Training the Joint Replacement Client

Transcription

1 KNEE PRE-OP SAMPLE EXERCISE PLAN Quadricep: Shuttle 1 leg and 2 legs (focus on 1 leg) Leg Press 1 and 2 legs (focus on 1 leg) Sit to Stand (if no pain or compensation) Supine Circle Foam knee extension (option with small ball) Bridge Supine (option with small ball or band) Prone Knee Extension with quad contraction Ball Squats / Step Ups / Wall Squats may be too painful pre-op depending on their current pain level and the progression of OA VMO: Hamstring: Balance: Supine Circle foam knee extension with small ball Seated on Chair or Ball knee extension with small ball between knees Shuttle or Leg Press with toes slightly externally rotated (body awareness) Clam Shell Side lying Side leg raise Adductor Machine Flex Ring Bridge Lift with inner thighs gripping outside edge of body ball Single Leg Leg Curl Cable or Machine (low weight / use more for ROM tool) Bridge with legs up on ball *usually tight so assess if strength is needed Glute squeezes seated on ball facing mirror and hold (single too!) Prone Knee Extension with Hip Extension Bridge Lifts Prone Ankle ball squeeze with glute squeeze focus Rocker Board both directions (watch to see if the good leg is doing all the work) Single leg lift seated on ball (core and posture focus) 1 leg balance on floor usually would be too painful pre-op LeapFit Training Professionals 2016 Page 1

2 KNEE POST-OP SAMPLE PROGRAM Quadriceps: Non Weight Shuttle 1 leg and 2 legs (focus on 1 leg) (Sit Fit option advanced) Bearing Leg Press 1 and 2 legs (focus on 1 leg) (Circle Board option adv) Sit to Stand (if no pain or compensation) Extension Supine Circle Foam knee extension (option with small ball) Bridge Supine (option with small ball or band) Extension Prone Knee Extension with quad contraction Weight Bearing Extension VMO: Extension Extension WB WB Hamstring: Flexion Ball Squats (start with ¼ range and work up to 90 degrees) -small ball squeeze option if needed or band Step Ups (start with platform and then progress) -front and side steps ups Wall Squats (1/4 range to begin and then work up to more with tolerance) Almost Sits on Chair (foam blocks / mirror) Step Up and over and down Standing Band & Bar Split Stance Knee Extension (towel under band) 1 leg ¼ to ½ dip squats off riser (advanced) 1 leg ¼ to ½ dip squats using body ball against wall outside leg (advanced) Rocker Board Squats ¼ to full progression (advanced) Supine Circle foam knee extension with small ball Seated on Chair or Ball knee extension with small ball between knees Shuttle or Leg Press with toes slightly externally rotated (body awareness) Ball Squat toes positioned in slight external rotation Clam Shell Side lying (band progressions) Side leg raise (ankle weight option) Standing Side Step with band Side leg raise cables on platform or ½ foam (advanced) 1 leg balance sideways to ball against wall and abduct inside leg (adv.) Fitter abduction option (advanced) Adductor Machine Flex Ring Bridge Lift with inner thighs gripping outside edge of body ball Single Leg Leg Curl Cable or Machine LeapFit Training Professionals 2016 Page 2

3 KNEE POST-OP SAMPLE PROGRAM Balance: Knee Flexion* Agility Stretches: Glute squeezes seated on ball facing mirror and hold (single too!) Prone Knee Extension with Hip Extension Bridge Lifts Prone Ankle ball squeeze with glute squeeze focus Ball Walk Out Supine Glute Bridge Push Ups Rocker Board both directions (watch to see if the good leg is doing all the work) Single leg lift seated on ball (core and posture focus) 1 leg balance on floor 2-3 months post-op (monitor pain) Sit Fit Balance Bosu 2 leg balance blue side up (advanced quad strength first) Mini trampoline Seated on Ball forward knee flexion roll keeping heels on floor small ball between knees optional for tracking *This is an excellent exercise that has helped a lot of clients who have trouble with knee flexion post-op.* Once strength has returned and you feel your client is stronger and stable And more confident then add in controlled agility exercises. This will help retrain your client s proprioceptors and connective tissue for directional changes and sport related physical demands. Calf Hamstring Quadricep Hip Flexor IT Band Piriformis Glutes LeapFit Training Professionals 2016 Page 3

