Course Outline


 

Course Outline

  1. Introduction
    1. Exercise to Improve Health-Span Not Just Life-Span 
    2. Keys to Low Back Pain Prevention
    3. Community Based Exercises: Pros and Cons
  2. Movement Assessment Tests – 7 (MAT-7)
    1. Squats
      1. 2 – legged
      2. 1 – legged
      3. Hip Airplane
    2. Balance – Reach, Step – Downs and Jump – Downs
    3. Core Range of Motion
      1. Directional Preference
      2. Sagittal Plane
      3. Frontal Plane
      4. Transverse Plane
    4. Eccentric Control of the Core
      1. Sagittal Plane
      2. Frontal Plane
      3. Transverse Plane
    5. Scapular Reaction
      1. Sagittal Plane
      2. Frontal Plane
      3. Transverse Plane
    6. Unloaded Foot/Ankle Evaluation
      1. First MTP Joint Extension
      2. Talar Rock
      3. Talar Tilt
        1. Eversion
        2. Inversion
      4. Calcaneal Inversion with
        1. Subtalar Joint Inversion/Eversion
        2. Mid-foot tri-planar motion
      5. Calcaneal Eversion with
        1. Subtalar Joint Inversion/Eversion
        2. Mid-foot tri-planar motion
      6. Bridges, Planks, Bird-dog and Modified Curl Up
        1. Importance of Levels I-V
        2. Prone Plank
        3. Side Bridge and Plank
        4. Supine Bridge
        5. Bird-dog
        6. Modified Curl Up
  3. Upper Quarter: Evaluation and Treatment of the Container
    1. Evaluation of Container
      1. Upper Limb Neurodynamic Tension Test (ULNT)
      2. C2-C7
      3. C2
      4. C0-C1
      5. Scalene
        1. Anterior and Middle
        2. Posterior
      6. Pectoralis Minor
      7. vii.Pronator Teres
      8. viii.Carpal Tunnel
    2. Treatment of the Container
      1. Treat most restricted area
      2. Repeat ULNT Test
      3. Treatment of next most restricted area
      4. Repeat ULNT Test
      5. Neuromobilization
        1. Trapped – Sliders
          1. 10-12 reps
          2. 3X/d
        2. Tight – Tensioners
          1. 10-12 reps
          2. 3X/d
        3. Sensitive – Sliders, aerobic conditioning
          1. 2-3 reps every 2-3 hours
  1. Shoulder Evaluation and Treatment
    1. Impingement Tests
      1. External (Bursa Side)
        1. Neer’s
        2. Modified Neer’s
        3. Hawkins-Kennedy
        4. Modified Hawkins-Kennedy
        5. Yocum’s Test
      2. Internal (Articular Side)
        1. Relocation Test (posterior-superior)
        2. Hawkins-Kennedy (anterior-posterior)
      3. AC Compression Test
      4. SC Compression Test
    2. Rotator Cuff Tests
      1. Supraspinatus
        1. Empty Can
        2. Full Can
        3. Scapular Assist
          1. Better = impingement
          2. Same = tear
      2. Infraspinatus
        1. External Rotation at side
        2. Horn Blower’s Sign
          1. Full thickness tear
        3. Scapular Assist
          1. Better = impingement
          2. Same = tear
      3. Teres Minor
        1. External Rotation at 90 degrees abduction
      4. Subscapularis
        1. Hands on belly – push elbow forward
          1. Partial Tear
        2. Lift – Off Test
          1. Full thickness tear
    3. Biceps Test
      1. Speed’s Test
      2. Yergason’s
    4. Stability Tests
      1. Anterior
        1. Anterior Drawer
        2. Anterior Slide
      2. Posterior
        1. Posterior Drawer
        2. Jerk Test
        3. Kim’s Test
      3. Inferior
        1. Sulcus Sign
          1. Indicates Multi-directional Instability (MDI)
      4. Dynamic Stability Test
        1. Apprehension Sign, Relocation and Surprise
          1. Anterior Instability
        2. Closed Kinetic Chain
          1. Anterior Drawer
            1. Better
            2. Same
          2. Posterior
            1. Better
            2. Same
          3. Sulcus Sign
            1. Better
            2. Same
      5. Labral Tests
        1. Dynamic Labral Shear
        2. O’Brien’s Test (Active Compression Test)
        3. Resisted Supination External Rotation Test
        4. Clunk Test
        5. Crank Test
        6. Biceps Load II Test
        7. Peel Back v SLAP Lesion
          1. Resisted Supination/ER = Peel Back Mechanism
          2. O’Brien’s and Biceps Load Test I = SLAP Lesion
      6. Hypermobility v Laxity v Instability
        1. Hypermobility
          1. Modified Beighton Scale
            1. Score at least 5/9 = Gen. Ligamentous Laxity
        2. Laxity
          1. > or =  to grade II laxity w/o dyn. Instability
        3. Instability
          1. Laxity with lack of protective muscular control
  2. Lower Quarter: Evaluation and Treatment of the Container
    1. Evaluation of the Container
      1. Slump Test
        1. Lumbar segmental dysfunction, especially L4 and L5
        2. Sacroiliac/pelvic dysfunction
        3. Capsular thickening, especially posterior hip capsule
        4. Muscular tightness (esp. piriformis/hamstrings & psoas)
      2. Straight Leg Raise (SLR)
        1. As above
      3. Prone Knee Bend (PKB)
        1. Upper lumbar segmental dysfunctions, especially, L1-L3
        2. Sacroiliac/pelvic dysfunctions
        3. Capsular thickening, especially anterior hip capsule
        4. Muscular tightness, especially psoas/rectus femoris
    2. Treatment of the Container
      1. Treat the most restricted area
      2. Repeat ANDT Test that applies
      3. Treatment of next most restricted area
      4. Repeat ANDT Test that applies
      5. Neuromobilization
        1. Trapped – Sliders
          1. 10-12 reps
          2. 3X/d
        2. Tight – Tensioners
          1. 10-12 reps
          2. 3X/d
        3. Sensitive – Sliders, aerobic conditioning
          1. 2-3 reps every 2-3 hours
  3. Hip Evaluation and Treatment
    1. Range of Motion
      1. 90 degrees hip and knee flexion
        1. Internal rotation
        2. External rotation
      2. Scouring Tests
        1. Clockwise
        2. Counterclockwise
    2. FAbERS (Patrick’s)
      1. Flexion Abduction External Rotation
    3. FAdIR
      1. Flexion Adduction Internal Rotation
        1. Anterior Impingement
        2. Osteoarthritis (OA)
        3. Femoral-Acetabular Impingement (FAI)
    4. Impingement Tests
      1. Anterior
      2. Posterior
      3. Lateral
      4. Femoral-acetabular
      5. Ischiofemoral 
    5. Capsular Test
      1. Anterior
      2. Posterior
      3. Medial/Inferior
    6. Labral Tests
      1. Prone hip extension
        1. Internal rotation
        2. External rotation
      2. Supine Abduction External Rotation with
        1. Flexion Adduction Internal Rotation
    7. Soft Tissue Tests
      1. Rectus Femoris
        1. Seated resisted hip flexion/knee extension
        2. Supine resisted hip flexion/knee extension
        3. Prone passive hip extension/knee flexion
        4. Palpation over anterior inferior iliac spine
      2. Psoas
        1. Seated resisted hip flexion/external rotation
        2. Supine resisted hip flexion/external rotation
        3. Prone passive hip extension/internal rotation
        4. Palpation over lesser trochanter
      3. Gluteus Medius
        1. Side lying resisted hip abduction/external rotation
        2. Side lying passive hip adduction/internal rotation
        3. Palpation over posterolateral facet of greater trochanter
      4. Gluteus Minimis
        1. Side lying resisted hip abduction/internal rotation
        2. Side lying passive hip adduction/external rotation
        3. Palpation of anterior facet of greater trochanter
      5. Gluteus Maximus
        1. Prone resisted hip extension/external rotation
        2. Supine passive hip flexion/internal rotation
        3. Palpation of posterior ridge of greater trochanter
      6. Pyriformis
        1. Below 90 degrees of hip flexion
          1. Supine resisted hip abduction/external rotation at 70 degrees hip flexion
          2. Passive hip adduction/internal rotation at 70 degrees
        2. Above 90 degrees of hip flexion
          1. Supine resisted hip adduction/internal rotation
          2. Supine passive hip flexion/abduction/external rotation
          3. Snapping Hip
            1. Psoas Tendon
            2. Iliotibial Band
            3. Suction Phenomenon of Hip Joint
      7. Bony Lesion
        1. Stress Fracture
          1. Hip
            1. Standing Ipsilateral Heel Drop Test
          2. Femur
            1. Seated Cantilever Compression Test
          3. Pubic Rami
            1. Pubic Rami Compression Test
            2. Supine Resisted Adduction Test
      8. Osteochondral Defect
        1. Axial Load with Scour
          1. Clockwise
          2. Counterclockwise
  4. Spine Stabilization Exercises – Levels I-V

