Self help exercise
How often should I exercise?
- There is no hard and fast rule to this question. It may vary from individual to individual.
- If there is greater pain it means you are doing too much.
The advised exercise prescription:
From when the swelling/pain has reduced significantly, do each exercise 5 times. Have a 5 second break. Repeat again 5 times.
Do each exercise 5 times. Have a 5 second break. Repeat again 5 times. Do exercises twice a day (AM and PM). Continue till day seven. Revert to Day 1 exercise regime if Day 2 regime causes too much pain.
After 7 Days
Do each exercise 10 times. Have a 10 second break. Repeat each exercise 10 times. Do exercises twice day. Revert to Day 2 / Day 1 exercise regime if Day 7 exercise regime causes too much pain.
It is important to continue PRICE technique post exercise, if slight swelling or pain persists.
Look to continue sports like swimming.
If exercises at this point are too painful to do, it is advisable to seek the advice of your physiotherapist or GP.
After 14 Days
Do each exercise 15 times. Have a 20 second break. Repeat 15 times. Do exercises twice a day. If exercises are not painful at this stage low grade sport like flat/static cycle or rowing machine should be started.
Return to any sport only if pain/swelling have virtually gone. A good warm up is vital, prior to sport. Continue PRICE (see below) post sport if residual pain/ swelling are present. Stretches are usually done once or twice with 20-30 seconds hold.
Heat should only be started if there are no signs of swelling and problem is chronic (ongoing).
To prevent further injury following a sprain, strain, muscle pull or tear you must follow immediate first aid treatment to prevent complications and to heal faster.
The most popular acronym to follow post injury is “PRICE”
P – Protect:
Stop playing sport and avoid putting weight on the injured part.
R – Rest:
Rest is vital to protect the injured area, and to facilitate the healing process. Rest affected limb and avoid full weight bearing, as long as the pain persists.
I – Ice:
If you have circulatory or blood disorders please check with GP before icing. When icing, choose a cold pack or crushed ice in a secure plastic bag or frozen pea’s wrapped in a thin, damp tea towel for 10–15 minutes. Ice can be reapplied once skin returns to normal temperature. Smaller areas ankles/ foot or wrist/ hands can be submerged in an ice bath contained filled ½ with cold water, topped up with ice cubes. Ice for no longer than 10 minutes, and ensure skin temperature fully returns to normal before icing again.
C - Compression:
Use an elasticised bandage to apply firm, yet non constrictive compression to swelling. If you feel throbbing, then you need to unwrap and re-wrap the bandage a little looser.
E – Elevation:
Elevate the affected limb. The upper limb can be placed on several pillows so to rest above the level of the heart. The lower limb can be placed on pillows, or on a stool so that it is above the hip joint (not if the hip has been replaced). Please note that you can rest limb in an elevated position, whilst securing bandage. Rest, elevation, compressive bandage can be reapplied after ice is removed.
PRICE may be required for a few weeks, before exercise can begin.
Ankle and foot exercises
Calf Stretch - Whilst sitting up in bed, hook a towel around your foot and using both hands, pull the towel up towards body, until a calf stretch is felt. Hold for 20 seconds.
Plantarflexion and Dorsiflexion - Whilst sitting up in bed. Relax leg. Gently bend and straighten ankle as far as pain would allow.
Inversion and Eversion - Whilst sitting up in bed. Relax leg. Gently turn foot and ankle in and out as far as pain allows.
Ankle Circles - Sitting, have foot dangling above floor. Slowly rotate foot and ankle clockwise a few times then counter clockwise. Gradually increase the range of movement (bigger circles).
Arch Strengthening - Standing or sitting, curl big toes to increase the arch of your foot, relax and then repeat. (Once you can do this, try to progress by raising the arch of your foot without curling the toes)
Frozen shoulder exercises
Abduction or Adduction - Lean forward with good arm resting on a solid object. With your feet wide apart, let affected arm hang down and gently swing from side to side.
Circles - Lean forward with good arm resting on a solid object, feet wide apart. Let affected arm hang down and gently swing arm around in a circle, clockwise and anti-clockwise.
Rowing - Lean forward with good arm resting on a solid object, feet wide apart. Bend elbow of affected limb, pull elbow back drawing shoulder blades together.
Flexion and Extension - Lean sideways with good arm resting on a solid object. One foot far ahead of the other. Let affected arm hang down and gently swing arm forward and backward.
Starting position: lying on back
Flexion - Clasp both hands together and raise arms to the end of movement until a stretch is felt.
External Rotation - With elbow on affected side close to body and bent to 90°. Hold a stick between both hands. Move the stick sideways to stretch the stiff shoulder.
Golfers elbow / medial epicondylitis
Pain on the inner aspect of elbow.
Starting position: Sitting with forearm rested on a table, wrist and hand (palm up) hanging of the edge of the table.
Extension and Flexion - Gently move hand up and down.
Eccentric Flexion - Gently move hand up, place a light weight in hand, slowly lower hand as far as it would go. Remove weight and repeat by gently moving hand up.
Extension Stretch - With elbow straight, gently pull affected hand up towards you, until a stretch is felt, close to the elbow. Hold for 20 seconds.
Deep massage - Deep massage to the inner elbow muscles.
Hip joint exercise
The first three exercises must not to be done if your hip has been replaced.
Illiotibial Band Stretch - Sitting, place foot of the affected limb, on the outside of the unaffected thigh. Pull on the knee of the affected limb. Hold for 20 seconds.
Piriformis Stretch - Lying, place the ankle of the affected limb, just above the knee of the unaffected limb. Bend the knee of the unaffected limb, and use arms to pull the unaffected knee towards your chest. Hold for 20 seconds.
