Setup -Lie supine, feet flat on floor/bench. Spine and pelvis nuetral or lumbar spine pressed flat with pelvis posteriorly tilted (for beginners or those with back pain). Use wide, closed, pronated grip with evenly spaced hands. Elevate feet on low box or bench if spinal alignment is not possible otherwise.

Alignment

1. upper arm angeled 80-90 degrees from torso
2. forearms perpendicular to the floor
3. wrists in neutral

Movement - Contract abs, lower weight with control, and keep shoulder joint from rolling forward as the elbow lowers. Press up, fully extending (but not hyperexetending elbows). Exhale on upward(concentric) phase.

Safety

1. watch for uncontrolled decent
2. avoid rolling wrists
3. avoid back arching
4. avoid hips pressing up
5. avoid bouncing bar off sternum

Engage -Engage and contract pectoralis major, anterior deltoids, and triceps.

Modifications - Back pain/cleared by Dr. elevate feet onto boxes or up onto bench, press lower back flat, perform poseterior pelvic tilt

Shoulder pain/cleared by Dr. shorten ROM (especially on downward phase) and bring elbows in toward ribs.

Progressions - Perform a plus by protracting then retracting scapulae back to neutral before the down phase of the press. (not appropriate for those with round shoulders of excessive kyphosis). Advanced exercisers only.

Unilateral dumbbell press

Bench press on stability ball

Pectoralis Major and Anterior Deltoid

Butterfly Chest Stretch sit or stand in proper alignment and bring hands to back of head. Gently draw elbows back.

Standing Chest Stretch stand in proper alignment with arms reaching behind the body. Hands may clasp together or stay unclasped depending on flexibility.

Standing Unilateral Wall/Door Stretch stand in proper alignment with one hand holding wall, doorway, or stable equipment. Slowly turn body away from the outstretched arm.

Triceps

Triceps with Arm Overhead reach one arm overhead and bend the elbow with hand reaching down the spine. Ideally the elbow should point straight up. Support the upper arm with the opposite hand.

Triceps Stretch with Arm in Front sit or stand in proper alignment. Cross one arm in front of the chest and bend the elbow with the hand reaching over the opposite shoulder. Support the upper arm witht he opposite hand.

Posterior Deltoid

Reverse Fly shoulder horizontal abduction 

1.  standing with unilateral arms
2. on stability ball
3. on ball unilateral arms
4. on ball one leg up

Seated High Row shoulder horizontal abduction

1. on stability ball
2. on ball one leg up
3. standing high row at mid pulley
4. standing high row on one leg

Biceps

Alternate Dumbbell Biceps Curl elbow flexion

1. curls on incline bench
2. curls on ball
3. curls on ball one leg up
4. standing on one leg

Barbell Curl elbow flexion

1. stand on one leg
2. at low pulley one leg on half foam roller

Reverse Curl elbow flexion

1.  stand on one leg
2. at low pulley stand on one leg on half foam roller

Purpose - to develop strendth and endurance of the chest and fronts of shoulders

Joint Actions - shoulder horizontal adduction and optional shoulder girdle protraction and shoulder internal rotation

Muscles Used - Pectoralis Major, Anterior Deltoid, and Coracobrachialis. (Optional - Shoulder girdle protraction - Pectoralis Minor, Serratus Anterior, and shoulder internal rotation - Subscapularis and Teres Major)

Setup lie supine, feel flat on floor or bench spine and pelvis in neutral, OR lumbar spine pressed flat with pelvis posteriorly tilted (better for beginners or those with back pain). Start in up position, elbows flexed slightly, palms facing each other (mid pronated).

Alignment

1. elbows maintain slightly flexed postition throughout exercise.
2. Wrists are in neutral;spine, neck, and pelvis are stablized.
3. Shoulders are the only moving joints; maintain scapular stabilization.

Movement contracting the abs lower the weights until upper arms are parallel with chect, keeping elbows in a slightly flexed, stable position. Palms face up, although some trainers prefer to horizonatlly abduct the shoulders and move into external rotation, and then finish the movement with the shoulders internally rotated (minimizing radioulnar joint movement). Exhale on the upward phase; inhale on the downward phase.

Safety can be high risk because of the potential for an out of contraol descent and excessive ROM. Leading to shoulder injuries.

1. Dumbbells should go no lower than chest level.
2. Watch for problems with wrist breaking
3. Watch for elevated shoulders as well.

Engage engage and contract the pecs and anterior deltoids. Keep the contraction thoughout both the concentric and the eccentric phases.

Modifications Back pain and cleared by Dr. elevate feet onto boxes or up onto bench, press lower back flat, and perform posterior pelvic tilt.

Shoulder pain and cleard by Dr. avoid exercise

Progressions perform 4 ct plus at end of up phase. Unilateral dumbbell fly. Dumbbell fly on stability ball.

Pectoralis Major and Anterior Deltoid

Butterfly Stretch

Standing or Seated Chest Stretch

Wall/Doorway Chest Stretch

Posterior Deltoid

Reverse Fly -

1. standing with unilateral arms

2. on stability ball

3. on ball with unilateral arms

4. on ball one leg up

5. with plus

Seated High Row

1. on ball

2. on ball one leg up

3.at mid pulley

4. on one leg

Purpose to develop strenth and endurance of the chest, front of shoulders, and triceps muscles, and promote core stability

Joint Actions shoulder horizontal adduction and elbow extension

Muscles used Pectoralis Major, Anterior Deltoids, and Triceps

Setup Distribute body weight on hands and knees or hands and toes. Start in up position. Neck, spine, and pelvis stabilized in neutral position. For standard push up, hands are slightly wider than shoulder-width apart with fingers facing straigh ahead.

Alignment shoulders and elbows are the only moving joints. Stabilization of all other joints is very important for injury prevention. There should be no movement of the spine, neck, scapulae, or pelvis.

Movement perform the exercise smoothly, contract the abs, and avoid sagging through the back. Avoi hyperextending the elbows on the way up; lower until the chest is approximately a fist's width from the floor. Exhale on the way up, inhale down. Avoid looking up as this stresses the cervical vertebrae.

Safety turning the hands inward or outward increases stress to the wrists and elbows. If neutral spinal alignment is difficult to maintain, modify the exercise. The most common error is the loss of core stabilaization, which may lead to back injury. Control the descent and avoid bringing the chest to the floor as this may cause stress to the shoulder joint.

Engage engage and contract the pecs, anterior deltoids, and the triceps. Maintain a constant awareness of abdominals contracting.

Modifications back pain and cleared by Dr. if moving to an easier variation (wall push up, hands and knees, incline knee pushup etc) doesn't help, avoid this exercise and train the chest muscles on a seated chest press machine.

Progressions easiest to hardest -- wall pushup, hands and knees tabletop, knee pushup with hands on weight room bench, knee push up with hands on step, knee pushup with hands on floor, knee push up with knees elevated, full body push up with hands on bench, full body push up with hands on floor, full body push up with feet elevated, full body decline push up with weights on back.

Use of nonstable equipment in any of the above positions. For skilled clients consider - hands on wobble board, core board, flat side of Bosu, foam roller, medicine balls, feet on stability ball or foam roller

Plyometric Push up

Intersperse each push up with another move, such as a side plank

Pectoralis Major and Anterior Deltoid

Butterfly Chest Stretch sit or stand in proper alignment and bring hands to back of head. Gently draw elbows back.

Standing Chest Stretch stand in proper alignment with arms reaching behind the body. Hands may clasp together or stay unclasped depending on flexibility.

Standing Unilateral Wall/Door Stretch stand in proper alignment with one hand holding wall, doorway, or stable equipment. Slowly turn body away from the outstretched arm.

Triceps

Triceps with Arm Overhead reach one arm overhead and bend the elbow with hand reaching down the spine. Ideally the elbow should point straight up. Support the upper arm with the opposite hand.

Triceps Stretch with Arm in Front sit or stand in proper alignment. Cross one arm in front of the chest and bend the elbow with the hand reaching over the opposite shoulder. Support the upper arm witht he opposite hand.

Posterior Deltoid

Reverse Fly shoulder horizontal abduction

1. on stability ball
2. standing on one leg

Seated High Row shoulder horizontal abduction

1. on stability ball
2. on ball with one leg

Biceps

Hammer Curl elbow flexion

Alternate Dumbbell Biceps Curl elbow flexion

1. on stability ball

Concentration Curl elbow flexion

Preacher Curl elbow flexion

Barbell Curl elbow flexion

Reverse Curl elbow flexion

Purpose to develop muscle strength and endurance of the upper back and the back of the shoulders as well as to promote better posture.

Joint Actions shoulder horizontal abduction and scapulae retraction

Muscles Used posterior deltoid, infraspinatus, teres minor, trapezius III, and rhomboids

Setup lie prone on flat or incline bench, or seated on bech (bend over, flexing at hips). Support back either on bench (prone), or on thighs (seated). Start with arms down, palms facing each other.

Alignment

1. spine and neck are in neutral.
2. Elbows are stabilized in a slightly flexed position; wirtst in neutral. Stabilize spine (no spinal rotation with extension) and neck. Shoulders and scapulae are the only moving joints
3. Avoid looking up and hyperextending neck.

Movement Keep upper arm perpendicular to torso, lead with elbows and move up slightly beyond the shoulder joint ROM and into conscious scapular retraction. Another variation is to start with scapular retraction, and then perform the shoulder joint movement. Stay in the horizontal plane. Exhale on the upward movement and control the descent.

Safety

1. keep movement slow and controlled to avoid shoulder injury. Watch for tendency to extend the shoulder joint in the sagittal plance, especially if weights are too heavy (which allows the lats to help out).
2. Most clients will need to start this exercise with little or no weight.
3. Avoid the seated, hip flexed position if the clients are unable to adequately support the torso either with the abs and erector spinae, or on thighs.

Engage engage and contact the posterior deltoid, and especially the mid trapezius and rhomboids.

