♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Hello and welcome to this video
on the realignment routine.
This is the exercise portion, and this is
the where I start with most people with osteoporosis,
just lying, starting in decompression.
Christina is here to help us demonstrate
the exercises that we do.
Thanks for coming Christina, so much fun to work with you.
- It's my pleasure.
- Yes, okay.
So she's lying in the decompression exercise position
and I like people to straighten out their fingers also.
So the whole arm is kind of extended out
and then lengthen the arms from the shoulders,
so we get maximum length of the arms there.
So as in the decompression, I'll ask her to begin to focus
and bring your attention to her breath
and notice how you breathe, how fast or slow you breathe.
What's moving, just notice your breath
and then slow it down.
Slowing down the breath causes more relaxation,
general relaxation in the body.
Allow the breath to come to you, don't force it.
Just notice your breath.
And during this period of time, the back is relaxing
and we have the back isolated from the lower extremities
and the hips and the knees bent to avoid the pull
of the muscle on the back.
So we're going to start
with something called the shoulder press.
Now, the idea here is to strengthen
before getting more flexibility.
So, it's strength before flexibility.
These exercises are called isometric
which means that you're contracting a muscle
without actually moving the body part.
And I'm going to be focusing on the back extensors
which have been shown in research,
the strength of those muscles helps to reduce
the compression fracture rate in people with osteoporosis.
So the shoulder press,
we want to lengthen out the front of the chest
and we're going to be contracting the muscles in the back.
So, I palpate here for a bone that's called the acromion,
part of the acromion process of the shoulder blades.
As you feel my fingers right there.
And I want you to understand that there's a space
between that and the table.
And within that space,
I want you to visualize a sponge that's filled with water.
Okay, so you take a breath in
and then you squeeze the sponges
by pressing your shoulders down toward the table
and squeezing the water out of the sponges.
Hold two, three, and then relax as you breathe in
and then press down again, press two, three, and relax.
Some people will feel,
you can see her chest begin to raise a little bit.
She's starting to stretch
out the muscles in the front of the body.
One more time, breath in
and then pressing down, press, hold and release.
Now, if Christina was not able to do this
and let's bring this arm just a little bit more
out there like that.
So we get all this stretch here through your shoulders.
Then I would ask her to do one shoulder.
So take a breath in and you get to pick the shoulder.
Okay, all right.
And just squeeze the water
out of the sponge on one side only.
Okay, so she's picking her left down, hold and relax
and then do the right down, hold and relax.
Now, if a person is unable to do that, for example
people who are watching the video
and you try this exercise and you don't feel any movement.
Well, don't get excited about it.
The muscles in your chest tend to be a lot tighter
than the ones in your back.
And so, you may need to just lie
in that decompression exercise position
for a few days and allow these muscles to stretch out.
So you can then do the shoulder press.
Okay, the next exercise is called the head press.
Now you'll, it's not the neck press.
A lot of people tend to call it the neck press
but we're not gonna press the neck down.
We're gonna press the back of the head down.
I want you to notice
that I have a rolled up towel underneath her neck.
This is because when she doesn't have the support
under her neck, she tends to flex her neck
and bring her chin down towards her chest.
And the neck should actually have a reverse curve
to that in it.
So we support it as little as possible
but as much as necessary,
some people even use just a washcloth, just roll
up a washcloth if they need that kind of a support.
So, Christina, what I'd
like you to do is just bring your attention
to your head and feel the pressure on the back of your head.
Just feel how heavy your head feels on the table, okay?
Take a breath in, keep your chin where it is, okay?
And make your head heavier on the table.
Press to two, three and relax.
So in the beginning, I just have people try to hold this
for two to three seconds, take another breath
and press two, three, and relax.
And according to the research we want to build up
to about a six second hold for the isometric exercises.
So take one more breath.
And then as you exhale, press two, three, and relax.
Now I'm gonna have you do one more
and I'm going to place my hands on either side of your neck
just so I can palpate the neck muscles.
So take a breath and press your head.
Now don't press into my hands, press your head.
Whoa, nice, strong neck muscles.
I want you to put your hands
your fingertips, right where I just did.
And you can feel your own muscles.
You could let your elbows out a little if you want,
I don't know, whatever you want there
and then press and feel those muscles.
Those muscles in your neck are extension
of those back muscles that run all the way
from your sacrum down at the other end of your spine
all the way up and insert into the base of the skull.
So this is a really important exercise.
It happens to be one of the exercises
people don't like to do very much
because they're not used to and they may have to have some,
they may need to have
they may have some back pain or some neck pain.
So I say just, you don't have to press hard.
Just imagine that you're gonna just go,
just go light like a feather, well to start out
just to we want to get these muscles activated again.
A lot of people have a lot
of weight move in their neck extensors
and those are the muscles that hold our head
and our body up against the force of gravity.
