Hands, Wrists & Elbows

tennis elbow (tendentious)

• self palpation with wrist movements
• ice :( (hand squeeze hurts)
• stabilize upper arm and move forearm over (laterally) and squeeze hand
• same as above with hand turned back
• Laurie sequence

neck

• SUPPORT HEAD AND MAINTAIN DECENDED SCAPULA
• head mobility
• chin tucks as warm-up
• extensions (watch range)
• side bending with chin tuck
• avoid head forward posture
• head is too heavy (neck hurts)
• test: shoulders and head against the wall
• massage suboccipital and hold shoulders to extend neck
• with towel or hands support shoulder depression for extension

shoulders: Rotator cuff etc

four muscles with both move and support the shoulder joint. tests see if any of the four movements are impaired at all:

rotator cuff tear

1. lateral thumb down lift with resistance (empty can test)
2. drop arm test (self-test) to let down slowly
3. elbows at 90 degrees resistance in
4. lift away in internal rotation

impingement

1. lift are grab right shoulder and lift up
2. hawkins /kennedy test (funky chicken movement)
3. mears test: hold down shoulder blade, internally rotate arm and lift
4. moores test: externally rotate with them on their back. Lift arm over their head, then bring to ear and internally rotate (straight arm)

treatment:

stretching

• shoulder squeezes
• dd on a chair walking back and forward
• chest openers (doorway lean, 1 or two arms- variations)
• arms behind back
• heartbench variations

strengthening

• ustrasana superman/goal post/T/ reverse Y (lifting arms
• resistance band-external rotation elbows in/internal rotation
• chest opening

tendonitis

Scapula problems:

look to increase mobility in the shoulder blades

size

• head mobility
• chin tucks as warm-up
• extensions (watch range)
• side bending with chin tuck
• avoid head forward posture
• head is too heavy (neck hurts)
• test: shoulders and head against the wall
• massage suboccipital and hold shoulders to extend neck
• with towel or hands support shoulder depression for extension

Bursitis (inflamation)

NEEDS REST

McKenzie Approach

• centralize pain and then relieve it
• method
• supine: chin back

psoas

Is the psoas HYPER or HYPOtonic

psoas goes from T12 attaches to all the veribrae and disks and goes underneath the pelvis bilaterally. responsible for hip flexing and side bending ( inter-faces with iliacus)

Diagnosis

• look at tilt of pelvis...anterior or posterior?
• one knee in and one leg straight in supta pada gustasana---if leg will not go down it is a tight psoas. 
• more extreme openings in supta eka pada virasana
• knee drops in flexion with resistance

stretching psoas

• ajanay/ add side bend
• supta virasana
• supported and unsupported backbends
• thai pulls
• splits/supported splits on chair sitting or standing
• cogra with HIPS ON THE GROUND
• bounds backbends

strengthening

• chair marching
• standing marching
• with weights
• squats on ball prone/one or two legs
• knees in blankets on floor (or furniture sliders)

spinal/back pain

Lumbar Stabilization- builds core strength for back pain reduction

• supine
• just arms, just legs, alternater
• knees bent, neutral spine, engage ribs-setu bandha sequence
• steps
• lifts
• dead bug (kundalini)
• vipriti korani sequence
• leg lowering
• lifted leg extensions
• prone
• ustrasana variations with arms and legs
• knees
• arm and leg lift variations maintaining root lock and neutral spine
• balance
• planks (hands & forearms)
• side planks (variations ---bent knees)
• planks with rotation
• standing
• lunging & reverse lunging with root lock and neutral spine
• balancing with root lock
• ball work/chair work
• ball lifts prone
• crossed elbows to knees
• belly on ball/bolster
• leg lifts-closer to chest makes it harder, single double
• cobras
• cobras twisted
• hands/no hands/weights
• sitting on ball feet against wall variations

SPINAL STENOSIS

• stretches
• supine knees bent spinal tilts
• legs lifted bolster
• single and double leg hugs
• twists with feet on floor
• forward bends in chair with legs wide and feet pressed down
• flat backed forward bends/knees bent to start
• figure 4
• lunge on step with belly on thigh
• down dogs variations on chair

hips

Sciatica (pain radiating into you butt from impingement in L4/5)