Modifications shoulder pain and cleard by Dr. avoid the movement of shoulder horizontal abduction. Instead, allow the wrms to hand down towards the floor, elbows straight, and sk client to perform scapular retraction only.

Progressions standing reverse fly with unilateral arms

Reverse fly with a plus

Reverse fly on stability ball

Reverse fly on stability ball with unilateral arms

Reverse fly on stability ball, one leg up

Posterior Deltoid, Trapezius, Rhomboid

Lateral Flexion Stretch stand or sit in proper alignment. Gently tilt head to side.

Cervical Spinal Flextion stand or sit in proper alignment. Gently tilt head forward, looking down

Upper Back Stretch stand or sit in proper alignment. Clasp hands together in front of the body, allow the shoulders to round forward and feel the shoulder blades pulling apart in the back.

Pectoralis Major

Bench Press - shoulder horizontal adduction and protraction of the scapulae

1. unilateral arm movement
2. on ball

Pushup - shoulder horizontal adduction

1. decline pushup from bench
2. decline with weights on back

Subscapularis, Teres Major, Serratus Anterior, Pectoralis Minor

Bilateral Cable Cross Over - shoulder horizontal adduction, shoulder protraction, and internal rotation

1. unilateral arm movement
2. stand on one leg

Dumbbell Fly - shoulder horizontal adduction, protraction, internal rotation

1. on stability ball
2. unilateral arm movement

Purpose develop strenth and endurance of the chest and fronts of shoulders

Joint Actions shoulder horizontal adduction and optional shoulder girdle protraction and shoulder internal rotation

Muscles Used Pectoralis Major, Anterior Deltoid, and Coracobrachialis (Optional shoulder girdle protraction - Pectoralis Minor, Serratus Anterior, and shoulder internal rotation - Subscapularis, and Teres Major)

Setup stand with feet slightly wider than hip width apart, or feet can be staggered. Knees are flexed, abs contracted, scapulae depressed and adducted, elbows slightly flexed. Start with arms in open position.

Alignment

shoulders are the only moving joint.

1. Stabilize elbows and wrists, with elbows slightly flexed and wrists in neutral.
2. Pay particular attention to maintaining a neutral, stable position with the torso.
3. Depress and stabilize scapulae unless pec minor and serratus anterior strenthening is a goal.

Movement contract the abs, exhale as arms are brought forward in horizontal plane. Palms may stay in mid pronated position, or shoulders can internally rotate so that at full concentric contraction the thumbs are touching and palms are pronated. Inhale as arms return, controlling the movement.

Variations - arms below horizontal plane from high pulley, arms above the horizontal plane from low pulley, perform multijoint press movement tot he front (elbows extend and flex) instead of the single joint cross over movement.

Safety

1. too much weight can make this exercise very difficult to control. The potential for excessive ROM and too much speed on the eccentric phase increases shoulder joint risk.
2. Perform the edccentric phase slowly
3. and keep shoulders and scapulae down.

Engage Engage and contract the pectoralis major and the anterior deltoids

Modifications Staggered foot stance is slightly easier and seated position is easier to stabilize

Progressions unilateral arm movement and stand on one leg

Pecotralis Major, Anterior Deltoid, Coracobrachialis

Butterfly Chest Stretch shoulder horizontal abduction/extension

Standing Chest Stretch shoulder horizontal abduction/extension

Wall/Door Unilateral Chest Stretch shoulder horizontal abduction/extension

Pectoralis Minor, Serratus Anterior, Subscapularis, Teres Major

Posterior Deltoid, Infraspinatus, Teres Minor, Middle Trapezius Rhomboids

Reverse Fly shoulder horizontal abduction, scapulae retraction

1. unilateral arm movement
2. on ball
3. on ball unilateral arms

Horizontal Seated High Row shoulder horizontal abduction, scapulae retraction

1. on ball
2. on ball on one leg
3. standing at mid pulley
4. standing on one leg

Purpose to develop strength and endurance of the upper back, back of the shoulders, and to promote better posture

Joint Actions shoulder horizontal abduction, scapulae retraction, elbow flexion

Muscles Used Posterior Deltoid, Infraspinatus, Teres Minor, Trapezius III, Rhomboids, Biceps, Brachialis, Brachioradialis

Setup sit with hips flexed at 90^o, spine in neutral alignment. If seated on the floor, flex knees slightly to assist with proper seated posture. Use grips or a bar that allows palms to pronate and face down. Start with elbows extended and arms in horizontal plane. (out phase)

Alignment

1. contract the abs
2. keep entire spine in neutral, including neck.
3. Maintain scapular depression,
4. elbows slightly lower than shoulders,
5. wrists slightly lower than elbows.
6. Keep wrists in neutral. The only moving joints are the shoulders, scapulae, and elbows.

Movement when rowing, lead backwards with elbows. Keep upper arm in horizontal plane and consciousl go back into scapular movement (or scapular movement can precede the arm/shoulder movement). Pull the bar directly into the chest. Exhale when pulling (in phase), and control the eccentric (out) phase.

Safety

1. watch for wrist breaking (pulling with the wrists)
2. and rocking with the lower spine.
3. Avoid elevating the shoulder girdle.

Engage engage and contract the posterior deltoids and consciously contract the mid trapezius muscles and rhomboids

Modifications shoulder pain and cleared by Dr. avoid the action of shoulder horizontal abduction and have client perform scapular retraction only.

Progressions high row on stability ball, high row on stability ball on one leg, standing high row at mid pulley, standing high row on one leg

Posterior Deltoid, Infraspinatus, Teres Minor, Trapezius III, Rhomboids

Lateral Flexion Stretch stand or sit in proper alignment. Gently tilt head to side.

Cervical Spinal Flextion stand or sit in proper alignment. Gently tilt head forward, looking down.

Upper Back Stretch stand or sit in proper alignment. Clasp hands together in front of the body, allow the shoulders to round forward and feel the shoulder blades pulling apart in the back.

Biceps, Brachialis, Brachioradialis

Biceps Stretch with Arms Behind elbow extension and shoulder extension. Stand or sit in proper alignment. Reach arms behind body with elbows straight.

Biceps Stretch with Arms in Front elbow extension and shoulder flexion. Sit or stand in proper alignment. Reach one arm forward with elbow straight and palm supinated; support arm with opposite hand

Pectoralis Major, Anterior Deltoid

Bench Press - shoulder horizontal adduction and protraction of the scapulae

1. on stability ball
2. unilateral arms

Pushup - shoulder horizontal adduction

1. decline
2. decline with weights on back

Subscapularis, Teres Major, Serratus Anterior, Pectoralis Minor

Bilateral Cable Cross Over - shoulder horizontal adduction, shoulder protraction, and internal rotation

1. standing on one leg
2. seated on ball

Dumbbell Fly - shoulder horizontal adduction, protraction, internal rotation

1. on ball
2. Unilateral arm movement

Triceps

Triceps Kickback/Extension - elbow extension

1. standing bilateral kickback
2. standing kickback on one leg
3. prone extension on ball

Standing Triceps Press-down - elbow extension

1. on one leg
2. on one leg balanced on 1/2 foam roller

Seated Triceps Extension - elbow extension

1. sit on ball
2. sit on ball one leg up

Supine Elbow Extension - elbow extension

1. on ball
2. on foam roller
3. on foam roller one leg up

Triceps Dip - elbow extension and shoulder flexion

1. on foam roller
2. on ball
3. on ball one leg up

Purpose to develop strength and endurance of the upper trapezius and scapular elevators

Join Actions scapular elevation

Muscles Used trapezius I & II, rhomboids, and levator scapulae

Setup stand or sit with feet shoulder width apart for stability. If using a barbell, place hands directly in line with shoulders (some trainers recommend holding the barbell behind the body for the optimal line of pull). If standing, maintain proper alignment; start with shoulder girdle depressed.

Alignment sit or stand with pelvis, spine, and neck in neutral alignment, abs contracted, scapulae down. If standing, have knees slightly flexed; if sitting, flex hips at 90^o. The only moving joint is the shoulder girdle; all other joints are stabilized. Elbows and wrists have no independent movement.

Movement elevate the shoulder girdle in a straight line up towards ears; feel the scapulae sliding up and down the ribcage in the back. Many strength training experts recommend inhaling when elevating shoulders and exhaling on the descent.

Safety with the exceptionof body builders, football players, and wrestlers, this may not be an important exercise for most clients. From a functional perspective, many clients need to stretch the scapular elevators and relax tight neck muscles, and they need to strengthen the scapular depressors. Many clients are unable to maintain sufficient scapular depression throughout the day and/or during standard exercises. It is suggested that trainers focus more on scapular depression that scapular elevation for most clients.

Engage engage and contract the upper trapezius muscles, levator scapulae, and rhomboids.

Trapezius I and II, Rhomboids, and Levator Scapulae

scapular depression, cervical spinal lateral flexion, cervical spinal flexion, scapular protraction, and shoulder horizontal adduction

Lateral Flexion

Cervical Flexion

Upper Back Stretch

Trapezius IV, Pectoralis Minor

Depression Dip - scapular depression

High Pully Scapular Depression - scapular depression

Purpose to develop strength and endurance of the lower trapezius and the scapular depressors; to promote scapular stabilit and better shoulder joint mechanics and posture; and to help reduce the incidence of neck fatigue and muscle spasm

Joint Action scapular depression

Muscles Used Trapezius IV and Pectoralis Minor

Setup if using a bench, support torso with heels of hands on bench, fingers pointing forward. Allow spine and pelvis to hang in a neutral line, hips and knees flexed, feet flat on floor. Start with scapulae elevated up towards ears.

Alignment

1. elbows slightly flexed (not hyperextended),
2. with neck, spine, and pelvis in neutral. The only moving joints are the scapulae;
3. keep elbows, spine, pelvis, and neck still.

Movement feel the shoulder blades sliding down the back of the ribcage as the scapulae are shrugged down (depressed) on an exhale. Inhaling, allow gravity to pul them back up to the ears (scapular elevation).

