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Corrective Theraputic Exercise with an Emphasis on the Joint Replacement Patient

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1. Downward Therapy Dog-to get proper overhead shoulder range of motion the muscles of the shoulder girdle and glenohumeral joint need to be well balanced. Often times rehabilitation exercises for the shoulder patient are done individually and are performed in isolation. Unfortunately, the shoulder muscles work as a coordinated unit. The downward facing dog yoga exercise is a great way to facilitate the lower scapular muscles while inhibiting the often over dominant upper scapular muscles resulting in smooth scapulohumeral rhythm. The downward therapy dog (as I have named it) will also improve thoracic spine and latissimus dorsi mobility and facilitate the deep core musculature that is required to get the arm overhead in an efficient manner.

2. Total Hip Replacement patients often have tightness of their hip flexor due to the adaptive shortening that occurs when the patient has had pain and thus restricts the normal hip range of motion. When the hip flexor gets tight it inhibits the gluteus muscles. Hip replacement surgery can further comprise the strength of the gluteus muscles and if the hip flexor muscle is not stretched appropriately then the patient's gluteus muscles with not control the femur eccentrically at initial contact through the stance phase of gait and result in a functional deficit with ambulation.

3. Joint Replacement Quadricep Facilitation Exercise-"The Church Pew": it has been documented in the literature that prior to a knee replacement surgery the patient can have at least a 20% quadricep deficit. This deficit persists following a total knee replacement. Traditional knee replacement exercises do not specifically address the neural inhibition that occurs in the quadricep muscle. The persistent inhibition of the quadricep muscle affects a total knee replacement patient’s walking and stair climbing abilities. The "church pew" exercise facilitates the quadricep by causing an involuntary muscle contraction, just the way the quadricep muscle functions during the gait cycle. Traditional quadricep exercises are volitional contractions and thus do not stimulate the muscle functionally. The "church pew" exercise is a great way to get that neurological-re-education and augment the traditional exercises.  The church pew exercise is for neuromuscular re-education of the quadricep and augments all the other traditional quadricep exercises. I recommend that you assess your patients gait before and after the exercise and document the change in stance time, speed and the patients subjective comments post exercise.

4. Joint Replacement Knee range of motion-bike tips: loss of range of motion can result following knee replacement surgery. Pedaling backwards on a stationary bike is a great way to achieve range of motion into flexion. This occurs because the backward pedaling motion results in a hip flexion moment first, then a knee flexion moment. This sequence is opposite of traditional cycling. I like having the patient start by placing their heel on the pedal first and then pedal backwards. Once they loosen up I have them put their foot in the traditional position and then at their toe to get extra flexion. Once this is accomplished the patient can ride the bike for range of motion in the forward method but they start on their heel first and then progress to their toe. The patients seat is also moved back and the forward during this exercise.


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