EXERCISE THERAPY GUIDE POSTURE LEVEL 1

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1 EXERCISE THERAPY GUIDE POSTURE LEVEL 1

2 IMPORTANT BEFORE YOU BEGIN Please complete the Physical Activity Readiness Questionnaire (Par-Q) before starting this or any other exercise program. If you answer yes to one or more of the questions, consult with your physician and outline your intensions for activity. If you answer no to the questions but experience pain or discomfort with any of the exercise, consult with your physician to discuss the exercises. If you or your physician has any questions about the prescribed exercises in this guide, feel free to contact me anytime. or

3 EXERCISE THERAPY POSTURE LEVEL 1 1. PELVIC TILTS This exercise is used primarily to increase the mobility in your lower back. I am using it here to help you become aware of the movement in your own spine. You will see the extremes of each phase of the movement in the pictures below. Only move within a comfortable range for yourself. As you inhale, arch your lower back by tilting your pelvis away (pressing your tailbone into the floor) as shown in the left hand photo. You will feel your lower back lift off the floor and you should be able to slide your hand partially underneath. abdominal

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5 EXERCISE THERAPY POSTURE LEVEL 1 1. PELVIC TILTS This exercise is used to increase the mobility of the lower back. You will see the extremes of each phase of the movement in the pictures below. Only move within a comfortable range for yourself. Ensure that the movement in the spine is coming from movement in the pelvis (rocking back and forth) and NOT from movement in the upper back or chest. Phase 1 - As you inhale, arch your lower back by tilting your pelvis away. It will feel like you are pressing your tailbone into the floor (as shown in the left hand photo). You will feel your lower back lift off the floor and you should be able to slide your hand partially or all the way underneath. Phase 2 - As you exhale, tilt your pelvis towards you. It will feel like you are peeling your tailbone off the floor (as shown in the right hand photo). You will feel your lower back press into the floor and your abdominal muscles activate. You should not be able to slide your hand under your back at all in this phase. Perform up to 10 repetitions in each direction paying attention to your range of motion as well as which direction feels more natural or more comfortable for you.

6 2. OBLIQUE ABDOMINAL ACTIVATION Before we begin this exercise, you must have a good understanding of the pelvic tilts. Begin by finding the half-way point between the full arch and the full flattening from the previous exercise. I will refer to this as your NEUTRAL position of your lower spine in the remainder of this guide. Maintaining NEUTRAL during this and the remaining exercises is important. It will be your primary focus during this exercise. Place your right and left thumb on your bottom rib on each side and your fingers on your hipbones (as shown in the left hand photo). Make note of how much space there is between your bottom rib and hip bones; most likely these 4-points will resemble a square. Begin by inhaling normally; then as you exhale, imagine bringing your ribs approximately 1- inch closer to your hips bones (as shown in the right hand photo) WITHOUT allowing your lower back position to change (i.e. do not let it flatten to the floor). The shape at this stage should more resemble a rectangle. It is a very subtle movement, and you will feel your oblique abdominal muscles activate. This is important to understand before progressing through the remaining posture exercises as well as exercises in my lower back series. Perform up to 10 repetitions maintaining a NUETRAL spine.

7 3. CHIN TUCKS Begin lying comfortably on the floor, preferably with your knees bent to about 90 degrees. If you feel your head is tilted back significantly, you may place a small folded towel under your head (as shown in the left hand photo insert). The movement in this exercise is very subtle, and is designed to lengthening the muscles in the back of the neck while strengthening those in the front. Begin by gently tucking your chin downwards, imagining the back of your head begin pulled toward the wall behind you (as indicated by the arrow in the right hand photo). Hold this position briefly for 3-5 seconds, and relax. Be sure to maintain a neutral spine in the middle and lower back while performing this movement. As you perform this exercise, you may feel a stretch in the back of the neck and the muscles in the front contracting. Repeat 5-10 times as comfortable.

8 4. LYING ARM RAISES We will not take what you learned in the previous exercises, and challenge your oblique abdominals one step further. Again, be sure to maintain your NUETRAL spine throughout this exercise. Begin with your arms at your side, with your palms facing towards you (as shown in the first photo). The exercise consists of 4 phases, described below. The challenge for the oblique muscles is during phase 2 and 3, while maintaining your oblique muscle position and your neutral spine. As you raise your arms over your head, your ribs will want to expand further away from your hip bones, but you want to maintain their distance without flattening your lower back to the floor. This is incorporating the previous 2 exercises. Phase 1 Inhale as your raise your arms to vertical (go from photo #1 to photo #2). Phase 2 Exhale and continue your arms overhead (go from photo #2 to photo #3). Phase 3 Inhale as you return your arms to vertical (go from photo #3 to photo #2). Phase 4 Exhale and you return your arms to your side (go from photo #2 to photo #1). Perform up to 10 repetitions continuously, allowing consistent movement through the arms. Avoid stopping your arms at any point of the movement. You want the speed of your arm movement to MATCH the speed of your breath.

