RMR2 Support Material Sample

SUPPORT MATERIAL

THE MH&F DIFFERENCE Our team of experts strives to provide fitness and rehab professionals with access to thorough, scientifically-based programming, wide-ranging education options, quality equipment, and the ongoing opportunities and support that are important to your success and to the success of your clients, members and patients. Thanks to our uniquely integrated operation, STOTT PILATES Certified Instructors enjoy numerous benefits, including strong post-graduate support and preferred equipment rates, while our equipment customers have access to comprehensive training, instructional videos and manuals, and business solutions. At Merrithew Health & Fitness, our engineers and talented Instructors work together to refine and evolve our equipment so it continuously exceeds and challenges.

RMR2—PERIPHERAL JOINT STABILIZATION: MATWORK & REFORMER This course builds on the biomechanical and stabilization principles presented in RMR1, keeping the emphasis on core stability while mobilizing the peripheral

STOTT PILATES MANUALS The following manuals are available from Merrithew Health & Fitness: ◗

RMR1 SUPPORT MATERIAL

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RMR2 SUPPORT MATERIAL

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RCCB1 SUPPORT MATERIAL

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RCCB2 SUPPORT MATERIAL

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COMPREHENSIVE MATWORK

Intermediate Reformer technical manuals that list the full exercise repertoire.

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ESSENTIAL REFORMER

This manual is intended for those training at a Licensed Training Center, Corporate

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INTERMEDIATE REFORMER

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ADVANCED REFORMER

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ESSENTIAL CADILLAC

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INTERMEDIATE & ADVANCED CADILLAC

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STABILITY CHAIR

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LADDER BARREL

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ARC BARREL

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SPINE CORRECTOR

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INJURIES & SPECIAL POPULATIONS

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joints. The exercises are designed to prevent and rehabilitate common injuries by balancing and strengthening the muscles around the joints in order to restore and maintain healthy movement patterns specifically of the shoulder, elbow, wrist, hip, knee and ankle.

This support material guide is designed as a reference for exercises taught in the course along with the Comprehensive Matwork, Essential Reformer and

Training Center or host site offering STOTT PILATES branded programming, under the instruction of representatives of Merrithew Health & Fitness.

ADDITIONAL SUPPORT MATERIALS To complement our technical manuals, Merrithew Health & Fitness also provides the following helpful support materials: ◗

WALL CHARTS Outlining the STOTT PILATES repertoire for each piece of equipment

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CLIENT WORKOUT SHEETS Our repertoire in handy pads of 100 tear-off pages

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WORKOUT VIDEOS Unparalleled instruction from beginner to advanced level

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ALL AVAILABLE at merrithew.com

RMR2 “When there is a variety in the stresses and direction of movements of a specific joint, the supporting tissues are more likely to retain optimal kinesiologic behavior than when there is constant repetition of the same specific movement or maintenance of the same specific position.” – Shirley Sahrmann

Objectives 1. Learn the Therapeutic Foundations of STOTT PILATES for use in the rehabilitation setting and their application to the joints of the upper and lower extremities.

2. Learn how to teach and apply the STOTT PILATES Five Basic Principles.

3. Learn the choreography, modifications, indications and contraindications for STOTT PILATES rehabilitation exercises on the Mat and Reformer.

4. Develop the ability to assess proper form for each exercise and the skills to correct improper execution.

5. Learn and practice manual and verbal cueing for each exercise.

6. Learn how to integrate STOTT PILATES into clinical scenarios.

Note: Exercises that are new in RMR2 are denoted in BOLD.

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1705C-1 SUPPORT MATERIAL: RMR2 PERIPHERAL JOINT STABILIZATION: MATWORK & REFORMER

