Range of Motion Exercises and Positioning Tips

Taken From :

1. The Arthritis Helpbook, 5th Ed. By K. Lorig and J. Fries
2. The Arthritis Solution By J. Kandel and D. Sudderth

*Reminder for patients with internal pacemaker or AICD -no elevation of the elbow above 90 degrees (shoulder level) on the same side for 6 weeks.

1. Chin In (VIP)
   This exercise relieves jaw, neck and upper-back pain and is the start of good posture. You can do it while driving sitting at a desk sewing, reading, or exercising. Just sit or stand straight and gently slide your chin back. Keep looking forward as your chin moves backward. You'll feel the back of your neck lengthen and straighten. To help, put your finger on your nose and then draw straight back from your finger. (Don't worry about a little double chin-you really look much better with your neck straight!) If it's uncomfortable for you to do this exercise at first, practice the movement lying flat on your back on the floor or on a firm mattress without a pillow. In this position, pull your chin in by pressing the base of your skull into the floor or mattress. As your neck becomes more flexible, you will be able to hold this good head position comfortably when you are sitting and standing.
2. Two-Way Neck Stretch
   Start in chin-in position (Exercise 1) and with your shoulders relaxed:
   1. Turn slowly to look over your right shoulder. Then turn slowly to look over your left shoulder.
   2. Tilt your head to the right and then to the left. Move your ear toward your shoulder. Do not move your shoulder up to your ear.

If these exercises make you dizzy, close your eyes. If you are still dizzy, skip it. Don't do these exercises if they cause neck pain, or pain or numbness in your arms or hands.

3. Shoulder Circles
   You can do this exercise anytime to relax your shoulders and upper back.
   With shoulders relaxed and arms at your sides or hands resting in your lap, gently roll your shoulders forward, up, back, and down. Reverse and go the other way.
4. Sunrise Stretch (VIP)
   You can do this stretch either sitting or standing.
   1. Relax (your arms, cross your wrists in front of you, and make gentle fists with your thumbs pointing down.
   2. Start the movement with your hands. Roll your hands over, straighten fingers, move your arms upward and outward, and reach as high up as you can. Breathe in as you raise your arms.
   3. Relax and return to the starting position, and breathe out as you bring your arms down.

This exercise encourages good posture and is a relaxing stretch for your upper body.

5. Bend and Reach
   You can sit, stand, or lie on your back to do this exercise.
   1. Start with your arms relaxed and elbows straight.
   2. Bend your elbows to bring your hands up to touch your shoulders.
   3. Then reach your hands up to the ceiling as you straighten your elbows. Reach as high as you can stretching elbows and shoulders.
   4. Breathe in as you stretch up and breathe out as you relax back to the starting position.

6. Pat and Reach
   This double-duty exercise helps increase flexibility in both elbows and shoulders.
   1. Raise one arm over your head and bend your elbow to pat yourself on the back.
   2. Move your other arm to your back, bend your elbow and reach up toward the other hand. Can your fingertips touch?
   3. Relax and switch arm positions. Can you touch on that side? For most people one position will work better than the other.
7. Shoulder Roll and Squeeze (VIP)
   This is a good exercise to strengthen the middle and upper back and to stretch the chest.
   1. Sit or stand with your head in chin-in position (Exercise 1) and your shoulders relaxed. Raise your arms to shoulder level out to the sides, with elbows bent and fingertips pointed down.
   2. Roll your hands upward until you are in a "stick 'em up" position.
   3. Pinch your shoulder blades together by moving your elbows as far back as you can. Hold briefly. Relax and return to starting position.

If this exercise is uncomfortable, lower your arms below shoulder level.

8. Shoulder Pulley
   Fasten a hook or pulley in a beam or on the top of a doorframe. Place a piece of rope or clothesline through the hook as shown. Start with enough rope so you can sit while exercising. Hold one end of the rope in each hand. If gripping the rope is uncomfortable, add padding or handles. As you pull down with one arm, the other arm wi1l be raised. Stand (or sit) so your arms clear the frame. Move your arms up and down in front of you and also out to the side. 
9. Wand Exercise
   This shoulder exercise and the preceding one allow the arms to help each other. If one or both of your shoulders are particularly tight or weak, you may find this a "helping hand".
   
