7th Inning Stretch Demonstration of Exercises to Improve Mobility, Balance, &Strength Chad Shinabery MS ATC CPT Owner of Atlantis Personal Training LLC Denver, Colorado Purpose of Talk Goals of Exercise Program Behavioral Changes to Improve Overall Quality of Life Safe Progression of Exercise Routine Demonstrate a Sample Workout to Include Warm-up, Strength, and Balance Exercises Goals of an Exercise Program and Peripheral Neuropathy Maintain or Improve Muscle Strength Safely Challenge Proprioception and Body Position Awareness Prevent or Slow Down Neurological Degeneration Implement Exercises Into Daily Life Lifestyle changes that could improve Peripheral Neuropathy (PN) Get Physical Exercise Balanced Nutrition Plan – Explain this later Decrease Weight, If If you Smoke, STOP Overweight or Obese – Decreases circulation – Increase Heart Disease Carefully Limit Alcohol Before Starting an Exercise Program Discuss Conditions and Plan of Care with your Physician involved in your PN Treatment Remember, Take it slow. – Rome wasn’t built in a day!! Progression of Exercise Be done with caution First, increase frequency – From 4 days to 5 days to 6 days to everyday Then, increase duration – 20 minutes to 30 minutes Lastly, increase intensity – Small increases to reduce the risk of harmful cardiovascular events, muscle soreness and relapses Advance slowly and with careful monitoring Lets talk about Pain Level I - Intial Discomfort (established, minimal) Level II - Moderate Discomfort (attention can be diverted) Level III – Intense Pain (attention can not be diverted Level IV – Excruciating and unbearable pain Pain, cont. Keep Pain at Level II or below Exercise selection should reflect your pain level Take caution before progression Not a Wise Exercise choice for PN Factors that may assist in maintaining a physical activity program: Take measures to Include a partner avoid injury: warm-up, – Motivation cool-down, & stretches – Encouragement Set objective goals Identify alternative rather than hopeful exercises. outcomes – Reduces boredom Set an exercise – Opens the door for more schedule in advance. options Exercise Routine Format Warm-up Stretches Cardiovascular exercises Strength Exercises Balance Exercises Cool-down Warm up Exercises, Arm Circles Instructions: 1. Start by holding your arms out to the side at shoulder height. 2. Swing your arms in a small circular rotation. 3. Continue for the recommended time and then repeat going the opposite direction. Across Body Arm Swings Instructions: 1. Stand tall and hold arms out to your side. 2. Slowly swing your arms back and forth across the front of your body. 3. Repeat this continuous motion until warm or until recommended time is met. Lateral Side Bend Instructions: 1. Stand with your feet parallel and shoulder width apart. 2. Keeping your body in a straight line bend to the side and reach for the floor with your hand. 3. Bend only until you reach a comfortable range of motion. 4. Make sure to not bend forward or backward while completing this movement. 5. Repeat for the desired repetitions Forward Backward Leg Swing Instructions: 1. Start by standing with your feet shoulder width apart. You can stand on a small step or on the ground. 2. Keeping your upper body perpendicular to the ground swing one leg forward and backward. 3. Do not swing your leg so hard that you can not keep your upper body from moving. 4. Repeat for the recommended repetitions and repeat with the other side. Lateral Leg Swings Instructions: 1. Start by holding onto a secure object and raise your outside leg out to the side. 2. In a smooth and continuous motion swing your leg back and forth across the front of your body. 3. Swing through your full range of motion but keep your upper body stable throughout the movement. 4. Repeat for the recommended repetitions and then flip sides and repeat with the other leg. Goals of Cardiovascular Exercise Start Slow and Progress – 5 minutes to start, progress to 10 and so forth AMA recommends 20-30 minutes of daily CV Exercise Monitor Heart Rate – Target Heart Rate (220-age) x .7-.85 – Pulse method (radial, carotid) – Heart Rate Monitors Aerobic Exercise Choices Swimming – Preferably without your shoes and fully clothed like the picture encourages you! Cardio, Elliptical Elliptical Instructions: Place your feet on the foot plates and grab the arm handles. Set your resistance so that it is challenging and start the elliptical motion by pulling machine arm with one arm and push the other machine arm. Pick a pace that will elevate your heart rate yet let you stay on the machine for a while. Cardio Exercise, Bike Progression Cardio Advanced Bike Progression Cardio Walking Goals of a Strength Routine Work Large Muscle Groups Start slow and Progress as tolerated Repetitions of 15-20 Set of 1-3 Non-weight bearing exercises Partial-weight bearing exercises Full weight bearing exercises Lower Body Exercises NWB Single Leg Kickbacks Instructions: 1. Start in a four point position with your hands and knees on the ground. 