Table of Contents Introduction

Forearm Push Ups

32

Long Stretch

45

Push Up

32

Chest Expansion

45

9

Mermaid

32

Reverse Expansion

45

12

Arm Work

32

Mermaid

46

Mermaid With Rotation

46

2

Theoretical Foundations Functional Classification Charts

Biomechanical Review

Reformer Exercises

Matwork Exercises Breathing

19

Popliteus in Sitting

33

Star Prep

46

Leg Lifts / Toe Taps

19

Footwork

33

Case Study

47

Leg Slides

19

Second Position

34

Clinical Reasoning Challenge

49

Hip Release

19

Second Position on Rotational Diskboard

34

35

Supine Hip Extension

19

Appendices A Visual Assessment for Movement Dysfunction

50

B Myofascial Trains

51

C Conditions Addressed in RMR2

52

D Matwork Exercises for Lower Extremity Joint Stabilization

53

Arm Raises

19

Sleeper Position on Rotational Diskboard

Protraction / Retraction

20

Ankle Exercise

35

Depression / Elevation

20

Supine Hamstring Curls

35

Arm Scissors

20

Seated Hamstring Curls

35

Arm Circles

20

Head Nods

20

Single Leg on Rotational Diskboard

35

Ab Prep

21

Plyometrics

36

Breast Stroke Preps 1, 2 & 3

21

Sleeper

36

Bend & Stretch

37

Lift & Lower

37

G Reformer Exercises for Upper Extremity Joint Stabilization 73

Adductor Stretch

38

References

Leg Circles

38

Selected Pages From the Intermediate Reformer manual

Beats

38

Long Box, Feet Pulling Straps

38

Scooter

38

Knee Stretches

39

Hip Lift

39

Side Splits

39

Front Splits

40

Back Splits

40

Midback Series

40

Quadruped Arm Work

41

Back Rowing Preps

42

Side Arm Preps Kneeling

42

Side Twist Sitting / Kneeling

43

Front Rowing Preps

43

Long Box, Arms Pulling Straps

44

Arm Work on Long Box

44

Hundred Half Roll Back

22 23

Half Roll Up

23

Roll Up

24

One Leg Circle

24

Spine Twist Single Leg Stretch Obliques

25 25 26

Double Leg Stretch

27

Scissors

27

Heel Squeeze Prone

27

Single Leg Extension

28

One Leg Kick Prep

28

Shoulder Bridge Prep

29

Spine Stretch Forward

29

Swan Dive Prep

29

Swimming Preps

30

Side Kick

30

Side Leg Lift Series

31

Leg Pull Front

31

Side Bend Preps

32

Arms Pressing Straps on Long Box 45

E Reformer Exercises for Lower Extremity Joint Stabilization 61 F Matwork Exercises for Upper Extremity Joint Stabilization

66

7 77

Beats

[43]

80

Front Rowing

[58]

81

Feet Pulling Straps

[72]

82

Long Stretch

[92]

85

[103]

87

Side Arm Preps Kneeling [106]

90

Side Twist Kneeling

[114]

98

Reverse Expansion

[115]

99

Mermaid With Rotation

[122] 104

Chest Expansion

Knee Stretches, Knees Off [133] 106 Front Splits

[142] 107

Back Splits

[144] 109

Side Splits

[146] 111

Star Prep

[155] 119

Selected Page From Advanced Reformer Manual Breast Stroke

[69] 121

STOTT PILATES Five Basic Principles Establishing the Background Posture & Setting the Local Stabilizers

CONCEPT OF PRINCIPLE

RELEVANCE TO UPPER EXTREMITIES

RELEVANCE TO LOWER EXTREMITIES

1. BREATHING

Optimal breathing ensures oxygenation and decreases strain on adjacent parts of the body

Excess accessory muscle usage affects scapular control and neural tension

Poor breathing can shift axis of motion and limit energy for lower extremity

2. PELVIC PLACEMENT

Neutral & imprinted positions, neutral position for shock absorption and function, imprint position for safety and specific conditions

Pelvic placement determines upper thoracic and scapular placement

Origin / insertion of muscles determines placement & motion of lower extremity

3. RIB CAGE PLACEMENT

Center rib cage over pelvis, and establish smooth mobility throughout

Origin / insertion of muscles, determines scapular placement and motion

Determines line of gravity through lower extremity and pelvic position

4. SCAPULAR MOVEMENT & STABILIZATION

Neutral placement and scapulohumeral rhythm

Neutral placement ensures glenoid fossa is upward facing, scapulohumeral rhythm depends on starting position, mobility and strength

Affects line of gravity, short latissimus dorsi effects lumbar spine and pelvis

5. HEAD & CERVICAL PLACEMENT

Head balanced on cervical spine, head and neck balanced on thorax

Neural relationship, muscular origin / insertions

Determines line of gravity and balance

PRINCIPLE NAME

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1705C-1 SUPPORT MATERIAL: RMR2 PERIPHERAL JOINT STABILIZATION: MATWORK & REFORMER

Causes of Static versus Dynamic Winging Static Winging ◗ May be the result of the architecture of the subject, e.g. flat thoracic spine, shortened clavicle, scoliosis ◗ May be muscular, e.g. serratus anterior, or gripping Dynamic Winging – flexion, abduction or both ◗ Serratus anterior weakness (winging occurs before 90° of abduction but very little with flexion) ◗ Lesion to long thoracic nerve (C 5, 6, 7) due to direct blow, compression , backpack, radiation, heavy effort above shoulder, repetitive strain ◗ Trapezius dysfunction (winging begins before 90° abduction; little winging with flexion) ◗ Spinal accessory nerve lesion (cranial nerve XI, C3, 4) due to direct blow, traction injury, brachial plexus lesion ◗ Scapula elevates, adducts, and downwardly rotates ◗ Splinting / bracing of glenohumeral joint ◗ Due to pain, gripping with teres major, pec minor, pec major etc. ◗ Causes reversal of scapulohumeral rhythm: reverses action of rotator cuff to pull the scapula / glenoid toward the humerus and cause winging and tipping ◗ Rhomboid weakness ◗ If unable to adequately use the rhomboid for leverage, then the scapula is moved to position the glenoid under the head of humerus (HOH) and then lever the arm up ◗ Multidirectional instability ◗ Inadequate compression of the HOH in the joint requires another approach to find some stability, so scapula is tucked under the HOH as per above scenarios – Magee, Sahrmann, Watson

