1 Dr. Struble Madison Moore Ch. 14 Critical Thinking 1. A positive Ober’s Test indicates a tight IT band and Tensor fascia la1tae (TFL). A good stretch for the IT band: sit with legs extended out, cross the hurt leg over your other leg, bend the knee and place your foot flat on the floor, rotate your body to look over the shoulder on the involved side until a stretch is felt. Do this for 10 minutes on and off for 30 seconds. The therapist can stabilize the patient by holding the flat foot stable on the table or place a hand on the shoulder that is rotated to prevent bouncing/movement during the stress. 2. For the first home band exercise, the patient will have the band around their wrists and pull the wrists apart with forearms parallel. (Protract the shoulder blades by pushing the upper back away from the wall to activate the serratus anterior) Walk the forearms up the wall in a controlled manner to around eye level. Return back to the starting point in a controlled manner and repeat 10 times for 3 sets. For the second exercise, the patient will perform a bow and arrow exercise with the bands. This can be done by either tying one end of the band down or holding it with the unaffected arm, then with the other shoulder the patient would horizontally abduct (pull back as if drawing a bow) and elevate the shoulder, all of this should be done while retracting/squeezing the scapula. Do this for 3 sets of 10. For the third exercise, the patient will hold a resistance band in front of them with their arms extended straight out. There should be 4-6 inches of band left at the ends where their grip is (but they can adjust to make it harder or easier). Pull the band apart by bringing shoulder blades together so that the band touches their chest. Then, slowly return to the starting position by bringing your arms back down in front you at eye level. Do 3 sets of 10. I chose these exercises because the first one focuses on the serratus anterior, the second one focuses on the lower trapezius, and the third one focuses on the rhomboids. I only prescribed that the patient does 3 sets of 10 because she will be performing these exercises for a full week. 3. I would tell the patient that, when in doubt and choosing a Swiss ball, it is always safer to go with a slightly larger ball because you could deflate it if needed. However, since the patient is 70 in tall, I would recommend 65 cm or 26 in ball. 4. I would recommend that the patient uses machine weight if they are new to lifting, had a recent injury they are overcoming, or do not yet have the proper form. Free weights are good for more dynamic exercises as well as more experienced or stronger patients. Alternating Exercises: 1. Seated cable Row = Dumbbell row 2 2. 3. 4. 5. Leg extension machine = One leg seated dumbbell extension Leg curl machine = lying dumbbell curl Leg press machine = barbell squat Pulldown machine = Two-hand Bent-Over Dumbbell Row 5. Following my patient’s ACL surgery, I would use graston as my chosen soft tissue mobilization tool. The reason I chose this is because it will help to loosen/break up scar tissue or muscle tender points, which will make it easier to stretch and increase range of motion in the joints. It will also help quicken the healing process, increase the strength of muscle, and reduce pain. It can also help to move and alleviate swelling in the area.
