FOR THE SERVICE MEMBER: Rx3 REHABILITATION PROGRAM

Transcription

1 CREATED BY THE HUMAN PERFORMANCE RESOURCE CENTER / HPRC-ONLINE.ORG / FROM THE CONSORTIUM FOR HEALTH AND MILITARY PERFORMANCE HUMAN PERFORMANCE RESOURCE CENTER Injury/Condition: Injury/Condition: What is shoulder pain? FOR THE SERVICE MEMBER: Rx3 ILITATION PROGRAM Shoulder Pain Shoulder pain is characterized by dysfunction of or damage to the muscles, tendons, or ligaments that control movement and provide stability to the shoulder joint. Shoulder pain can result in limited movement and weakness in and around the shoulder joint. The exact causes are varied and can be difficult to identify. Some possible causes include altered mechanics of the shoulder blade, repetitive overhead activities such as lifting, and weakness or tightness in the muscles comprising the shoulder joint. What are the symptoms of shoulder pain? Symptoms of shoulder pain include pain around or within the shoulder joint, especially with reaching or overhead movements, feelings of weakness in the shoulder and arm, a clicking or catching during movements, and an inability to move your arm through its normal range of motion. The pain can come on slowly or quickly and is often worse when you lift your arm overhead. Symptoms may disrupt your sleep patterns and affect your ability to perform normal daily tasks such as shampooing hair, putting on clothes, lifting groceries, or playing with children. Is there a test for shoulder pain? Your healthcare provider will ask you about your symptoms and will perform a physical exam. Depending on your age and your specific symptoms, your doctor may or may not order imaging tests (X-ray, MRI, CT scan, or bone scan) to help with the diagnosis. How is shoulder pain treated? The mainstay of shoulder pain treatment is through physical rehabilitation: performing exercises and stretches to increase the strength, endurance, and flexibility of the muscles of the shoulder, arm, and upper back. Exercises in this program are organized by phases based on how far along you are in the recovery process. Unless your healthcare provider tells you otherwise, start with Phase 1. Advance to the next phase no sooner than 3 weeks and only when you feel you have mastered the exercises and can perform them with minimal effort and discomfort. If you have pain during or after the Phase 1 exercises, or if you have questions about when to go on to the next phase, check with your healthcare provider. Each phase includes a session of stretches, shoulder and core exercises, and a cardio component. Make sure you do all the parts of each session in order. Perform the session at least 3 days a week, increasing to 5 days a week as it becomes easier. Each exercise session should take about 20 minutes, plus the cardio component, and less than 15 minutes for stretching. You will need very little equipment for this program. The overall goal of this program is to reduce your shoulder pain and increase your overall physical fitness. Your healthcare provider may recommend using these exercises along with another treatment plan.

2 Phase 1: Stretches Perform in the order listed, holding each stretch for sec and taking a brief rest between reps. 2 3 reps Phase 1: seconds each Rest 5 10 sec 1. Self-Massage Upper Back Starting position: Lie with your back on the floor, with your knees bent and your arms crossed, with a tennis ball, foam roller, or similar object between the floor and your upper back. How to perform: Support your body weight with your legs, moving up, down, and around your upper back. Try to relax your body, especially the area you re rolling. Give extra attention and time to areas in the muscles that feel sore. To make the stretch more challenging, try extending each arm to the side or overhead so you can massage the muscles on the sides of your back and under your armpits. 2. Standing Cross-arm Stretch Starting position: Stand with good posture: head up, chest up, arms relaxed at your side. How to perform: Lift the arm of your injured shoulder in front of you, grasp it with the opposite hand or arm, and pull it across your body. Hold for sec. 3. Standing Chest Stretch (Low and High) Starting position: Stand next to the outside corner of a wall or a doorframe. Lift your injured arm to the side at shoulder height, bend your elbow 90 degrees, and rest your forearm on the wall or doorframe (see photo). How to perform: Using the wall or doorframe to keep your forearm immobile, lean or step forward so you push into and past the corner, stretching the front of your shoulder and chest muscles. Hold for sec. Repeat with your elbow raised to ear level. 4. Bent-over Lat Stretch Starting position: Stand 3 4 feet in front of the outside corner of a wall or a doorframe. How to perform: Extend your injured arm out, lightly grabbing the edge of the doorframe or wall. Bend your torso forward and sit back into your hips. Try to relax the arm that is extended. You should feel a stretch under the armpit and toward the side of your back. Hold for sec.