   Use a cane yardstick or mop handle as your wand. Place your hands about shoulder width apart and raise the wand as high overhead as possible. You might try this in front of a mirror. This wand exercise can be done standing, sitting, or lying down.

A good place to do these hand exercises is at a table that supports your forearms. Do them after washing dishes after bathing or as a break from handwork.

10. One-Two-Three Finger Exercises
    For the best hand function, you should be able to make a loose fist with your thumb crossed over your fingers, and also be able to straighten your fingers completely. Use the one-two-three approach.
    1. Begin bending the middle finger joints, then bend your knuckles so your fingertips are as close as possible to your palm.
    2. Cross your thumb over your fingers toward your little finger.
    3. Hold this position momentarily and then straighten your fingers and spread them wide apart. Use one hand to help the other if necessary.

11. Thumb Walk
    Holding your wrist straight form the letter "O" by lightly touching your thumb to each fingertip. After each "O", straighten and spread your fingers. Use the other hand to help if needed.

12. Hi and Bye (Hello and Cheerio)
    1. To strengthen and limber your wrist, rest your forearm on a table with your hand over the edge. Keep fingers relaxed and bend your wrist up and down.
    2. To strengthen the small muscles of the hand, slide your arm back until your fingers hang over with your knuckles at the table edge. Keeping your fingers straight and together and your palm flat, move your fingers up and down.

13. Door Opener
    This is an exercise to stretch the muscles and ligaments that rotate the forearm, letting you turn doorknobs, use a screwdriver, or put your hand in your back pocket.
    1. Start with your forearm resting on a table, palm down.
    2. Keeping your upper arm and elbow tucked in close to your side and your little finger on the table, turn your hand so the palm faces up. Do not move your upper arm or elbow. If you use your other hand to help grip your forearm, not the wrist or hand.

14. Trunk Twist
    You can do this stretch either sitting or standing. Move your arms to shoulder level or cross them over your chest. Slowly and gently twist at the waist to one side and then the other. Turn your head with your torso so that you don't twist your neck. Don't turn your head too far, this exercise is for your back. The purpose is to increase the flexibility of your trunk and make it easier and more comfortable for you to turn and roll. It will help loosen up your back to prepare for other exercise, such as walking or dance.

15. Up and Over
    This is a good stretch for trunk, shoulders, elbows, and hands. Sitting or standing, reach one arm up over your head and then reach with that hand over toward your other side, leaning your trunk slightly in that direction. You should feel a stretch along your trunk on the reaching side. Relax. Stretch your fingers out straight when you reach up and make a loose fist as you move back down. Do the same thing on the other side.

16. Pelvic Tilt (VIP)
    This is an excellent exercise for your lower-back pain. It can be done on the floor or on a firm mattress.
    1. Lie on your back with your knees bent feet flat. Place your hands on your abdomen.
    2. Flatten the small of your back against the floor by tightening your stomach muscles and your buttocks. It helps to imagine bringing your pubic bone to your chin or trying to pull your tummy in enough to zip a tight pair of trousers.
    3. Hold the tilt for five to ten seconds. Relax.
    4. Arch your back slightly. Relax.
    5. Repeat the Pelvic Tilt. Keep breathing. Count the seconds out loud.

Once you've mastered the Pelvic Tilt lying down, practice it sitting, standing, and walking.

17. Lower-Back Rock and Roll
    1. Lie on your back on the floor or firm mattress and pull your knees up to your chest with your hands behind the thighs. Rest in this position for ten seconds.
    2. Gently roll knees from one side to the other, rocking your hips back and forth. Keep your upper back and shoulders flat on the floor or mattress.

18. Back Lift (VIP)
    This exercise improves flexibility along your spine. Lie on your stomach on the floor or a firm mattress. If possible, your hands should be beneath your shoulders. Rise up onto your forearms. If this is comfortable, keep your hands in place and straighten your elbows. Breathe naturally and relax. If you have moderate to severe lower-back pain, do not do this exercise unless it has been specifically prescribed for you. This is not a good exercise if you have spinal stenosis.