So they're very, very important.
Okay, so the next exercise is called the leg press.
So I have these rolled up towels here.
I just wanna show these to the audience.
This is a beach towel held together
with some fancy, colorful duct tape.
So you can get very creative here.
So I'm going to put one of these right underneath her knees
and close up against the buttocks and then another one,
so she can get this between the hip and the knee.
So length in one leg, down to the table, either one.
So she's picked her left leg.
I wanna come around to the end of the table
to make sure that she's in alignment with her hip.
A lot of people will either bring the leg
out to the side or they'll rotate it in some way
but we wanna have the leg as straight as possible.
The kneecap up toward the ceiling
press out through your heel, take a breath
and press your leg right into those towel rolls right
in that area, press down, hold and relax.
And let's keep this knee
in alignment as you do the other one, okay?
It's coming over there trying to help it out, that's all.
Press out for your heel, okay?
Take a breath and press, hold and relax.
Now this exercise targets the gluteus maximus muscle.
One of the most powerful muscles in your body
also your lower back extensors and also a group
of muscles called the quadriceps
that are on the front of the thigh.
And these are the muscles that help you get
up out of a chair, climb steps, and so on.
Not only up the steps
but also helpful coming down the steps, okay?
Slide this foot back up,
straighten the other leg down again.
We wanna watch for alignment.
Now it's been my observation that people
will usually pick the most flexible, easy side first.
So I always wanna watch for the alignment of the second leg.
So we press the heel out.
Take a breath again and press this leg into the rolls.
One, two, three, and relax again.
You wanna work up to count of about six,
let your knee relax two there, okay?
Take another breath, press your heel out.
And on the breath out, press, hold and relax.
Okay, now while this leg is straight,
we'll straighten the other one down next to it.
So both legs are lengthened out,
press out through both heels, take a breath
and press both legs down into the TALs.
Notice how her body lifts right up
off the table a little bit when she does this.
Again, we're strengthening some
of the most important muscles
in the body for stability of the lower extremities.
We need the stability in the lower extremities
as well as within the abdominals and the back
in order to function in daily life.
So one more time, breath in and press the legs down.
Okay, good, all right.
Now, in terms of repetitions, I usually use something,
a formula called three, five or eight.
If I have somebody who's very frail and weak,
I'll say do three repetitions.
If somebody's sort of average, five,
and somebody more athletic, eight repetitions are plenty.
I find that if people go much above eight
certainly above 10, these tend to lose form
because these muscles are very site specific.
These exercises have been designed
to target the muscles that we need the most for stability.
So those are the first few muscles.
Now I want you to bend your knees and your hips.
I'm gonna take these out from underneath.
All right, I'll put 'em right back over here.
All right, so the last exercise
that she's going to demonstrate is called a leg lengthener,
so she already knows what we're gonna do.
So she's getting ready
and she's getting this one ready too,
to be wherever she wants it when this one is working, okay?
Now the leg lengthener,
I usually don't teach people on the first visit
and I don't give it to people
who have had a compression fracture
or any serious back pain.
Because when you lengthen the leg,
you're going to also affect the spine.
And that may cause pain.
So here are the directions for the leg lengthener,
I have people press out through the heel
and then I like them to start out by lengthening
from the pelvis, pulling the pelvis here,
away from the ribs.
So take a breath and lengthen this left leg,
lengthen, hold and relax.
I usually just repeat this a couple of times.
So one more breath in and then on the breath out,
lengthen, hold and relax.
Okay, slide this foot back up,
straighten the other one down, press out through the heel.
Take a breath in, stretch out, hold and relax.
Do you feel any difference between one leg and the other?
I can see a difference
but I'd like you to see if you can feel it.
Do one more lengthener here.
The lengthening isn't quite as long
on this leg as the other one.
So this leg is a little bit tighter.
I can see things like that through these exercises.
And then once she has learned that,
what I'm gonna have her do is lengthen both legs down,
press out through your heels, lengthen one leg,
relax it, coordinate it with your breath.
And then the other one, this is kind of an advanced version.
Now don't pull this one up as that one's lengthening,
you don't just focus on the leg that you're working on.
Okay, bend this knee back up
and then the right one coming up also.
So those are the main exercises of the realignment routine.
Just as a little bit of a recap, we've got it.
Just getting in the decompression exercise position.
That's part of it.
You wanna make sure that the knees are hip distance apart.
People will get tired here.
Their knees will tend to come together.
And then the first exercise we did was the shoulder press.
The second one we did was the head press.
Then we did the leg, press both one leg
at a time and then both legs together.
And then the leg lengthener
is usually the last one that I teach.
Thank you for coming and watching this video.
And thank you very much, Christina,
for being a wonderful model here today for these exercises.
- Oh, it's my pleasure.
- Thank you so much.
(upbeat music)