exercise programming for injury prevention 3/24

kegel

for urinary incontinence

several factors can contribute to weak pelvic floor muscles, including pregnancy, birth, surgical procedures, aging, excessive straining due to constipation or chronic coughing, being overweight

involves isometric contractions of pelvic floor muscles

part of rx program for incontinence

follows same strength training principles as other muscles—isom is a key rx and progression is primarily via gravitational force

kegel progression

elbows & knees quadruped/assisted bridge→hooklying or sidelying→sitting→tall kneeling→standing

kegel instructions and prescription for HEP

make sure bladder is empty, then assume appropriate starting position

tighten pelvic floor muscles, hold 3-5 seconds and progress to 6-10 seconds after 2-3 weeks

imagine sitting on a marble and tighten pelvic muscles as if trying to lift marble, hold 3 seconds, relax for 3

for optimal results→contract solely pelvic flor muscles, don’t engage abs, thighs, buttocks; don’t hold breath

dosage: 10 reps, 3x daily; follow up 2-3 days after initial consult then every 2 weeks

ACL rehab framework

immediate postoperative period (week 0-3))

early rehabilitation (weeks 1-6)

intermediate rehabilitation (weeks 6-12)

advanced rehabilitation (months 3-6 and beyond)

immediate postoperative period (week 0-3)

pain management, swelling reduction

isometrics and concentric to preserve mm and joint physiology

early rehabilitation (weeks 1-6)

controlled, supervised exercises to gradually restore knee ROM

initial strengthening exercises for quads and hamstrings

WB activities as tolerated

intermediate rehabilitation (weeks 6-12)

advanced strengthening exercises for entire LE

proprioceptive and balance training to improve joint stability

introduce low-impact CV exsc

initiate more functional activities

advanced rehabilitation (months 3-6 and beyond)

continued progression of strength and endurance training

integration of sport-specific exsc

gradual return to more intense challenging activities

monitor for signs of readiness for gradual return to activity/sports

key exercises to consider for ACL rehab

quad sets, ankle pumps, SLRs

triple leg extension exercises w/o impact

small/moderate amplitude, low impact symmetrical jumps

box jump up-phase

stationary cycling, swimming→running

depth jump

countermovement squat jumps sticks

repetitive CMJs+symmetrical jumps

huddle CMJs—forward, lat: sticks→non sticks

huddle CMJs—rotational: sticks→non sticks

power, NM control and perturbation exsc: frog jumps w elastic band, swiss ball perturb (touch/toss) with CMJs: sticks→ non sticks

performance based and return to “work” activities: simulated work type movements, intensive S&C

fall prevention rehab

standing sway exsc fwd/back, left/right

fixed-support rehab strategy

LBP prevention/management

flexibility/mobility exsc—cat-cow, prayer, SKTC, LTR, makenzie exsc

strength training exsc—bird dog, superman (alternate→simultaneous), dead bug

both important for prevention, but flexibility during acute flare up is helpful

makenzie exsc

progress from prone on elbows to back ext from prone as tolerated

neuromuscular training warm-up exercises

structured exsc that train nerves and muscles to react and communicate efficiently w each other and w brain

help address neuromuscular deficits that puts athletes at risk of injury during sports participation

exercises target improvements in movement quality and control during change of direction and landing activities, improvements in core strength and stability, improvements in local muscle strength and joint stability

reduces risk of diverse musculoskeletal injuries by 40-67% and improved athletic performance

components of neuromuscular training warm-up program

“integrated” aerobic exsc, strength exsc, balance exsc, agility exsc

cardio and tissue activation, movement control/quality exsc, focused strength training, dynamic stretches, sport-specific movements