Cervical & Thoracic Spines ◗ Neurological and positional cause and effect relationship with upper extremity ◗ Thoracic spine kyphosis causes scapular abduction and downward rotation, restricts end-of-range elevation ◗ Excessive thoracic spine extension causes winging and decreased support ◗ Decreased mobility causes increased strain on glenohumeral joint ◗ Cervical spine neural connection with upper extremity ◗ Breathing is of quintessential importance to proper positioning and functioning of the upper quadrant and especially scalene, pectoralis minor and diaphragm

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Exercises 1. Ab Prep Refer to page 30 of the Comprehensive Matwork manual and Appendices D and F LOWER EXTREMITY

a. Legs over Arc Barrel, Foam Roller or Feet on Arc Barrel, Foam Roller ◗ Allows muscles to relax and rest knee in acute injuries, promotes different hip ranges and levels of support b. Fitness Circle on outside or inside of knees c. Staggered legs with hip extension on Fitness Circle or Mini Stability Ball i. Isolate hip extension with leg extended or leg flexed ii. Combine hip extension with thoracic movement d. Foam Roller, Mini Stability Ball, Toning Ball under feet i. Keep prop still ii. Isolate leg flexion and extension iii. Combine leg movement with thoracic movement iv. Unilateral or bilateral ◗ Teach client dissociation of abdominal work from hips ◗ Monitor tensor fascia latae ◗ Monitor segmental stability of spine, especially area of concern UPPER EXTREMITY

a. Modification 2. Hold Fitness Circle i. Add sustained abduction or adduction with Fitness Circle between hands b. Flex-Band around feet i. Add Bicep Curls on spinal flexion 21 c. Toning Ball in hand i. Hold Toning Ball in hand palm up / down / side or Toning Ball on floor – rolling Toning Ball along floor while pressing down ◗ Works elbow stabilizers isometrically d. Overhead Bicep Press in supine with Fitness Circle ◗ Closed-chain, works inner range of elbows while challenging scapula and neck ◗ Challenge tonic scapular control and strength ◗ Watch for overuse of neck flexors and anterior chest instead of abs / hip flexors 2. Breast Stroke Preps 1, 2, 3 Refer to page 32 of the Comprehensive Matwork manual and Appendices D and F LOWER EXTREMITY

a. Add Single Leg Extension b. Prone over Arc Barrel or Stability Ball™ i. Legs flexed throughout (Breast Stroke Preps 1 & 2 only) ii. Legs extended throughout (Breast Stroke Preps 1, 2 & 3) iii. Isolate leg movement iv. Integrate leg movement with spinal extension ◗ Ensure lumbar spine is in slight flexion on apex of Barrel or Ball when knees are in flexion throughout ◗ Ensure pelvis is positioned on Barrel or Ball to facilitate a neutral position of the pelvis and lumbar spine when knees are extended ◗ Extended legs challenge extensor system more ◗ Flexed knees focus on disassociation of hip and pelvis ◗ Stability Ball provides proprioceptive input and challenge

Reformer Exercises LOWER EXTREMITY

1. Popliteus in Sitting Refer to Appendix E a. Seated on Footbar or Reformer Box i. Foot on Toning Ball ii. Foot on Rotational Disk iii. Seated on Rotational Disk on Reformer Box I. Pelvis still II. Pelvic rotation iv. Various foot positions and degrees of tibial rotation b. Seated on carriage i. Foot on Toning Ball ii. Foot on Rotational Disk iii. Seated on Rotational Disk on carriage I. Pelvis still II. Pelvic rotation iv. Various foot positions and degrees of tibial rotation ◗ ◗ ◗ ◗ ◗

Seated on carriage challenges proprioception of the pelvis and spine to maintain neutral on a moving surface Seated on Footbar or Reformer Box (positioned between wooden standing platform and carriage) is a lighter load and easier to stabilize torso Popliteus runs from lateral condyle to medial tibia, providing translational stability to knee especially in 30° to 90° of knee flexion – Nyland / Lachman, 2005 Ensure axis of motion at center of knee Ensure popliteus, hamstrings, and gastrocnemius are working together

2. Footwork Refer to pages 22- 27 of the Essential Reformer manual and Appendix E a. b. c. d. e. f.

Footwork 1-5 Modification 1. Alternative breath Modification 2. Small range pulse Modification 3. End range pulse Modification 4. Feet slightly abducted Modification 5. Use a spacer ◗ Foam Cushions between knees for tracking or to facilitate adductors

g. Footwork 5 – Lower & Lift with knees flexed to 45° ◗ Flexed knee position isolates soleus h. Toning Balls, Stability Cushion under feet i. Different positions under feet for mobility and stability ii. Different positions of feet on Rotational Diskboard or Cardio-Tramp™ Rebounder ◗ Toning Balls allow clients with decreased ankle mobility to move through greater hip and knee range ◗ Unstable surface challenges level 1 & 2 muscles iii. Extension Straps behind knees ◗ Adding a valgus or varus force through the Extension Straps to facilitate adductor or abductor muscles and challenge rotational control ◗ Help engage proximal hip extensors, decrease gripping of tensor fascia latae and maintain terminal extension control