19. Knee-to-Chest Stretch
    1. For a hip and lower-back stretch, lie on the floor or on a firm mattress with knees bent and feet flat.
    2. Bring one knee toward your chest using your hands to help.
    3. Hold your knee near your chest for ten seconds and lower the leg slowly.
    4. Repeat with the other knee. To get more lower-back stretch, tuck both legs at the same time. Relax and enjoy the stretch.

20. Cat Back and Sway
    This is a good way to loosen up your back and strengthen stomach muscles too.
    1. On hands and knees, on forearms and knees, or leaning over a counter or table, relax and let your back sway and your stomach sag.
    2. Slowly arch your back like a mad cat as you tighten and pull in your stomach.
    3. Relax your back and let it sway again.
    4. Repeat the whole sequence.

Be sure to keep looking at the floor and to breathe naturally as you move back and forth from arch to sway.

21. Hip Rolls
    This is an important exercise to keep the hip flexible and in good position for comfortable walking and standing up straight.
    1. Stand with one foot slightly in front of the other. Slightly bend the hip and knee of the forward leg so that your heel is off the floor.
    2. Keeping your foot in place and swiveling on your toes, roll your knee in, then out. Although you can see your knee moving the motion is really in your hip.

If you have hip pain when you stand on one foot, you can do this movement lying down (Hip Hooray, Exercise 23).

22. Back Kick (VIP)
    This exercise increases the backward mobility and strength of your hip. Hold on to a counter for support. Move the leg backward and forward. Keep your knee fairly straight and do not point your toes. Stand tall and do not arch your back.

23. Hip Hooray
    This exercise can be done lying on your back (A) or standing (B).
    1. If you lie down, spread your legs as far apart as possible. Roll your legs and feet out like a duck and then in, pigeon-toed. Keep your knees straight.
    2. If you are standing, hold on to a counter for support. Move one leg out to your side as far as you can. Roll your leg to turn your toes inward when you move your leg out then point your toes outward as you return to starting position.

24. Hamstring Stretch
    This exercise helps loosen tight hamstrings. Do the self-test for hamstring tightness to see if you need to do this exercise. It is also a good exercise to do if you get muscle cramps in the back of your thigh. If you have unstable knees, or "back knee" (a knee that curves backward when you stand up) do not do this exercise.
    1. space
       1. Lie on your back, knees bent, and feet flat.
       2. Bend one hip so your leg is at about a right angle with the body.
       3. Slowly straighten the knee. Hold the leg as straight as you can as you count to fifteen.
    2. You can also do this exercise by sitting with your foot on a low footstool. Rest your hands either on your thighs or at your sides. With your knee straight and toes pointed up, lean forward from the hips (back straight) until you feel a stretch on the back of your leg. Hold and count to fifteen. Relax.

Be careful with this exercise. It's easy to over stretch and be sore.

Do these exercises sitting in a straight-backed chair with your feet bare. Have a bath towel and ten marbles or small paper wads next to you. These exercises are for flexibility, relaxation, and comfort.

25. Ankle Circles
    With your heels on the floor, slowly circle your feet to the right and then to the left. Go as far in each direction as you can.

26. Towel Grabber
    1. Spread a towel out in front of your chair. Place your feet on the towel with your heels on the edge closest to you. Keep your heels down.
    2. Scoot the towel back underneath your feet by pulling it with your toes as you arch your feet.
    3. When you have done as much as you can reverse the toe motion and scoot the towel out again. You may do both feet together or separately.

27. Marble Pickup
    Do this exercise one foot at a time. Place several marbles on the floor between your feet.
    1. Keep your heel down and pivot your toes toward the marbles.
    2. Pick up a marble in your toes and pivot your foot to drop the marble as far as possible from where you picked it up.
    3. Repeat until all the marbles have been moved.
    4. Reverse the process and return all the marbles to the starting position.

If marbles are difficult, try other objects like jacks, dice, or wads of paper.