Safety

1. in order to avoid wrist stress, experiment with placing the heels of the hands close to the edge of the bench,
2. maintaining as neutral a wrist as possible.
3. Keep elbows slightly flexed in order to avoid elbow stress.

Engage engage and contract the scapular depressors. Triceps act only as elbow stabilizers.

Modifications for new/unskilled clients simply have them stand and elevate and depress the shoulder girdle to become familiar with the movement

Progression depression dips on a dip stand utilizing the entire bodyweight as resistance

Trapezius IV and Pectoralis Minor

scapular depression, cervical spinal lateral flexion, cervical spinal flexion, scapular protraction, and shoulder horizontal adduction

Lateral Flexion - stand or sit in proper alignment. Tilt head to side 

Cervical Flexion - stand or sit in proper alignment. Gently tilt head forward

Upper Back Stretch - stand or sit in proper alignment. Clasp hands together in front of body, allow shoulder to round forward, and feel the shoulder blades pull apart in the back. 

Trapezius I & II, Levator Scapulae

Shoulder Shrugs - scapular elevation

Purpose to develop muscle strength and endurance of the scapular depressors; to promote scapular stability and better shoulder joint mechanics and posture; and to help reduce the incidence of neck fatigue and muscle spasm.

Joint Action scapular depression

Muscles Used Trapezius IV and Pectoralis Minor

Setup sit at a high pulley (lat pull down) machine using a bar with a wide grip. With feet on floor, secure the legs under the stabilizing pad. Allow the bar attached to the high pulley to pull the scapulae up into elevation; starting position is up.

Alignment

1. hips flexed at 90^o, with pelvis, spine, and neck in neutral, and abdominals contracted.
2. Elbows are straight without being huperextended;
3. wrists are in neutral,
4. palms pronated,
5. wide grip.
6. The scapula are the only moving joints; shoulders and elbows do not move (unlike a lat pull down).

Movement starting with the scapulae elevated, slide and depress the scapulae down the ribcage, exhaling. Smoothly return to scapular elevation.

Safety

1. Avoid elbow hyperextension

Engage engage and contract the scapular depressors

Modifications  shoulder pain and cleared by Dr. avoid exercise. Instead try depression dips, prone propping, or standing, unresisted scapular elevation and depression to increase body awareness

Progressions - none listed

Trapezius IV and Pectoralis Minor

scapular depression, cervical spinal lateral flexion, cervical spinal flexion, scapular protraction, and shoulder horizontal adduction

Lateral Flexion

Cervical Flexion

Upper Back Stretch 

Trapezius I & II, Levator Scapulae

Shoulder Shrugs - scapular elevation

Purpose to develop strength and endurance in the front of shoulders and the upper chest

Joint Actions shoulder flexion

Muscles Used Anterior Deltoid, Pectoralis Major

Setup stand or sit in proper alignment; feet shoulder width apart. Starting position is down.

Alignment

1. in standing postion, feet are shoulder width apart,
2. knees slightly flexed,
3. with neck , spine, and pelvis in neutral alignment, abs contracted.
4. Elbows are fully extended but not hyperextended;
5. palms are pronated
6. with dumbbells or barbell against thights.
7. In seated position, feet are flat on floor, hips are flexed at 90^o, and spine and neck are in neutral.
8. Scapulae are depressed and in neutral in both poistions,
9. wrists and elbows are stabilized; abs are contracted to stabilize spine. The only moving joints are the shoulders.

Safety

seated, unilateral front raises are safer for the back than standing, bilateral raises.

1. If client is standing, take care to ensure that the torso is stable
2. and that there is no momentum.
3. Watch that the neck maintains a neutral position.
4. Aviod wrist breaking.
5. Be aware that the anterior deltoids tend to be overwoarked in activities of everyday living and are generally much stronger than the posterior deltoids; be cautious with too much emphasis on the anterior deltoids.

Engage engage and contract the anterior deltoids and the upper pectorals throughout both the concentric and eccentric phases.

Modifications shoulder pain and cleared by Dr. shorten ROM, perform exercise with thumbs up

back pain and cleared by Dr. perform exercise seated in weight room chair or standing, knees flexed, with back stabilized against a wall

Progressions FR facing away from low pulley; FR seated on stability ball; FR seated on stability ball, one foot up; FR standing on one leg; FR while performing a front or back lunge

Anterior Deltoid, Pectoralis Major

Pectoralis Major and Anterior Deltoid

Butterfly Chest Stretch shoulder horizontal abduction/extension

Standing Chest Stretch shoulder horizontal abduction/extension

Wall/Door Unilateral Chest Stretch shoulder horizontal abduction/extension

Anterior Deltoid 

Deltoid Stretch in Front - Stand or sit in proper alignment. Gently pull arm in front of body; maintain shoulder girdle depression; lightly support arm with opposite hand

Deltoid Stretch in Back - Stand or sit in proper alignment. Gently pull arm in back of body (elbow may be bent or straight), maintain shoulder girdle depression; lightly support arm with opposite hand

Posterior Deltoid, Latissimus Dorsi

Bent Over Row (Unilateral) - shoulder extension and elbow flexion

1. unilateral from low pulley
2. unilateral from low pulley on one leg
3. standing bilateral row (advanced clients only)

Seated Lat Row (Low Row) - shoulder extension, elbow flexion, and optional scapulae retraction

1. on ball
2. standing low row
3. standing low row on one leg
4. low row with tubing anchored while performing a back lunge

Lat Pullover - shoulder extension, scapular depression, scapular downward rotation, and scapular upward tilt

1. on ball
2. plyometric lat pull over with medicine ball on ball

Purpose to develop strength and endurance of the shoulder muscles

Joint Actions shoulder abduction and scapular upward rotation

Muscles Used Medial Deltoids, supraspinatus, Trapezius II and IV, Serratus Anterior

Setup stand or sit, holding dumbbells or tubing down at sides.

Alignment

1. in standing postition, feet shoulder width apart,
2. knees slightly flexed,
3. with neck, sine, and plevis in neutral alignment.
4. In seated position, feet are flat on floor, hips are flexed at 90^o, and neck and spine neutral.
5. Abs contracted;
6. scapulae are depressed and in neutral;
7. elbows slightly flexed,
8. and wrists are in neutral (arms hang down at sides, palms facing thighs). The only moving joints are the shoulders.
9. Wrists and elbows are stabilized.
10. Scapulae remain depressed and in neutral, neck stays in neutral. There should be no movement of the spine or legs.
11. Note that some experts recommend a a slight flexion at the hips (spine in neutral) in order for the medial deltoid to recieve optimal resistance against gravity.

Movement as the shoulders are abducted, maintain partial shoulder external rotation (palms should face the floor), and abduct shoulders only to 90^o (the greater the abduction, the more important the external ratation). Lead with the elbows, not the wrists. Exhale on the way up.

Safety

1. abducting the shoulders beyond 90^o while maintaining internal rotation may lead to impingement syndrome (the greater tubercle of the humerus abuts the acromion process and irritates soft tissue structures, especially the supraspinatus tendon).
2. Some experts recommend performing the entire exercise in external rotation (thumbs point up) as the shoulders abduct to 90^o.
3. Also, if standing in slight hip flexion as mentioned above, there is increased risk to the spine unless abs are sufficiently strong to maintain core stability throughout the set.

Engage engage and contract the deltoids throughout both the concentric and eccentric phases.

Modifications shoulder pain and cleared by Dr. decrease weights and ROM to less than 30^o, if pain pesists, discontinue exercise and perform front raises instead. Try bringing lat raise in front of the frontal plane (yellow zone)

back pain and cleared by Dr. perform seated on weight room chair

Progressions unilateral lat raise, unilateral lat raise at low pulley, lat raise on stability ball, one foot up, lat raise standing on one leg, lat raise while performing standing, one-leg hip abduction

Medial Deltoids, Supraspinatus, Trapezius II and IV, Serratus Anterior

Shoulder Adduction

Deltoid Stretch in Front - Stand or sit in proper alignment. Gently pull arm in front of body; maintain shoulder girdle depression; lightly support arm with opposite hand

Deltoid Stretch in Back - Stand or sit in proper alignment. Gently pull arm in back of body (elbow may be bent or straight), maintain shoulder girdle depression; lightly support arm with opposite hand

Latissimus Dorsi

Lat Pull Down Wide Grip - shoulder adduction, scapular downward rotation, and elbow flexion

1. kneeling
2. standing from high pulley

Bent Over Row - shoulder extension, elbow flexion

1. unilateral from low pulley
2. unilateral from low pulley on one leg
3. standing bilateral row (advanced only)

Seated Lat Row (Low Row) - shoulder extension, elbow flexion, scapular retraction

1. on ball
2. standing low row
3. low row with tubing anchored while performing a lunge

Lat Pull Over -shoulder extension, scapular depression, scapular downward rotation, and scapular upward tilt

1. on ball
2. plyometric lat pull over

Purpose to develop strength and endurance of the top of the shoulders and backs of the arms

Joint Actions Shoulder abduction, Elbow extension, Scapulae upward rotation

Muscles Used Deltoids, Supraspinatus, Triceps, Trapezius II and IV, Serratus Anterior 

Setup stand or sit in proper alignment. Start down with shoulders externally rotated and palms pronated (with dumbbells arms can be mid pronated facing ears).

Alignment

1. seated - feet flat on floor, hips flexed at 90 degrees, spine neutral,
2. scapulae depressed and adducted.
3. Standing - knees slightly flexed, with pelvis, spine, and neck in neutral and scapulae depressed and adducted.
4. Abs contracted,
5. hands slightly wider than shoulder width. Only shoulder , scapulae (in upward rotation), and elbows move.
6. Spine and neck should be stabilized, wrists in neutral, and shoulder elevation minimized.

Movement exhale when pressing up. Fully entend elbows without hyperextending; can perform bilaterally or unilaterally. Maintain scapular adduction and depression as weight is lifted. Barbell- lightly touch clavicle and press up in front of the face. Lower with control, inhaling on eccentric phase (way down).