2. Proceed to kick your leg back and up until you reach full extension. 3. Squeeze your glute muscle while performing this movement. 4. Repeat with the other leg. 5. For a more advanced movement you can attach an ankle weight around your leg. Lower Body Exercises NWB Hip Hikes Instructions: 1. Start by lying face down with your legs straight. 2. Slowly raise one leg keeping it straight using just your glute muscles. 3. Return to the starting position and repeat for the desired repetitions. Repeat with the other leg. Lower Body Exercises PWB Partial WB Leg Swings Instructions: 1. Start by standing on the platform and placing a foot in the foot harness. Step to the side so that your foot hangs off the edge of the platform. 2. Proceed to curl your foot back and up keeping your knee stabilized next to your other knee and bringing your foot all the way to your butt. 3. Return to the starting position and repeat according to the prescribed repetitions. Repeat with the other leg. Lower Body Exercises FWB Bodyweight Squats Instructions: 1. Start by placing feet shoulder width apart and holding your arms out in front of you. 2. Proceed to squat down like you are going to sit in a chair. Your upper body will lean forward slightly and your hips will shift backwards while going down. 3. Remember to keep your knees from going out in front of your toes while squatting. 4. Repeat according to your required repetitions. If you want to make the exercise more challenging hold your arms at your sides or behind your head. Lower Body Exercises FWB Bodyweight Lateral Squat Instructions: 1. Stand with your feet shoulder width apart. 2. Start by stepping to the right with your right foot and proceed into a squat. 3. Return to the standing position with your feet shoulder width apart. 4. Now step to your left with your left foot and proceed into a squat. 5. Return to the starting position and repeat. Chest Exercises NWB Instructions: 1. Start by lying on the floor on your back holding a dumbbell in each hand. 2. Proceed to bend your arms until the back of your arms touch the floor. 3. Push the dumbbells back up to full extension. 4. Repeat for the desired repetitions. Chest Exercises PWB Instructions: 1. Start by placing your hands on the wall at shoulder level with your feet approximately 2 feet away from the wall. 2. Bend your elbows so that your chest gets closer to the wall. 3. Once your elbows are bent to about 90 degrees then press back out to the starting position. 4. Repeat according to the required repetitions. Chest Exercises FWB Instructions: 1) Sit in upright position on ball with feet flat on floor and DB in each hand. (You may rest each DB on the corresponding thigh.) 2) Walk feet forward allowing ball to roll underneath body until it is positioned on mid to upper back region (you may rest head on ball). Raise hips to create a “table top” position parallel to floor. 3) Start position: Maintaining stability, bring DB’s to shoulders and press up positioning DB’s above the chest with palms facing forward. 4) Lower the DB’s keeping your forearms perpendicular to the floor and your hands aligned at the nipple line. Low Back, NWB Alternating Superman Instructions: 1) Lie face down on floor with arms extended overhead. You may place a rolled towel under forehead to clear face from floor. 2) Raise right arm and left leg 4-8 inches off floor. 3) Lower and raise alternate opposite arm and leg. Remember to keep head and back in a neutral position. Shoulders and hips should remain squared throughout movement. Low Back, NWB Cobra on Floor Instructions: 1. Start by lying on your stomach with your arms at your sides. 2. Slowly raise your shoulders up off the ground by contracting your low back. 3. Return to the starting position and repeat. Low Back, PWB Bridging Instructions: 1. Begin by lying on your back, knees bent, and feet on the floor. Extend your arms out to steady yourself. 2. Squeeze buttocks and raise your hips and lower back off the floor to form a straight line from your knees to your chest. Do not arch your back. 3. Hold for 5-10 seconds and slowly return to starting position. Relax for 5 seconds. 4. Repeat for required number of repetitions. Low Back, FWB Bodyweight Good Mornings Instructions: 1. Start by placing your hands behind your head and your feet shoulder width apart. 