1. Supine Bridge

a. Level I     Arms at side hold 10 sec x 6 reps

b. Level II    Arms Crossed hold 60 sec x 1 rep

c. Level III   Alternate leg raises x 60 sec

d. Level IV  Back supported on gym ball w or w/o leg raises hold x 60 sec

e. Level V   Feet supported on ball w or w/o leg raises hold x 60 sec

2. Side Bridge and Planks (Test R and L sides < 5% difference from side to side)

a. Level I    From Knees 10 sec hold x 6 reps

b. Level II   From feet 60 hold x 1 rep

c. Level III   Top arm and leg raise up and down for 60 sec

d. Level IV  Bottom arm on ball hold 60 sec

e. Level V   Feet on ball hold 60 sec

3. Prone Plank

a. Level I     Elbows and knees hold 10 sec x 6 reps

b. Level II    Elbows and toes 60 sec hold x 1 rep

c. Level III    Elbows and toes w/alternate leg raise x 60 sec

d. Level IV   Elbows on ball hold 60 sec or stir the pot

e. Level V    Feet on ball hold 60 sec or knees to chest or toward each shoulder

4. McGill Curl-up

a. Level I      Raise elbows (paper thin) and unweight head - 10 s hold x 6 reps

b. Level II     As above hold 60 sec x 1 rep

c. Level III    Alternate leg raises w/elbow raises

d. Level IV   Back and neck supported on ball 60 sec hold x 1 rep

e. Level V    Feet on ball still one knee bent 60 sec hold x 1 rep

5. Bird-dog

a. Level I     Raise one arm or one leg hold 10 sec x 6 reps

b. Level II    Alternate arm/leg raise for 60 sec hold

c. Level III   Sweep the floor opposite arm to knee x 60 sec

d. Level IV  One hand on disco sit or BOSU ball hold x 60 sec

e. Level V   One knee on disco sit or BOSU ball hold x 60 sec

Why start with the McGill Big 3

  1. What are they?
    1. Bird-dog – Activates posterior core
    2. Modified Curl-up – Activates anterior core
    3. Side Bridge – Activates lateral core
  2. They have low loads on the spine and high muscle activation for the posterior, anterior and lateral core