Safety

1. perform exercise in front of the head.
2. Encourage client to use proper shoulder joint mechanics with humeral head depression.

Engage engage and contract deltoids and triceps. Isometrically contract the scapular retractors, the pectoralis minor, and lower trapezius to maintain depression

Modifications Shoulder pain and cleared by Dr. move arms in front of the frontal plane and more into the sagittal plane (JA becomes less shoulder abduction and more shoulder flexion); continue to press weights straight up. For some clients ROM will need to be decreased. Reduce weight lifted. Or perform OH press slightly inclined (20 degrees) on an inclined chair, which helps take the shoulder away from the riskier shoudler abduction and external rotation.

Back pain and cleared - perform on weight room chair

Progressions sit on stability ball with one foot up, perform OH press standing on one leg, combine OH press with squat, combine overhead press with Russian lunge

Deltoids, Supraspinatus, Trapezius II and IV, Serratus Anterior, Triceps

shoulder adduction

Deltoid Stretch in front

Deltoid Stretch in back

Latissimus Dorsi, Infraspinatus, Teres Minor, Middle Trapezius, Rhomboids, Biceps

Lat Pull Down (Wide Grip) - shoulder adduction, scapulae downward rotation, elbow flexion

1. kneeling
2. standing from high pulley

Bentover Row (Unilateral)- shoulder extension, elbow flexion

1. unilateral from low pulley
2. unilateral from low pulley on one leg
3. standing bilateral

Seated Lat Row (Low Row)- shoulder extension, elbow flexion, and scapulae retraction

1. on ball
2. standing low row
3. standing on one leg

Purpose to develop strength and endurance of the shoulders and biceps

Joint Actions Shoulder abduction, elbow flexion, and scapulae upward rotation and elevation

Muscles Used Deltoids, supraspinatus, biceps, trapezius II and IV, serratus anterior, trapezius I and II, and levator scapulae

Setup stand with feet shoulder width apart in proper alignment. Hands are in a pronated, narrow grip in front of thighs. Start down.

Alignment

1. knees slightly flexed, and pelvis, spine, and neck in neutral with abs contracted.
2. Sholders, scapulae, and elbows move.
3. Elevation of the scapulae at the beginning or at the end of ROM is an option if upper traps strengthening is a goal. (otherwise keep scapulae depressed).
4. Wrists stay as neutral as possible. Stabilize the lower body, keeping abs contracted.

Movement lead with elbows, not wrists. Keep barbell or dumbbells close to the body. If Upper trap work is a goal, lift elbows above shoulder level and elevate scapulae, otherwise shoulder abduction occurs only to 90 degrees or less. Exhale when lifting up.

Safety

1. tendency to lead with wrists and keep elbows down, increasing wrist stress.
2. Abduction above 90 degrees coupled with internal rotation may lead to shoulder impingment.
3. Keep abduction below 90 degrees
4. and minimize shoulder girdle elevation for optimum safety.

Engage engage and contract the deltoids, biceps, and upper trapezius

Modifications shoulder pain and cleared - avoid exercise

back pain and cleared - avoid exercise

Progressions perform upright row from low pulley 

Deltoids, Supraspinatus, Trapezius II and IV, Serratus Anterior, Biceps, Trapezius I and II, and Levator Scapulae

Deltoid Stretch in Front

Deltoid Stretch in Back

Biceps Stretch with Arms Behind

Biceps Stretch with Arms in Front

1. Latissimus Dorsi, Infraspinatus, Pectoralis Minor, Triceps, Rhomboids, Pectoralis Minor, Trapezius IV

Lat Pull Down (Wide Grip)- shoulder adduction, scapulae downward rotation, and elbow flexion

1. kneeling
2. standing from high pulley

Bent-Over Row (Unilateral)- shoulder extension and elbow flexion

1. on ball
2. unilateral from low pulley
3. unilateral from low pulley on one leg
4. standing bilateral

Seated Lat Row (Low Row) -shoulder extension, elbow flexion, and scapulae retraction

1. on ball
2. standing low row
3. standing low row on one leg

Lat Pull-Over- shoulder extension, scapulae depression, downward rotation, and upward tilt

1.  on ball
2. plyometric with medicine ball

Purpose to develop strength and endurance of the external rotator cuff muscles, to provide muscle balance against the powerful internal rotators of the shoulder, and to promote healthy shoulder joint functioning.

Joint Actions - External Rotation

Muscles Used - infraspinatus and teres minor (assisted by the posterior deltoid)

Setup sit or stand. Elbow on working side is pressed against ribs and is flexed at 90 degrees (a towel may be placed underarm for more comforatable alignment). Palm may be either supinated or mid-pronated. Start with palm in front of body and forearm perpendicular to torso.

Alignment Keep pelvis, spine, and neck in neutral, and abs contracted. Shoulders are the only joint moving. Elbow is stabilized against ribs and fixed at 90 degrees, wrist is locked in neutral, and scapulae are depressed.

Movement with elbow anchored against side, externally rotate shoulder (forearm will visibly move through horizontal plane at hip height). Movement should be slow and controlled during both phases of movement. Keep humerus depressed throughout ROM. Make band tighter or looser as necessary to fatigue the muscles and maintain proper form. Exhale on backward movement. May be performed unilaterally or bilaterally.

Safety shoulder external rotation should be performed frequently in order to help maintain healthy shoulders and prevent injury. Avoid forcing a large ROM; it is not necessary for the forearm to move completely into (or behind) the frontal plane.

Engage engage and contract the external rotators (infraspinatus and teres minor)

Modifications none listed

Progressions none listed

Infraspinatus, Teres Minor (Assisted by Posterior Deltoid)

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Subscapularis and Teres Major

Assisted by Anterior Deltoid, Pectoralis Major, Biceps, and Lattisimus Dorsi

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Purpose - to develop strength and endurance of the middle back and biceps muscles

Joint Actions - shoulder adduction, elbow flexion, scapulae downward rotation

Muscles Used - Latissimus Dorsi, Teres Major, Pectoralis Major, Pectoralis Minor, Rhomboids, Biceps, Brachialis, Brachioradialis

Setup sit or kneel. If seated, knees are placed under knee pad with hips flexed at 90 degrees. If kneeling, pelvis should be held in neutral position (avoid hip or spinal flexion). Start in up position, hands in wide, pronated grip.

Alignment

1. Keep shoulder blades back and down
2. Keep head in line with the spine
3. Keep wrists in neutral and elbows straight, but not hyperextended

Movement pull bar in front of the head towards the sternum, exhaling. Elbows should stay away from the body during pull-down release. Release bar upwards slowly, with control keeping the scapulae depressed.

Safety Use the pull down in front for safey of the client.

Engage and contract the latissimus dorsi prior to pull-down, maintaining a conscious contraction on the way down and on the way up.

Modifications -shoulder pain and cleared - avoid this exercise and sub a low row instead

Progressions kneeling lat pull down is harder to stabilize than seated, standing lat pull down from high pulley in a two cable column set-up; progress to unilateral lat pull down

Latissimus Dorsi, Teres Major, Pectoralis Major,  Biceps, Pectoralis Minor, Rhomboids,

shoulder flexion and shoulder abduction

Arms reach forward Lat stretch - bend over with one hand on thigh; contract abs for support. Reach opposite hand forward and diagonally off to opposite side; keep spine flexed

Unilateral Side Stretch for Lats - sit or stand in proper alignment. Reach one arm up and over; adding lumbar spinal lateral flexion is optional. Keep opposite hand on floor or thigh for support

Medial and Posterior Deltoids, Infraspinatus, Teres Minor, Trapezius, Serratus Anterior, Triceps

Lateral Raise

1. unilarerally

2. unilateral at low pulley

3. on ball

4. on ball one foot up

5. standing with one leg hip abduction

Overhead Press

1. on ball one foot up

2. standing on one leg

3. OH Press with Squat

4. OH Press with Russian Lunge

Upright Row

1. from low pulley

Triceps Dip

1. on ball

2. on foam roller

Tricep Kickback

1. standing bentover kickback

2. standing on one leg

3. prone on ball

Purpose to develop strength and endurance of the middle back and biceps

Joint Actions shoulder extension, elbow flexion

Muscles Used latissimus dorsi, pectoralis major sternal portion, teres major, biceps, brachialis, brachioradialis

**Trapezius III and Rhomboids contract strongly isometrically due to antigravity position

Setup half-kneel on bench. Same side hand and knee are on bench; working side has extended leg with foot on floor. Dumbbell is held with mid-pronated palm (facing bench). Starting position is straight down.

Alignment

1. back straight and parallel to floor
2. head in line with spine
3. shoulder blades back and down

Movement

• exhale as weight is lifted
• keep working arm close to the body
• lower weight slowly maintaining shoulder blade contraction

Safety

1. Abs contracted to help stabilize spine
2. lower the weight slowly
3. extend the elbow, but do not go into hyperextension

Engagement

• engage and contract the lattisimus dorsi, teres major, pectoralis major, and the biceps

Modifications 

• back pain - sub a seated low row, because it is easier to stabilize

Progressions

• unilateral bent over row from a low pulley
• unilateral bent over row from a low pulley on one leg
• standing bilateral bent over row (adv clients only)

Latissimus Dorsi, Teres Major, Pectoralis Major, Biceps

Lats

1. Arms Reach Forward Lat Stretch

2. Unilateral Side Stretch for Lat

Pectoralis Major

1. Butterfly Chest Stretch

2. Wall/Doorway Chest Stretch

3. Standing Chest Stretch

Biceps

1. Double arm biceps stretch behind back

2. Biceps stretch arm in front

Pectoralis Major, Anterior Deltoid, Triceps

Bench Press

1. on ball

2. unilateral arm movement

Triceps Dip

1. on ball

2. on foam roller

Purpose to develop strength and endurance of the middle back and back of the arm.

