Peripheral Nerve Tensioner videos for that irritated nervous system

Below are Tensioner videos for your irritated and sensitive peripheral nerves. Warning: please only do this if your knowledgeable health care provider has taught these and specifically said that you should do these exercises.

Gentler "Slider" movements can be seen at a previous post here: Slider Videos

Median Nerve Tensioner

http://youtu.be/dimiK2GzE6o

Radial Nerve Tensioner

http://youtu.be/uR4BzP61Jvk

Ulnar Nerve Tensioner

http://youtu.be/DE5YwKxIrOY

Sciatic nerve slump tensioner

http://youtu.be/Xy1Lv3FK2Dk

Sciatic nerve long sitting tensioner

http://youtu.be/Wrn0gqDjl5U

 

Persistent pain resources can be found here: Pain resources

Hamstring Tendinopathy: Sample Rehabilitation Program Videos

Audience: Therapists and Patients Purpose: This post is video overview of the sample exercise progression I might advocate for patients (primarily runners) who present with persistent longstanding high hamstring pain.

Background

Runners, particularly faster runners, will often present with high hamstring tendon pain.  The pain is typically felt where the muscles insert into the bottom bone of the hip (the ischial tuberosity).  In addition to the hamstrings the adductor magnus can often be involved.

Patients will feel pain with running (particularly at speed), pain when pulling their shoe off with the foot, often pain with sitting and even some pain getting out of a chair.  When I see these patients they have often had this condition for months or years.

When the pain has been around for months you may want to consider this dysfunction a failed healing response.  Throw the ideas about inflammation out the window.  These patients have rested their leg and even done some remedial exercises but to no avail.

 

The exercise approach is simple – TISSUE RESPONDS TO LOAD.  Injury treatment is the judicious application of stress – applying this stress to an injured tissue is stimulus for adaptation.  This application of stress to the  non-responding tissue (i.e. your hamstrings) can be complimented with all other treatment techniques and assessments.  In addition to applying stress we also want to try the find the cause of the initial hamstring overload (Good luck).  Some possibilities being:

1. Weak glutes

2.  Poor trunk strength/endurance/control

3. Restricted joints anywhere (feet, fibular head, SI joints, Thoracolumbar junction)

4. Excessive anterior tilt while running (motor control or tight passive/active tissues?)

5. Overstriding

6. Understriding and “hanging” on to your hamstrings when running (rare)

7.  The big daddy – too much, too soon, for you at that point in time.

8. Poor tissue quality (sometimes our muscles and tendons just need a little rubbin’ lovin’  e.g. ART, myofascial, Gua Sha, Acupuncture, general massage)

OK, enough lecturing, you are still in pain

My clinical take is that many athletes get issues 1-8 somewhat taken care with usual care. (This assumes it is not crappy run of the mill care where someone sticks ultrasound and a TENS machine on you and then tells you to stretch). After the usual care (which is the non-horrible kind) patients are then given remedial exercises for the hamstrings (stretching, bridges, curls) but they still aren’t responding.

With these recalcitrant cases we often then need to stress the tissue harder (or find the other key link in the dysfunction).  Inspired by the painful eccentric loading protocol’s variable success in tendon pain (a nice review here and here) I choose to ignore some of the eccentric loading exercises alone and also add heavy resistance training.  For my patients, eccentric loading means that you just work a muscle as it gets longer not as it gets shorter.  It is like lowering a weight but never picking it up again.  It never made sense that concentric exercises would negate the benefits of eccentric exercises and why would daily loading be necessary? (Update: I should listened to  Jill Cooke's podcasts (search on itunes if you care), she is an amazing tendon researcher and has been saying this for a long time).  I had good success with heavy resistance training  but did not have any research to support it.  Fortunately, I found some (click here on a comparison of heavy resistance training versus painful eccentric loading), so I can go back in time and support my previous views and say I was evidenced-based(this is definitely some confirmation bias on how I select the papers that I read).

 

Here are some exercises that I often recommend for runners

A warning, don’t do these willy nilly.  Have your therapist or strength and conditioning coach guide you through these exercises and create the appropriate parameters (how much, how often etc).  Not all of these exercises are meant to be done on the same day.  Work with a professional to create a program.  You can also be doing a lot of other exercises for your core or upper body.