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Case Study Assignment For each of the following case studies, write out: a. Factors contributing to the client’ s complaint b. Your goals with STOTT PILATES c. Ten to 15 exercises including appropriate props and modifications d. Five progressions

1. Gloria the Gimpy Golfer ◗ ◗

◗ ◗

A 32 year old, right-handed, pro golfer with recurrent upper extremity problems Right-sided carpal tunnel symptoms; this is her fourth episode on the same side; she had surgery for it five years ago which was successful for only six months, and she has had ongoing traditional therapy with other reputable PT / OT s annually She has protracted and dumped scapulae, worse on the right vs. left, and exaggerated internal rotation of the right humerus at rest

◗

Serious pec minor breather Exaggerated flexion at T5–8 and C7–T1; head forward posture You have her for one to two hours per day, fully paid

a. b. c. d.

Contributing Factors Goals Exercises Progressions

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2. Telula the Tennis Player with Tennis Elbow ◗

◗

Plays tennis Tuesdays, Thursdays and weekends; she has developed tennis elbow which is no longer managed with a brace Right-handed; she has a one handed forehand and backhand Great strength and balance of mobility and muscles across elbow and wrist; not terrible scapular stability Restricted thoracic mobility (rotation and side flexion) to right greater than left Left sacroiliac joint dysfunction – pain and clicking Hyperfacilitated hamstrings

a. b. c. d.

Contributing Factors Goals Exercises Progressions

◗ ◗ ◗ ◗

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Clinical Reasoning Challenge Assignment 1. a. List six biomechanical causes of supraspinatus tendonitis / tendonopathy. b. Name two STOTT PILATES exercises to address each.

2.

Name four closed kinetic chain exercises to target gluteus medius.

3. a. Name six exercises to work on midfoot mobility. b. Why is midfoot mobility necessary for full rehabilitation of hip pathologies?

4.

Name three conditions which may result from a downwardly rotated scapula with poor local stabilizer control.

5.

How can you modify Push Ups for a client with carpal tunnel?

6. a. Name six exercises to help a client develop hip adductor strength. b. What conditions may result from long term weakness of adductor magnus?

7. a. What postural habits and muscle patterns will result in anterior femoral head syndrome? b. Name eight exercises to correct anterior femoral head syndrome.

8.

List four closed-chain hip extension exercises.

9.

List four open-chain hip extension exercises.

10. a. List eight exercises to help correct patellofemoral syndrome. b. How is the VMO involved? c. What exercise parameters help to recruit the VMO? 11. a. How is gluteus medius weakness related to a recurrent ankle inversion sprain? b. List eight exercises to address the hip and ankle issues.

12.

What exercises can help restore neutral resting placement of the scapula for a client who presents with protracted and downwardly rotated scapula?

13. a. Why is proper breathing essential for proper glenohumeral function? b. How can you detect excessive pectoralis minor involvement in Breathing?

14.

How can a client with carpal tunnel syndrome do Knee Stretches?

15.

Name four exercises to assist with popliteus function.

16. a. Explain why good pelvic control and placement is essential for proper patellar tracking? b. Ankle function? c. Biceps tendonitis?

17. a. Does left hip abductor shortness create a high right or left iliac crest? b. How can you differentiate between something that is of bony and muscular origin? c. What exercises can you do to address shortness of the abductors?

18. a. What can toe gripping indicate with respect to the ankle, pelvis and hips? b. What six exercises may be useful to reduce gripping?

19. a. What are the local stabilizers of the elbow? b. How can a lack of supination create subacromial impingement? c. What exercises can you do to increase elbow mobility and stabilize the humeral head?

20. a. What six areas of the body do you have to monitor when working with a client with tennis elbow? b. Name four exercises for tennis elbow which do not involve elbow motion. c. Name four exercises for tennis elbow which involve elbow mobilization.

21.

List six progressions of Hip Release – from closed-chain low-load through open-chain high-load.

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Appendix D

Matwork Exercises for Lower Extremity Joint Stabilization WARM UP BREATHING

HIP RELEASE supine, pelvis and spine neutral, knees flexed, abducted hip-distance apart 1. FEET ON PROP Foam Roller, Mini Stability Ball or Toning Ball

BREATHING seated, pelvis and spine neutral, legs abducted hip-distance apart in: prepare, ex: initiate from head and sequentially articulate spine into flexion over legs, in: expand sides and back of rib cage, ex: through pursed lips, allowing rib cage to close.