Joint Actions shoulder extension and elbow flexion

Optional scapular retraction

Muscles Used -latissimus dorsi, teres major, biceps

Optional trapezius III, rhomboids

Setup sit with hips flexed 90 degrees. If seated on floor or low pad, knees should also be flexed. Start with arms out, elbows soft, and palms facing each other. (if using bar, take a narrow, pronated grip)

Alignment

1. Keep shoulder blades back and down
2. lift chest, keep lower back still, and torso and neck in neutral.
3. Moving joints are the shoulders and elbows. Every other joint should be still.

Movement exhale while pulling back on the band/bar, pull handles to lower chest, leading with the elbows. Keep torso upright throughout movement.

Safety

1. remember to breath throughout the movement
2. keep abs contracted
3. Keep knees soft

Engage engage and contract the latissimus dorsi and the biceps

Modifications -none listed

Progressions

• seated low row on stability ball
• standing low row
• standing low row on one leg
• low row with anchored tubing while performaing a back lunge

Latissimus Dorsi, Biceps

Arms Reach forward Lat Stretch

Unilateral Side Stretch for Lats

Biceps Stretch arms behind

Biceps Stretch arm in front

Deltoids

Front Raise

1. facing away from low pulley

2 on stability ball

3. on ball one foot up

4. standing on one leg

5 while performing a lunge

Triceps

Triceps Dips

1. on ball

2. on foam roller

Purpose to develop strength and endurance of the middle back muscles

Joint Actions - shoulder extension, scapular depression, scapular downward rotation, scapular upward tilt

Muscles Used - latissimus dorsi, pectoralis major, teres major, pectoralis minor, trapezius IV, rhomboids

Setup lie supine on bench, feet flat on floor or one bench. End of bench should support head, neck matural alignment. Hold barbell with narrow, pronate grip over the lower chest; elbows flexed at sides with wrists locked. If using dumbbell cup both hands on end of dumbbell

Alignment

1. pelvis, spine, and neck neutral or press lumbar spine into bench with posterior pelvic tilt
2. stabilize elbows in flexd position
3. abs contracted
4. shoulders and scapulae move

Movement

1. move weight over face, behind the head and toward the floor
2. exhale as elbows are pulled back toward sides of chest
3. keep movement slow and controlled

Safety

1. perform slowly with control during eccentric phase
2. avoid back arching
3. contract abs
4. avoid elbows flaring out

Engage engage and contract the pectoralis major and latissimus dorsi. Keep abs isometrically contracted throughtout exercise

Modifications

shoulder pain or back pain - avoid exercise

Progressions

1. on ball
2. plyometric on ball with medicine ball

Pectoralis Major, Latissimus Dorsi, Teres Major, Pectoralis Minor, Trapezius IV, Rhomboids

1. Butterfly Chest Stretch
2. Lat reach overhead 

Pectoralis Major, Anterior Deltoids, Posterior Deltoids, Upper Trapezius, Levator Scapulae

Bench Press

1. on stability ball
2. unilateral arm movement

Purpose to develop stength and endurace of the back of the arms

Joint Actions elbow extension

Muscles Used Triceps

Setup 

·         ½ kneel on bench

·         Same side hand and knee are on bench

·         Working side has extended leg with foot flat on floor

·         Dumbbell is held at side with elbow flexed at 90 degrees

Alignment

1.   Torso stays parallel to floor

2.   Elbow is flexed at 90 degrees with wrist straight

3.   Shoulder blades are back and down

Movement

·         Elbow extends fully without hyperextending

·         Return elbow to 90 degrees of flexion

Safety

1.   Exhale as elbow extends

2.   Movement should be slow and controlled (no slamming elbow)

3.   Brace core to help protect back and maintain neutral spine

Engage - Engage the triceps. Isometrically contract the latissimus dorsi, pectoralis major, teres major, posterior deltoid, mid-trapezius, and rhomboids

Modifications

if client unable to maintain alignment try a triceps press down or a supine unilateral triceps extension

Progressions

1. standing bilateral bentover triceps kickbacks

2. standing triceps kickbacks on one leg

3. prone triceps extension on ball

Biceps, Posterior Deltoid, Latissimus Dorsi

Alternate Biceps Curl

1. on ball

2. standing on one leg

Bent over Row

1. on ball

2. bilateral bent over

Purpose - to develop strength and endurance of the front of the arms

Joint Actions - elbow flexion, radioulnar supination

Muscles Used - Biceps, supinator

Setup

- stand or sit in proper alignment

- palms face sides of body

- starting position is down

Alignment

1. in standing position, knees are slightly flexed, with pelvis, spine, and neck in neutral.

2. If seated, hips are flexed to 90 degrees with spine and neck in neutral

3. Shoulder blades back and down

4. Shoulders stay still; scapulae, neck, spine all stabilized, wrists are neutral

Movement

- palm supinates graually as weight is lifted

- Inhale to gradually return to mid-pronation as weight is lowered.

- Repeat other side

Safety

1. avoid wrists breaking

2. exhale as you lift the weight slowly

3. brace the abs to keep spine, neck, and pelvis in neutral

4. keep shoulders back and down with chest lifted

Engage - engage the biceps in both phases of movement

Biceps

1. Behind the back double arm biceps stretch

2. One Arm in Front Biceps Stretch

Modifications

back pain - sit instead of stand or stand against wall with knees flexed

Progressions

1. curls on incline bench arms hanging straight down

2. curls on ball

3. curls on ball one leg up

4. curls standing on one leg

Triceps, Pronators

Tricep Dip

1. on ball

2. on foam roller

3. on ball one leg up

Purpose - to develop strength and endurance of the front of the arms

Joint Actions - elbow flexion

Muscles Used - biceps, brachialis, brachioradialis

Setup

- sit placing elbow of working arm on inside thigh

- opposite hand is placed on opposite thigh or behind working arm for support

- feel flat on floor and hips flexed

- dumbbell held with a supinated grip and neutral wrist

- start with elbow extended

Alignment

1. flexion should occur at hip only

2. spine, neck are neutral and stabilized

3. shoulder blades back and down

Movement

- bring weight up toward shoulder

- use slow controlled movement

Safety

1. keep wrists from breaking

2. exhale as you lift the weight toward shoulder

3. abs contracted and shoulders down

4. extend elbow, but be careful not to move into hyperextension

Engage - engage and contract the biceps

Biceps

1. Behind the back double arm biceps stretch

2. One arm in front biceps stretch

Modifications

back pain - avoid this exercise, do weight room chair biceps exercises instead

Progressions

seated on ball

Triceps

Triceps Kickback/Extension

1. perform on ball

2. bilateral bent over kickback

3. standing kickback on one leg

Purpose - to develop strength and endurance of the back of the arms

Joint Actions - elbow flexion

Muscles Used - biceps, brachioradialis, brachialis

Setup

- stand in proper alignment

- hold bar in supinated, shoulder width grip

- start position is down

Alignment

1. keep knees slightly bent

2. pelvis, spine, and neck neutral

3. shoulder blades back and down

4. elbows extended and upper arms are tight agianst the body

Movement

- keep arms pressed against ribs as you lift weight to shoulder

Safety

1. keep torso still and isolate movement in the biceps

2. abs in and braced

3. allow elbows to extend at the bottom of the ROM without hyperextension

4. exhale as you lift weight to shoulders

Engage - engage and contract biceps, brachialis, and briachioradialis in both phases. An isometric contraction at the top is recommended by many experts.

Biceps

Behind the back double arm biceps stretch

One arm in front single biceps stretch

Modifications

back pain - stand against a wall

Progressions

1. stand on one leg

2. at low pulley stand on 1/2 foam roller

Triceps

Triceps Dip

1. on ball

2. on foam roller

Purpose -to develop strength and endurnace of the front of the arms with greater emphasis on the brachialis

Joint Actions - elbow flexion

Muscles Used - Biceps, brachialis, brachioradialis

Setup

- stand in proper alignment

- hands pronated on barbell or dumbbells (palm facing floor)

- if using dumbbells can perform seated

Alignment

1. knees are flexed

2. pelvis, spine, and neck in neutral and stabilized

3. elbows extended with upper arm tight against body

Movement

- keep arms against ribs as weight is brought up to shoulders

- extend arm fully without hyperextending

Safety

1. Exhale as you lift bar to shoulders

2. keep torso still

3. keep shoulders back and down

4. keep chest lifted

Engage - engage biceps, brachialis, brachioradiais. Experts recommend slight isometric hold at top of movement

Biceps

1. Behind the back double arm biceps stretch

2. Arm in front single arm biceps stretch

Modifications

back pain - stand against a wall

Progressions

1. on one leg

2. at low pulley one leg on 1/2 foam roller

Triceps

Triceps Dips

1. on ball

2. on foam roller

Triceps Kickback

1. bilateral bent over kickback

2. prone on stability ball

3. standing on one leg

Purpose - to develop body awareness, teach neutral spine and abdominal hallowing, and provide a mild stimulus for the abs

Joint Actions - lumbar flexion, posterior pelvic tilt

Muscles Used - rectus abdominis

Setup

- lie supine on mat with knees flexed

- feet flat on floor

- and arms at sides

Alignment

1. pelvis, scapulae, and neck in neutral

2. very slight lift under lower back to maintain a natural lordotic curve

3. relax upper body and gluteals

Movement

- posteriorly tilt pelvis though full ROM (approx 10 degrees)

- using only abs press low back and sacrum to floor

- pull abs in toward spine on exhale

Safety

1. return spine to neutral

2. keep pelvis and lower back from arching on return

3. exhale as you draw belly in to spine

Engage - engage and contract the transverse abdominis and the rectus abdominis.