3 Phase 1: Shoulder Exercises Perform 10 reps (repetitions) of each exercise in order (1 5), and then repeat the entire cycle for a total of 3 sets with minimal rest between exercises. Many of the shoulder exercises require elastic tubing or bands when the weight of your body alone does not provide enough resistance. 10 reps each 3 sets Cycle all exercises Minimal rest between exercises 1. Lying Ys, Ts, and Ws Phase 1: Starting position: Lie on your stomach with your chest just off the edge of a bed, flat bench, or physioball, with your arms/shoulders hanging down towards the ground, relaxed. How to perform: Keeping your head and neck in a neutral position (looking down toward the ground), pull your shoulders down and back as if you were trying to place your shoulder blades in your back pants pockets. Lying Ys: While keeping shoulders down and back, lift your straight arms up and overhead in a Y shape, with thumbs pointing towards the ceiling. Pinch your shoulder blades together. Hold this position for 3 seconds before slowly returning to the starting position. Perform 10 reps and take a brief rest if necessary before moving on to lying Ts. Lying Ts: While keeping shoulders down and back, lift your arms up in a T shape, arms straight and stretched out to your side, with thumbs pointing towards the ceiling. Pinch your shoulder blades together. Hold this position for 3 seconds before slowly returning to the starting position. Perform 10 reps and take a brief rest if necessary before moving on to lying Ws. Lying Ws: While keeping shoulders down and back, lift your arms up in a W shape, elbows bent and pulled in towards the ribs, with thumbs pointing towards the ceiling. Pinch your shoulder blades together. Hold this position for 3 seconds before slowly returning to the starting position. Perform 10 reps and take a brief rest if necessary before moving on to the shoulder internal rotation exercise. Add repetitions (up to 20 reps each) to make the exercise more challenging. 2. Shoulder Internal Rotation (Elbow In) Starting position: Attach an elastic band to a safe anchor point at about bellybutton height. Stand with your injured side facing the anchor point and your shoulders down and back. On your injured side, pinch a towel between your elbow and your ribcage, with your elbow bent 90 degrees. Hold the end of the band with your injured arm so there is light resistance on the band. How to perform: Keeping your shoulders down and back and pressure on the towel, rotate your forearm inward towards your bellybutton. Pause briefly before slowly returning to the start position. Perform on the injured side only. Add repetitions (up to 20 reps), stand further from the wall, or use a thicker elastic band to make the exercise more challenging.

4 3. Shoulder External Rotation (Elbow In) Starting position: Attach an elastic band to a safe anchor point at about bellybutton height. Stand with your uninjured side facing the anchor point and your shoulders down and back. On your injured side, pinch a towel between your elbow and your ribcage, with your elbow bent 90 degrees. Hold the end of the band with your injured arm so there is light resistance on the band. Phase 1: How to perform: Keeping shoulders down and back and pressure on the towel, rotate your forearm outward away from your body. Pause briefly before slowly returning to the start position. Perform on the injured side only. Add repetitions (up to 20 reps), stand further from the wall, or use a thicker elastic band to make the exercise more challenging. 4. Standing Row with Band Starting position: Attach the midpoint of an elastic band to a safe anchor point at about bellybutton height and your shoulders down and back. Hold one end of the band in each hand and stand 3 5 feet away from the anchor point, arms stretched out in front of your body and with a light resistance on the band. How to perform: Keeping shoulders down and back, slowly pull the band towards your body until your hands are almost touching your ribs. Pinch your shoulder blades together. Pause briefly before slowly returning to the starting position. Add repetitions (up to 20 reps), stand further from the wall, or use a thicker elastic band to make the exercise more challenging. 5. Wall V Arm Raise Starting position: Stand with your back flat against a wall, arms at your side, shoulders down and back, and your head, back, and butt touching the wall. How to perform: Keeping your head, back, and butt in contact with the wall and your shoulders down and back, raise both arms at a 45-degree angle to the wall. Raise your arms as high as possible, but not to the point of pain. Pause briefly before slowly returning to the starting position. Add repetitions (up to 20 reps) or use a light-resistance elastic band to make the exercise more challenging.