2. Keeping your low back flat and your legs semi-straight bend forward until your individual range of motion is reached. 3. Return to the starting position and repeat. 4. Make sure to keep good technique and bend from the hips keeping your lower back relatively flat. Shoulder, NWB/PWB Seated DB Shoulder Press Instructions: 1. Sit in upright position or stand with feet shoulder width apart and knees slightly bent. 2. Start position: Position DB’s to ear level with an overhand grip (palms facing forward). 3. Press hands up above head keeping wrists over the elbows and arms moving parallel to body at all times. 4. Return to start position. Shoulder, FWB DB shoulder press Instructions: 1. Starting position: Dumbbells are at shoulder level with your palms facing your head. 2. Press the dumbbells over your head keeping your palms facing each other. 3. Return to the starting position and repeat. Remember to not arch your lower back as your press the dumbbells over your head. Biceps, NWB/PWB Seated Dumbbell Bicep Curl Instructions: 1) Sit in upright position on stability ball. 2) Start position: Grasp DB’s with underhand grip (palms facing forward) and allow arms to hang down at sides. Elbows should be close to sides. 3) Flex at the elbows and curl DB’s up to approximately shoulder level. Keep elbows close to sides throughout movement. 4) Return to start position. Biceps, FWB Dumbbell Curl Instructions: 1) Stand with feet shoulder width apart and knees slightly bent or sit in upright position. 2) Start position: Grasp DB’s with underhand grip and allow arms to hang down at sides. Elbows should be close to sides. 3) Flex at the elbows and curl DB’s one at a time up to approximately shoulder level. Keep elbows close to sides throughout movement. Return to start position. Triceps, NWB/PWB Overhead tricep extension Instructions: 1) Sit on ball with feet shoulder width apart in upright position. 2) Start position: Grasp DB and place palms on inner side of weight plate as shown. Press DB directly overhead (now palms are up). 3) Stabilize shoulders and lower weight moving only at the elbow joint until forearm is parallel to floor. Keep elbows pointing forward throughout movement. 4) Return to start position. Triceps, FWB Standard Pushup Instructions: 1. Lie face down on the floor with hands palm down, fingers pointing straight ahead, and aligned at the nipple line. 2. Place hands slightly wider than shoulder width, and feet should be at hip width with toes on floor. 3. Start position: Extend the elbows and raise the body off the floor. 4. Lower your entire body (legs, hips, trunk, and head) 4-8 inches from the floor. 5. Return to the start position Goals of a Balance Routine Select exercises that safely challenges stabilization. Repititions of 15-20 Set 1-3 Can be Done Daily if Tolerated Progress with caution Balance, Beginner Seated Reverse Wood Chop Instructions: 1. Sit on a stability ball with your knees bent at 90 degrees. 2. Hold a medicine ball and start at your right hip. 3. Rotate your trunk and arms to lift the ball above your left shoulder. 4. You should rotate at your trunk first and then lift and twist your arms. 5. Return to the starting position and repeat to the other side. Balance, Intermediate Same Side Superman Instructions: 1. Start position: Lie face down on ball with hands down at sides. Raise left arm and left leg off floor. 2. Return to start position and repeat with the other side. Balance Exercise, Intermediate 1 Leg Balance Squat Instructions: 1. Start by standing on one leg with the other leg elevated. 2. Bend forward keeping your planted leg semi straight and reach for the ground. 3. Keep your back relatively flat during the exercise. 4. Repeat for the prescribed repetitions and then repeat with the other leg. Balance, advanced Leg ext/Tricep Ext with band Instructions: 1. Start by placing the band underneath your foot and holding it with one hand over your head. 2. With your knee bent and elbow bent simultaneously straighten the limbs until both are in full extension. 3. Return to the starting position and repeat with the other leg. Balance, Not a good idea!!! Kneeling Balance Instructions: Start Position: Position yourself on the ball by placing your shins on top of the ball and balancing in this position. Use the tops of your feet to help control the movement of the ball by placing them against the ball. Hold for the prescribed number of seconds. Cool Down Repeat Warm-up Exercises Stretch any Muscles That May Have Bothered You during the Workout Conclusion Check with your doctor before starting any exercises program Progress slowly and with caution Pain at a Level II or below Have Fun and Enjoy your Workouts Thank you For your Time Any Questions?