Rectus Abdominis and Transverse Abdominis

Prone Modified Cobra

- propped on elbows, press pubic bone down

- extend the spine upward with neck in line with spine

- shoulder blades back and down

Supine Pencil Stretch

- straight line with body

- reach toes and fingers as far as possible to opposite directions

Modifications - none listed

Progressions

1. on incline board

2. on ball

Erector Spinae

Prone Back Extension

1. on ball

2. on ball with one leg up

3. add spinal rotation 

Purpose - to develop strength and endurance of the abdominals

Joint Actions - lumbar flexion, posterior pelvic tilt

Muscles Used - rectus abdominis, internal and external obliques

Setup

- lie supine with legs elevated

- hips are flexed at 90 degress

- knees may be flexed or straight

- hands at sides, crossed on chest, behing head etc

Alignment

1. hips are stabilized and kept in one position throughout exercise (no hip flexion or extension)

2. knees are stabilized

3. neck stays in line with spine

Movement

- posteriorly tilt pelvis using only the abs and curl the lower torso up

- pull the abs in so that the pubic bone rises higher than the navel; tip tailbone upwards

Safety

1. controlled spinal flexion must be performed in order to work abs

2. prevent legs from dropping toward floor

3. exhale as you curl up the lower torso

4. pull abs in toward spine

5. Use controlled movement and avoid swinging legs

6. breathe throughout movement

Engage - engage and contract the abdominals. Concentrate on pulling the lower area in an feeling the pull on the pubic bone 

Rectus Abdominis, External, and Internal Obliques

Prone Modified Cobra Stretch

Supine Pencil Stretch for Abdominals

Supine knee Down Twist

- pull knees toward torso

- slowly rotate torso, lowering knees to floor

- reach opposite arm away and press opposite shoulder to floor

Seated Knee to Chest Twist

- cross on knee over opposite leg and place the foot flat on the floor

- hug knee to chest with opposite arm

- lengthening the spine upwards, rotate spine in the direction of the bent knee, looking back over shoulder

Modifications

back pain - avoid this exercise; perform ab curls with feet flat on floor or elevated on chair instead

Progressions

1. incline the body on a slant board, hands holding on above the head

Erector Spinae

Supine Double Knee to Chest Stretch

- pull both knees toward chest, holding behind the knees.

- allow the pelvis to posteriorly tilt and the lower spine to flex

All fours Angry Cat

- kneel on hands and knees in tabletop

- flex spine with head and tailbone down and abs liftend

Standing Angry Cat

- bend over with hands on thighs

- flex spine with head and neck continuing the line of the spine, contract the abs

Rectus Abdominis, Internal, and External Obliques

Prone Modified Cobra Stretch

Supine Pencil Stretch for the Abdominals

Supine Knee Down Twist

Seated Knee to Chest Stretch

Erector Spinae

Supine Back Extension

1. on ball

2. on ball one leg up

3. add rotation to the spinal extension

Purpose -to develop strength and endurance of the abdominals

Joint Actions - spine flexion

Muscles Used - rectus abdominis, external, and internal obliques

Modifications

back pain - perform exercise with feet supported on wall or bench with knees flexed at 90 degrees

- instruct client to imprint spine into floor

neck pain - gently support head with one or both hands behind ears

- remind client to relax neck and contract the abs

- rest neck (turning it from side to side) as often as necessary

Progressions

1. curls declined on slant bench

2. on ball either flat or declined

3. on ball one leg up

4. on ball holding tubing anchored on wall behind head

5. curls adding lower body movement

Setup

- lie supine

- keep knees flexed with feet flat on floor a comforatable distance from hips

- starting position is down

Alignment

1. spine and neck are neutral (or spine can be imprinted)

2. hands and arms can be at sides, on chest, fingers behind ears etc

3. entire spinal column moves and curves into flexion

Movement

- pull ribs toward pubic bone and pull pubic bone toward ribs (draw ribs and hip bones together)

- full range of spinal flexion is about 40 degrees

- shoulder blades lift off floor

- neck is stablilized and continues the line of the spine

Safety

1. use abs for movement - no neck jerking or pulling

2. exhale on the lift inhale on the lower

3. keep movement slow and controlled with focused awareness on abs

4. keep abs pulled in towards spine throughout movement

Engage - engage and contract the abdominals, pulling them in hard while exhaling and lifting. Add an isometric contraction at the top to increase difficulty

Purpose - to develop strength and endurance of the abdominal muscles

Joint Actions - spinal flexion with rotation

Muscles Used - external and internal obliques

Setup

- lie supine

- legs may be elevated, ankels crossed, feet flat on floor, hands behind head, reaching toward legs etc.

-Spine and neck in neutral alignment

Alignment

1. Neck is stabilized and has no independent movement

2. if hand(s) behind head, shoulder and elbow joints are stabilized to isolate obliques

3. Lower body stabilized in order to isolate the obliques.

Movement

- cross on one side of the upper torso diagonally across toward the opposite hip

- shoulder blade lift off floor

Safety

1. use the abdominals for the movement not the neck

2. keep the movement slow and controlled

3. exhale as you lift the upper body across and bring opposite shoulder toward knee, but keep elbow in stabilized

Engage - engage and contract the obliques. Add an isometric contration at the top to increase the difficulty

Internal and External Obliques

Supine Knee Down Twist

Seated Knee to Chest Stretch 

Modifications

back pain - support feet on bench to facilitate lumbar flexion and to help prevent spinal extension on the down phase

neck pain - gently support head with one or both hands behind ears. Rest head and neck frequently.

Progressions

1. on decline slant board

2. on ball

3. on ball one leg up

4. add lower body movement

Erector Spinae

Supine Back Extension

1. on ball

2. on ball one leg up

3. add rotation  

Purpose - to develop strength and endurance of the lower back

Joint Actions - Spinal (lumbar and thoracic) extension

Muscles Used - Erector Spinae

Setup

- lie prone with forehead on mat and neck in neutral alignment

- hips pressed to floor with gluteals contracted

- for modified cobra - elbows are flexed and pressed into sides with palms on floor

- for other variations - arms can be in neutral at sides, or flexed overhead and resting on mat

Alignment

1. spine and neck are neutral

2. shoulder blades back and down

3. Hips are stabilized against floor

Movement

- slowly press up onto elbows hold for a few seconds and return to start slowly

Safety

1. avoid hyperextending the back

2. control movement in both directions (slow and controlled)

3. neck needs to extend with the movement, but avoid hyperextension -  has no independent movement

Engage - engage the erector spinae. Isometrically contract the cervical extensors, the scapular retractors, and the buttocks

Modifications

low back pain - reducing ROM significantly; have client lie prone an lift the head, neck, and chest only an inch or two off floor; hold and breathe. If pain persists avoid exercise

Progressions

1. on ball

2. on ball on leg lifter

3. add rotation

Erector Spinae

Supine Double Knee to Chest Stretch

- Lie supine and pull both knees into chest holding behind the knees. Allow the pelvis to posteriorly tilt and lower the spine to flex

All-Fours Angry Cat

- kneel on hands and knees in tabletop, flex spine with head and tailbone down and abs lifted

Standing Angry Cat

- stand with hands on thighs and bendover; flex spine with head and neck continuing line of the spine, contract abs

Rectus Abdominis and Internal & External Obliques

Abdominal Curl

1. on ball

2. on ball one leg up

Reverse Curl

1. on slant board with arms holding on overhead

Purpose - to learn to maintain a neutral alignment in the all fours position; to promote balance

Joint Actions - Isometrically contact the shoulder in flexion, the hip in extension, the abs

Muscles used

Torso

- rectus abdominis, external and internal obliques, transverse abdominis, quadratus lumborum, erector spinae, multifidus

Scapular

- trapezius, rhomboids, pectoralis minor, serratus anterior, levator scapulae

Setup

- on hands and knees in ideal alignment on a mat

Alignment

1. Pelvis, spine, and neck in neutral

2. Hips and shoulders level, forming an even rectangle when viewing from above.

3. Abs lifted and contracted

4. Hands directly under shoulders, knees under hips, elbows slightly flexed with fingers pointing straight

Movement

- exercise is performed completely statically: one leg lifts so that the leg is in line with spine

- opposite arm is lifted also in line with spine, parallel to floor

- hold this position for several seconds and switch sides

Safety

1. Abs remain lifted and contracted to protect spine

2. neck stabilized and extended without hyperextension

3. scapulae are back and down

Engage - engage all spinal and scapular stabilizing muscles simultaneously and isometrically

Torso

- rectus abdominis, external and internal obliques, transverse abdominis, quadratus lumborum, erector spinae, multifidus

Scapular

- trapezius, rhomboids, pectoralis minor, serratus anterior, levator scapulae

Prone Pencil Stretch

Modified Cobra Stretch

Supine Knee Down Stretch

Seated Knee to Chest Stretch

Modifications

poor core stability and or balance problems - place a stability ball under the torso (small enough that torso is still parallel to floor): allow core to rest on the ball while performing the quadruped

Progressions

1. one knee balancing on Bosu ball while opposite hand balances on a medicine ball

Purpose - to learn to maintain neutral alignment in the plank position and provide a significant challenge to the core stabilizer muscles

Joint Actions - Spinal, Abdominal, and Scapular Stabilization

Muscles Used

Torso

- rectus abdominis, external and internal obliques, transverse abdominis, quadratus lumborum, erector spinae, multifidus

Scapular

- trapezius, rhomboids, pectoralis minor, serratus anterior, levator scapulae

Setup

- on hands and toes with torso in neutral alignement

Alignment

1. hands under shoulders, fingers spread wide, elbow just slightly flexed

2. pelvis, spine, and neck in neutral alignment with abs tight

3. Hips and shoulders are level

4. Scapulae depressed and neutral

5. Straight line from head to heels

Movement

- held without movement for 10-60 seconds

- no moving joints

Safety

1. maintain neutral spine without hyperextension

2. brace abs to protect back

3. for less skille, perform on knees

4. breathe throughout the hold

Engage - engage and contract all spinal and scapular stabilizing muscles simultaneously and isometrically

Supine Pencil Stretch

Prone Modified Cobra

All Fours Angry Cat

Standing Angry Cat

Supine Knee Down Twist

Modifications

back pain - plank on knees

wrist pain - on elbows and forearms

Progressions

1. one leg up

2. perform basic plank lower into hover and hold

3. side plank one hand with legs straight feet stacked on top of each other

4. side plank on one hand with one leg straight the other held in abduction

5. basic plank, move to side plank on one side, repeat on other side

Purpose - to develop strength and endurance of the quadriceps - rectus femoris, vastus medialis, vastus lateralis, vastus intermedius