4 Hip Pre-Op Sample Exercise Plan Quadricep: Clam Shell (band progressions) Side lying best or Supine Side leg raise Bridge lying supine (band around thighs option) Prone Hip Extension (over bench / ball option) Glute Squeezes seated on Ball and hold (single / double) mirror Prone small ball ankle squeezes with glute squeeze focus and hold Shuttle 1 leg Leg Press 1 leg Sit to Stands with foam blocks (only if compensation is limited) Ball Squats (only if no pain and can be performed with good form) Step Ups (usually too painful pre-op) Circle foam knee extension lying supine (if quad needs help firing) Transverse Pelvic floor draw ups lying supine (progress to leg fall out or lift) Abds / Pelvic Seated TVA set on Chair / Ball working on neutral pelvis & posture Floor Hip Flexors: Usually these are very tight; however they could also be weak and so gentle active exercises such as marching in a chair or on a ball may help them lift their leg better for gait purposes and for getting in and out of cars. If Gait needs improvement and your client is stumbling then add in the following: Stretches: Hip Flexors Hamstrings IT Band Quad Low Back Calves Adductors and External Rotators (Glutes) if no pain LeapFit Training Professionals 2016 Page 4

5 Hip Post-Op Exercise Program Quadricep: Clam Shell (band progressions) Side lying best or Supine Side leg raise Side Step Band (advanced) Side Leg Raise Cables on platform / ½ foam (advanced) Bridge lying supine (band around thighs option) Prone Hip Extension (over bench / ball option) Glute Squeezes seated on Ball and hold (single / double) mirror Prone small ball ankle squeezes with glute squeeze focus and hold Supine Ball Walk Out Glute Bridge Lift Ups and hold (advanced) Shuttle 1 leg Leg Press 1 leg Sit to Stands (foam blocks dependent on form and height) Ball Squats start with ¼ progress to ½ then ¾ and finally 90 degrees Step Ups front and side - platform only to start & increase with good form Lunges stationary near bar to hold (advanced) 1 leg ¼ dip squats off step platform (advanced) Sideways ¼ 1 leg ball squat (outside leg does work, lift inside leg) (adv.) Transverse Pelvic floor draw ups lying supine (progress to leg fall out or lift) Abds / Pelvic Seated TVA set on Chair / Ball working on neutral pelvis & posture Floor Dead Bug & lots of other advanced options *The Adductors and Hip Flexors can be tight, but they also need to be assessed for strength.* Seated on Chair or Ball, small ball squeeze with hip flexion and knee extension holding extended for 5 seconds and concentrating on squeezing Hip Flexors: Seated Hip Flexion and hold up 5 sec on chair or ball using TVA, neutral pelvis and concentrating on posture (seated on ball is advanced) If Gait needs improvement and your client is stumbling then add in the following: LeapFit Training Professionals 2016 Page 5

6 Hip Post-Op Exercise Program Stretches: Hip Flexors Hamstrings Quad Low Back (watch hip flexion restrictions up to 3 months or more ) Calves *Both the IT Band and Glute stretches will have to be modified or not performed until 3 months or more post-op dependent on the individual.* Massage can be used for these muscle groups and is a great alternative until range of motion restrictions are lifted. Balance: Rocker Board both directions 1 leg balance 2-3 months post-op dependent on muscle recruitment, pelvic stability and pain Mini trampoline Bosu blue side up Sit Fit Cushions LeapFit Training Professionals 2016 Page 6