3-5 breaths. On the last exhale, initiate from tail and sequentially articulate spine to neutral

in: laterally rotate both legs and extend knees to press Roller / Ball away, ex: medially rotate legs and flex knees to return NOTE: Can be done unilaterally or bilaterally 2. FLEX-BAND BEHIND THIGH, unilateral in: laterally rotate leg and extend knee to slide foot away, ex: medially rotate leg and flex knee to return

SUPINE HIP EXTENSION PELVIC PLACEMENT LEG LIFTS supine, imprinted, legs abducted, hip-distance apart, arms long by sides in: prepare, ex: lift one foot off Mat, in: return foot to Mat

supine, pelvis and spine neutral (or modified as needed), heel or calf on Fitness Circle (in vertical position), Mini Stability Ball or Toning Ball 1. LEG IN EXTENSION in: prepare, ex: gently press Circle / Ball, contracting gluteals and hamstrings, in: release 2. MAINTAIN KNEE FLEXION, foot on prop

TOE TAPS supine, imprinted position, both legs tabletop in: prepare, ex: tap one foot toward Mat, in: lift it up to tabletop

in: prepare, ex: extend hip to press Circle / Ball, while maintaining neutral pelvis and spine in: release.

3. BIAS LINE OF PULL WITH FLEX-BAND Instructor holding Flex-Band wrapped around thigh, calf or heel NOTE: Can change the direction of pull of Band to facilitate adductor or abductor engagement for previous exercises

LEG SLIDES supine, pelvis and spine neutral, legs abducted, hip-distance apart, arms long by sides

EXERCISES

1. REGULAR in: prepare, ex: slide one foot along Mat, maintaining pelvic stability, in: return to starting position 2. FOOT ON FOAM ROLLER / MINI STABILITY BALL, other leg flexed, foot on Mat in: prepare, ex: extend knee and dorsiflex ankle to press Roller / Ball away, maintaining pelvic stability, in: flex knee and plantar flex ankle, return to starting position 3. FLEX-BAND UNDER SOLE OF FOOT, holding Flex-Band, elbows flexed, ankles dorsiflexed in: prepare, ex: extend knee to slide foot along Mat, plantar flex ankle on terminal knee extension, in: dorsiflex ankle and flex knee to return

AB PREP supine, pelvis and spine neutral, knees flexed, adducted or abducted hip-distance apart, arms long by sides 1. LEGS OVER ARC BARREL / FOAM ROLLER in: nod head, ex: flex thoracic spine, reaching arms off Mat level with shoulders, maintain pelvis neutral and stabilize scapulae, in: stay, ex: return to Mat 2. PROP UNDER FEET Foam Roller, Mini Stability Ball or Toning Ball a. KEEP PROP STILL in: nod head, ex: flex thoracic spine, reaching arms off Mat level with shoulders, maintain pelvis neutral and stabilize scapulae, in: stay, ex: return to Mat

continued >

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Appendix E

Reformer Exercises for Lower Extremity Joint Stabilization EXERCISES POPLITEUS, SEATED ON FOOTBAR

FOOTWORK

NO SPRINGS

seated on Footbar or Reformer Box facing carriage, pelvis and spine neutral, knees flexed with one foot on carriage, other foot on floor or Reformer rail 1. FOREFOOT ON TONING BALL, heel on carriage

2 TO 3 SPRINGS

supine, pelvis and spine neutral, legs parallel, adducted or abducted hip-distance apart, feet on Footbar, Jumpboard or Cardio-Tramp, arms by sides 1. TOES APART, HEELS TOGETHER 2. WRAP TOES ON BAR 3. HEELS ON BAR / FEET ON JUMPBOARD OR CARDIO-TRAMP

in: extend knees to press carriage out, ex: flex knees to pull carriage in

4. HIGH HALF TOE

2. FOOT ON ROTATIONAL DISK, one foot on Rotational Disk on carriage, forefoot on Toning Ball, heel on disk in: extend knees to press carriage out, ex: flex knees to pull carriage in

in: prepare, ex: extend knees to press carriage out, in: flex knees and control return of carriage 5. LOWER & LIFT in: press out, ex: lower heels, in: lift heels, 3-6x, ex: flex knees and control return of carriage

3. SEATED on Rotational Disk on Reformer Box, one foot on Rotational Disk, forefoot on Toning Ball, heel on disk in: extend knee to press carriage out, rotate pelvis and torso away from working leg maintaining tracking, ex: flex knee to pull carriage, in: rotate pelvis and torso to start position NOTE: Can omit pelvis and torso rotation and be done in various foot positions and degrees of tibial rotation

6. LOWER & LIFT, knees flexed to 45째 in: press carriage half-way out, keeping knees flexed 45째, ex: lower heels, in: lift heels, 3-6x, ex: flex knees and control return of carriage a. TONING BALLS / STABILITY CUSHION UNDER FEET (1-4) b. EXTENSION STRAPS BEHIND KNEES (1-6)

