IMPACTO SOCIOECONÓMICO
ORDENANZA Nª 298/MLV La Victoria, 11 de febrero de 2019
suggest stretches or strengthening exercises. If you are not competent, or if you feel that suggesting stretches is outside your scope of practice, do not follow this step. Be safe, refer out. Wait until you become competent by becoming certified as a personal trainer or certified in active isolated stretching.
SOLEUS
The client is seated with one knee bent 90 degrees and with the hands on the ball of that foot.
The knee must be bent to 90 degrees to isolate the soleus.
The client plantar flexes the ankle against the resis- tance of the hands for 5 to 10 seconds at 20 percent force.
He or she relaxes, inhales, and then on exhale actively dorsiflexes the ankle while gently assisting (pulling back) with the hands for about 2 seconds.
At this new position, the client then relaxes, takes a breath, and on exhale repeats the stretch several times. He or she repeats the stretch on the other leg to pre- vent compensation and secondary injury, and to bal- ance out the body (Figure 4-55 ■).
Tell the client to not stretch into pain. The client needs to differentiate between uncomfortable stretching due to tight muscles and painful stretching that can aggra- vate a pre-existing clinical condition.
The client starts the stretches with the tightest side first until normal range of motion is achieved. Then he or she continues to stretch both sides for continued balance and symmetry.
Print copies of the stretches for your clients to take with them for reference.
GASTROCNEMIUS
The client is seated on the floor.
The affected leg is straight with the stretch rope around the ball of that foot.
He or she brings the ankle to dorsiflexion to lengthen the gastrocnemius.
Then the client plantar flexes the ankle against the resistance of the stretch rope for 5 to 10 seconds at 20 percent force.
He or she relaxes, inhales, and then on exhale actively dorsiflexes the ankle while gently assisting (pulling back) on the stretch rope for about 2 seconds.
At this new position, the client repeats the stretch several times to lengthen the gastrocnemius and then repeats it on the other leg, if needed (Figure 4-54 ■).
FIGURE 4-54 Gastrocnemius Stretch.
FIGURE 4-55 Soleus Stretch.
CORE PRINCIPLE
Suggest only two to four stretches or strengthening exer- cises, specific to the condition, each time you see a client. Make sure he or she can perform these correctly before suggesting any additional exercises.
PRECAUTIONARY NOTE
Do not have the client stretch beyond normal range of motion, as this could create hypermobile joints and result in injury. Do not suggest stretches for weak, inhibited, or overstretched muscle groups. These muscles need to be ton- ified and strengthened to maintain structural balance. This is based on restoring normal muscle resting lengths of oppos- ing muscle groups, and normal range of motion at that joint.Tell the client that the stretches will take only a few minutes a day to perform and are necessary for contin- ued results.
The client should stretch after joint movement, exercise, or a hot shower when the fascia and muscles are warm.
TIBIALIS POSTERIOR
If the client has excessive weight bearing supination or is inverted and cannot evert the foot 20 degrees when prone or not weight bearing, suggest this stretch. If he or she is hyperpronated, strengthen the tibialis posterior instead.
These exercises are performed on the weak, inhibited muscles. All the client needs is a Thera-Band. The Thera- Band is inexpensive and you could provide it for them. Show the client how he or she can control and adjust the amount of resistance by holding the band.
Make sure the client understands that the movements are slow and controlled during both the concentric contractions (muscle shortening phase) and eccentric contractions (mus- cle lengthening phase), spending more time on the eccentric
phase. Suggest roughly 2 seconds in the concentric phase
and 4 seconds in the eccentric or lengthening phase. It is imperative that the client strengthens these muscles that are weak and usually overstretched to return the body to proper and optimum balance and to prevent injury in the future.
PERONEALS
The client seated with one knee bent 90 degrees (the knee must not move).
Using the hands around the ball of the foot, the client inverts the ankle against the resistance of the hands at 20 percent force for 5 to 10 seconds.
He or she relaxes, inhales, and on exhale actively everts the ankle for about 2 seconds while assisting with the hands.
At this new position, the client then relaxes, takes a breath, and on exhale repeats the assisted stretch.
The client repeats this sequence several times, then repeats on the other leg (Figure 4-56 ■).
Note: The tibialis posterior is strengthened, not stretched if the client hyperpronates.
This stretch can also be performed using a stretch rope wrapped around the ball of the foot. The client follows the same directions for this stretch, substituting the stretch rope for the hands.
Step 12: Strengthening (Client Self-Care)
TECHNIQUES FOR STRENGTHENING
Goal: to strengthen weak, inhibited muscle groups around a joint creating muscle balance throughout the body— structural integration.
The client must stretch the tight, contracted antagonist mus- cles before strengthening the opposing weak, inhibited, and overstretched muscles.
FIGURE 4-56
Posterior Tibialis Stretch.
CORE PRINCIPLE
This muscle group must be strengthened by clients with lateral ankle sprains and damage to the ligaments of the lateral ankle for prevention of reinjury!
PRECAUTIONARY NOTE
To prevent reinjury after treating a strain, have the client refrain from beginning a strengthening program for 7 to 10 days, or until he or she is pain-free. To facilitate heal- ing, have the client stretch the tight antagonist muscles, taking the tension off the injured muscles until pain-free strengthening can begin.The client is seated with both legs straight.
The Thera-Band is looped individually around each foot, finishing on the outside of the ankles and held in the client’s hands.
The client everts the ankles while pulling on the Thera-Band to create tension. Adjusting the distance between the feet can control the amount of tension on the tubing.
If the client doesn’t feel a “burn” during the exercise, he or she needs to move the feet further apart.
The key is to perform the exercise slowly. Since eccentric contraction is more beneficial than con- centric contraction, the client everts the ankle for 2 seconds (concentric) and then returns to neutral (eccentric) taking about 4 seconds.
The client performs one to three sets of 8 to 10 repetitions (Figure 4-57 ■).
ANTERIOR COMPARTMENT SYNDROME
This exercise strengthens the weak, inhibited ankle dorsi- flexors to help prevent anterior compartment syndrome.
The client is seated with the Thera-Band looped around the exercising foot and secured under the other foot.
The client dorsiflexes the ankle for 1 to 2 seconds (concentric) and then returns to neutral (eccentric) tak- ing about 4 seconds.
He or she performs one to three sets of 8 to 10 repeti- tions (Figure 4-59 ■).
The client is seated with both knees flexed, one hip externally rotated.
The Thera-Band is looped individually around each foot, finishing on the inside of the ankles and held in the client’s hands.
The client inverts the ankles while pulling on the tub- ing to create tension. Adjusting the distance between the feet can control the amount of tension on the tubing.
If the client does not feel a “burn” during the exercise, he or she needs to increase the resistance in the band.
The key here is to perform the exercise slowly. Since eccentric contraction is more beneficial than concen- tric contraction, he or she inverts the ankle for 2 sec- onds (concentric) and then returns slower to neutral (eccentric) taking about 4 seconds.
The client performs one to three sets of 8 to 10 repetitions (Figure 4-58 ■).
FIGURE 4-58
Strengthen Posterior Tibialis. FIGURE 4-57
Strengthen Peroneals.