• piriforims syndrome
• SI joints rotated
• herniated/bulging disc
• tests to tell what is causing sciatica
• straight leg raise with flexion (if pain is above knee-bad)
• slump test (seated with bad posture, raise leg & flexion)
• walk on heel/toes (L5 test)
• piriformis test
• sitting too much
• is it tender when palpated
• twist in flexion (is it tight-one leg straight)
• does external rotation hurt? with resistance?
• does abduction hurt? with resistance?
• spinal stenosis
• pain down both legs to the knees, better sitting and worse walking (shopping cart syndrome---can not stand up straight)
• Hip problems
• look at rotations, are they painful
• back pain can refer

Treating Sciatica

• piriformis syndrome

• stretching
• working toward lotus (everything you might do)
• figure 4, pigeon, pigeon on chair or bolster
• thai stretching
• massage
• ball, or massage in marichi A, or roller if you like them (with figure 4)
• strengthening
• abduction in butterfly opposite side on bolster
• rope wall

• SI JOINTS (ligaments get stretched out and one or both get rotated
• tests
• pain tends to be on one side
• common in pregnancy (relaxin)
• hips uneven
• one leg longer
• supta badha (one leg each or figure 4 supta) or bolster work
• anjanay on back or feet
• pelvic push on side
• contralateral pain with alternate knees to chest
• SI joint will hurt!!!!
• push on sacrum is a release, or squeeze hips from sides when they walk
• correcting SI imbalance
• supta badhakonasana with belt
• belt around sacrum tight
• wall squats with block
• herniated disc (want symptoms to be centralized to L4/5)
• backbends!!!! McKensie, cobra variations
• with bolster or pillow to start
• sphinx, cobra, seal
• sacral pressure
• elevate hip where pain is if it is one sided
• belt with over-pressure
• half butterfly with bolster or not
• supine variations on blocks
• single leg with sand bags
• supine twists with hips centralized
• supine butterfly with weight
• bolster on side (rolls)
• side flexion with bolster under feet
• rope wall
• PREVENTION/change in lifestyle
• avoid sitting ever
• don't round your back in forward bends
• do not bend and twist with hips unstable
• full sit ups suck/ with twists worse
• do not lift heavy shit
• dont sleep in flexion
• SLEEP ROLL

TEST for weak muscles in the hip

• thai stirring
• supine flexion with resistance
• side abduction with resistance
• side adduction with resistance
• prone lift with resistance/straight or bent knee

Hip Strengthening

• wall squats with straps and blocks
• setubandha with strap and blocks
• uttkatasana with block
• leg lifts with/out weight
• abbduction and adduction w/without weights with lifts
• side steps with resistance (dynaband)---standing work hips are always center of gravity
• standing hip rotation with resistance kicks

Knees

Diagnosis:

1. ACL (stops bone from moving forward) anterior cruciate ligament

• injuries caused by planting foot and twisting knee (unstable)
• lockmans test-secure femur & pull forward (25deg)
• anterior draw test (90deg) palpate joint

1. meniscus tear test (cartledge)

• Thesaly test: hold wall stand on one leg and twist (pain?)
• pain along joint line
• is there full extension?
• does it "click into place"?
• prone, bend knee & push through hell as you turn it

1. innervation

• straight leg lift -ostrasana or supine
• leg straightening in dandasana
• leg straightening sitting
• bridge
• prone knee bend (flexion)
• bow pulling (flexion)

2. lunging

• chair lift/block
• skandasana
• weight transfer

3. squats

• with chair (up to 60 deg)
• with block support

Meniscus rehab?

1. isometrics (creating tension without contraction) -maintained
2. side leg lifts/outer and inner
3. isotonic: creating contraction through movement

Arthritis of the knee

1. mulligan technique ---helps tibia turn inward with flexion (lunging on a chair)-no pain (flexion)
2. mckenzie technique ---straighten leg/pressure on and pressure off (thai technique) (extension)
3. strengthening
1. straight leg raises (isometric)
2. straight leg raises with external rotation (isometric)
3. setu bandha on a chair (starting with isometrics)
4. shallow squats