RECOVERY ASSISTANCE / ADVICE

Occasionally, you may feel some increased tenderness after treatment. This is not unusual & is a result of the changes, induced by treatment.

Some people liken the feeling, to the effects of unaccustomed exercise. If you are worried or would like any advice please do not hesitate to contact David. 
In the mean time, see the following for some useful general tips. It's quite common & normal following osteopathic treatment, for a patient to feel sore / achy for a few days following treatment (similar to what you might experience after exercise).

Some patients have an aggravation of symptoms but these usually settle down quickly. 


Cold Packs

These are very helpful reducing pain & assisting the inflammatory (healing) process.
They are most effective when used as follows:
In the first 24 hours after any injury, apply hourly for 5 minutes at a time. Subsequently apply for 15 minutes every 3 - 4 hours
Never place the ice pack, directly on the skin.
Cover the area to be treated with a thin cloth. Apply the cold pack (frozen peas, gel pack).

Sitting

If you have low back pain, avoid sitting for more than 20 minutes where possible.
If sitting is unavoidable, use an upright chair.
Use a cushion to raise your hips, a little above your knees. Stand up & move around every twenty minutes. Driving involves sitting & long journeys, should be broken up.


Lying down comfortably

On your back with a pillow under your knees; or,
On your side, knees bent with a pillow between them.
Placing a duvet under your sheet, may make a hard bed more comfortable.

Neck Comfort

A collar or rolled towel around your neck, may help relieve neck pain. Easing Repetitive Motion
Avoid repetitive movements, (reaching stretching & twisting, even for small items).
Too many uninterrupted repetitions of an activity or motion, unnatural or awkward motions such as twisting the arm, feet or wrist, overexertion. incorrect posture, or muscle fatigue.

EXERCISE NOTES

All exercises are intended only as reference for patients of David, taken through identified exercises devised for them specifically. Successful Rehabilitation is a shared & established goal of treatment. Rehabilitation Exercises Regular exercises to restore the strength of your body and a gradual return to everyday activities are important for your full recovery.

This guide is for you (patient’s) to reference as notes, further too specific advice, which has been individually provided by David. This provides a basic over view of some of the stretches & exercises suggested by David Gray, and is by no way a substitute for the specific advice, he delivers in individual cases.

Please contact David for individual advice, to help you develop an appropriate exercise program for your own rehabilitation.

Exercises to Avoid

It is best to avoid the following exercises because they strain or negatively effect the bodies mechanics

• Lying on your stomach with legs extended and lifting together
• Sit-ups (need to eliminate any involvement of the hip flexors)
• Any stretching that requires quick and bouncy movements.

Good activities for people with back problems include

• walking
• strength training on machines
• Aerobic exercise on machines
• Bicycling
• Swimming all with optimum posture
• Yoga

There are different systems of yoga, the low impact Hatha Yoga is most appropriately advised and to practically follow with a qualified teacher.

Rehabilitation of any area, you need to condition your whole body.

Physical activities such as walking or swimming can help strengthen your back. It is always best to check with your Osteopath before you start any rigorous exercise program.

Remember to begin slowly.

All exercises are intended only as reference for patients of David, taken through specific exercises devised for them specifically.

Circulation

Circulation can be increased with appropriate Osteopathic treatment and exercise to improve mobility, lymphatic drainage and cardiovascular circulation.

Ankle Pumps

1. Lie on your back.
2. Move ankles up and down. Repeat 10 times.
3. Repeat 10 times.

Diaphragmatic (abdominal) breathing) 


The diaphragm is a large muscle separating the abdomen and thorax (chest), being the primary muscle used in breathing. Breathing exercises concentrating on the diaphragm enable efficient usage of the entire lungs, keeping muscles of the chest active and aid in reducing stress in everyday life. Correct breathing also aids in the setting up of a pressure gradient between the abdominal and chest cavities, this in turn helps drainage of blood and lymph back to the chest cavity from the legs and abdomen. Improved performance may also be gained during physical activity.

Perform this exercise twice a day or more. Lie on your back with your knees bent, and your head and back of your knees supported by pillows. One hand should be placed on your chest, the other on your abdomen just below your ribs. During this exercise you should aim to keep the hand on your chest as still as possible, while during deep in-breaths the hand on your abdomen should rise relative to, that on your chest, to ensure that all the air spaces of your lungs are used. Exhale fully through your mouth, then inhale deep and slowly through your nose. Slowly exhale as much air as possible through your mouth. Repeat for a couple of minutes at least twice a day.

Leg Exercises

Calf Muscle Stretch

1. Low step - Stand with both feet pointed forward. Place hands on a wall or similar for support
2. Place the heels pressed towards the floor 
3. Push your hips gently forward, while pressing your back heel to ground
3. Hold the stretch (minimally 30 seconds).

All exercises are intended only as reference for patients of David, taken through specific exercises devised for them specifically.