61 POPLITEUS, SEATED ON CARRIAGE

NO SPRINGS

seated on carriage, facing Footbar, pelvis and spine neutral, pelvis close to edge of carriage, knees flexed, one foot on floor between rails, Toning Ball under forefoot and heel on floor, hold other leg toward chest with both hands 1. PLAIN in: extend knee to press carriage out, ex: flex knees to pull carriage in 2. FOOT ON ROTATIONAL DISK, Toning Ball under forefoot, heel on disk in: extend knees to press carriage out, ex: flex knees to pull carriage in 3. SEATED ON ROTATIONAL DISK on carriage, foot on Rotational Disk, Toning Ball under forefoot, heel on disk in: extend knee to press carriage out, rotate pelvis and torso away from working leg maintaining tracking, ex: flex knee to pull carriage in, rotate pelvis and torso to start position NOTE: Can omit pelvis and torso rotation and be done in various foot positions and degrees of tibial rotation

SECOND POSITION ON JUMPBOARD

2 TO 3 SPRINGS

supine, pelvis and spine neutral, knees flexed, feet hip-distance apart on Jumpboard, arms by sides 1. PARALLEL 2. LATERALLY ROTATED 3. MEDIALLY ROTATED in: prepare, ex: extend knees to press carriage out, in: flex knees and control return of carriage a. TONING BALL / STABILITY CUSHION UNDER FEET (1-3) b. DIFFERENT POSITIONS OF PROP UNDER FEET (1-3) c. DIFFERENT POSITION FOOT ON JUMPBOARD / CARDIO-TRAMP (1-3) d. EXTENSION STRAPS BEHIND KNEES (1-3)

WEIGHT TRANSFER

2 TO 3 SPRINGS

supine, pelvis and spine neutral, feet on Jumpboard in line with hip, knees flexed, extension straps just above knees, arms by sides 1. FLEXION (in phase) in: extend knees to press carriage out, bringing one leg to tabletop, ex: flex knee and control return of carriage, returning other foot to Jumpboard as carriage returns fully

continued >

Appendix F

Matwork Exercises for Upper Extremity Joint Stabilization WARM UP

4. ARM CIRCLES, arms long by sides a. PLAIN in: reach arms toward ceiling and overhead, maintaining abdominal connection and upwardly rotate scapulae, ex: circle arms out to sides and around to hips and downwardly rotate scapulae to neutral, reverse

RIB CAGE PLACEMENT ARM RAISES supine, pelvis and spine neutral, knees flexed, abducted hip-distance apart on Mat, arms long holding Maple Pole down by thighs

b. FLEX-BAND WRAPPED AROUND BACK, holding ends of Band in: reach arms overhead, ex: circle arms out to sides and around to hips, reverse

in: reach arms to ceiling, ex: reach arms overhead as far as abdominal connection can be maintained and rib cage remains on Mat, in: reach arms to ceiling, ex: lower arms down by thighs

c. FLEX-BAND IN FRONT OF CHEST in: reach arms overhead, ex: circle arms out to sides and around to hips, reverse

SCAPULAR MOVEMENT & STABILIZATION

HEAD & CERVICAL PLACEMENT

SCAPULA ISOLATIONS

CRANIO-VERTEBRAL FLEXION – HEAD NOD

supine, pelvis and spine neutral, knees flexed, abducted hip-distance apart on Mat, arms long reaching to ceiling

supine, pelvis and spine neutral, knees flexed, abducted hip-distance apart on Mat, arms long by sides in: lengthen back of neck, leaving head on Mat, ex: return to neutral

1. PROTRACTION & RETRACTION, holding Maple Pole

66

a. BILATERAL in: protract scapulae, ex: bring scapulae back to neutral, in: retract scapulae, ex: bring scapulae back to neutral

EXERCISES

b. UNILATERAL in: protract one scapula, ex: bring scapula back to neutral, in: retract one scapula, ex: bring scapula back to neutral

AB PREP supine, pelvis and spine neutral, knees flexed, adducted or abducted hip-distance apart, feet on Mat

NOTE: Can be done seated 2. ELEVATION & DEPRESSION, arms reaching overhead, with or without Toning Balls / Fitness Circle / Maple Pole

1. FITNESS CIRCLE BETWEEN HANDS, arms long overhead in: nod head, ex: flex thoracic spine, flex elbows and gently press into Circle, maintain pelvis neutral and stabilize scapulae, in: stay, ex: return to Mat, reaching arms overhead

in: slide shoulders up toward ears, elevating scapulae, ex: slide shoulders away from ears, depressing scapulae NOTE: Can be done seated with arms long by side, with or without Toning Balls / Fitness Circle / Maple Pole

NOTE: Can be done with sustained abduction 2. FLEX-BAND AROUND FEET, holding ends of Band

3. ARM SCISSORS

in: nod head, ex: flex thoracic spine and elbows, maintain pelvis neutral and stabilize scapulae, in: stay, ex: return to Mat and extend elbows to return

a. PLAIN in: prepare, ex: reach one arm overhead, other down by hip, stabilizing ribs and spine, in: return both arms to ceiling

3. HANDS ON TONING BALLS in: nod head, ex: flex thoracic spine, rolling Balls forward, in: stay, ex: return to Mat

b. END OF FLEX-BAND WRAPPED AROUND TONING BALLS in: prepare, ex: reach one arm overhead, other down by hip, stabilizing ribs and spine, in: return both arms to ceiling.