5 Phase 1: Core Exercises Perform each exercise in the order below, and then repeat 2 more times, alternating the exercises, for a total of 3 sets. 3 sets Alternate exercises (back-to-back) Minimal rest between exercises 1. Glute Bridge with Hold Reps: 10x (with 5 sec hold) Starting position: Lie face up on the ground, knees bent about 60 degrees, with your feet hip-width apart and firmly planted on the floor. How to perform: Lift your hips off the floor, pushing through your heels and squeezing your glutes as you lift your hips. Hold for 5 sec. Do not overextend your back! You should feel the activity mostly in your legs. If you feel strain in your back, lower your hips a bit until you feel your legs and glutes take control, and hold there. Add time to each hold (up to 20 sec) to make the exercise more challenging. Phase 1: 2. Plank (knees down) Reps: 2x (with 15 sec hold) Starting position: Lie face down propped up with your forearms on the ground and your elbows under your shoulders, with both knees bent and a towel beneath to cushion your knees. How to perform: Lift your hips off the ground, creating a bridge from your forearms to your knees. Keep your abs your abdominal muscles tight and your back flat as you hold the position for 30 sec. (Do this in front of a mirror so you can see that you re keeping a straight body position.) To make the exercise more challenging, bridge from forearms to toes, lifting your knees off the ground. However, don t try this unless you can keep a tight-ab, flat-back, straight position. Phase 1: Cardio component Do some kind of low-impact cardio activity at least 3 days a week, and then 5 days a week as it becomes easier. As a general rule, don t increase the volume or intensity of your cardio exercises more than 10% per week. Exercises: Bike, walk, or light jog How to perform: The key is low-impact activity that doesn t cause pain in your shoulder. At this initial stage, the intensity doesn t need to be extreme, as long as you re making progress. Duration: minutes Progression Perform all the exercises outlined in Phase 1 for at least 3 weeks. Move on to Phase 2 when you can complete all the Phase 1 exercises for the maximum recommended sets and repetitions for at least 3 days a week. If you have pain with the Phase 1 exercises, or if you have questions about when you should progress to the next phase, consult your healthcare provider.

6 Phase 2: Stretches Perform in the order listed, holding each stretch for sec and taking a brief rest between reps. 2 3 reps seconds each Rest 5 10 sec 1. Self-Massage Upper Back Phase 2: Starting position: Lie with your back on the floor, with your knees bent and your arms crossed, with a tennis ball, foam roller, or similar object between the floor and your upper back. How to perform: Support your body weight with your legs, moving up, down, and around your upper back. Try to relax your body, especially the area you re rolling. Give extra attention and time to areas in the muscles that feel sore. To make the stretch more challenging, try extending each arm to the side or overhead so you can massage the muscles on the sides of your back and under your armpits. 2. Standing Cross-arm Stretch Starting position: Stand with good posture: head up, chest up, arms relaxed at your side. How to perform: Lift the arm of your injured shoulder in front of you, grasp it with the opposite hand or arm, and pull it across your body. Hold for sec. 3. Standing Chest Stretch (Low and High) Starting position: Stand next to the outside corner of a wall or a doorframe. Lift your injured arm to the side at shoulder height, bend your elbow 90 degrees, and rest your forearm on the wall or doorframe (see photo). How to perform: Using the wall or doorframe to keep your forearm immobile, lean or step forward so you push into and past the corner, stretching the front of your shoulder and chest muscles. Hold for sec. Repeat with your elbow raised to ear level. 4. Bent-over Lat Stretch How to perform: Extend your injured arm out, lightly grabbing the edge of the doorframe or wall. Bend your torso forward and sit back into your hips. Try to relax the arm that is extended. You should feel a stretch under the armpit and toward the side of your back. Hold for sec. Starting position: Stand 3 4 feet in front of the outside corner of a wall or a doorframe.