28. Foot Roll
    Place a rolling pin (or a large dowel or closet rod) under the arch of your foot and roll it back and forth. It feels great and stretches the ligaments in the arch of the foot.

29. Achilles Stretch
    This exercise helps maintain flexibility in the Achilles tendon and the large muscles you feel on the back of your calf. Good flexibility helps reduce the risk of injury, calf discomfort, and heel pain. The Achilles Stretch is especially helpful for cooling down after walking or cycling and, for people with ankylosing spondylitis or psoriatic arthritis. Also do this exercise if you get calf cramps.
    1. Stand at a counter or against a wall. Place one foot in front of the other toes pointing forward and heels on the ground.
    2. Lean forward, bend the knee of the forward leg and keep the back knee straight heel down. You will feel a good stretch in the calf.
    3. Hold the stretch for fifteen seconds. Do not bounce. Move gently.

It's easy to get sore doing this exercise. If you have worn shoes with high heels for a long time, be particularly careful.

30. The Stretcher
    This exercise is a whole-body stretch to do lying on your back. Start the motion at your ankles as explained here, or reverse the process if you want to start with your arms first.
    1. Point your toes, and then pull your toes toward your nose. Relax.
    2. Bend your knees. Then flatten your knees and let them relax.
    3. Arch your back. Do the Pelvic Tilt {Exercise 16). Relax.
    4. Breathe in and stretch your arms above your head. You can raise your arms either to the side or in front of you. Whichever feels natural and comfortable. Breathe out and lower your arms. Relax.
    5. Stretch your right arm above your head, and stretch your left leg by pushing away from you with your heel. Hold for a count of ten. Switch to the other side

Walking Posture
As you begin to walk, consciously pull your head, neck, and shoulders back. Heel should strike first while pushing off with the toes of the back foot.
As you step forward, lift trunk tall and pull abdominals in.
This may feel strange at first but remember you are not used to walking or moving with correct alignment. Eventually this will feel natural.

Prolonged Standing Technique
While standing or prolonged periods of time, stagger feet shoulder-width apart and shift weight from one leg to the other. To alleviate pressure on the lower back while ironing or doing dishes, stand close to the ironing board or sink with one leg elevated 2-4 inches off the floor. Avoid leaning forward from the pelvis, back or shoulders.

NOTE: Keep a soft knee, abdominals in, shoulders back, and raised sternum (breastbone). Keep your head and neck back.

Frequent One-Minute Breaks
The one-minute break is designed to enable you, to change position frequently. Take time to get up and move around. Perform a few of the exercises you have learned. Use the corner stretch to help you stretch the chest and straighten your posture. Walk around your desk or office. Go to the bathroom.
Do anything that gets you moving!

Using the Telephone
When talking on the telephone, keep your head level, with shoulders and neck back. Try not to hold the telephone with your shoulder elevated and head tilted to the side. This holds stress and tension in the upper back and neck.

Sleeping
Improper sleeping posture increases the mechanical stress on the spine. The tightness in the soft tissues of the pelvis and legs, coupled with poor hip alignment, can be a source of discomfort along the whole spine. This can lead to neck spasm. The following rules will aid in supporting the spine and pelvis as well as reducing the mechanical stress to spine.

• Sleep on a firm mattress to reduce tension caused by excessive curvature.
• If you sleep on your side: place a pillow in between your knees. This will reduce the mechanical stress to 75 percent.
• If you sleep on your back: place a pillow under your knees. This will reduce the mechanical stress to 5 percent. With legs extended, stress increases to 150 percent.
• If you sleep on your abdomen: place a pillow underneath your hips.

Ideal Sitting and Driving posture
Sitting causes the greatest increase in spine pressure (up to 275 percent); therefore, proper sitting posture is essential in order to reduce chronic back pain. Knees should be slightly higher than the hips, and your back should be firmly supported by the back of the chair or seat. The chair back should ideally be on an incline and have armrests.
Keep head and neck retracted and abdominals in. While driving, keep both hands on the steering wheel, in the ten and two o'clock positions, for support. Be certain that you are close enough to the foot pedals so that you do not have to reach for them.

