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To comply with professional boards/associations standards: • I declare that I (or my family) do have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship. •Requirements for successful completion are attendance for the full session along with a completed session evaluation. •Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity. Session 405: Active Care: Mobility Techniques & Tools to Clinically Progress Patient Outcomes John Hisamoto, PT, ATC & Shawn Burger, PT, DPT Leading the Way in Continuing Education and Professional Development. www.Vyne.com

Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

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Page 1: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

To comply with professional boards/associations standards:• I declare that I (or my family) do have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship.•Requirements for successful completion are attendance for the full session along with a completed session evaluation.•Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity.

Session 405: Active Care: Mobility Techniques & Tools to Clinically Progress Patient Outcomes

John Hisamoto, PT, ATC & Shawn Burger, PT, DPT

Leading the Way in Continuing Education and Professional Development. www.Vyne.com

Page 2: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

John Hisamoto PT, ATC

Owner, Pro‐Active Physical Therapy 

Shawn Burger, PT, DPT

Owner, PearFIT Physical Therapy

Before we get started…

• Phones

• Names on workbooks

• Bathrooms

• Waiver

• Pre‐test

• Latex Allergies?

• Anything else…

Page 3: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Today’s Schedule

• Evidence for Home Exercise

• Science Behind Elastic Resistance

• Evidence‐based Mobility Tools & Techniques

Associations Between Treatment Processes, Patient Characteristics, and Outcomes in Outpatient Physical Therapy Practice 

Prospective, 2.5 years, 54 clinics, >22,000 musculoskeletal patients

Deutscher D et al. 2009. Arch Phys Med Rehabil. 90:1349-63.

1. HEP & visit compliance associated with better outcomes

● Poor home exercise program compliance had poor outcomes

2. Patient education is needed to improve compliance

● Need to “sell” patient that what they are doing will work

3. Modalities associated with worse outcomes

● Shoulder ultrasound particularly worse

To improve cost‐effectiveness, improve outcomes first!

How do you improve compliance?

1. An Individualized exercise program is the key.

2. Identify patient’s goals and barriers to exercise• Barriers (more than motivators) predict adherence in home exercise 

programs 

(Forkan et al. 2006)

3. Both the therapist and patient are responsible for patient compliance (Sluijs et al. 1993)4. “Educate and Demonstrate”

Page 4: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Delivering Home Programs

• Verbal explanation & demonstration 

(Chase et al. 1993)

• Handouts effective but not alone (Friedrich et al. 1996, Reo and Mercer 2004, Udermann et al. 2004)

• Correlation between performing exercises correctly and reducing pain      (Friedrich et al. 1996)

Therapeutic Exercise ProgressionFramework for 

Clinical Decision Making

Anyone can follow a protocol…

How do you treat dysfunction?

Page 5: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Dysfunction

Is it a Stability or Mobility Problem?

Stability

Emphasize strength, stability, motor control

Mobility

Emphasize joint and soft tissue 

mobility

www.RehabEducation.com/SFMA

Assessment is Critical

Page 6: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Tools & Techniques

MobilityStability Movement

Emphasize joint and soft tissue 

mobility

Emphasize strength, stability, motor control

Mobility Tools & Techniques

Page 7: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Force Elongation Characteristics of TheraBand CLX

• Tested 3 different lots of each color CLX

• 4 different lengths (number of loops)

• Validated published force values (within 0.2 pounds)

• No significant difference between number of loops used (ie, length of band)

Same force at same elongation regardless of # of loops

Progression

40%  in color

25%  in color

TheraBandColor

~125% stretch(pounds)

Yellow 3.0

Red 3.7

Green 4.6

Blue 5.8

Black 7.3

Silver 10.2

Gold 14.2

33

44

66

55

88

1212

15.515.5

TheraBand CLX resistance provides a strength curve 

equivalent to ~125% elongation

TheraBand CLX equivalence to weights

(in pounds)

Yellow = 3.42 lbs

Red  = 4.20 lbs

Green = 4.93 lbs

Blue = 6.23 lbs

Black = 8.00 lbsbs

Silver = 11.99 lbs

Gold 15.56 lbs ~125%

Regression equation predicts torque

ISOTONICELASTIC

Force AngleFA = Angle created by force and lever arm

2 5 0

resistance-arm angle

0

20

40

60

80

100

120

140

160

180

200

0 11 22 33 45 57 69 83 98 115 135 156 180

joint angle

resi

sta

nce

-arm

an

gle

angle

As joint angle increases, force angle decreases

Force Angle

Join

t Ang

le

Page 8: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Warning: RED Isn’t Always RED

Ensure your patients are using the appropriate resistance at home!

Equivalent to TheraBand

Silver

Equivalent to TheraBand

Black

Equivalent to TheraBand

Blue

Authentic TheraBand

Red

Other retail products on the market

TheraBand CLX Features

• Increase or decrease resistance by changing loops

• Easy connection to lower body

• Quick transition between exercises

• Create multiple resistance vectors

• Connect upper and lower chains

• Loop‐through

• Create spiral transverse plane

CLX Wall Station

• Wall Station– TheraBand CLX – Wall unit– Three Wall Anchors– Accessory Rack– Full color poster

• Clinic Focal Point– Change setups quickly for 

maximum use– Small footprint – Transition from Clinic to HEP 

consistently and efficiently

Page 9: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Wall Unit Features

• Unique secure connect system• Adjusts height quickly• Can be mounted to be utilized with Silver and Gold CLX• Prescription markers designed to help track and  measure individual 

progress

Mobility Tools & Techniques

Assisted Range of Motion

Mobility

Elbow Flexion AAROM

1. Securely anchor CLX2. Create vector of assistance3. Assist motion with CLX 

To assist joint motion when strength or pain limit ROM

Page 10: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Low Load Prolonged Stretch

