DSP: Right Sided Neck Pain, Upper Cross Syndrome, Patellofemoral Pain: Phase 5 (3-5-18)

Email Follow Up
- Symptoms in neck and shoulder have dissipated and are very minor currently
- Still feels there is a weakness/vulnerability that could resurface
- Posture has improved but still has tendency to round forward
- Knee is more of a challenge and has had slight increase in knee pain along with increase in running
  - Pain more so at the beginning of activity that improves as it warms up
  - This is true for squats and running
  - Feels he is ready for a challenge and has progressed to most challenging option of current program
Phase 5
- This phase will progress strengthening and endurance to more challenging variations or substitution for more challenging options
- As we progress into more challenging movements, make sure you maintain control of shoulder and trunk position, especially as you get tired
- make sure you do not feel an increase in neck tension as the challenge increases
- ALL CHANGES/UPDATES WILL BE IN BOLD BELOW
- Organization of the week
  - Day 1: Daily Sequence + Strength Circuit #1 (2 sets of strength circuit)
  - Day 2: Daily Sequence
  - Day 3: Daily Sequence + Strength Circuit #2 (2 sets of strength circuit)
  - Day 4: Daily Sequence
  - Day 5: Daily Sequence + Strength Circuit #1 and #2 (1 set of each)
- Daily Sequence
  - NEW: I WILL GIVE YOU A COUPLE NEW OPTIONS IN THE DAILY SEQUENCE
    - AS I ADD TO THIS SEQUENCE, I WANT YOU TO FOCUS YOUR ATTENTION ON THE MOVEMENTS THAT YOU FEEL ARE MOST BENEFICIAL
    - TYPICALLY THIS SEQUENCE SHOULD INCLUDE 4-6 MOVEMENTS, AND YOU CAN CHOOSE WHICH ONES FEEL LIKE THEY ARE MOST RELEVANT TO YOUR SYMPTOMS OR FEEL LIKE THEY ARE HAVING THE MOST POSITIVE IMPACT
  - This is meant to be somewhat easy and focused on maintaining mobility and muscle activation
  - You should choose a couple of these movements as options to do gently thorughout the day to break up static postures
  - 10-20 reps of each movement is recommended
  - They can be done in a circuit 1-2x a day along with doing a couple of them frequently throughout the day as able
- Strength Circuits
  - Goal is to try and remain in a range where you are able to achieve muscle fatigue with the least amount of pain
  - We will have some movements that are meant to be more endurance based and the reps will remain higher in the 15-20 range or 30sec to 2 minutes
  - There will also be some movements that are meant to generate a stronger contraction and those will have lower reps at 8-15
- If any of these movements cause an increase in pain, either try to adjust the exercise or email me…if have a pretty extensive arsenal of options so if something doesn’t feel right I can probably find a better alternative
- Do all reps slow and controlled
  - I would rather you do 5 very slow and controlled reps with great form rather then rushing to 30 reps out of boredom
- IF YOU WANT TO GET BETTER, DO EACH REP SLOWLY, FOCUSED ON TECHNIQUE AND CONTROL, AND DO IT UNTIL YOU FEEL TIRED OR AN INCREASE IN PAIN…TRY TO REMAIN IN A RANGE OF MOTION THAT DOES NOT HURT…AT ALL IF POSSIBLE
- Daily Sequence
  - 53) Deep Neck Flexor Activation Head Supported Chin Tuck VIDEO
    - Do this carefully and gently
    - Can be done in sitting as well and is typically helpful to complete lightly and frequently throughout the day
    - If this feels fine you may want to try the seated version throughout the day seen below to break up seated postures for long periods
      - 55) Deep Neck Flexor with Thoracic Extension Seated and Foam Roll VIDEO
  - Progress the motion that feels better, compare between the 2 exercises below and pick the one that feels most helpful
    - 5) Neck Rotation Self SNAG VIDEO
      - Other option
        