Joint Actions - Knee Extension

Muscles Used - Quadriceps (rectus femoris, vastus medialis, vastus lateralis, vastus intermedius)

Setup

- adjust machine so axis of rotation lines up with knee joint

- Knees flexed at slightly more than 90 degrees

- If using bench with ankle weights, place hands at sides for support

Alignment

1. Press back into pad

2. Maintain a neutral spine, neck, and shoulder blades

3. Keep hips, spine, and neck stabilized

Movement

- extend knees fully

- an isometric contraction may be held at top

Safety

1. Exhale as knees extend

2. Keep movement slow and controlled

3. Be very cautious with heavy weight due to the greater than 90 degree of flexion starting position

4. keep hips and back still; back pressed against seat

Engage - engage and contract the quadriceps and isometrically contract abs to press back to seat 

Quadriceps

1. Standing Quad Stretch

2. Prone Quad Stretch

3. Side-Lying Quad Stretch

Modifications

Knee pain - reduce weight and use ROM limiters if available on machine; if pain persists avoid this exercise and use short arc quad exercises (place towel under knee and slightly extend to strengthen quads)

Progressions

1. Seated unilateral knee extension on ball with elastic band around ankle

2. standing unilateral knee extension with band around ankle

Hamstrings

Knee Flexion Machine

1. standing unilateral knee flextion with elastic band around ankle

Purpose - to develop strength and endurance of the hamstrings

Joint Actions - Knee Flexion

Muscles Used - Hamstrings (semitendinosis, semimembranosis, biceps femoris)

Setup

- sit, stand, or lie prone depending on machine

- in all cases hip action is neutralized

- if prone on flat bench, gluteals should be contracted to press hips down and kneecaps should be just off the bench

- if standing - neutral pelvis and spine should be maintained

- sitting - press back, neck and head against pad

Alignment

1. Keep pelvis, spine, scapulae, and neck in neutral

2. contract abs

3. keep hips still

Movement

- exhale as knees flex

- bring heels as close to buttocks as possible

Safety

1. extend knees to full ROM without hyperextending

2. Use ROM limiters if necessary to prevent knees from going into uncomforatable position

3. abs in and back pressed against pad

Hamstrings

Standing Hamstrings Stretch

- stand with one foot on a chair, bench, or bar. Safest if one hand can be placed on a nearby object or on the leg for support

- square the hips and torso in the direction of the leg to be stretched, and slowly hinge the hips in the direction fo the leg. Maintain a neutral spine and neck as long as possible. Contract the abs. Avoid flexing the spine if possible and avoid hyperextending the knees.

Supine Hamstring Stretch

Seated Unilateral Hamstring Stretch - modified hurdler's stretch

Modifications

back pain - prone standing hamstring machines are higher risk if those are the only available machines substitute a supine buttock squeeze on the floor or supine knee flexion with feet on stability ball

Progression

1. Standing Unilateral knee flexion with elastic band around ankles

Quadriceps

Knee Extension

1. Standing Unilateral knee extension with band around ankle

Leg Press or Leg Sled Machine

1. Perform Unilaterally

2. Add ankle plantar flexion and dorsiflexion; flex knees and hips bakc to starting position

Purpose -to develop strength and endurance of the lower body muscles

Joint Actions - hip extension, knee extension, ankle plantar flexion

Muscles Used - gluteus maximus, hamstrings, quadriceps, gastrocnemius, soleus

Setup

- sit or lie supine

- adjust seat or foot pad so that knees are flexed at 90 degrees and feet are flat on footpad

Alignment

1. Pelvis, spine, neck, and scapulae are in neutral

2. Hips stabilized in neutral, spine and neck do not move

3. Abs contracted

Movement

- hips and knees extend

- knees come to full extension in a controlled manner without hyperextension

- return to flexion

Safety

1. keep movement slow and controlled without snapping and jerking

2. keep knees soft (no locking of the knees)

3. keep knees from going much beyond 90 degrees of flexion

4. keep back still and abs contracted

5. keep foot position so that slipping off the footpad is not a problem

Engage - engage and contract the gluteus maximus, hamstrings, and quadriceps. Isometrically contract the abdominals to maintain the back against the seat.

Quadriceps, Hamstrings, Gluteus Maximus

Standing Quad Stretch

Prone Quad Stretch

Side-lying Quad Stretch

Standing Hamstring foot on chair

Supine Hamstring Stretch

Seated Unilateral Hamstring Stretch - Modified Hurdler

Supine Double Knee to Chest Stretch - glutes

Seated Knee to Chest Stretch - glutes

Modifications

knee or back pain - decrease ROM and reduce weight

Progressions

1. perform unilaterally

2. perform ankle plantar flexion and dorsiflextion when knees and hips extended

Dorsiflexion - Anterior Tibialis, Extensor Digitorum Longus

Ankle Dorsiflexion

1. band resiste dorsiflexion

Hip Flexion - Illiopsoas, Rectus Femoris

Standing Hip Flexion

1. standing hip flexion at low pulley

2. standing hip flexion at low pulley on 1/2 foam roller

Purpose -to develop strength and endurance of the lower body

Joint Actions - hip extension, knee extension, ankle plantar flexion

Muscles Used - gluteus maximus, hamstrings, quadriceps, gastrocnemius, soleus

Setup

- stand feet shoulder width apart

- toes facing forward

- hands slightly wider than shoulder width pronated closed grip on bar

- rest barbell on posterior deltoids

- starting position is up

Alignment

1. Shouder blades are back and down

2. Pelvis, head, neck, and spine in neutral and stabilized

3. Knees soft

Movement

- hinge from the hip and lower weight while flexing hips and knees

- Shift middle 3rd of body back so knees don't overbend and overshoot toes

- Lower until thighs are almost parallel to the floor, keeping torso erect, chest lifted, and head in line with spine

- exhale and extend knees and hips, bringing pelvis back to neutral

- lift with legs and buttocks not back

- keep heels nailed to the floor

Safety

1. use collars and evenly load the bar

2. keep hips just above the knees

3. keep knees behind toes

4. inhale on eccentric phase and exhale as you lift the weight back to neutral

Engage - engage the gluteus maximus, hamstrings, quadriceps, gastrocnemius, and soleus. Contract erector spinae and abs throughout movement

Modifications

deconditioned clients - sitback squat

knee pain - sit back squat with limited ROM or wall squat with stability ball

back pain- wall squat with stability ball

Progressions

1. squat with heel raise

2. squat with hip abduction on one side; alternate

3. single-leg squat

4. plyometric squat

Gluteus Maximus, Hamstrings, Quadriceps, Gastrocnemis, Soleus

Supine Double knee to Chest Stretch - Glutes

Seated Knee to Chest Stretch - Glutes

Supine Hamstrings Stretch

Standing Hamstrings Stretch with one foot on chair

Standing Quad Stretch

Prone Quad Stretch

Supine Quad Stretch

Standing Calf Stretch

Seated Calf Stretch - dorsiflex ankles, bringing toes toward knees and pushing heels away. or use strap to pull forefeet towards knees.

Dorsiflexion - Anterior Tibialis, Extensor Digitorum Longus

Ankle Dorsiflexion

1. band resiste dorsiflexion

Hip Flexion - Illiopsoas, Rectus Femoris

Standing Hip Flexion

1. standing hip flexion at low pulley

2. standing hip flexion at low pulley on 1/2 foam roller

Purpose -to develp strength and endurance of the lower body

Joint Actions - Hips extension, knee extension, ankle plantar flexion

Muscles Used - Gluteus Maximus, Hamstrings, Quadriceps, Gastrocnemius, Soleus

Setup

- stand in proper alignment.

- Dumbbells may be held at sides with palms facing body

- Barbell is held in same place as for squats

- Feet are shoulder width apart with toes pointing straight ahead

Alignment

1. Pelvis, spine, neck, scapulae are in neutral

2. knees slightly flexed and abs contracted

3. keep torso upright

Movement

- lead leg takes big step forward, landing heel first

- knee flexeds until front thigh is parallel to the floor

- front knee should flex no more than 90 degrees and knees stay behind toes

- back knee either bent to no more than 90 degrees (easier) or straight

- back heel stays up

- torso stays upright and stabilized throughout both phases

- exhale on return, one or two stutter steps are acceptable if balance is an issue

Safety

1. back knee stays slightly above floor

2. use slow controlled movement in both directions

3. Keep hips, knees, and ankles all pointing in the same direction

4. Exhale on the return

Engage - engage the gluteus maximus, hamstrings, quadriceps, gastrocnemius, and soleus. Isometrically contract the abs, scapular adductors, and erector spinae

Modifications

knee pain - avoid this exercise

back pain - try a stationary lunge at the Smith Press with no weight. If pain persists avoid exercise

Progressions

1. Traveling front, side, back, or Russian

2. lunge with back foot on slideboard

3. lunge with front foot on slideboard

4. plyometric lunge

Gluteus Maximus, Hamstrings, Quadriceps, Gastrocnemius, and Soleus

Supine Double knee to Chest Stretch - Glutes

Seated Knee to Chest Stretch - Glutes

Supine Hamstrings Stretch

Standing Hamstrings Stretch with one foot on chair

Standing Quad Stretch

Prone Quad Stretch

Supine Quad Stretch

Standing Calf Stretch

Seated Calf Stretch - dorsiflex ankles, bringing toes toward knees and pushing heels away. or use strap to pull forefeet towards knees.

