BE: Bilateral Medial Elbow, Knee, and Ankle Pain Week 6: 9-11-17

Current report from email this week
- Difficulty with the counter/wall push with pain in the elbows, groin, knee and ankle
  - I will provide an alternative movement for this one
  - I would like to have him gradually working on tolerating some support through the hand so I will look for a lesser version of this and will substitute it below in bold
- The shoulder flexion towel slide
  - Ben was doing the ball version of this later in the video which was going well when he left here…has that changed?
  - Ultimately lighten the pressure if able to reduce symptoms
- Activating the glute during the adductor isometric is fine
- Adding the finger web is fine along with the hammer exercise…for the finger web try to start with opening before progressing to closing…see list below for more specfic instructions
- Anytime there is an increase in symptoms, try to go back to the movements that do not increase any symptoms and gradually add one of the more threatening movements each time you do the upper body stuff
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
- Hammer exercise: supination and pronation
  - Do slow and controlled beginning in a comfortable range
  - Goal is endurance so try for minimum of 15-20sec progress towards 60-90sec
- Counter Push Phase 1 VIDEO
  - This did not go well
  - Let’s try Shoulder Wall Ball Multiple Positions VIDEO
    - Start with the first postion, you can use and open hand or a fist…you can adjust the pressure as tolerated to attempt to load the forearm and shoulder
- 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
- Finger Web
  - Start with opening as opposed to closing
  - start with position of most comfort for time once again begin with short bouts of 15-30sec and progress endurance as tolerable
  - You may incorporate the closing motion as tolerable with the same parameters
- 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