7 Phase 2: Shoulder Exercises Perform 10 reps (repetitions) of each exercise in order (1 5), and then repeat the entire cycle for a total of 3 sets with minimal rest between exercises. Many of the shoulder exercises require elastic tubing or bands when the weight of your body alone does not provide enough resistance. 10 reps each 3 sets Cycle all exercises Minimal rest between exercises 1. Lying Ys, Ts, and Ws Phase 2: Starting position: Lie on your stomach with your chest just off the edge of a bed, flat bench, or physioball, with your arms/shoulders hanging down towards the ground, relaxed. How to perform: Keeping your head and neck in a neutral position (looking down toward the ground), pull your shoulders down and back as if you were trying to place your shoulder blades in your back pants pockets. Lying Ys: While keeping shoulders down and back, lift your straight arms up and overhead in a Y shape, with thumbs pointing towards the ceiling. Pinch your shoulder blades together. Hold this position for 3 seconds before slowly returning to the starting position. Perform 10 reps and take a brief rest if necessary before moving on to lying Ts. Lying Ts: While keeping shoulders down and back, lift your arms up in a T shape, arms straight and stretched out to your side, with thumbs pointing towards the ceiling. Pinch your shoulder blades together. Hold this position for 3 seconds before slowly returning to the starting position. Perform 10 reps and take a brief rest if necessary before moving on to lying Ws. Lying Ws: While keeping shoulders down and back, lift your arms up in a W shape, elbows bent and pulled in towards the ribs, with thumbs pointing towards the ceiling. Pinch your shoulder blades together. Hold this position for 3 seconds before slowly returning to the starting position. Perform 10 reps and take a brief rest if necessary before moving on to the shoulder internal rotation exercise. Add repetitions (up to 20 reps each) to make the exercise more challenging. 2. Shoulder Internal Rotation (Elbow In) Starting position: Attach an elastic band to a safe anchor point at about bellybutton height. Stand with your injured side facing the anchor point and your shoulders down and back. On your injured side, pinch a towel between your elbow and your ribcage, with your elbow bent 90 degrees. Hold the end of the band with your injured arm so there is light resistance on the band.

8 How to perform: Keeping your shoulders down and back and pressure on the towel, rotate your forearm inward towards your bellybutton. Pause briefly before slowly returning to the start position. Perform on the injured side only. Add repetitions (up to 20 reps), stand further from the wall, or use a thicker elastic band to make the exercise more challenging. Phase 2: 3. Shoulder External Rotation (Elbow In) Starting position: Attach an elastic band to a safe anchor point at about bellybutton height. Stand with your uninjured side facing the anchor point and your shoulders down and back. On your injured side, pinch a towel between your elbow and your ribcage, with your elbow bent 90 degrees. Hold the end of the band with your injured arm so there is light resistance on the band. How to perform: Keeping shoulders down and back and pressure on the towel, rotate your forearm outward away from your body. Pause briefly before slowly returning to the start position. Perform on the injured side only. Add repetitions (up to 20 reps), stand further from the wall, or use a thicker elastic band to make the exercise more challenging. 4. Standing Row with Band Starting position: Attach the midpoint of an elastic band to a safe anchor point at about bellybutton height and your shoulders down and back. Hold one end of the band in each hand and stand 3 5 feet away from the anchor point, arms stretched out in front of your body and with a light resistance on the band. How to perform: Keeping shoulders down and back, slowly pull the band towards your body until your hands are almost touching your ribs. Pinch your shoulder blades together. Pause briefly before slowly returning to the starting position. Add repetitions (up to 20 reps), stand further from the wall, or use a thicker elastic band to make the exercise more challenging. 5. Assisted Pushup Starting position: Place your hands just wider than shoulder width on a bench, table, or step. Begin with a taller bench and work to a lower height over time. How to perform: Your body should be in one straight line with your back flat and your abdominals tight. Starting at the top of the pushup, lower your body by bending your arms until your upper arm is at least parallel to the floor and elbows bent 90 degrees. Do not proceed to the point of pain. Pause briefly before pushing back to the start position. When you can lower completely without feeling pain in your shoulder, then reduce the height of the bench to make the exercise more challenging.