Dorsiflexion - Anterior Tibialis, Extensor Digitorum Longus

Ankle Dorsiflexion

1. band resiste dorsiflexion

Hip Flexion - Illiopsoas, Rectus Femoris

Standing Hip Flexion

1. standing hip flexion at low pulley

2. standing hip flexion at low pulley on 1/2 foam roller

Purpose - to develop strength and endurance of the lower body

Joint Actions - Hip Flexion, Abduction, Adduction, Extension

Muscles Used - Illiopsoas, Rectus Femoris, Gluteus Medius, Adductor Longus, Adductor Brevis, Adductor Magnus, Gracilis, Pectineus, Gluteus Maximus, Hamstrings

Setup

- adjust floor pad so that when client sits on it, one hip lines up with the machine's pivot point or axis of rotation

- adjust machine for exercise desired

- thigh should rest against middle part of thigh, and body should be positioned for the appropriate joint action can be performed through full ROM

Alignment

1. knees slightly flexed

2. pelvis, spine, neck, and scapulae are in neutral with abs contracted

3. knees, spine, shoulder, and neck are stabilized

4. Pelvis remains in neutral pelvic alignment throughout exercise

Movement

- exhale as hip abducts, flexes, adducts, or extends

- Move leg through its full ROM, lifting as high as possible within the context of a stable pelvis (no pelvic movement)

Safety

1. lack of core (pelvic) stability can lead to back or hip injury

2. keep movement slow and controlled throughout exercise

3. brace the core

4. exhale on the concentric phase and inhale on eccentric phase

Engage - contract the prime movers for the hip movement

Flexion - iliopsoas, rectus femoris

Abduction - gluteus medius

Adduction - hip adductors

Extension - gluteus maximus, hamstrings

Hip Flexion - Iliopsoas, Rectus Femoris

Standing hip flexor stretch

Runners Lunge

Supoine Hip Flexor Stretch - bring knee to chest

Hip Abduction - Gluteus Medius

Figure Four Stretch

Side-Lying Abductor Stretch - bring bottom leg forward on floor knee bent. Place top thigh directly in line with the torso adn bend top knee to 90 degree angle. Lower top knee toward floor without flexing at the hip.

Hip Adduction - Adductor Longus, Adductor Medius, Adductor Brevis, Gracilis, Pectineus

Seated Straddle Stretch - hands behind you leaning slightly forward

Standing Side Lunge

Hip Extension - Glueteus Maximus, Hamstrings

Seated knee to Chest Stretch

Double knee to Chest Stretch

Standing Hamstring Stretch

Supine Hamstring Stretch

Modifications

back pain - avoid this exercise

1. instead perform hip abduction and adduction in a side-lying position

2. perform hip extention in the prone position

3. avoid weight bearing hip flexion

Progressions

1. standing hip abduction, adduction, extension, flexion at low pulley

2. standing at low pulley standing at low pulley

Hip Flexion - Opposing Hip Extension (Gluteus Maximus, Hamstrings)

Squat

1. squat with heel raise

2. squat with hip abduction on one side; alternate

3. single-leg squat

4. plyometric squat

Lunge

1. Traveling front, side, back, or Russian

2. lunge with back foot on slideboard

3. lunge with front foot on slideboard

4. plyometric lunge

Hip Abduction - Hip Adduction (Adductors)

Hip Adduction Side-Lying

1. Use ankle weights

2. perform with a stability ball held between lower legs; lift both legs laterally simultaneously

Hip Adduction - Hip Abduction (Gluteus Medius)

Hip Abduction Side-Lying

1. Use Ankle Weights

2. Perform planked on a stability ball

Hip Extension - Hip Flexion (Iliopsoas, Rectus Femoris)

Multi-Hip Machine Hip Flexion

1. stand at low pulley

2. stand at low pulley on half foam roller

Purpose - to develop strength and endurance of the outer thigh muscles

Joint Actions - Hip Abduction

Muscles Used - Gluteus Medius

Setup

- rest head on arm and stack hips

- move top leg out of the way of the working leg by flexing the top hip and positioning the top leg so that the hips remain stacked (top leg can rest on low bench or knee can be slightly elevated or one the floor)

- bottom leg may have either a flexed or extended knee

Alignment

1. Maintain stacked hips

2. Pelvis, spine, neck, and scapulae in neutral

3. Head and neck should continue the line of the spine

Movement

- move working leg through full ROM; as high as possible without distorting or changing the hips

- keep the knee the working leg facing forward

- exhale as leg lifts inhale on the lower

Safety

1. Avoid the couch-potato position for the head and neck

2. keep the head in line with the spine

3. contract the abdominals

4. keep hips stacked

Engage - engage the hip adductors (adductor longus, adductor brevis, adductor magnus, gracilis, pectineus)

Setup

- lie on one side

- rest head on arm and stack hips

- legs may be extended in a straight line or flexed at hip about 45 degree angle

- top arm may be used to stabilize torso

Alignment

1. Maintain stacked hips

2. Neutral spine, neck, pelvis, scapulae

3. Head and neck should continue the line of the spine

Movement

- move the top working leg through full ROM, as high as possible without distorting or changing the hips

- keep knee of working leg facing forward

Safety

1. Avoid flexing the hip to 90 degrees

2. keep head resting on bottom arm not in couch potato position

3. exhale on the lift and inhale on the lower

4. keep abs contracted to help stablilize the spine

Engage - engage the hip abductor (gluteus medius). Maintain conscious contraction through both phases of movement

Hip Abductor - Gluteus Medius

Figure Four Stretch

Side-lying Abductor Stretch

Hip Adductiors - Adductor Longus, Adductor Magnus, Adductor Brevis, Gracilis, Pectineus

Seated Straddle Stretch

Staning Side Lunge

Purpose - to develop strength and indurance of the inner thigh muscles

Joint Actions - Hip Adduction

Muscles Used - Hip Adductors (Adductor Magnus, Adductor Longus, Adductor Brevis, Gracilis, Pectineus)

Modifications

back pain - make certain head is down on arm and knees are bent. Avoid rolling hips back and using hip flexors.

Progressions

1. use ankle weights

2. Use bodybar against lower leg

3. perform with ball between leg and lift both legs simultaneously

Modifications

back pain - keep knees bent, make sure head is resting on arm. Keep hips stacked to avoid using the hip flexors for the movement.

Progressions

1. use ankle weights

2. perform on ball

3. use elastic band around thighs

Hip Abductor -  Gluteus Medius

Side-Lying Hip Abduction

1. with ankle weights

2. on ball

3. use elasic band around thighs

Hip Adductors

Side-Lying Hip Adduction

1. with ankle weights

2. place body bar on bottom leg

3. place ball between legs and lift legs simultaneously

Purpose - to develop strength and endurance for the calf muscles

Joint Action - Ankle Plantarflexion

Muscles Used - Gastrocnemius, Soleus

Setup

- stand feet hip-distance apart and toes pointing straight ahead.

- Balls of feet are on the edge of the step or board with heels hanging down.

- with dumbbells use mid-pronated grip (palms face sides)

- barbell - on posterior deltoid, hands pronated, wide grip

Alignment

1. knees flexed slightly

2. pelvis, spine, neck, and scapulae in neutral, and shoulders level

3. no movement of any other joints other than the ankle

Movement

- exhale and raise up on balls for feet as high as possible

- inhale and lower slowly as far as possible

Safety

1. use slow controlled movement

2. only lower to the point of tension, not pain

3. make sure hips and knees stay stable and still

4. if balance is an issue hold onto wall with no weight or hold onto rail with no weight or wear a weighted belt

Engage - enage and contract the gastrocnemis and the soleus. Maintain an isometric contraction of the abs, quads, etc

Gastrocnemius and Soleus

Standing Calf Stretch - both

Seated Calf Stretch  -both perform dorsiflexion of the ankle with or without a strap

Standing Soleus Stretch - same as standing calf only back knee bent

Modifications

Hold onto bar or other sturdy object for balance and support

Progressions

1. perform heel raise unilaterally

2. perform heel raise on half foam roller or BOSU

Anterior Tibialis, Extensor Digitorum Longus

Ankle Dorsiflexion

1. Use anchored band to resist movement

Purpose - to develp strength and endurance of the front of the lower leg

Joint Action - Ankel Dorsilfexion

Muscles Used - Anterior Tibialis, Extensor Digitorum Longus, Peroneus Tertius

Setup

- sit on bench or floor in a propper sitting alignement

- hands may be at sides or slightly behind for support or may sit with back against a wall

- if on bench rest working leg on bench, foot off the end

- Rubber band is placed over top of foot, trainer hold other end

Alignment

1. sit in hip hinge, weight on sitting bones

2. pelvis, spine, neck, and scapulae in neutral

3. knees extended, but not hyperextended

Movement

- exhale and pull forefoot toward the body as far as possible

- slowly return to start

Safety

1. keep movement smooth and controlled

2. avoid locking the knees

3. breathe throughout the movement

Engage - engage and contract the dorsiflexors (anterior tibialis, extensor digitorum longus, pectineus tertius)

Gastrocnemius and Soleus

Heel Raises

1. Unilateral

2. on half foam roller or bosu

Anterior Tibialis, Extensor Digitorum Longus, Pectineus Tertius

Standing Shin Stretch - Stand staggered stance with back toe pointed

Seated Shin Stretch - Legs Straight both toes pointed

Purpose - to develop strength and endurance of the front lower leg muscles. Strengthening the everters to prevent ankle sprain

Joint Actions - Ankle Eversion

Muscles Used - Peroneus Tertius, Peroneus, Longus, Peroneus Brevis, Extensor Digitorum Longus 

Setup

- sit on bench or floor in a propper sitting alignement

- hands may be at sides or slightly behind for support or may sit with back against a wall

- if on bench rest working leg on bench, foot off the end

- Rubber band is placed over top of foot, trainer hold other end

Alignment

1. sit in hip hinge, weight on sitting bones

2. pelvis, spine, neck, and scapulae in neutral

3. knees extended, but not hyperextended

Movement

- exhale and evert the foot against resistance of the band (Lift up the outside edge of the foot)

- and isometric contraction may be held

- slowly return to start

Safety

1. keep movement smooth and controlled

2. avoid locking the knees

3. breathe throughout the movement

Engage - engage and contract the everters (peroneus tertius, peroneus longus, peroneus brevis, extensor digitorum longus)

Ankle Dorsiflexion - Anterior Tibialis, Extensor Digitorum Longus

Ankle Dorsiflexion

1. Band resisted