Hamstring Stretch

Lie on your back with a small rolled towel under your waist lower back (if advised).
Place your left leg down with your knee straight (if comfortable or keep bent for more ease). Bend your right hip so your knee is pointing to the ceiling.

Hold your right thigh by interlocking your fingers, (or use a towel dependent on your arm length). Keep your elbows straight and shoulders are relaxed on the floor, while holding and straighten your right knee and move the foot toward the ceiling.

You should feel a stretch on the backside of your thigh. Hold for 3-5 seconds and use the joint to play the muscle as shown to you, by David.

Then repeat twice. Repeat the same Stretch/Process on your other leg.

1. Lie on your back with legs bent.
2. Hold one thigh behind knee.
3. Slowly straighten knee until a stretch is felt in back of thigh.
4. Hold 3-5 seconds.
5. Use the joint to play the muscle as shown to you by David
5. Repeat 3 times for each side.

Stretch for Quadriceps

Sitting On Your Ankles

Kneel and sit on your feet with your heels pointing outward. Your knees should be separated, about the width of your hips. This exercise is facilitated initially by placing a rolled towel or cushions between the calf and back of the thigh, making this exercise more comfortable/achievable. 
Muscles tendons and ligaments in the knee are stretched, as well as the quadriceps and the musculature of the anterior lower leg.

Rhomboid or Central Mid Back Stretch

• Cross one arm in front of your body
• Use the opposite arm to squeeze into your body and above or below elbow joint. Hold this stretch for about 30 seconds

All exercises are intended only as reference for patients of David, taken through specific exercises devised for them specifically.

Arm Mid Upper Back Stretches

Rhomboid or Central Mid Back Stretch

To complete this exercise complete the following

• Cross one arm in front of your body
• Use the opposite arm to squeeze into your body and above or below elbow joint. Hold this stretch for about 30 seconds

Pendulum Swings


Stand and lean over with arm hanging, (leaning forward with your head balancing on an ironing board may support your lower back. Begin swinging the arm in small circles and gradually enlarge the size of the circles. Repeat 10 times. 
This stretch can be increased by holding in the swinging arm a light weight.

Arm flexion extension with finger movement, (Spiders).

Face the wall. Place the fingertips of both hands against the wall and walk the fingers up the wall until you feel a stretch in your shoulders. Hold the stretch for a count of ten. Then lower the fingers to the bottom of the wall until you feel a stretch in your shoulders. Hold the stretch for a count of ten. Repeat ten times.

Towel Stretch - Internal Rotation

Place right hand behind back.

With the left hand, dangle a towel behind the back.

Grasp the towel with the right hand.

Gently pull the right hand upward by raising the left arm to stretch the right shoulder.


Towel should be in vertical position.

Hold for 30 seconds. Repeat on other side.

Towel Stretch - External Rotation

Place right hand behind back.

With the left hand, dangle a towel behind the back.

Grasp the towel with the right hand.
Pull right hand downward to stretch the left shoulder. 

Towel should be in vertical position.

Hold for minimal 30 seconds. Repeat on other side.
You can also reverse this and put the involved hand behind your head and pull down with the other hand.

Neck and Shoulder Stretch

Stand or sit. Drop shoulder (side of stretch towards the floor your lowering arm). Tilt head forward looking toward the floor, then bend the head sideways away from the lowered shoulder, until you feel a gentle stretch through the side of neck and above shoulder. Hold for 30 seconds. Repeat on the other side. The careful use of the correct exercises, may reduce the length of your discomfort & increase freedom of movement.

TENNIS ELBOW EXTENSOR STRETCH

The forearm extensor stretch (Tennis Elbow)
Start with the backs of your hands together in front of you at your waistline, with your forearms parallel to the floor.
Slowly bring your wrists up toward your face by bending your elbows until you feel a mild to moderate stretch in your forearms. Keep the backs of your hands together & your hands close to your body.

Hold for 30 seconds.
Repeat 3 times every day, or as advised.Neck & Shoulder Stretch Stand or sit.
Drop shoulder (side of stretch towards the floor your lowering arm).
Tilt head forward looking toward the floor, then bend the head sideways away from the lowered shoulder, until you feel a gentle stretch through the side of neck & above shoulder. Hold for 30 seconds. Repeat on the other side.
The careful use of the correct exercises, may reduce the length of your discomfort & increase freedom of movement.

LOWER BODY STRETCHES

Exercises that stretch and strengthen the muscles of your abdomen and spine can help prevent back problems. If your back and abdominal muscles are strong, it will help you to maintain good posture and keep your spine in its correct position.

Warm up your muscles with light aerobic activity like walking before doing any strengthening or stretching. Wear loose clothing to make it easier to do the exercises.

I recommend particular stretches to alleviate your specific condition. Many of these stretches are for the lower back and surrounding areas and are given as further notes to patient specifically prescribed exercises, including; Knee Hugs, Abdominal Breathing, Hamstring Stretch, Core Stability. Stop doing any exercise that causes pain until you have talked with David your Osteopath.

