Mobility Key Components

Chronic diseases frequently cause reduced mobility, pain and diminished quality of life. This leads to the hottest trend in mobility right now is not being a smart phone or a wireless gadget. Need for mobility is making health headlines in a way mobility is that freedom and control of our bodies that lets us do what we need to do: walk and move.

Mobility is essential for getting through the day, whether you need to walk across a room to the bathroom or kitchen, get out of bed or a chair, or walk through a grocery store. Here we highlight the key concepts of mobility in this infographic.

Mobility encompasses the use of functional movements.  Learning functional movements will have you using multiple muscles with each move and will minimize your risk of injury as you train, move or with your activities of daily living. Whether you’re a seasoned athlete, a beginner, or an older adult, you will reap the benefits of taking exercise back to the basics with functional movement training. 

WHY MOBILITY?

Human movement is facilitated by how conditioned the body is to allow movement and how much control in general the body has when moving the body. That is the basis of mobility. In a day to day basis, we are required to move up and about to perform our daily routines ranging from doing house chores, working to exercise. These are called functional movements.

Mobility is how the joints move regarding to the surrounding joint muscle flexibility and coordinated movement of the joint.

All types of motions the body goes though are facilitated by the flexibility of the tissues supporting the joint and the control the body has of the joint facilitated by neuromuscular control.  We depend on our bodies to take us through functional movements with ease regardless of how difficult the task may be. This is due to specific range of motions the joints to be achieved while executing functional tasks and the amount of neuromuscular control the tissues surrounding the joint has for the joint to be able to move in a specific direction.

As an infant, the larger population is born with appropriate basal joint flexibility. We tend to learn how to control the flexibility and gain the required mobility through motor development. These start with the basic gross motor skills to refined motor skills. Gross motor skills are large movements of the body which include sitting, walking, running and climbing stairs. Fine motor skills involve use of the small muscle groups for example movements of the fingers and hands.  The more complicated our movements are when growing up the more refined our movements skills will be thus the more mobility we will possess. Apart from how physically active we’re raised; our jobs or daily routines have a role in how mobile we can get. People with physically active lifestyles tend to have more mobility while individuals with sedentary lifestyles might have lesser mobility. As a human age, their flexibility and mobility may vary depending on their daily activities.

A focus on mobility is essential since recent studies have shown mobility and cognitive function being the hallmark of ageing. This is the reason why to promote healthy ageing, we should focus on maximizing functional movements, maintaining functional movements to delay the decline of it for as long as possible. This is by including functional exercises in our daily work or workout routines. Remember functional movements are exercises that mirrors how the human body is meant to move thus making movements even easier. The best way to improve mobility is through practice and exploration. We are encouraged to be always moving and challenging our bodies for a healthier biological ageing.

Exercise Program for A Person with Recovering from COVID or Moderate to Mild COPD

Correct Exercise Intensity Program for Someone Recovering from Covid or with Mild to Moderate Level Of COPD:

Weeks 1 to 3

Monday, Wednesday, Friday: 20 -30 Minute Walking
Saturday and Tuesday: 10 to 15 Min Climbing Stairs
Appropriate Active and Passive Stretching before and after aerobics session.
Thursday & Sunday: 20 -30 min Tai Chi/ Breath Work & Stretching/ Yoga

Weeks 4 to 9

Endurance, Flexibility & Balance
Monday, Tuesday & Friday: 30-minute brisk walk
Wednesday & Saturday: 20 -30 Minute cycling 5 to 9mph 
Appropriate Active and Passive Stretching before and after aerobics session.
Tuesday & Saturday: 20 -30 min Tai Chi/ Breath Work & Stretching/ Yoga

Strength and Conditioning:

Strength and Conditioning exercises are to be performed on Monday and Friday. After each session:
•          10 sec x 3 active static stretching of the main muscles involved especially the pecs, thoracic back, hamstrings, quads and hip flexors. Myofascial release or neuromuscular facilitation of large muscle groups is also indicated.
MondayWednesdayFriday
TricepsCalvesAbs/Lower Back
ShouldersHamstringsBiceps
BackQuadsPecs
MESOCYCLE SPLITS
ExerciseRepsSetsExerciseRepsSetsExerciseRepsSets
Push Ups82Standing Calf Raises82Hip Bridge82
Shoulder Press82RB Deadlifts82RB Bent Over Row82
Back Row2RB Squat82Pec Dec82
Back Extensions82Leg Curl82RB Bicep Curl82
Tricep Extensions8 -102RB Leg Press8-102RB Chest Press82
Sample Program

POST-COVID PHYSICAL REHABILITATION.

Recommended Exercise Intensity for Someone Recovering from COVID or Other Pulmonary Obstructive Conditions (COPDs)

Some people who recover from COVID-19 or other pulmonary conditions such as asthma need physical rehabilitation to help them resume normal activities after staying in the hospital, or following periods of prolonged isolation. This program can help those with decreased strength begin to move more, gradually building up their stamina.

At least 150 minutes per week of moderate-intensity aerobic activity, 75 minutes of vigorous aerobic activity, or a combination of both for adults. Strength and conditioning that includes resistance training is indicated to be done twice-a-week for muscle strengthening. All these targeted at a 3.0 to 6.0 (moderate) metabolic equivalent of task according to the ACSM and CDC general physical activities Level of Intensity guidelines. More specific guidelines include: 

 Aerobic: 

40-80% of maximal effort. 1-2 sessions, 3-5 days per week. 30minutes; broken into smaller durations if necessary due to symptoms.

Strength training:  

Free weights, TheraBand’s, body weight exercises, inspiratory muscle training. 60 – 80% of maximal effort (Modified Borg 3-4 ) IMT = > 30%, or respiratory muscle training in a controlled manner. 2 to 3 days/week. 1 set of 8-12 reps; additional sets added when strength improves. 8-10 exercises, or 30- 40minutes; depending on exercise capacity and any symptom limitations.

Flexibility: 

Low to moderate; depending on capability and function. 3 or more days per week; preferably on all days that aerobic or strength exercise is performed. 30 seconds minimum for each static stretch. 

Neuromuscular;

Tai chi, yoga, breathing exercises. Low to moderate; depending on capability and function. In conjunction with other exercises on their program and taking into consideration their goals and capacity as tolerated.

STAY HYDRATED THEY SAID;

Water is the basis of life. Without it, life is not possible. Here are important notes regarding to water as the basis of life:

  • Water accounts for up to 75 percent of the weight of the human body.
  • Water provides a relatively stable medium in which chemical reactions can take place.
  • Water’s unique chemical properties (as a solvent with a high boiling point and high heat capacity) make it essential for homeostasis.
  • The body’s thermoregulation relies on water’s high heat capacity to buffer it against swings in external temperature.
  • Cooling of the body is carried out by evaporative water loss—perspiration.
  • Water is also vital as a transport medium.
  • Oxygen is carried by red blood cells suspended in serum, which is mostly water.
  • Nutritional substances are dissolved in water and transported to cells.
  • Water is used to dissolve and dilute waste molecules.
  • If the body is deprived of water for very long, death will result.

Physiological role of water in our bodies.

The Mobility Journal.

MOBILITY ROUTINE FOR STUDENTS AND TEENS.

With this age, most students especially teenagers are doing very little to no physical activity. This leads to these young people accumulating high volumes of sedentary behaviour which are risk factor for multiple negative health-related outcomes. Here is a simple routine I drafted for my busy on the schedule students clients to keep them mobile and fit while still managing those heavy school hours.

1. Have at least 40 minutes of running or cycling or swimming 4 to 6 times a week.

2. Stretching routine after every other day or two days depending on how easy it is for you. Aim at stretching with proper form (being stable and in control of the pose/position without shaking/slipping) at first and the duration comes in later.

