat 5 times (again, there is debate about the exact protocols including the length of contraction time and reps - the numbers here are based on the study by Rio et al, 2015, and my personal clinical experience). The other thing Iike with this exercises is it is easy to progress as tissue healing and tolerance allows. Progressions could include lifting the hip off the ground, just slightly at first then higher as the program progresses. Rio E, et al. Br J Sports Med 2015;49:12771283. doi:10.1136/bjsports-2014-094386 #mobility #movement #injuryprevention #rehab #rehabexercises #chiropractor #jointhealth #chiropractic #niagarachiropractor #kneepain #kneerehab #isometrics

Trunk Rotation Strength Progressions People seem to love planks, curls and side bridges, yet often forget about rotation. Here are some option to train this often forgotten motion. ... The first video shows a basic isometric training option often called a Pallof Press. Start with the band close to your body. Create a trunk/abdominal contraction then extend your arms. The idea here is that extending the arms creates a longer lever arm for the band, thus creating more rotational force on the trunk. The key here, and the point of the exercise, is to actively resist this rotational pull and hold the trunk in neutral position. Typically 5 sets of 30-45 seconds works well but you can vary based on goals and tissue tolerance. Of course you can also vary the load by creating more or less stretch in the band. The second video is another isometric option but now instead of holding the spine in neutral posture we are pre-positioning the spine into rotation. Isometric contraction can be a great rehab and training option but theres a catch....it will only strengthen the muscles at the specific ranges trained (+/- 10 degrees). So with this progression we are focusing on capturing the outer ranges of trunk rotation. With the third video we are adding movement. Here we are actively moving into rotation under load. This is a more complicated task for the nervous system and is associated with more joint stress compared to isometrics so it is a generally a good idea to be proficient with the first 2 exercises before moving onto this one. In the last video the focus is on eccentric control. We are rotating into rotation using lower load (hands close to our body) the slowly rotating back under higher load (arms extended). This can be an effective way to improve strength (we can use higher loads) and improve mobility as we are teaching the nervous system control increasing ranges. #rehab #exercise #mobility #rehabexercise #core #coretraining #strength #strengthtraining #backexercise #backtraining #backpain

We typically think of the biceps as an elbow flexor BUT it also has a critical role at the shoulder. Heres a great exercise option to help train this important while also incorporating greater shoulder / scapular demand. Begin in a kneeling lunge position with one end of an exercise band held in your hand and the other end secured high in a door beside you. Your hand should be higher than your shoulder with your arm fully extended. Pull your hand towards your head. Do not al...low your upper arm to drop as you do this (Keep your elbow raised above shoulder height). Hold your arm curled for 1-2 seconds then slowly straighten your elbow again. Perform 2-3 sets of 10-15 repetitions - use enough tension in the band that you are fatigued with the exercise, but not so much that you perform the exercise with proper form.

We typically think of he adductor group as frontal plane muscles, which is true, but they are also very powerful hip extensors when the hip is positioned in a flexed position. This is particularly true for the adductor magnus. When these muscles are restricted and/or display limited mobility they can limit hip flexion motion during activities such as squatting (or that involve squat type motions). The "adductor lunge" is one exercise option to help target this common issue. ... Heres what to do... Begin kneeling on the floor in a lunge position, then bend your trunk forward to bring the outside of your shoulder towards the inside of your lead knee. Now lunge forward so your hips slide forward. You should feel a stretch along the inside of your upper leg (on the forward leg). Hold the stretch for a few seconds then slide the trunk and pelvis back to release the stretch. Perform 10-15 repetitions. Of course you can vary the hold time and/or even add isometric contractions to the end range depending on exactly when you are trying to accomplish with the stretch.

