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Static Closed chain stabilization exercise-WPS Office
Renal Anatomy and physiology
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Static Closed - Chain ( Weight Bearing ) Stabilization Exercises
Weight bearing activates contraction of stabilizing mus cles in proximal joints and may be a stimulus for improv ing fluid dynamics of the articular cartilage. Early during the controlled motion phase of treatment ( subacute stage ) , if the healing tissues tol erate it , it may be beneficial to initiate protected weight bearing stabilization exercises. The amount and intensity of weight bearing and resistance is progressed as tissues heal.
NOTE : If scapular winging is observed when the patient is weight bearing , do not progress these exercises until there is enough strength to stabilize the scapula against the rib cage.
Focus on Evidence
Seeking an answer as to when upper extremity weight bearing exercises could be included in an exercise pro gram , Uhl and colleagues 186 analyzed the pectoralis major , anterior and posterior deltoid , supraspinatus , and infra spinatus with surface electromyography ( EMG ) in a pro gression of static exercises in 18 healthy subjects. Positions for isometric exercises included the prayer position ( to simulate weight bearing against a wall ) , quadruped , tripod , pointer , push - up position ( shoulders flexed to 90 ° ) , push - up position with feet elevated 18 inches ( 45 cm ) , and one - arm push - up position.
There was a significant correlation between the increasing weight - bearing postures and increased muscular activity ( r = 0 , p < 0 ) in all the muscles. Also , the infraspinatus was the most active of the muscles tested in all positions except the prayer position ( in which the pectoralis major was most active ). The authors suggested that the prayer and quadruped positions were appropriate for early rehabilitation owing to the low - activity level in all the muscles ; that the tripod and pointer positions placed an intermediate demand on the infraspinatus and deltoid musculature ; and that the push - up positions placed a high demand on the infraspinatus. They also concluded that the two - handed positions required less demand on the posterior deltoid but more load on the ante rior deltoid and pectoralis muscles and that the one - arm push - up placed a high demand on all muscles except the supraspinatus.
Scapular stabilization. Patient position and procedure : Side - lying on uninvolved side. Both the elbow and shoulder of the involved arm are flexed to 90 ° , with the hand placed on the table and bear ing some weight. Resist the scapular motions of elevation / depression and retraction directly against the scapula ; resist protraction by pushing against the elbow.
Protected weight bearing. Patient position and procedure : Sitting with forearms rest ing on thighs or a table ; or standing with arms resting on a table. Apply a gentle resistance force against the shoulders and ask the patient to match the resistance and " hold. " Alternate resisting in various directions.
Progression of closed - chain stabilization exercises. Patient position and procedure : Standing with shoulder at 90 ° and one or both hands leaning against a wall or on a ball.
Additional , more advanced progressions include hav ing the patient in the " all - fours , " or quadruped , position with hands on the floor , on a rocker or wobble board , or on a ball. The ball provides an unstable surface and requires greater neuromuscular control and balance reactions. Each of the positions can also be done with weight on only the involved upper extremity. Apply alternating resistance against the shoulders or trunk and ask the patient to " hold " against the force. Pressing forward against the trunk increases the effect of the body weight and requires the serratus anterior to stabilize more strongly against the additional force. As already noted , if the scapula wings , the resistance is either too strong and should be reduced , or the degree of weight bearing is excessive.
Dynamic Closed - Chain Stabilization Exercises
Dynamic stabilization in weight - bearing positions requires the stabilizing muscles to maintain control of the scapula and GH joint while moving the body weight over the fixed extremity or extremities.
Patient position and procedure : Standing with shoul ders flexed 90 ° and hands supported against a wall , leaning hands on a table , or assuming a quadruped ( all - fours ) position. Have the patient shift his or her body weight from one extremity to the other ( rock back and forth ). Apply resistance against the shoulders
Progress by having the patient alternately lift one extremity and then the other , so one extremity bears the body weight and stabilizes against the shifting load. Apply manual resistance to the shoulders or strap a weight around each wrist.
When the muscles are able to control and stabilize , progress to using unstable surfaces ( such as a rocker board , biomechanical ankle platform system ( BAPS ) board , or ball ]. Suggestions for more vigorous closed chain activities are described in the following section.
Dynamic Strengthening Exercises - Scapular Muscles
It is imperative that the proximal stabilizing muscles of the thorax , neck , and scapula function properly before initiating dynamic strengthening of the muscles that move the GH joint through the ROM to avoid faulty mechanics. Strengthening exercises can be done in both open- and closed - chain positions. Progress exercises with repetitions and resistance within the mechanical limits of the involved tissues.
Initially apply light resistance with multiple repetitions to develop dynamic control and muscular endurance. As control develops , progress to combined patterns of motion and training for muscle groups to function in a coordinated sequence. Begin with simple functional activities and progress to more complex and challenging activities. Both muscular endurance and strength are necessary for postural and dynamic control of activities.
Focus on Evidence.
shoulder level or a two - handled pulley that is at shoulder level , and pinch the scapulae together by pulling against the resistance.
Scapular Retraction Combined with Shoulder Horizontal Abduction / Extension ( Rhomboids , Middle Trapezius , Posterior Deltoid )
Patient position and procedure : Prone with shoulders abducted 90 ° , elbows flexed , and forearms pointed verti cally toward the floor. Instruct the patient to perform hor izontal abduction with scapular retraction. This exercise can also be done with the elbows extended for greater resistance. Progress this exercise by adding weights and then by having the patient perform the row ing motion standing or sitting in front of a length of elas tic resistance that has been secured at shoulder level.
Corner press - out. Patient position and procedure : Standing with the back toward a corner , shoulders abducted 90 ° , and elbows flexed. Instruct the patient to press the elbows into the walls and push the body weight away from the corner.
Static Closed chain stabilization exercise-WPS Office
Course: Renal Anatomy and physiology
University: Rajiv Gandhi University of Health Sciences