9 Phase 2: Core Exercises Perform each exercise in order (1 3), and then repeat the entire cycle 2 more times, for a total of 3 sets with minimal rest between exercises. 3 sets Cycle all exercises (back-to-back-to-back) Minimal rest between exercises 1. Glute Bridge March Reps: 10x (with 3 sec hold) Starting position: Lie face up on the ground, knees bent about 60 degrees, with your feet hip-width apart and firmly planted on the floor. How to perform: Lift your hips off the floor, pushing through your heels and squeezing your glutes as you lift your hips. Lift one foot slightly off the ground and hold for 3 sec. Alternate sides in a marching fashion, but continue to keep your hips in the same position. Do not overextend your back! You should feel the activity mostly in your legs. If you feel strain in your back, lower your hips a bit until you feel your legs and glutes take control, and hold there. One rep is both legs (2 steps). Add time to each hold (up to 10 sec) to make the exercise more challenging. 2. Plank Reps: 2x (with 15 sec hold) Starting position: Lie face down propped up with your forearms on the ground and your elbows under your shoulders, with legs extended straight. How to perform: Lift your hips off the ground, creating a bridge from your forearms to your toes. Keep your abs your abdominal muscles tight and your back flat as you hold the position for 30 sec. (Do this in front of a mirror so you can see that you re keeping a straight body position.) Add time to each hold (up to 60 sec) to make the exercise more challenging. 3. Side Plank (knees) Reps: 2x each side (with 15 sec hold) Starting position: Lie on your side, propped up on your forearm, with one elbow directly under your shoulder and your hip on the ground. Bend both knees with your feet behind you. How to perform: Lift your hips off the ground, creating a bridge from your forearm to your knee. Keep your abs your abdominal muscles tight and your back straight as you hold the position for 30 sec. Immediately switch to the opposite side before moving to the next activity. Add time to each hold (up to 60 sec) to make the exercise more challenging. Phase 2:

10 Phase 2: Cardio component Do some kind of low-impact cardio activity at least 3 days a week, and then 5 days a week as it becomes easier. As a general rule, don t increase the volume or intensity of your cardio exercises more than 10% per week. Exercises: Running (cushioned track, running trail, or treadmill) Phase 2: How to perform: You should only perform impact running (cushioned track, running trail, or treadmill) a maximum of 3 days per week with a day of rest between running days. If you wish to perform cardio exercise 4 or 5 days a week, you can bike, row, or elliptical for the remaining training days. Duration: minutes Progression Perform all the exercises outlined in Phase 2 for at least 3 weeks. Move on to Phase 3 when you can complete all the Phase 2 exercises for the maximum recommended sets and repetitions for at least 3 days a week. If you have pain with the Phase 2 exercises, or if you have questions about when you should progress to the next phase, consult your healthcare provider.