Lateral epicondylosis (aka Tennis Elbow, Extensor Tendinopathy) is an overuse injury characterized by lateral elbow pain with use the hand such as gripping or lifting/picking up objects. This is an overuse/excessive load condition in which the extensor tendons become progressively injured and less tolerant to stress/load. Rehabilitation of these (as well as other tendon disorders) focuses around progressive loading to rebuild strength, capacity, and load tolerance in the inju...red tendon. The key is to perform these exercises at the appropriate level. If they are too difficult they can flare up the condition, if too easy they will not provide the appropriate stimulus to promote adaptation. As a general rule slight symptom during the exercise is OK (and perhaps even beneficial) but this symptom should remain low (like 2-3/10) and should dissipate quickly after the exercise. Isometric loading is a good starting point for most patients. To perform this exercise begin with the front of your forearm resting on a bench or table. You hand should be hanging off the edge with your wrist and fingers extended so they are in line with your forearm. Use your opposite hand to press your hand and fingers down towards the floor. You need to resist this pressure with the hand/wrist that is resting on the table. You should feel the muscles on the back of your hand/forearm contract - as noted above a slight symptom (2-3/10) at the elbow is OK but dont contract past this point. Hold this contraction for 15-30 seconds. Then relax and rest for 30 seconds. Perform 5-10 repetition up to 2-3 times per day and monitor your response. As the tendon heals you should find that you need to use more force to produce the same level of sx. If this is not the case you may need to adjust the exercise dose. As the tendon heals and load capacity improves the exercises can/should be progressed to incorporated different wrist/elbow positions and different types of contraction.

The iliacus and psoas are primary hip flexors, but they demonstrate an external rotation line of action as well. Therefore, adding an internal rotation component to hip extension mobility exercise can help target this critical muscle group. Heres one option to do this.... Begin in a kneeling lunge position with a heavy weight on the floor by your back ankle. Make sure your hips are pointing straight ahead.... Now lift your foot so the inside of your ankle/lower leg is resting against the weight. (Note: Instead of a weight you can place the inside of your ankle against a door frame or any heavy object). Slide your pelvis forward. You should feel a stretch in the front of your hip. You should NOT feel any pain or pressure in your lower back. Hold the stretch for 1-2 seconds then slide the trunk and pelvis back to release the stretch. Perform 10-15 repetitions. Of course you can vary the hold time and/or even add isometric contractions to the end range depending on exactly when you are trying to accomplish with the stretch.

Heres a great exercise to help improve overhead mobility. Keep the elbow straight and slowly lower your arm overhead towards the floor. Be sure to keep the abdominals tight so the lower back does not lift off the roller. As the arm reaches back pull the shoulder blade back as well to allow the scapula to slide back against the rib cage. Use a light weight for some added resistance. You can also vary the angle of the arm depending on the specific motion/restriction you are trying to mobilize.

Training balance and the ability to maintain joint control against unexpected perturbations can be an important aspect of rehabilitation for many people. Here is one advanced exercise option that can be used as a great progression from the classic "short foot" re-training exercise tract. Tossing the ball not only helps to add some less predictable balance challenges but helps to incorporate neck and eye tracking challenges. You can also add ball tosses of the floor or a wall to keep things fresh.

Thoracic joint restrictions can not only lead to problems locally in the thoracic spine but can also create abnormal compensatory patterns in the neck, shoulders, and lower back as well. Heres a great exercise option to help mobilize the thoracic spine. Adding a band to the movement helps to more specifically target the affected area(s). Work on rounding your back up into the band, then try to arch your mid/upper back towards the floor. Try focus the arch directly under the band.

Lower back pain is often associated with forward flexed postures and forward bending. These patients generally present with flexion intolerance in both their history as well as on physical examination. Teaching these patients how to hinge from the hips and load the hip and posterior chain is an important part of management and rehabilitation. This Kneeling Hip Hinge exercise is a great option that can be used to start to groove this pattern. A dowel or broomstick can be helpful to provide feedback for the patient at home to ensure the lower back remains in a neutral position.

Weakness of the posterior shoulder and scapular muscles are common findings with shoulder, neck, and upper back conditions. Heres one simple exercise option to help improve strength and control of this area. The quadruped position helps to integrate the cervical spine. You can even increase balance and trunk activation by keeping one of the legs extended like a classic bird dog position as strength and control improves.