  1. 30 to 50 rope skips/Jumping Jacks
  2. Side stretch by the wall (10 to 30 seconds).
  3. Wall Stretch facing down (10 to 30 seconds).
  4. Deep Front Lunge (10 to 30 seconds)
  5. Deep Side Lunge (10 to 30 seconds)
  6. Hamstring and Calf stretch against the wall. (10 to 30s)
  7. Hip Bridge. Hold the pose for 10 to 30s.
  8. Cobra pose. Repeat 5 to 15 times.
  9. Cat cow pose. Repeat 5 to 15 times.
  10. End with a child’s pose for 10 to 30s.

POST KNEE REPLACEMENT REHAB PROTOCOL

PHASE 1 (0-2 Weeks)

Goals:The main goals will be to control pain, inflammation and protect the healing graft. Restoration of range of motion will begin aiming at total knee extension and establishing good quadriceps activation.

Contraindications: Weight-bearing as tolerated with assistive device for the knee and partial weight-bearing with assistive device for the muscle group the graft was taken from. The knee brace locked in extension with ambulation and sleeping Bledsoe Brace unlocked 0-900 when non-weight bearing.

Therapeutic exercises include:

Range of Motion 3- 5 times a day

  1. Heel Slides 2 Sets of 20 Repetitions.
  2. Assisted Knee Flexion/Extension in Sitting 2 Sets of 20 Repetitions Heel Prop (passive extension)
  3. Rolled towel under the heel seated leg extension (with permission) 5 to 10 s x 3.
  4. Band Stretch (Calf and Hamstring stretch) Hold for 30 Seconds 3-5 Repetitions.
  5. Ankle Pumps without resistance at least 2 Sets of 20

Strength Training once daily

  1. Quad Sets 2-3 Sets of 20 Repetitions
  2. SLR *(no Lag)* 2-3 Sets of 10-20 Repetitions
  3. Hip Abd/Add/Extension (against gravity) 2-3 Sets of 10-20 Repetitions
  4. Standing or Prone
  5. Hamstring Curls (contraindicated for Hamstring Graft) 2-3 Sets of 10-20 Repetitions T-Band on the ankle.
  6. Ankle Pumps 2-3 Sets of 20-25 Repetitions
  7. Stationary bike repetitions cycle with minimal resistance 10-15 Minutes Daily if possible.

PHASE 2 (Week 3- Week 5)

The goal is to progress ROM as tolerated without restriction. Protect the healing tissue. Progress weight-bearing as tolerated to full weight-bearing. Wean the client off crutches when good quad control is demonstrated. Introduce strengthening especially quadriceps.

Therapeutic Exercises will include:

Range of Motion

  1. Continue with ROM exercises from phase 1.
  2. Stationary bike 15 Min daily if possible. No resistance with unoperated knee doing all the work.
  3. Patella mobilization is active and passive.
  4. Figure 4 Hamstring stretch with a band on the operated leg. Hold for 5s to 10s three times

Strengthening once a day, 2 sets of 15-20 reps

  1. Continue Quad Sets (as needed for VMO activation)
  2. Continue 4 way SLR program (add ankle weight as needed)
  3. Hamstring Curls (Patellar Tendon and Allograft Only)
  4. Standing Terminal Knee Extension
  5. Leg Press
  6. Heel Raises
  7. Leg Stance Standing hip abduction. Both limbs to activate the hip musculature. Use a broomstick for support.

PHASE 3 (Week 6- Week 12)

The main goals of this phase are achieving AROM of 0-110’ progressing knee flexion as tolerated, having good voluntary quadriceps control (develop a strong base), normalize the gait of the client to achieve independent ambulation community distances (>/= 800 feet) without the walker with minimal; antalgia, pain, and inflammation as well as introduce balance and proprioception exercises.