Alternate arms

NOTE: Can be done holding Toning Balls off Mat 4. OVERHEAD BICEP PRESS, elbows flexed overhead, hands resting on top of Fitness Circle in: prepare, ex: flex elbows to press Circle down, in: release tension continued >

1705C-1 SUPPORT MATERIAL: RMR2 PERIPHERAL JOINT STABILIZATION: MATWORK & REFORMER

Appendix F cont’d

SPINE STRETCH FORWARD

SWIMMING PREPS

seated on Mat, pelvis and spine vertical, legs long and abducted shoulder-distance apart, arms long by sides

on hands and knees, pelvis and spine neutral, legs abducted hip-distance apart and toes tucked under, Flex-Band around one foot, holding ends of Band

1. HANDS ON TONING BALL / STABILITY BALL in: prepare, ex: articulate spine into flexion from head to tail, rolling Ball away, keeping pelvis vertical, in: stay, ex: articulate spine from tail to head, rolling Ball in and return to start position 2. FLEX-BAND AROUND TORSO, arms long reaching toward knees in: prepare, ex: articulate spine into flexion from head to tail, reaching hands toward feet then parallel to floor, in: stay, ex: maintain hands at shoulder height and articulate spine from tail to head then return arms to start position

1. ELEVATION & DEPRESSION, one shoulder flexed reaching arm forward in: elevate scapula, ex: depress scapula 2. HUG THE MOON PREP, one arm lifted shoulder height, elbow flexed, palm facing shoulder in: prepare, ex: extend elbow to reach arm overhead, in: flex elbow to return 3. SHOULDER FLEXION & EXTENSION

NOTE: Arms can remain reaching toward feet throughout

SWAN DIVE PREP

in: flex shoulder of gesture arm to reach forward, ex: return to starting position 4. SHOULDER ABDUCTION & ADDUCTION, one arm down by side in: prepare, ex: abduct gesture arm, in: return arm by side

prone, pelvis and spine neutral, legs long laterally rotated, abducted wider than hips, hands by shoulders

NOTE: Can be done without a Flex-Band

1. FLEX-BAND BEHIND BACK

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in: prepare, ex: extend spine and hips off Mat, in: stay, ex: return to Mat

FOREARM PUSH UPS modified plank position on forearms (Arc Barrel / Reformer Box / Stability Ball under elbows), pelvis and spine neutral, legs adducted

2. WRISTS ON FOAM ROLLER, torso hovering a. ELBOWS EXTENDED THROUGHOUT, arms reaching overhead in: prepare, ex: extend spine and hips off Mat, in: stay, ex: return to hover position

1. SCAPULA ISOLATIONS, knees on Mat in: protract scapulae, ex: bring scapulae back to neutral, in: retract scapulae, ex: bring scapulae back to neutral

b. ELBOW FLEXION & EXTENSION, elbows flexed in: prepare, ex: extend spine, hips and elbows, rolling Roller away, in: stay, ex: return to hover position, flexing elbows

2. SCAPULA ISOLATIONS, toes on Mat in: protract scapulae, ex: bring scapulae back to neutral, in: retract scapulae, ex: bring scapulae back to neutral

c. SLOW ROCK, elbows flexed in: prepare, ex: extend spine, hips and elbows, in: stay, ex: maintain spinal and hip extension, slowly rock torso forward rolling Roller away, in: rock back up rolling Roller in, ex: return to hover position, flexing elbows

3. SHOULDER FLEXION & EXTENSION ON STABILITY BALL, knees up or down

3. HANDS ON TONING BALLS, torso hovering a. ELBOWS EXTENDED THROUGHOUT, arms reaching overhead in: prepare, ex: extend spine and hips, in: stay, ex: return to hover position b. ELBOW FLEXION & EXTENSION, elbows flexed in: prepare, ex: extend spine, hips and elbows rolling Balls away, in: stay, ex: return to hover position, flexing elbows c. SLOW ROCK, elbows flexed in: prepare, ex: extend spine, hips and elbows rolling Balls away, in: stay, ex: maintain spinal and hip extension, slowly rock torso forward rolling Balls away, in: rock back up rolling Balls in, ex: return to hover position, flexing elbows

1705C-1 SUPPORT MATERIAL: RMR2 PERIPHERAL JOINT STABILIZATION: MATWORK & REFORMER

in: flex shoulder joint to roll Ball away while maintaining scapula stability and spinal position, ex: extend shoulder joint to return Ball

Appendix G

Reformer Exercises for Upper Extremity Joint Stabilization EXERCISES MIDBACK SERIES

MIDBACK SERIES HEAD TOWARD FOOTBAR

1 TO 2 SPRINGS

supine, imprinted position (or modified as needed), hands in straps, on Footbar, extension straps just above knees, shoulders slightly away from shoulder rests.