If you are my patient and aren’t sure, email me.

Stage One (2 weeks)

Rationale: Train the glutes, get the  hamstrings ready for more load, train the trunk, say hello to the external hip rotators

Bridge Series (Front to Side)

http://youtu.be/nOw87GtKgFY

 

Back Bridge

http://youtu.be/rjNLyGcfV8E

 

Bird Dog

http://youtu.be/xGHusEEYj6U

ClamShell

http://youtu.be/2aVy6sDVa4c

 

Squats with External Rotation

http://youtu.be/Js0JFw7N4QY

 

Perform the squat as seen in the video below but have tubing around both knees.  When squatting down attempt to press the outside of your knees against the tubing.

The squat in the video is not ideal.  You DO NOT want the knees to start the motion.  The first motion is the butt going backwards with the weight through the heels and the balls of the feet.  The squat starts with a bow or a “hip hinge”.

Hip Flexion Drives

http://youtu.be/HfZnPU1-XhI

Put a cable or tubing around your knee.  Drive your knee forward training your hip flexors.  If you can do 15 easily then add more weight.  Try to not let your spine bend forwards or backwards.

Cabled Hip Extensions

http://youtu.be/knovP_bSv4s

This exercise attempts to mimic the function of the hamstrings during running.  The hamstrings and glutes work to pull the swinging leg backwards toward the ground and support your weight during foot strike.  Hamstring strains occur during this phase.  Click on this link for a post about hamstring function during running (click here).

With this exercise you want a cable or tuning tied around your ankle.  You then pull your leg backwards with your butt and hamstring and slowly return your leg back to the start.  Try not to arch your back during this exercise.  Focus on feeling tension in your hamstrings and glutes.  You will also feel this in the leg that is standing on the ground.  For balance it is OK to grab onto something while doing this exercise (it will also take the strain off the leg that is on the ground).

Stage Two Learning Phase(weeks 2-6)

Repetitions: 8 to 12 (2-3 repetitions shy of muscle failure or form breakdown)

Sets: 1-2

 

Bridge Series (Front and Side)

 

Back Bridge Walkouts

http://youtu.be/TsjQOLHupCE

 

Deadlift Learn (light weights)

http://youtu.be/Mp_XwsEGQ-4

 

One Leg Deadlift

http://youtu.be/F8XBCWHJ3FA

 

Hip Airplane

http://youtu.be/0okjZoaSRLA

 

Cabled Hip Extensions

Cabled Hip Flexion

Stage 3 (weeks 6 to 12)

Repetitions: 4 to 8 (1-2 repetitions shy of muscle failure or form breakdown)

Sets: 2-3

Nordic Hamstring Curls

http://youtu.be/BgLDQ83jh7I

 

Bridge Series (Front and Side)

Single Leg Bridge Eccentric Slide Outs

http://youtu.be/8pw-Ek5AxWM

Deadlift

One Leg Deadlift

Hip Airplane

Cabled Hip Extensions

Cabled Hip Flexion

Spine exercise video series

Below are a number of exercises that are typically called stability exercises.  While this might be true they are really movements to me.  These movements can make you stronger, can calm down your pissed off nervous system and can increase your capacity to withstand stress.  We typically say that they increase your stability but I think it is more complicated.  They are many reasons to do these exercises and if you are unsure please ask.  The body is smarter than we are.  If our spine could talk I bet it would be pretty condescending discussing how we try to explain its function.

Front Bridge to Side Bridge

http://youtu.be/nOw87GtKgFY

 

Back bridge

http://youtu.be/rjNLyGcfV8E

 

Bird dog (you can also raise your opposite arm at the same time)

http://youtu.be/xGHusEEYj6U

 

Curl up

Runner Strength: Basic Exercise Videos for runners

Audience: Patients Purpose: Exercise videos for patients wishing to train their trunk and hips

 

This article is just a video series for runners to do some basic strength work.  Stop worrying about the core.  Just get strong during all movements.  We try to build capacity to withstand load.  We might also improve running efficiency with strength work.  There could probably be thirty different exercises below.  This is not a program just a few suggestions for what can be easily done.  You will notice that there are no exercises that are specifically "core" exercises.  With these exercises you the benefits to training the core can be gleaned from the appropriate choice of compound exercises.