Knee Hugs

• Lie flat on your back with the knees straight. Bend the knee’s and bring it up towards the chest.
• Hold the knee’s with both hands then take a deep breath in and on the out breath hug the knee gently, without forcing it into the belly, as your tummy grows bring the knee outwards to the side of your tummy, so that it does not press into your tummy.
• Loosen the grip on the knee, then very gently as shown to you by David, rock from side to side for at least 30 seconds. Often this exercise is suggested after sitting for periods of time or on waking first thing in the morning, as required.

All exercises are intended only as reference for patients of David, taken through specific exercises devised for them specifically.

Clam Shells

Why - Strengthens gluteus medius to improve knee and pelvis stability
Hip Muscle Exercise: Clams or Easy Gluteus Medius Exercise 1. Lie on your left side with your head resting on an outstretched left arm. 2. 3. ankles 4. 5. 6. 7. Bend both knees slightly, approximately 45 degrees. As you exhale, lift your top knee up, keeping your together. Hold that position for 2 seconds.
Slowly lower the leg back down.
Repeat 20 times.
Switch legs and repeat the exercise on the other side – 20 times
Perform this exercise every day.

Gluteus Medius at wall with squat:

More difficult exercise
To work the right gluteal, stand side on to a wall on the right leg with the left knee resting on the wall, as shown to you by David
Gently contract the buttock muscle on the right leg and press into the wall with the left knee without unbalancing the pelvis or spine Hold for 10 seconds

CORE STABILITY EXERCISE NOTES

Core stability

Core stability-exercises for multifidus and transverse abdominus. N.B. Abdominal Breathing very important. After an episode of low back pain, up to 80% of patients suffer further episodes of pain within the following year. Research indicates this is partly due to the muscles multifidus and transverse abdominus being inhibited (shutdown) as a reflex response to the original injury. These muscles combine to support and stabilize the lower spine, and having being inhibited by the original injury, they often do not switch back on easily.

Multifidus is a series of small muscles being part of the deepest layer of muscles running the length of your spine. Transverse abdominus is the deepest layer of the corset of muscles that pass around your abdomen attaching to your spine, lower ribs and pelvis. These 'inner unit' muscles contract fractions of a second prior to contraction of other muscles used in normal daily activity, thus providing a stable muscular 'core'.

Before working these muscles it is necessary to find your position of neutral spine. Lie on your back with your knees
bent. Slowly tilt your pelvis so that the upper part moves toward the floor, then tilt your pelvis in the opposite direction with the upper part moving toward the celling. This should be a short range of movement, and should not cause discomfort. Select the most comfortable point between the two extremes of movement, this is the neutral position.

This position should be maintained while performing the following exercises; To make active transverses abdominus gently draw your navel toward your lower spine and hold the contraction, continue abdominal breathing while holding the neutral spine position and contracting transverses abdominus. Hold for up to 10 breadth cycles, slowly exhaling whilst holding each contraction. To make active multifidus (in the same pose), gently draw your very lower spine toward the floor and hold the contraction, continue abdominal breathing while holding the neutral spine position and contracting multifidus. Hold for up to 10 breadth cycles, slowly exhaling whilst holding each contraction. To remind you of the simple illustration I give in teaching these exercises, using an imaginary glass on the navel; exercises for transverses abdominus spills the glass on your thighs and exercises for multifidus spills the glass on your chest.

These exercises are very precise targeting the particular muscles, that David has helped you to identify. The use of larger muscles in the area, is easily done, but not helpful.

WOBBLE BOARD

Wobble Board Exercises

1. Whilst sitting down place the wobble board under the feet and slowly rotate it a number of times in each direction, allowing yourself to feel comfortable with the board and the exercises you will then go onto perform standing on the board. Stand on the board in the security of a door frame to provide reassurance for your stability & safety.
2. Stand on the wobble board, feet shoulder width apart. Rock the board forwards and backwards, then side to side. Do this for 2 to 3 minutes.
3. Stand on the wobble board, feet shoulder width apart. Rotate the wobble board round so that the edge of the board is in contact with the floor at all times. Again try this for 2 to 3 minutes.
4. Stand on the wobble balance board, again feet shoulder width apart. Rock the board front to back for 1 minute then side to side for one minute.
5. Balance on the wobble board for as long as you can without the edges touching the floor. Aim for over 2 minutes without touching the floor.
6. Rotate the wobble board in a circle but do not allow the edge of the board to touch the floor. Aim for 2 minutes in both directions of full circles.
7. Stand on the wobble board, feet shoulder width apart. Rock the board forwards and backwards, then side to side, without the edges touching the floor. Do this for 2 to 3 minutes.
8. When you have mastered all of the above you should have strong stable ankles and be an expert, however this takes time as patience is part of the exercise.


All exercises are intended only as reference for patients, taken through specific exercises devised for them, with David.

David Gray Osteopath, www.davidgray-osteopath.co.uk.