NOTE: Still correct posture. Adjust all mirrors to accommodate this posture. The mirrors will act as a reminder to correct your position when your posture fails. Also, place a rolled towel in the natural curve of your lower back to add support and to remind you to remain in correct posture.

Mechanical Stress to the Low Back:

Sitting with proper posture: 140 percent
Sitting with improper posture: up to 275 percent

Getting Out of Bed or Off the Couch
Using proper mechanics to get out of bed will reduce unnecessary tension on the spine. Before getting out of bed, bring knees to chest and grasp legs under knees. Pull into chest and raise shoulders to meet knees. Hold 10-30 seconds, release, then repeat. This will help you get ready to move. Roll onto your side and use your free arm to help push your torso up while you simultaneously, swing your feet and legs off the bed or couch. This will cave you in a seated position.

Standing and Sitting
Using the proper technique to stand and/or sit will strengthen the legs and reduce discomfort and stress on the vertebrae.

To stand: Move to the edge or the chair. Place feet shoulder-width apart with one root slightly in front of the other (back foot should be placed slightly under chair). Lean forward from the hips. Lift body with your legs. Stand erect and in good posture.

To sit: Stand tall with shoulder blades squeezing together. Back calf against the chair. Feet should be shoulder-width apart with one foot slightly in front of the other foot. Pull abdominals in, push hips back, and bend knees. Using the legs, ease back into the chair.

Getting In and Out of a Car or Confined Space
Always get in and out of a car without twisting or separating the legs. This leaves the pelvis in an unsupported position increasing the mechanical stress on the spine. To get into a car, turn your body so that your back is facing the seat. Use proper sitting technique to sit in the car seat, then swing both legs into the car simultaneously. Getting out of the car is the exact opposite. Begin by moving both legs out of the car (using u full body turn).
Place one foot in front of the other, lean forward from the hips, and stand erect. Keep shoulders back and chest elevated.

Half Kneeling
Move to the edge of your chair. Place one foot in front of the other with back leg under the chair. With back flat and abs in tight, lean forward from the hips while pressing through the heel on your front leg, lift up and back onto the chair. This technique is great for getting clothes out of the dryer, getting things out of low cabinets, and so on.

Getting off the Floor
Half kneeling is a, precursor to getting off the floor. Roll onto all fours. Pull abdominal muscles in tight, walk hands back toward knees, and move into a kneeling position using your bent leg for support. You can now get into a chair or stand straight up using the half-kneeling technique.

Proper Lifting and Transporting Techniques
Lifting in any position will increase the mechanical load on, the spine. The mechanical advantage to lifting with proper technique is to reduce the compressive forces on the spine and increase the stability of the spine during lifting and transport.
Stand with correct posture, place feet shoulder-width apart with one root slightly in front of the other. Pull the abs in light and lean forward from the hips while bending the knees (squatting down). Pick up the object (using your legs to lift), tighten abs, and exhale as you slowly lift to an upright position. Keep object close to your body and in front of you as you transport the item to its new location.

NOTE: Shifting the weight load to one side increases disc pressure and muscle activity on the opposite side.

GOAL: Lift slowly and in a controlled manner; disc pressure increases with faster lifts and heavier loads.

Other Helpful Hints

• Lighten pocketbook and switch shoulders frequently. This will keep you from leaning and/or favoring one side.
• Avoid wearing high heels higher than one inch above the sole of the shoe). These tend to tilt the pelvis forward and increase the curvature in the low back.
• Obesity greatly increases both the direct and indirect compressive loads on the spine by shifting center of gravity and increasing the curvature of the spine. Weight loss could reduce your pain.
• Stand with your arms behind your back. This will help you to keep your shoulders from rounding forward.

Disclaimer
Reviewed by Alberta clinical experts. Brought to you by HealthLink Alberta. Copyright.
This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. For more health advice call Capital Health Link at 780-408-LINK (5465) 24 hours a day, seven days a week. In Alberta, call Toll-free: 1-866-408-LINK (5465)