Tuesday, April 29, 2014

How do you physically prepare for retirement? Part 4: How I continue advancing my client’s mobility.

In case you missed the first 3 posts:




Mike Boyle working on Hip Stability and Mobility

What you will find is we will use some of the same exercises for improving posture, mobility and strength. The difference is how the exercises are performed.  


In part 1 of my posture series the main focus was on posture while also working on the mobility and stability of the head and neck at the same time.

In part 2 we focused on posture while also working on the mobility and stability of the shoulders and thoracic spine at the same time.

In part 3 we focused on posture while also working on the mobility and stability of the Lumbar/Pelvic/Hip Complex at the same time.

Why do I begin with posture and mobility before strength? I want my clients to maximize the gains, while minimizing the risks they will make from the complex movements I use to make them stronger. The results will be much better if they can stabilize what I want stable and move with control what I want mobile.

WHEN WORKING ON ANY OF THESE EXERCISES, NEVER FORCE YOUR BODY INTO A POSITION. The focus should always be on how you are controlling the muscles and joints and the movements they are making. The pace of each movement should be slow. Perform from 5 to 10 reps of each. The goal is to get the muscles turned on as opposed to tiring them out. If you feel fatigue in the muscle when you are done, you have done too many.

What exercises you perform are important. How you perform them is more important.

Before attempting any of the following exercises, be sure to get the approval of your Physician. Especially if you have ever had ANY JOINT OR BACK PAIN or INJURY.  If you aren’t sure how to perform any of these exercises, have someone show you that knows how to teach you.

To begin their warm up, I will have them go through the posture exercises focusing on their techniques. Once I know they are using their posture exercises on their own we move onto the mobility exercises. Some of these mobility exercises can also be considered balance exercises depending on how they are performed. (How much they are using their hands for balance)

We begin with what are called dynamic warm up exercises. Dynamic exercises involve using the muscles to move joints through various ranges of motion. The goal here is to warm the muscles and joints up so their bodies are ready for the balance and strength exercises that will follow. This is opposed to static stretching which have been shown to decrease the amount that the muscles being stretched can contract immediately after the stretch. This is the exact opposite of what I want for my client’s warm up. 

Since the upper body posture exercises are also mobility exercises we have this part of the body covered for dynamic warm up. Now it is time to move to the lower body.
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Hip Mobility and Dynamic Warm UP:
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It looks something like this except the feet are kept around hip       width apart so that the femurs rotate.                         https://www.dads.state.tx.us/texercise/resources/handbook/english/strength.html

The first mobility exercise taught is: External and Internal Hip Rotation.
First I have the client sit on the edge of a chair with their knees around hip width apart and bent around 90 degrees. 

I teach them how to gently externally and internally rotate their femurs from their hips. (Bring the knees farther apart and closer together using the muscles around their hips.) I look to see if there are any major differences between each him, femur, knee and ankle. If one side has a much greater range of motion, we work on that side more if possible. Is the clients spends a lot of time sitting down, it will probably be easier for them to externally rotate and internally. We will have them focus more on the internal rotation. I might have them hold the internal rotation for a count of 10 – 15 seconds. And repeat this hold for 3 – 5 reps. 

This external and internal rotation pays off when teaching client’s how to increase the depth of their squatting when we are working on them for mobility and strength building.
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                              Hip Flexion with knee bent                                    http://www.happyfitme.com/womens-workout-preview/?workout_view2094

Next we move onto Hip Flexion with Knee Bent
I begin with the client stand while holding onto a counter top so they can focus on feeling the muscles contract. 

First we begin with Knee Raises. The goal is to be able to raise the knees to above hip level without the shoulders or lumbar spine moving. 