11 Phase 3: Stretches Perform in the order listed, holding each stretch for sec and taking a brief rest between reps. 2 3 reps seconds each Rest 5 10 sec 1. Self-Massage Upper Back Phase 3: Starting position: Lie with your back on the floor, with your knees bent and your arms crossed, with a tennis ball, foam roller, or similar object between the floor and your upper back. How to perform: Support your body weight with your legs, moving up, down, and around your upper back. Try to relax your body, especially the area you re rolling. Give extra attention and time to areas in the muscles that feel sore. To make the stretch more challenging, try extending each arm to the side or overhead so you can massage the muscles on the sides of your back and under your armpits. 2. Standing Cross-arm Stretch Starting position: Stand with good posture: head up, chest up, arms relaxed at your side. How to perform: Lift the arm of your injured shoulder in front of you, grasp it with the opposite hand or arm, and pull it across your body. Hold for sec Standing Chest Stretch (Low and High) Starting position: Stand next to the outside corner of a wall or a doorframe. Lift your injured arm to the side at shoulder height, bend your elbow 90 degrees, and rest your forearm on the wall or doorframe (see photo). How to perform: Using the wall or doorframe to keep your forearm immobile, lean or step forward so you push into and past the corner, stretching the front of your shoulder and chest muscles. Hold for sec. Repeat with your elbow raised to ear level. 4. Bent-over Lat Stretch How to perform: Extend your injured arm out, lightly grabbing the edge of the doorframe or wall. Bend your torso forward and sit back into your hips. Try to relax the arm that is extended. You should feel a stretch under the armpit and toward the side of your back. Hold for sec. Starting position: Stand 3 4 feet in front of the outside corner of a wall or a doorframe.

12 Phase 3: Shoulder Exercises Perform 10 reps (repetitions) of each exercise in order (1 5), and then repeat the entire cycle for a total of 3 sets with minimal rest between exercises. Many of the shoulder exercises require elastic tubing or bands when the weight of your body alone does not provide enough resistance. 10 reps each 3 sets Cycle all exercises Minimal rest between exercises 1. Lying Ys, Ts, and Ws Phase 3: Starting position: Lie on your stomach with your chest just off the edge of a bed, flat bench, or physioball, with your arms/shoulders hanging down towards the ground, relaxed. How to perform: Keeping your head and neck in a neutral position (looking down toward the ground), pull your shoulders down and back as if you were trying to place your shoulder blades in your back pants pockets. Lying Ys: While keeping shoulders down and back, lift your straight arms up and overhead in a Y shape, with thumbs pointing towards the ceiling. Pinch your shoulder blades together. Hold this position for 3 seconds before slowly returning to the starting position. Perform 10 reps and take a brief rest if necessary before moving on to lying Ts. Lying Ts: While keeping shoulders down and back, lift your arms up in a T shape, arms straight and stretched out to your side, with thumbs pointing towards the ceiling. Pinch your shoulder blades together. Hold this position for 3 seconds before slowly returning to the starting position. Perform 10 reps and take a brief rest if necessary before moving on to lying Ws. Lying Ws: While keeping shoulders down and back, lift your arms up in a W shape, elbows bent and pulled in towards the ribs, with thumbs pointing towards the ceiling. Pinch your shoulder blades together. Hold this position for 3 seconds before slowly returning to the starting position. Perform 10 reps and take a brief rest if necessary before moving on to the shoulder internal rotation exercise. Add repetitions (up to 20 reps each) to make the exercise more challenging. 2. Shoulder Internal Rotation (Elbow Up) Starting position: Attach an elastic band to a safe anchor point at about bellybutton height. Kneel facing away from the anchor point (see photo), with your elbow bent 90 degrees and your shoulders down and back. Hold the end of the band with your injured arm so there is light resistance on the band.