Therapeutic Exercises will include:

Range of Motion and Flexibility: To be done once a day until normal ROM is achieved:

  1. Continue ROM exercises from phase 1 if necessary
  2. Hamstring and calf stretching. PNF contract-relax-(antagonist *rectus femoris)-contract) 5 x a week. This is key for optimizing neuromuscular coordination and recovery.
  3. AA/A/PROM, graduated dynamic stretching for flexion (>90 degrees) and extension. Supine heel slides and seated Long Arc Quad (LAQ). 10 reps 2 times every day.

Cardio: To be done 3 – 5 times a week for 20 – 30 minutes.

  1. Cycle with progressive resistance
  2. Start elliptical at 8 Weeks
  3. Initiate swimming at 6-8 Week
  4. 20 Min pool walking.

Strengthening: Performed 3-5 times a week. 2-3 sets of 15-20 Reps

  1. Forward step-ups.
  2. Static forward/backward lunge.
  3. Halfway-down chair squats. Aim at 90’.
  4. Back Extension targeting isometric contraction from the quadriceps, hamstring, and glute
  5. Bilateral SLR in 4 planes (flexion, abduction, adduction, extension).
  6. Hamstring curl with ankle weights.
  7. Introduce sit to stand and chair exercises.

Proprioception

  1. Single-Leg Stance
  2. Static Balance on Bosu/Wobble Board/Foam/Etc
  3. Star Drill (single leg stance with reach)

PHASE 4 (Week 12-Week 16)

The goal for this phase will be to maximize post-operative ROM to (0-125’).  AROM without pain, or plateaued AROM based on the non-operative side. Progress with single-leg strengthening. Establish good patella-femoral mobility and generally good muscular strength in all lower body to allow jogging and plyometric training. Get comfortable with running and sprinting. Pivoting and cutting are contraindicated. Straight line running only.

Therapeutic Exercises will include:

ROM and Flexibility: Continue with daily stretching.

Cardio: To be done 3 – 5 times a week for 20 – 40 minutes.

  1. Cycle with progressive resistance
  2. Elliptical increased intensity.
  3. Swimming with increased intensity.
  4. Deepwater running.

 Strengthening: 3 times a week

  1. Dynamic Lunge 2 -3 sets, 15 – 20 reps.
  2. Lateral Lunge 2 -3 sets, 15 – 20 reps.
  3. Single leg squat, 2 -3 sets, 15 – 20 reps.
  4. Lateral and Cross overstep ups. 2 -3 sets, 15 – 20 reps.
  5. Bilateral Bridge with Isometric Adduction 10×0:03s.
  6. MVP Shuttle Hop on Uninjured Leg 3×5 
  7. MVP Shuttle Press (light load) — Injured Leg 3×5

Proprioception

  1. Dynamic single-leg swing on a Bosu ball, 10 swings x 3.
  2. Side to side swings on a Bosu ball, 10 swings x 3.

Plyometrics: With a soft landing with good eccentric control, done 2 times a week.

  1. Double leg jump rope. 5 -10 jumps 3 times.
  2. Double leg hops (forward and backward over the line) 10 -15 jumps 3 times.
  3. Box Jump (6-8 inches max) 10 -15 jumps 3 times.

PHASE 5 (Week 16- Week 24)

Goals for this phase will have the client maintain adequate ROM  and achieving more flexibility, strength, and proprioception as needed for returning to their appropriate recreational sports and activities of daily life. We will continue with progressive dynamic strengthening, proprioceptive, plyometric and introduce agility training to achieve adequate strength to begin a return to sport progressions pending physician’s clearance.

Therapeutic Exercises will include:

ROM & Flexibility: Daily lower body stretches. 30s holds of 2 to 3 reps.

  1. PNF Stretching at least two times a week.
  2. Active dynamic stretches pre-session.
  3. Static active/passive as needed post-session

Cardio: To be done 3 – 5 times a week for 20 – 40 minutes.