Weight on the left leg and their right hand on the counter top for balance
Lift your right knee up using hip muscles, pause at top, feel hip muscles contract.
Slowly lower right knee back down. Repeat until hip muscles begin to feel tired.
Turn to face the opposite direction.
Weight is on the right leg and the left hand on the counter top for balance.
Using left hip muscles to lift left knee until left hip muscles begin to feel tired.
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                                    Standing Hip Extension                          http://b-reddy.org/2013/07/29/better-exercises-to-stretch-the-hamstrings/


Next we move to Hip Extension. The focus is on how the glutes are used for hip extension. The goal is to be able to raise the leg backwards without the shoulders or lumbar spine moving. One of the keys to this movement is making sure the client only moves the leg backwards using the muscles in that glute and stopping before the lumbar spine extends.  

Weight is on the left leg and the right hand on the counter top for balance.
Squeeze right glute while moving leg backwards and keeping the knee almost straight. Repeat until right glute begins to feel tired.
Turn to face the opposite direction.
Weight on the right leg and the left hand on the counter top for balance.
Repeat with the left glute muscles.
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                               Standing Hip Abduction                       http://www.lifescript.com/diet-fitness/workouts/5_exercises_for_strong_bones/standing_hip_abduction.aspx
                             Standing Hip Adduction                   http://www.forrestfitness.com/2013/10/23/tighten-your-glutes-in-15-minutes/

Next we begin working on lateral (side to side) hip mobility. (and Hip abduction and Adduction)
Side Leg Raises – I have them face the counter top.
Weight is on the right leg and the hands are on the counter top for balance
Lift left leg sideways using muscles on side of left hip while keeping shoulders still. Lower the leg down until it crosses in front of the right leg while keeping the shoulders still. Repeat until left hip begins to feel tired.
Lift right leg using muscles on side of right hip while keeping shoulders still. Lower the leg down until it crosses in front of the left leg while keeping the shoulders still. Repeat
until right hip begins to feel tired.
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Once I am satisfied that the client is performing these while holding onto the counter top I teach them how to perform them while moving. This makes them more challenging for their balance.
The pace of movements can move from SLOW  -  MODERATE – FAST. Slower is more challenging to their strength levels and faster is more challenging to their balance levels.
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                                       Forward Marching                                                                                                             http://www.health.com/health/article/0,,20410610,00.html
Forward Marching: Imagine Standing Hip Flexion while moving forward.
March forward slowly for 15 - 20 feet alternating raising each knee up as high as comfortable. I make sure they keep their torso as tall and still as possible. This is why I teach the Very Effective Spinal Straightening/Stabilization Technique before having them marching.
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Sideways Marching:
Next I have them march sideways slowly for 15 - 20 feet in each direction while alternating raising each knee as high as comfortable. Imaging stepping over something fairly tall from the side. I make sure they keep their torso as tall and still as possible. The focus is on moving/rotating from the hips. 



                       Imagine this while standing up straight                                                   http://bigstory.ap.org/article/jones-steps-sideways-ravens-march-forward

Forward Internal Hip Rotation with Flexion:
Next if I feel that they need it and can do it, I have them perform a forward walking exercise while alternately internally rotating and flexing their femurs for 15 – 20 feet. I make sure they keep their torso as tall and still as possible. They focus on feeling their inner thigh and groin muscles contracting while the outside of their hips/glutes stretch.
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Imagine moving sideways while lifting you leg to the side. http://www.drmavalankar.com/imp-total-knee-replacement.php

Sideways Hip Abduction:
The next movement I add is hip adduction while walking sideways. They use their hip muscles to pick their lead leg up to the side in the direction they are moving for 15 -20 feet. They repeat this in the opposite direction. I make sure they keep their torso as tall and still as possible. The goal is to activate the hip abductor muscles, not kick the foot as high as possible.
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                Imagine moving forward while doing this                http://learning.summitrehab.ca/Injuries-Conditions/Knee/Exercises/Standing-hamstring-curls/a~1082/article.html
Walking Knee Flexion:
Another movement I might add is alternately lifting the heels up towards the glutes while walking for 15 – 20 feet. They focus on how the hamstrings are contracting and the knees are stretching.
I make sure they keep their torso as tall and still as possible.
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Dynamic Ankle warm ups:
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Next we move to exercises to warm up the ankles: Planterflexion and Dorsiflexion.
                                         Ankle Pumps                                                                                                                         http://www.borgess.com/default.aspx?pId=2150