13 How to perform: Keeping your shoulders down and back, rotate your forearm forward towards the floor, making certain to keep the elbow in place while you rotate. Pause briefly before slowly returning to the start position. Perform on the injured side only. Add repetitions (up to 20 reps), move further from the wall, or use a thicker elastic band to make the exercise more challenging. Phase 3: 3. Shoulder External Rotation (Elbow Up) Starting position: Attach an elastic band to a safe anchor point at about bellybutton height. Kneel facing the anchor point, with your elbow bent 90 degrees and your shoulders down and back. Hold the end of the band with your injured arm so there is light resistance on the band. How to perform: Keeping shoulders down and back, rotate your forearm up and back behind you, making certain to keep the elbow in place while you rotate. Pause briefly before slowly returning to the start position. Perform on the injured side only. Add repetitions (up to 20 reps), move further from the wall, or use a thicker elastic band to make the exercise more challenging. 4. Standing Row with Band Starting position: Attach the midpoint of an elastic band to a safe anchor point at about bellybutton height and your shoulders down and back. Hold one end of the band in each hand and stand 3 5 feet away from the anchor point, arms stretched out in front of your body and with a light resistance on the band. How to perform: Keeping shoulders down and back, slowly pull the band towards your body until your hands are almost touching your ribs. Pinch your shoulder blades together. Pause briefly before slowly returning to the starting position. Add repetitions (up to 20 reps), stand further from the wall, or use a thicker elastic band to make the exercise more challenging. 5. Pushup Starting position: Place your hands just wider than shoulder width on a bench, table, or step. Begin with a taller bench and work to a lower height over time. How to perform: Your body should be in one straight line with your back flat and your abdominals tight. Starting at the top of the pushup, lower your body by bending your arms until your upper arm is at least parallel to the floor and elbows are bent to 90 degrees. Do not proceed to the point of pain. Pause briefly before pushing back to the start position. When you can lower completely without feeling pain in your shoulder, then reduce the height of the bench to make the exercise more challenging.

14 Phase 3: Core Exercises Perform each exercise in order (1 3), and then repeat the entire cycle 2 more times, for a total of 3 sets with minimal rest between exercises. 3 sets Cycle all exercises (back-to-back-to-back) Minimal rest between exercises 1. Single Leg Glute Bridge Reps: 10x each leg Starting position: Lie face up on the ground, knees bent about 60 degrees, and holding it slightly off the ground. Keep the foot of the other leg firmly planted on the floor. How to perform: Lift your hips off the floor, pushing through the heel of your foot and squeezing your glutes as you lift your hips. Slowly lower hips to the ground and repeat. Do not overextend your back! You should feel the activity mostly in your legs. Complete all reps on one leg before switching. Add repetitions (up to 15 reps each leg) to make the exercise more challenging. Phase 3: 2. Plank Reps: One (with sec hold) Starting position: Lie face down propped up with your forearms on the ground and your elbows under your shoulders, with legs extended straight. How to perform: Lift your hips off the ground, creating a bridge from your forearms to your toes. Keep your abs your abdominal muscles tight and your back flat as you hold the position for 45 sec. (Do this in front of a mirror so you can see that you re keeping a straight body position.) Add time (up to 60 sec) to make the exercise more challenging. 3. Side Plank (staggered feet) Reps: One each side (with 30 sec hold) Starting position: Lie on your side, propped up on your forearm, with one elbow directly under your shoulder and your hip on the ground. Extend both legs straight with one foot in front of the other (staggered stance). How to perform: Lift your hips off the ground, creating a bridge from your forearm to your feet. Keep your abs your abdominal muscles tight and your back straight as you hold the position for 30 sec. Immediately switch to the opposite side before moving to the next activity. Add time to each hold (up to 60 sec) to make the exercise more challenging.

15 Phase 3: Cardio component Do some kind of low-impact cardio activity at least 3 days a week, and then 5 days a week as it becomes easier. As a general rule, don t increase the volume or intensity of your cardio exercises more than 10% per week. Exercises: Running (cushioned track, running trail, or treadmill) Phase 3: How to perform: The goal of Phase 3 is to increase your intensity (speed) to build your endurance to a pace enabling you to pass and excel at the aerobic portion of your physical fitness test. You should only perform impact running (cushioned track, running trail, or treadmill) a maximum of 3 days per week with a day of rest between running days. If you wish to perform cardio exercise 4 or 5 days a week, you can bike, row, or elliptical for the remaining training days. Duration: minutes Progression Perform all the exercises outlined in Phase 3 for at least 3 weeks. If you have pain with the Phase 3 exercises, immediately contact your healthcare provider. When you can complete all the Phase 3 exercises for the maximum recommended sets and repetitions for at least 3 days a week, you are ready to move on to the maintenance phase. The maintenance phase is a return to your own physical fitness training program while still incorporating the same elements of stretching, strength, core stability, and cardio, but at a pace and frequency that meets your goals. Please visit our Moving On page to find more information and the program that is right for you.