BF: Post Back Surgery with Residual SIJ/Calf Pain and Tightness: In Office Patient with Online Follow Ups (1-26-20)

10-7-20: Do the movements in bold daily
9-16-20
7-7-20
- 136.2) Press 3 Phase into Stepping VIDEO
- 135.2) Lunge Row Progression to Stepping 3 phase VIDEO
- Band around the fot infront of wall barre or dresser/counter at home, band assists in raising your leg up and you push down to the floor
- 143.2 Resisted Stepping Support to None VIDEO
  - this covers a progression for resisted step forward, it is a little different in that I do not emphasize the post moving as much as just supporting. The video shows only the forward but can be done stepping backward as well
6-22-20
- Progressed the gait related row press and step with the press shown below
  - 135) Row Band in Lunge/Half Kneel VIDEO
  - 136) Press band in Lunge/Half Kneel VIDEO
  - 136.1) Band Press with Step VIDEO
    - This shows me moving the leg on the same side as the band which is not exactly what we did
    - You can step the right leg back as you press with right hand as shown in video or you can step the left leg forward as you press wiht right hand like we did in office weither is correct
5-19-20
- Hands and knees hip extension progression added
  - 97.1) Quadruped Hip Ext Towel Slide and Band Progression VIDEO
4-23-20
- Leg raise on the left causes SIJ pain
- Post Reach better in standing then sitting
- I still want to try to attempt improving your tolerance for flexion/straight leg raise
  - I want you to try a standing option at a step
  - Try to stay short of SIJ pain if possible
    - Phase 1
      - 102) Hamstring Isometric Standing/1/2 Kneel VIDEO
    - Phase 2
      - 103) Hamstring Loading Step or 1/2 Kneel into Stretch VIDEO
    - Try to keep the feeling in the back of the thigh without pain
  - Can you give me a general update from the movements I have listed below
    - Do you have 4-5 movements at this point that cause the least amount of pain and feel like they are most beneficial, if so which ones?
4-5-20
- You mentioned issue with feeling posterior thigh stretch without hip/SIJ pain
  - I assume you did fine with the pressing down motion below listed as #113 the Isometric
  - How does it feel to focus on hamstring activation first?
    - Can you feel tension in the back of your legs without SIJ pain, try the movement below to find the best position
      - 114.1) Straight Leg Bridge Gradual Integration of Bent Knee VIDEO
        
        Hold each for 5 sec and repeat this 5-15x every other day
    - Following I would like you to try part one the sitting option, but then also the second part of the video below in the standing version
    - Let me know what you feel with each
      - 17.1) Thoracic length Post Seated, Stand, Wall bar VIDEO
        
        Ideally in standing you should feel a little tension in the back of the legs
        
        This can be done 5-10x seated and standing everyday
3-18-20
- last session we looked at the cross body stepping and I want o include that as a balance drill
  - Try adding in the movement below. do it for time, anywhere between 30sec and 2 minutes
    - 187) Frontal Plane Stability VIDEO
      - This can be done everyother day
      - If this is going well you can add a band for resistance in the video below
        
        175) Side Step Band Progression VIDEO
  - I also want to add someting that engages your hamstring
    - First one is a light isometric where you are going to push down and hold 5 sec, goal is to feel tension in the back of the legs without significant pain, repeat 8-15x everyday
      - 113) Isometric Co-activation Abdominal/Glute Phase 1 VIDEO
      - Phase 2 would be the following which involves stretching one leg while engaging the other, do not stretch hard and start of very easy with lifting the leg….try to add this in place of the movement above once you are able to do the movement for above for a few days without increase in pain
        
        116) Hamstring Isometric with Contralateral Leg Raise VIDEO
3-8-20
- Added the tennis ball for the calf
  - 26.1) Self MFR Calf VIDEO
  - Goal was to improve endurance with heelraise
  - Let me know if that is happening
2-23-20
- One thing I want to add is a progression of calf strength for you to incorporate everyother day
  - Try the movement below everyother day 2 sets to fatigue and I want to know how long you can go before fatigue in each leg.
    - 127.2) Step Heel Raise Short Range VIDEO
    - Instead of doing it for a certain number of reps try it for time anywhere from 30sec to 2 minutes
Update 2-13-20
- We discussed the progression of hip mobility without putting too much pressure on the SI joint
  - I had you prop you foot up and pull your foot up and down
  - Then you can progress to the left leg moving more across to the right and doing the same thing
  - ultimately you want to try and get your leg across so you can rest on your knee like in the video below
    - 38.1) Cross Leg Basic Rock to Cross leg Progression VIDEO
- Also we looked at adductor or medial thigh activation
  - Start with the rocking movement first and then progress to the second movement in the list below
  - 19.2) Rock Heel to Toe Abduction Progression VIDEO
  - 178) Standing Adductor Isometric VIDEO
Program Update Number 2
- 36) Seated Sciatic Nerve Floss VIDEO
  - This movement is to mobilize the sciatic nerve which may be part of the reason for the feeling in the calf
  - Watch the whole video before you try it.
  - Try this for a couple days. Once it is going well try to add the next movement below
- 97) Quadruped with Physio Ball Hip Extension VIDEO
  - This can be done over a ball or over an ottoman/leaning over a chair/stool
  - 5-10 reps each leg
Initial meeting
- Three movements to be completed lightly and often
- 10-15 reps for each 3-5x per day
- If any of these are increasing pain, stop short of the pain or stop doing that movement
- Movement #1: 19.1) Rock Heel to Toe Counter Progression VIDEO
- Movement #2: 13) Seated Slide Hamstring and Quad Stretch VIDEO
  - Keep this one light and do not over stretch
- Movement #3: Standing or kneeling extension with hands on hips. We did this in your exam and it caused no pain.This is a good one to do gently throughout the day after sitting for any length of time
  - 66) Tall Kneel 5 Rites Version VIDEO
- Let’s start with the movements above for a week. Then email me with some feedback as to how they are going and I can make updates based on your feedback