Squat

http://youtu.be/Js0JFw7N4QY

 

One Leg squat

http://youtu.be/ysi8xVcWMcQ

 

Clam Shell

http://youtu.be/M0Hkr7gdqCg

 

Hip Airplane

http://youtu.be/0okjZoaSRLA

 

Deadlift

http://youtu.be/Mp_XwsEGQ-4

One Leg deadlift

http://youtu.be/F8XBCWHJ3FA

 

Hip Flexion against a cable

http://youtu.be/HfZnPU1-XhI

 

Hip Extension Cable Drives

http://youtu.be/knovP_bSv4s

 

 

 

 

Basic Shoulder Movement Videos

Audience: Patients Purpose: Exercise videos for those doing shoulder rehabilitation

Preamble

The same exercises or movements can be used with different intentions and to achieve a different goal.  Some possible intentions being:

1. Motion is Lotion - we are moving your shoulder in a manner just to calm down nerves, decrease pain and get that pissed off shoulder happy with moving again.  The amount of weight or resistance is not that important

2. Stress loading - for whatever reason we want to stress your shoulder and shoulder girdle musculature.  You might have some weakness (e.g. prolonged immobility, post surgical) or we wish to increase the capacity of your joint and muscles to withstand load.  Appropriate weight selection, speed of movement and technique is important

3. Motor control - certainly there is some overlap with the previous two intentions mentioned.  But with this intention we might look at trying to change how your muscles work together.  An example, is training both the internal and external rotator cuff during alternating movements.  We are trying to get the cuff to pull the humeral head away from the scapula or just get the muscles happy working together again.  Load or stress is important but so is learning the movement.

Here we go.  A bunch of videos.

Sidelying External Rotation (for training the rotator cuff and the lower trapezius)

http://youtu.be/2aVy6sDVa4c

Scaption (for training the supraspinatus and the posterior cuff during arm elevation)

http://youtu.be/3fRcgp2-nmM

Unilateral "Y" Exercise on Stomach

http://youtu.be/45tT5CsY7ws

 

Unilateral "T" Exercise

http://youtu.be/0ptjYqn0vbE

 

Unilateral External Rotation

http://youtu.be/N7KkQwL51cY

 

Standing External Rotation with tubing (care of www.mikereinold.com)

http://youtu.be/_G0feLqXA0E

 

 

 

Running mechanics video - great for comparison with your form

Audience: Runners and therapistsPurpose: A reference to compare running technique

Limitations: Many of us assume that there is one right and better way to run.  Deviations from that ideal are assumed to lead to injuries and decreased economy.  This is still a debatable concept.  Everything I write can be questioned so please do so.

Below is a video of Nicole Stevenson (www.nicolestevenson.com).  Nicole is Canada's former number 1 in the Marathon with a personal best below 2:33.  Nicole is also a running coach

I wanted to highlight some probably beneficial components of her running gait.  Future posts will look a deviations from this gait and how they might relate to injury.

Key Points on her Form

- cadence changes as speed increases.  When running less than a 5 min/km her cadence is less than 180 steps

- foot strike is midfoot with one odd exception.  When running at higher speeds she tends to heel strike on the left.  Interesting, Nicole has had some achilles problems on the left.

-the knee does not fully extend prior to impact, it lands bent and does not fully extend even when the foot comes off the ground to start the swing phase (i.e. at push off)

- there is not a significant increase in hip extension when moving from slow to fast speeds (ripping into the "psoas" with some sort of release technique may be questionable).  While the thigh is further back this is mostly due to an increased trunk extension

- the hips stay relatively level (no dropping) during foot strike and the knees don't cave in

-the arms do very little in terms of driving forward.  We should surely question the role of the arms in producing power.  They do not do this.  Nor do they significantly tension the thoracodorsal fascia and some how stimulate the opposite Glutes to fire.  The glutes fire because we are driving our leg back to the ground.  There is no evidence that the arms are required in this.  One misquoted and abused paper by Mooney et al (2000) does not support this idea. 

http://youtu.be/07PsYlhAVts