Seated Ankle Extension and Flexion: aka Ankle Pumps
I have the client sit in a chair with their legs out straight with the heels on the floor.
I have them alternate extending each foot like flooring a gas petal in a car. (Plantar flexion) and then alternate having them bring their toes as close to their shins as they can. (dorsiflexion) I have them hold this dorsiflexion for a count of 5 – 10 so they can really feel the shin muscles contracting. This also improves the mobility of the heel cord. (aka the Achilles’ tendon)
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                                          Ankle Rotations                                                                                               http://www.flowyogamagazine.com/2012/06/13/stress-management-through-yoga-a-daily-home-practice-by-soham-bose/ankle-rotations/

Seated Ankle Rotations:
I have the client sit in a chair with their legs out straight with the heels on the floor. They practice rotating each foot in one direction and then the opposite direction. I have them repeat each direction 5 – 10 times.
Once I feel that the client is ready, I add the following standing ankle exercises.
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Start with raising the toes and in one movement       https://www.dads.state.tx.us/texercise/resources/handbook/english/strength.html

And then do this in one smooth movement http://www.northeastfootandanklesurgery.co.uk/exercises/ankle-exercises
Stationary Heel and Toe Raises:
The client stands up straight while holding onto their counter top in front of them. Using their shin muscles, they slowly raise up their toes as their weight shifts towards their heels. They slowly shift their weight forward on their feet until they are standing on the balls of their feet. They alternate this weight shifting for 5 – 10 reps. This is also a great balance exercise. They focus on keeping their hip, torso, shoulder and head movements to a minimum.  
Once the client has enough control of this movement we move onto more dynamic versions.
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Standing Ankle Flexion and Extension:
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                         Keep those heels up                                                                                             http://livingafitlife.tumblr.com/post/36215939762/shin-splints-the-very-words-strike-fear-into-the
Forward Heel Walking: (ankle flexion)
They walk forwards slowly on their heels for 15 – 20 feet, with their feet pointed straight ahead while their toes are held as close to their shins as they can hold them. Their legs should be relatively straight as they walk. They focus on keeping the shin muscles contracted the whole time they are moving.
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                 Now do it while moving sideways                                 http://runnersfeed.com/category/training/running-drills-training/
Sideways Heel Walking: (ankle flexion)
They walk sideways slowly on their heels for 15 – 20 feet, with their feet pointed straight ahead while their toes are held as close to their shins as they can hold them. Their legs should be relatively straight as they walk. They repeat this in the opposite direction. They focus on keeping the shin muscles contracted the whole time they are moving.
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Imagine doing this while doing big steps forward http://www.focusonmexico.com/Painful-Feet.html
Forward Toe Walking: (ankle extension)
They concentrate on putting as much weight as possible on their big toes whenever walking on the ball of the foot.)
They walk forward slowly on your toes with their legs straight and feet pointed straight ahead, pausing with each step for 15 - 20 feet. The forward steps can be fairly large.         

Next they walk forward quickly on their toes with their toes pointed straight ahead for about 20 feet, getting as high up on their toes as they can. This time the steps should be very small.
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                      Do this while standing on your toes                                  http://www.nhs.uk/Livewell/fitness/Pages/balance-exercises-for-older-people.aspx
Sideways Toe Walking: (ankle extension)
They concentrate on putting as much weight as possible on their big toes whenever walking on the ball of the foot.)
They walk sideways slowly on your toes with their legs straight and feet pointed straight ahead, pausing with each step for 15 - 20 feet. They repeat this in the opposite direction.        
This covers most of the mobility exercises I use with my clients. 


Next week’s post will be about the dynamic and static balance exercises I add to my clients programs once they have enough control of their basic movements.

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