BE: Bilateral Medial Elbow, Knee, and Ankle Pain Week 5

Current report from email this week
- Dizziness has subsided
- Had elbow pain when doing pool exercise #5 with any significant force
  - I always want Ben to adjust hand position based on the severity of his symptoms
  - If pain is greater then a 5/10 and feels like it is getting worse, go to the most comfortable hand position. If that feels fine I encourage him to try 3-5reps lght with the more uncomfortable hand position and then switch to the more comfortable and he can focus on generating more force
  - On the upper body and pool day, definitely do the more comfortable hand position or hold off on the pain provoking exercise all together
  - I am including some brief Upper body weight bearing at the wall to begin to load the wrist flexors, try this for biref periods at the wall. The exercis is listed below in bold
Continue with the following schedule
- Day 1: Upper Body Movements and Pool program
- Day 2: Lower Body Movement and Pool Program
- Day 3: Pool Program
- Day 4: Upper Body Movements and Pool Program
- Day 5: Pool Program and then Lower Body Movements
- Day 6: Pool Program
- Day 7: Light Pool/Rest Day
Upper Body Movements
- N-14 Deep Neck Flexor Activation Head Supported Chin Tuck VIDEO
- Counter Push Phase 1 VIDEO
  - Try this at wall instead of counter
  - Try just 2-3 reps initially but if it is not going well hold off
- S-35 Full Can/Scaption Supraspinatus VIDEO
  - Using black band 24x
- H-46F Band Extension Deadlift VIDEO
  - black band 20x
  - Be careful with forward bending in regards to dizziness
- Wrist flexion using light weight in a range of motion short of pain, focusing on maintaining tension in the forearm with minimal to no discomfort at medial elbow
  - 1lb 20x
- S-17 Shoulder Flexion & Forward Reach Towel Slide to Ball Roll Out VIDEO
  - 20x
  - Be careful, this may be problematic in provoking dizziness
- S-27B Wall Sit Active/Band Abduction VIDEO
  - Black 18reps
- Resisted band opening
  - red
- H-19A Band Pull Down 3 Planes VIDEO
  - Blue Right 14 Left 18
- N-1C Neck Rotation Contract Relax VIDEO
Lower Body Movements
- N-3A Cross Leg Lower Trunk Rotation Pec Stretch VIDEO
- The adductor insertion is a problematic area, let’s adjust the movements to load that area
  - Previously doing:
    - H-48C1-Standing Adductor Isometric VIDEO
    - Seated adductor/medial hamstring stretch, seated at edge of chair with feet apart
  - Let’s change to:
    - Supine Adductor Isometric VIDEO
    - H-15A Lying Hip Adductor Stretch VIDEO
- A-6B Seated Ankle Dorsiflexion and Plantarflexion VIDEO
  - 10x
- H-30 Quadruped with Physio Ball Hip Extension VIDEO
  - This is another option to isolate glute activation with minimal weight bearing
- Foam/Airex pad, tandem balance, can also try the movement below
  - 30sec each
- H-42A Step Knee Flexion Intro VIDEO
- H-36A Hamstring Isometric with Contralateral Leg Raise VIDEO
  - Right 9x Left 17x
- H-6 Seated Quad Stretch Foot Under Chair VIDEO
- H-46H1 Reverse Lunge Towel Slide VIDEO
  - Right 9x Left 11x
- Band around foot pulling up towards you
  - Blue band
- H-45E Lunge with Band Around Knee Glute Med Activation VIDEO
  - Green Right 17x Left 20x
Pool Program:
- The pool seems like a good place to progress lower extremity activity
- I want to give you a couple things to mix in to a circuit in the pool. Try each movement below for 30-90sec
- Try to start with 1-3 sets once to twice a day
- If there is pain then hold on that movement all together and we can discuss it next week
- I do not have video of pool activities so I will do my best to describe each
  - #1: Walk slow and controlled like walking in slow motion
    - Stick with a short step length and progress to walking more heel to toe as able
  - #2: Noodle or intertube under armpits to float
    - Take feet apart laterally and back together while suspended in deeper water
    - This is like the bottom of a jumping jack
    - start in small range
    - With water, the faster you attempt to pull each direction the more resistance
    - Go through each direction pushing as forefully as comfortable and then pause before you change direction
      - EX: forceful push feet apart…pause….forceful pull of feet towards each other
  - #3: Side Steps in small knee bend
    - Three steps one way and threes steps back the other way
    - Deeper equals less weight on lower extremities
  - #4: Suspended as in movement # 2
    - Front to back opposing movements
    - One foot moves forward and the other moves behind
    - Pull forcefully towards each other as they alternate positions like a scissoring movement
  - #5: Standing Feet side by side
    - Arms forcefully pull apart and forcefully pull back together
    - This is made more difficult by standing with feet closer together or in a mini lunge or heel to toe
    - Proceed as discussed above with the more confortable hand position with brief attempt at the more painful position with much less force