        6) Neck Rotation Contract Relax VIDEO
        
        MAY GET INCREASED ROTATION BY ADDING IN SOME ISOMETRICS DEEPER INTO THE RANGE RATHER THEN THE PASSIVE STRETCH ABOVE
    - 3) Chin Tuck with Side Bending VIDEO
      - if either feel like they make it worse, try to decrease how far into the movement you go or hold off all together
  - 29.1) Prone to Supine Quad Stretch, Isometric, Active Motion VIDEO
    - Good initial movement to reduce quad tightness and improve knee pain
  - 109) Bridge Band Around Knees Progression VIDEO
    - band may help to reduce pain if you have any
  - 11.3) Pillow Case Active Shoulder Extension Hands Progress Closer VIDEO
    - Make sure you don’t go too far too fast
    - I want to know is this feels tighter on the R
  - 51.1) Humeral Head Depression at 90deg Abduction VIDEO
    - Ideally light pulling in the front of the shoulder is ok, not on the top or in the back, stay short of feeling top or back of shoulder in regards to pinching or pain
    - PHASE 2 PROGRESSION
      - 46) Side Lying Thoracolumbar Rotation Stretch VIDEO
  - NEW
    - 26) Self MFR Quad/Hip Flexor VIDEO
    - 27) Side Lying IT Band VIDEO
      - TWO OPTIONS TO ADDRESS TIGHTNESS THAT CAN LIKELY CONTRIBUTE TO AN INCREASE IN KNEE PAIN
      - TRY THIS BEFORE RUNNING OR SQUATTING AND LET ME KNOW IF IT IS LESS PAINFUL
- Strength Circuit #1
  - 75) Press band in Lunge/half Kneel VIDEO
    - 8-15 REPS
    - THIS CAN BE DONE WITH A CABLE OR BAND
  - 122) Wall Sit Active/Band Abduction VIDEO
    - Pay attention to the details
    - GOAL 30-90SEC OR 8-20 REPS SLOW
      - PHASE 2
        
        121.2) Band 3 Positions PNF D1 Variations VIDEO
        
        CAN BE DONE WITH LIGHT CABLE OR BAND
  - 84) Arm Bar VIDEO
    - Slow controlled transition from each point without putting weight down
    - 30-90 SEC…IF YOU GET TO 90SEC, INCREASE THE WEIGHT AND START BACK AT 30SEC
      - PHASE 2
        
        81) Basics of Bear with Leg Lift VIDEO
        
        ALTERNATING 5-10SEC HOLDS EACH LEG
      - PHASE 3
        
        103) Bear Up Wall to Hand Stand VIDEO
        
        UP AND DOWN SLOW
        
        5-15 REPS
  - 115) Bent Over Box Row VIDEO
    - 8-15 REPS
  - 31.1) Hands Elevated Plank Variation VIDEO
    - Make sure you control low back position
    - PHASE 2
      - 96.3) Lying on Weight Bench Pullover VIDEO
      - 8-20 REPS
- Strength Circuit #2
  - 74) Table Top Progression VIDEO
    - 8-20 reps
    - PHASE 2
      - 90) Band Low Fly VIDEO
        
        THIS CAN ALSO BE DONE WITH LIGHT CABLE OR BAND
    - PHASE 3
      - 91) Band Horizontal Adduction VIDEO
        
        BAND OR CABLE
        
        8-15 REPS
  - 125) Shoulder Flexion Laying->Wall Sit->Seated Against Wall VIDEO
    - 8-20 reps
    - The end of the video back against the wall
    - 134.1) Bar Hang Knees to Chest VIDEO
      - THIS CAN BE VERY CHALLENGING AND BE CAREFUL NOT TO CAUSE PAIN
  - Bridge Progression Physio Ball (CHOOSE THE ONE THAT YOU FATIGUE ABOVE 8 AND BEFORE 15 REPS WITH GOOD CONTROL
  - 85) Scapular Control with Weight Shift Side Plank Progression VIDEO
    - Begin with single arm holds and progress to sideplank in gradually lower position moving closer to floor.
    - Progresses to
      - 88) Side Plank with Rotation Progression VIDEO
      - 30-90sec
      - PHASE 3
        
        87.1) Side Plank Lateral Shift Floor VIDEO
        
        30-90SEC
  - 133) Sprinter Lunge VIDEO
    - 8-15 REPS
    - MORE OF A CHALLENGE TO HOLD A WEIGHT ONLY IN ONE HAND AT A TIME