9 5. POSTURE STRETCH ON THE FLOOR Now let s incorporate all the previous exercises to challenges your primary postural muscles in your middles back your lower trapezius. This muscle lies just below the shoulder blades, close to the spine, in a V-shape. Begin with your arms positioned with your shoulders and elbows at 90 degrees (as shown in the right hand photo). As you get set up in this position, remember all the key points that you have learned so far. If you do not have the flexibility in the shoulders to rest your hands on the floor (as shown in the left hand photo), that is fine; just allow them to go as close to the floor as you are comfortable. You may choose to place a rolled towel under each forearm to provide support. Phase 1 Tuck you chin gently, as you learned in exercise #3. Phase 2 Gently draw your shoulders away from your ears, imagining pulling your shoulder blades towards your back pockets. Phase 3 Perform a pelvic tilt, flattening your lower back into the floor, while maintaining the chin tuck and shoulder position. Hold this position for up to 10 seconds and repeat up to 10 times. As you repeat this exercise over and over, you will begin to feel the muscles between the lower parts of shoulder blades fatigue. If you do, are you doing it right!! We will challenge this further in exercise #8.

10 6. CORNER CHEST STRETCH Begin by standing facing a corner of a room. Place your forearms on the each side of the wall (as shown in the far left hand photo). Be sure that your whole forearm is touching the wall and not just your hands. Begin with you elbows at or just below shoulder level, and gently step forward with one foot, as show in the middle photo. You will need to incorporate some abdominal activation that you learned previously to maintain this neutral position of the spine and hips. I.e. you want to avoid letting your lower back arch and be sure to maintain level hips. Lunge forward until you feel a gentle stretch in your chest and shoulders. Hold the stretch for up to 30 seconds and repeat 2-3 times. You can also with your arms 1-2 higher (as shown in the far right hand photo).

11 7. LATISSIMUS DORSI STRETCH This stretch can be done using a variety of different objects. The photo shown below is using a wall. You can also use a fixed object that will allow you to grasp and lean backwards, such as grabbing either side of a door knob, or your kitchen sink. Place your palms on the wall or grasp onto the fixed object of choice. Stand approximately 1- foot further than arm s length away and slowly lower your body until it is close to parallel with the floor(as shown in the photo). Maintain a neutral neck posture by gazing at the floor; your head between your upper arms. While you hold this position for up to 30-seconds, be sure to relax through the shoulders. This will allow you to feel a deeper stretch through your middle back and shoulders. If you choose to grasp onto a fixed object, you can imagine someone is pulling your hips back. This option will give you an even deeper stretch. Repeat up to 3-times.

12 8. BEGINNER POSTURE STRETCH ON THE WALL For this last exercise in the level 1 posture series, we will incorporate all the exercise we have done so far. Begin by standing with your back against a wall, placing your heels approximately 10 away from the wall with your knees slightly bent (as shown in the left hand photo). lace your arms on the wall at about from your body with palms facing forward (as shown in the right hand photo). Step 1: Place your head on the wall and tuck your chin in as much as comfortable while maintaining contact with the wall. If you placed a small folded towel under your head in exercise #3, you may also need to place it behind your head here as well. Step 2: Gently pull your shoulders back and down slightly, as you did in the lying posture stretch. Step 3: While holding all this in place, slowly flatten your lower back on the wall by doing a pelvic tilt (as in exercise #1). In this phase, you will also feel your ribs come slightly closer to your hip bones (as in exercise #2). Hold for up to 15-seconds and repeat 5-10 times. If you are doing this exercise correctly, you will begin to feel the muscles between the lower parts of your shoulder blades start to fatigue, as you did in exercise #5). Your lower trapezius!

13 CONGRATULATIONS! You have successfully completed level 1 in the Exercise Therapy for Posture series. If you have any questions or concerns about any of the exercises contact myself or talk to you physician. Your goal is to master these exercises and begin incorporating better posture into your daily activities. There is an exercise therapy for posture level 1 video available that explains these exercises in more detail, as only so much can be described in text and photos. Please visit my website at to view this and other exercise therapy videos available and coming soon! If you have any questions or comments, please contact me at Sincerely, Lynda Foreman, BPE Practicing Kinesiologist Certified Work Capacity Evaluator

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