1. TRICEPS PRESS, elbows flexed by sides in: prepare, ex: extend elbows, in: return 2. STRAIGHT DOWN, arms long by sides in: reach arms up to ceiling, ex: extend shoulders to press arms down 3. FORTY-FIVE DEGREES, arms long by sides in: reach arms 45째 out and up, ex: pull arms down by hips 4. SIDE, arms long by sides in: reach arms out to sides, ex: pull arms down by hips 5. CIRCLES, arms long by sides in: reach arms up toward ceiling, ex: circle arms out to sides then in toward hips, reverse NOTE: Can be done with unilateral circles and in different ranges of motion 6. WRIST FLEXION / EXTENSION, multiple shoulder and elbow positions in: extend wrists, ex: flex wrists

1/2 TO 2 SPRINGS

shoulder rests removed, supine with head toward Footbar, imprinted position, legs tabletop, hands in straps 1. BICEP CURLS, arms long by sides in: prepare, ex: flex elbow, in: return 2. STRAIGHT UP, arms long by sides in: prepare, ex: flex shoulders reaching arms up to ceiling, in: return 3. FORTY-FIVE DEGREES, arms long by sides in: prepare, ex: flex shoulders to reach arms up and out to 45째, in: return 4. SIDE, arms long by sides in: prepare, ex: abduct shoulders to reach arms out to sides, in: return 5. CIRCLES, arms long by sides in: reach arms up toward ceiling, ex: circle arms out to sides then pull in toward hips, moving carriage out, reverse 6. WRIST FLEXION & EXTENSION multiple shoulder angles in: extend wrists, ex: flex wrists

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7. SCAPULA ISOLATION elevation & depression, arms long by sides in: slide shoulders up toward ears, elevating scapulae, ex: slide shoulders down away from ears, depressing scapulae 8. EXTERNAL ROTATION multiple shoulder angles, elbows flexed

7. SCAPULA ISOLATION, elevation & depression, arms long by sides

in: prepare, ex: externally rotate humeri, in: return

in: slide shoulders up toward ears, elevating scapulae, ex: slide shoulders down away from ears, depressing scapulae

9. OVERHEAD PRESS, elbows flex by sides, palms facing in

8. INTERNAL ROTATION multiple shoulder positions, elbows flexed in: prepare, ex: internally rotate humeri, in: return a. ADD AB PREP OR SUSTAINED FLEXION b. UNILATERAL OR BILATERAL c. VARIOUS HAND POSITIONS, supinated, pronated, mid-position d. ADD WRIST FLEXION / EXTENSION e. ADD SUPINATION / PRONATION

in: prepare, ex: extend elbows to reach arms overhead, in: return 10. BICEP CURLS & OVERHEAD PRESS COMBO, arms long by sides in: prepare, ex: flex elbows, then extend elbows to reach arms overhead, in: flex elbows, then extend elbows to return a. ADD AB PREP OR SUSTAINED FLEXION b. UNILATERAL OR BILATERAL c. VARIOUS HAND POSITIONS, supinated, pronated, mid-position d. ADD WRIST FLEXION / EXTENSION e. ADD SUPINATION / PRONATION

continued >

exercises LONG STRETCH ESSENCE

footbar position #1, 1 or 2 springs, headrest full STARTING POSITION

In a push-up position, with hands on footbar and feet on headrest, one line from feet to head (dart position). Pelvis and spine neutral. Legs straight, adducted and parallel with balls of feet at crease of headrest. Heels of hands on footbar shoulderdistance apart and directly under shoulders. Arms straight with elbows angled back. Scapulae stabilized.

EXERCISE INHALE

EXHALE

initiate by adducting legs to stabilize pelvis, then, keeping body in one long line, flex shoulders to press carriage out as far as possible maintaining torso and scapular stabilization.

TARGET MUSCLES: transversus abdominis to compress abdomen and stabilize lumbo-pelvic region; deep pelvic floor to aid in firing transversus; hip extensors, adductors and abdominals to stabilize pelvis; rectus abdominis, obliques and erector spinae to stabilize spine; scapular stabilizers with emphasis on serratus anterior; pectoralis major and anterior deltoids concentrically to press carriage out, eccentrically on return; latissimus dorsi, teres major and posterior deltoids eccentrically on press out, concentrically to return STABILITY:

torso; scapulae and arms; pelvis on femurs

MOBILITY:

shoulder flexion and extension

ENDURANCE:

maintaining torso stability throughout exercise

maintain dart position, initiate with scapular stabilization and extend shoulders to return carriage to starting position (carriage does not have to return fully).

Complete 5 repetitions.

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Long Stretch

1. starting position

2. press out

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3. return I N T E R M E D I AT E R E F O R M E R M A N U A L • E X E R C I S E S

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