  1. Cycle with progressive resistance
  2. Elliptical with increased intensity.
  3. Swimming.

Strengthening: 3 times a week 2 to 3 sets of 15 to 20 reps.

  1. High knee skip (light)
  2. High knee run (light).
  3. Double leg jump rope.
  4. Single leg jump rope.
  5. Backward lunge walks.
  6. Standing External Rotation/Abduction with Mini-Band below Patella 20×0:02s.

Proprioception: 3 times a week.

  1. Single-Leg Balance (Eyes Closed) on Airex with Resistance into Adduction 2×0:30s each leg.
  2. Dynamic single-leg swing on a Bosu ball.
  3. Side to side swings on a Bosu ball.
  4. Single leg lunges on dynamic surfaces and lateral lunge walk
  5. 20M Forward sprints to a backpedal.
  6. Acceleration and deceleration figure 8 carioca.

Plyometrics/Jumping/Agility: 2 times a week(limited to 90-foot contact per workout). From week 16 to 17, we will do independent jumps focusing on sticking each landing with good form in frontal and sagittal planes while stressing on a soft landing with good eccentric control.

  1. Double Leg Jump (for distance)
  2. Double Leg Jump (for height)
  3. Double Leg Jump (with 900 or 1800 turn)
  4. Double Leg Lateral Jump/Lateral Box Jump (side to side) Depth Jump (6-8 inches max)
  5. Double leg hurdle hops 3×5.
  6. Single-Leg Hurdle hops (Unoperated Leg 3×5)
  7. Single-Leg Line Hop (Recovering Leg 3×5)

From week 18 to 20 we begin combination jumps, aiming at moving from jump to jump.

  1. Repetitive Double Leg Jumps (distance, height, lateral, turns) Jump for Distance into Jump for Height
  2. Box Jump to Depth Jump
  3. Depth Jump to Jump for Distance/Height

Speed/Agility Progression: Begining each workout with sprinting and backpedaling 50 meters (2 reps at 1⁄2 speed, 5 reps at full speed).

From 16 to 20: Begin forward and backward sprinting.

  1. Week 1: Sprint 50-100 meters at 1⁄2 speed 10 reps.
  2. Week 2: Sprint 50-100 meters at 1⁄2 speed 5 reps. Sprint 50-100 meters  at 3⁄4 speed 10 reps
  3. Week 3: Sprint 100 meters at 1⁄2 speed 2 reps. Sprint 100 meters at 3⁄4 speed 5 reps. Sprint 50-100 meters at full speed 5 reps. Backpedal 50 meters at 1⁄2 speed 5 reps.
  4. Week 4: Sprint 100 meters at 1⁄2 speed 1 rep. Sprint 100 meters at 3⁄4 speed 2 reps. Sprint 50 meters at full speed 5 reps and 100 meters at full speed 5 reps. Backpedal 50 meters at 3⁄4 speed 5 reps.

From week 20 to 24: Start basic change of direction beginning each workout with sprinting and backpedaling 50 meters. (2 reps at 1⁄2 speed, 5 reps at full speed)

  1. Week 5: T drill 3 reps at 1⁄2 speed, forward/backpedal shuttle 5/10/20 meter 3 reps at 1⁄2 speed
  2. Week 6: T drill 3 reps full speed, forward/backpedal shuttle 5/10/20 meters 3 reps full speed, box drill with shuffling 3 reps at 1⁄2 speed
  3. Week 7: Box drill with shuffling 3 reps at full speed, 10-meter shuttle run (quick direction change) 3 reps at full speed, Z drill 6 reps at 3⁄4 speed
  4. Week 8: Box drill with cuts 3 reps at full speed, 10-meter shuttle run (quick direction change) 3 reps at full speed, Z drill 6 reps at full speed

After 24 weeks, the client will be free to begin advanced strength and conditioning. He will start working with his personal trainer to develop sport-specific drills or perform drills needed in his typical sports practice under a strength and conditioning coach supervision.