KP: Ballet Dancer/ Figure Skater Patellofemoral Pain: Day 4

Day 4:
- Information from this visit
  - Continues to have less pain but had some lateral knee grinding with lateral kicking motion in ballet
  - Significant weakness with squat at the door with pain at certain ranges
  - popping in the R hip during single leg deadlift with deeper range of motion
  - Improvement in hip mobility
  - slight elevation of L iliac crest with hands and knees rocking with potential mild scoliosis
- Important points
  - progress with the tennis ball down the outside of your leg
  - Progress into the squat with the band around your knees at the door/sink
  - add 4-5lbs to your single leg deadlift with the weight in the hand of the leg that is in the air, not the leg you are standing on
- Daily Sequence
  - These movement can be completed daily and will help to minimize tightness and discomfort
    - Self MFR Ball Glute/Piriformis VIDEO
      - This was the replacement for the sidelying IT band position
      - each spot for 30-60sec
      - A precursor to this would be standing with the ball between you and the wall
      - Back against the wall may be easier if lying down is not an option
        
        Self Myofascial Release Side Lying IT Band VIDEO
        
        Progress to this as tolerable but don’t rush it
        
        This should be uncomfortable on a 0-10 pain scale it should be no more then a 3 or 4
        
        Once you find a tender point try to keep pressure on that spot minimum of 30sec maximum of 1-2minutes
        
        It should stay the same or feel better as you are in the position, if it is hurting more as you do it, avoid that spot for now
        
        Hit various spots along the lateral thigh
  - Bridge Band Around Knees Progression VIDEO
    - 8-20 reps slow with a 5 sec pause at the top of the bridge
    - Keep abdominal tension and pressure on HEELS
  - Seated Flexion and Child’s Pose Breathing VIDEO
    - Breathing shown in sitting and on hands and knees, you can stick with the hands and knees position
    - 5-10 deep breaths
  - Hand Heel Rock Childs Pose to Plank or Up Dog VIDEO
    - Try to maintain lower abdominal tension as you rock forward without compensating by rounding your shoulders
    - 8-20x
  - Double Leg Heel Raise VIDEO
    - Keep feet straight and pressure through big toe
    - 8-20reps
    - WE discussed doing this 8-10 reps included in the daily sequence
  - Side Sit with Rotation and Glute Isometric VIDEO
    - Try not to over rotate, make sure you are turning your chest slightly down towards the floor as you rotate
    - Easier Version: Cross Leg Contract Relax Posterior Hip VIDEO
    - Harder Version: Side Sit to Side Plank VIDEO
    - 8-20 reps or 30-90sec
- Strength Circuit: Every other day
  - Complete 3-4 days per week
  - Preferably not on days with a lot of sport related activity unless able to be done afterwards
  - Complete 2 sets of the circuit, first set to fatigue(either for time 30-90sec or 8-20reps)
    - second set cut each exercise reps/time in half
  - Single Leg Deadlift VIDEO
    - try for 5-10 reps each leg slowly
    - Add 5lbs to the hand of the leg that is in the air
    - Stay short of the popping in the R hip
  - Side Step Band Progression VIDEO
    - Red band 8-20 reps or 30-90sec
    - Start standing on left leg with band around right foot, then switch to other leg
    - Do both sides
  - Pallof Press Lunge and Chest Press VIDEO
    - Pay attention to front foot and knee position
    - You will do 4 positions with this one explained in video
    - try for 5 reps of each to start and work up towards your favorite number 8
  - Double Leg Heel Raise VIDEO
    - Keep feet straight and pressure through big toe
    - 8-20reps
    - try for 10-20 reps…get tired
  - NEW:
    - Squat Pulses In Short Range VIDEO
      - Do this with the band around the knees
      - Start with 30 sec or 5-8 reps
      - Work your way up to 90sec or 20 reps