Mobility

Anterior Capsule Stretch

1. Securely anchor CLX2. Create vector of resistance3. Position at end ROM

Apply constant low load resistance to joint capsule

Page 11: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

1. Open Hands2. Extend Fingers3. Extend Thumbs4. Extend Wrist5. Supinate6. Externally Rotate7. Extend Elbows8. Extend Arms9. Retract Scapula

Slowly return

Postural Chain ResetPostural Chain Reset

Mobility

Facilitate phasic chain to reset posture by balancing postural muscles 

Bruegger Upper Body

Post‐Isometric Relaxation

Mobility

1. Stabilize one end of CLX in line with target muscle

2. Shorten target muscle against light resistance

3. Hold for 3 seconds4. Exhale as you relax into 

stretched position

Upper Trapezius P.I.R.

Light muscle contraction followed by relaxation to reduce muscular trigger points

Page 12: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Eccentric Stretch

Mobility

Achilles Eccentric Stretch

1. Secure CLX2. Shorten muscle to be 

stretched WITHOUT resistance

3. Load muscle in shortened position by stretching CLX

4. Slowly lengthen muscle against CLX

5. Hold stretch at end

Eccentric contraction to facilitate collagen realignment

Page 13: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Contract Relax

Hamstring Contract‐Relax

1. Secure CLX2. Grasp other end of CLX 

to stretch muscle3. Contract target muscle 

against resistance 

Mobility

Pre‐stretch contraction improves passive motion after stretch

AdditionalMobility Tools & Techniques

Page 14: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Standard versus feedback‐augmented shoulder pulley exercises

• Shoulder patients were randomly given either TheraBand or white shoulder pulley for home exercise

• TheraBand shoulder pulley group had significantly more shoulder range of motion after therapy

Marks help withinstruction and feedback for patient.

A comparison of assisted and unassisted PNF techniques and static stretching 

• TheraBand Stretch Strap provides flexibility gains similar to partner‐assisted PNF stretching

• “competitive athletes should use these techniques to improve flexibility in a separate stretching routine, and not immediately before training and competition”

Maddigan et al. 2012. J Strength Condition Res. 26(5):1238‐44.

Foam Rolling for DOMS and Recovery of Dynamic Performance Measures

• 20 minutes of foam rolling massage on quadriceps immediately after inducing DOMS. Repeated 24 & 48 hours post.

• Significantly reduced pain and increased performance compared to control condition

Page 15: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

• Conclusion:– Short‐term increases in ROM without affecting muscle performance

• Dosage:– Foam Roller: 30‐60 sec (2 to 5 times)– Roller Massager: 5‐120 sec (2 to 5 times)

May benefit pre‐exercise warm‐up & cool down

Cheatham SW et al. 2015. IJSPT. 10(6):827‐838

• Theoretical mechanisms of myofascial rolling– Change viscoelastic and thixotrophic properties of soft tissue

– Increased blood flow and tissue temperature– Changes muscle spindle length or stretch perception– Mechanical mobilization of fascia and scar tissue

Higher density tools may have stronger effects than softer density

Gentle tissue work (3 point support, yellow)

Aggressive tissue work (1 point support, blue)

Depth of tissue releasing is controlled through:

• Body Weight & positioning

• Stroke length & fluidity

• Progressive wrap densities and heights (colors)

TheraBand Foam Rollers and Roller Wraps

Page 16: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

TheraBand Roller Massager

Unique ridged design and latex‐free 

material Retractable handles

Standard Portable

Neutral Calf

Depth of tissue releasing is controlled through:

• Pressure applied 

• Body part positioning

• Stroke length and fluidity 

Elongated Calf TrP ReleaseShortened Calf

• Elongated muscle position + longer strokes for superficial tissue layers

• Shorter muscle position + shorter strokes for deeper knots and tightness

• Deep dig with handles for trigger point / tension point (“knots”) release

TheraBand Foot Roller

• Ridged design– Increases pressure points to deliver enhance mobilization

• Hollow core helps shape to foot• Can be chilled or frozen

Page 17: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

IASTM and STM Techniques

Mechanical:‐Recreation or Stimulation of the Inflammatory cascade 

Fascial:‐Superficial (skin), Middle and Deep (muscle + ligament)

Neurological: ‐Afferent Stimulation

‐Pain control, gait control theory‐Facilitation, motor control pathway

Fluid Dynamics:‐Improve edema, fluid mobility, tissue health

• Improved biomechanical function in treated tendons

• Increased cross‐sectional area in treated tendons. 

Untreated Achilles Tendon

IASTM Techniques

*This study was performed in animal models

Bon Vital & Prossage

Prossage Salve & Balm (Menthol) For IASTM and Scar massage 

Prossage Cream & Oil (Menthol)Bon Vital Muscle Therapy Massage Cream 

For Soft Tissue Mobilization

Page 18: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Janda’s Upper Crossed Syndrome

Neck Pain

Stability Mobility

Lateral Epicondylitis

Stability Mobility

Page 19: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Shoulder Impingement

Stability Mobility

Janda’s Lower Crossed Syndrome

Lower Back Pain

Stability Mobility

Page 20: Session 405: Active Care: Mobility Techniques & Tools to ... · • Shortermuscle position + shorter strokes for deeperknots and tightness • Deep dig with handles for trigger point

Anterior Knee Pain

Stability Mobility 

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