Illiopsoas Stretch - Stand a fair distance away from a low sturdy object. Place foot of affected limb onto the sturdy object, whilst using your hands for support. Bend unaffected knee until a stretch can be felt around the groin of the affected limb. Hold for 20 seconds.
Clam Shell - Lie on your unaffected side, hips and knees bent and feet together. Slowly move knee of the affected side, up and down.
Bridging - Lie on your back. Bend knees and hips, so that your feet are flat on the floor or bed. Slowly lift buttocks up and down.
Starting position: Sitting up in bed or on the floor with back against a sofa or wall. Both legs should be straight out in front of you
VMO (Vastus Medialis Obliques) Exercises
Place hands on either side of your knee cap. Try to tighten the muscles on the inside of the knee as strongly as the muscles on the outer aspect of the knee. Tighten thigh muscles by pushing knee into bed or floor and pulling toes back.
Inner Range Quads
Place soft football size ball or rolled up towel or pillow under the knee, turn foot out to 45°. Slowly straighten knee whilst pushing knee down onto ball.
Straight Leg Raise
Turn foot out to 45° and lift weight of limb straight up, off the bed.
VMO Static Contraction
Place a soft football sized ball between feet and squeeze. Try to keep both knees and toes pointing up toward ceiling.
Quadricep and Hamstring Stretch
Starting position: Standing, using hand(s) for support
Hold ankle of affected leg behind you. Pull ankle up toward buttock. Hold for 20 seconds. (Can be done whilst lying on your front if balance is poor)
Place heel or foot of affected leg on a low sturdy object. Lean forward, sliding hand down affected leg. Hold for 20 seconds.
Lower back (lumbar) exercises
Starting position: Lying flat on your back, knees bent, feet flat on floor. Arms rest out to your side.
Posterior Pelvic Tilt - Flatten the arch of your lower back by tightening stomach muscles and buttocks (Tilt pelvis backwards, towards the floor) Hold for 5 seconds and breathe normally.
Bridging - Slowly raise buttocks from the floor, keep your stomach tight.
Rotations - Rock knees from side to side (feet together) slowly. Go as far as pain may allow.
Lower Back Stretch - Gently bring knees to chest. Hold for 20 seconds. Repeat once.
Extension - Standing, place hands on hips and gentle arch backward.
If you are coping with the exercises above and have pain radiating into buttock or lower limb, attempt Piriformis Stretch. Example below is for right side radiating pain.
Piriformis Stretch - Lie on back, place right ankle over left knee. Bend left knee and pull left knee gently towards chest. Hold for 20 seconds. Swap over if you have left side radiating pain.
Mid-back (thoracic) exercises
Starting position: Sitting, feet flat on the floor hooked around the legs of a sturdy chair.
Lateral Flexion - Hold chair with left hand. Bend sideways to the right as far as possible. Repeat on the other side.
Rotation - Clasp forearms, raise to shoulder level, turn your upper body as far to the right as possible then repeat to the opposite side.
Shoulder Blade Retraction - Gently draw both shoulder blades back.
Sit with good upright posture in a supportive chair.
Turn your head to the right and hold for 5 seconds at the end of the available range of movement. Repeat 5 times then do the same exercise to the left side.
Draw your chin in gently (Like you are giving yourself a double chin) hold 5 seconds and repeat 5 times.
Take your chin to your chest (looking downwards) hold 5 seconds and do 5 times.
Shoulder impingment / painful shoulder
Shoulder Blade Retractions - Sitting, gently draw both shoulder blades down and back.
Codman’s Exercise/ Rowing - Standing, lean forwards with good arm resting on a solid object, feet wide apart. Bend elbow of affected limb. Pull elbow back drawing shoulder blades together.
Angel (Scapular Retraction) - Stand with your back leaning against a wall. Keep upper arms close to the sides and elbows bent to 90°.
Gently draw shoulder blades back and hold. Turn forearms outwards. Lift arms out to the side, keeping shoulder blades down. Only go as high as you can, keep shoulders down and back.
Scapular Control - In a crawling position, gently draw shoulder blades back and down ensuring you keep these muscles working throughout this exercise. Gently rock backwards and forwards transferring weight through arms and knees, whilst holding shoulder blades back. Do not do this exercise if you have poor mobility, balance or painful knees.
Tennis elbow (lateral epicondylitis) exercises
Pain on outer aspect of elbow.
Starting position: Sitting, with forearm rested on a table, wrist and hand (palm down) hanging of the edge of the table.
Extension and Flexion
Gently move hand up and down.
Gently move hand up, place a light weight in hand, slowly lower hand as far as it will go. Remove light weight. Raise hand up again and repeat.
With elbow straight, gently bend wrist down, until a stretch is felt, close to the elbow. Hold for 20 seconds.
Deep massage to the outer elbow muscles.
Wrist and finger exercises
Starting position: Sitting, with palm, face down, supported on a table top.
Radial and Ulnar Deviation - Slide hand to the left and right, until a stretch is felt.
Supination and Pronation - Turn palm, face up, and repeat to turn face down.
Flexion and Extension - Move hand over the edge of a table. Bend wrist down until a stretch is felt. Pick wrist up as far as the stretch will allow.
Forced Extension - Sitting, with elbows on the table and palms together, slowly lower wrists to table until a stretch is felt. Ensure palms stay together throughout movement.
Extension and Flexion Stretch - Keeping elbow straight, grip affected hand and slowly bend wrist back. Hold for 20 seconds whilst a stretch is felt, then slowly bend wrist forward for 20 seconds.
Intrinsic Muscle Strengthening - Place a fairly taut rubber band between affected finger and neighbouring finger slowly move affected finger away from neighbouring finger.
Joint Mobilisation - Gently bend and straighten the little joints of the affected finger(s).
Power Grip - Gently squeeze a stress ball (or a clean pair of rolled up socks)