1. No category

Ruth Sova
Progressive Core Drills for Ortho #404
[email protected]
SHARP TIP
(add to any exercise to destabilize and, therefore, improve core strength and balance …
and increase energy cost)
Stance, Heavy, Arms, ROM, Posture, Tempo, Inertia, Planes
Stance - Base of Support – narrow or wide, One foot, Head / eyes
Heavy - Imagine the limb or movement is heavy and difficult to do. This changes the muscle
recruitment pattern.
Arms - Reciprocal, non-reciprocal, behind back, different plane, unilateral, bilateral, CIT,
overhead, ipsilateral
ROM - Levers, bigger movement, larger reach, bigger jump, more flexion / extension, abduction
/ adduction, internal and external rotation, circumduction, bigger steps, reps, cross midline
Posture - Train with good alignment – it increases function. Poor posture is extremely common
in our populations – even with those who exercise.
Tempo - Slow, slower, slowest
Inertia - Stops (short or long), direction changes, re-starts without alignment changes
Planes - We move mostly in saggital plane. Add coronal and transverse. Mix arms and legs and
body. Multiplanar movement increases balance difficulties.
+ - I couldn’t find the right acronym to include depth of body, depth of arms, levers or drag. 
EXAMPLE
1. Seated Exercises – this will work with any exercise, we’ll use take hand in and out of the water
A. Stance – open knees easy, close knees harder, lift one knee a tiny bit, move eyes, move head,
eliminate LE movement during other progressions, lean forward
B. Heavy – heavy as hand goes up or reverse heavy as it lowers, kneelifts
C. Arms – put the non-moving had behind back, use the moving hand in front of the torso, then to
diagonal, then to side and further back
D. ROM – try moving arm close to the body (short lever) and then further from the body (long
lever)
E. Posture – vary tailbone positions, slouch, lean, reach – then return to upright
F. Tempo – move the hand slowly and then faster
G. Inertia – move the hand in and out several times at a normal pace and then stop (trunk will have
to take over)
H. Planes – while one hand moves up and down move the other hand in circles to the side (or in
any different plane), or have corresponding or opposite leg move
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Ruth Sova
Progressive Core Drills for Ortho #404
[email protected]
2. Stand With Vertical Trunk Control (open and close arms – horizontal ab and adduction)
A. Stance – turn eyes or head, close eyes, closed stance more difficult, long tandem stance or extra
wide stance also harder, weight over one foot, one footed, toes out or in, toes of one foot in and
other out
B. Heavy – reverse heavy on the upright body, open heavy, close heavy
C. Arms – moving reciprocally or unilaterally, ipsilateral, palms up, palms down, palms together
(thumbs up), arms lower
D. ROM – tilt and return, partial ROM with arms, bigger, smaller, elbows, wrist extension
E. Posture – head positioned, lift neck, depressed scapulae, externally rotated shoulders, lift rib cage
F. Tempo – change head and eyes and different speeds
G. Inertia – turn head side to side three times and then turn and hold, stop and restart UE movement
H. Planes – turn head up, down, right, left, tilt right and left, unilateral arms
3. Walk with Vertical Trunk Control
A. Stance – wide stance / short stride, narrow stance / long stride, head, eyes, deeper in the water will
also change difficulty
B. Heavy – swing phase, trunk glide, push, back up same
C. Arms – Circumduction, change hand position, unilateral, bilateral, ipsilateral, overhead, close going
forward, depth of arms
D. Range of motion – long or short lever, equal ROM in both arms and both legs, wrist, ankle
E. Posture – head positioned, lift neck, depressed scapulae, externally rotated shoulders, lift rib cage,
external hip rotation
F. Tempo – mix tempos, try super slow
G. Inertia – Stop and start arms on cadence, unpredictable stops, stop at end of range of motion, stop in
middle of movement – use for UE or LE
H. Planes – flex and extend one arm while horizontally abducting and abducting the other, move head
in different plane, circumduct LE while horizontally ad and abducting UE, vary ankle movement (one
plantar flexes with foot strike, the other dorsiflexes with foot strike), in aerobics this could be cross
country ski moving sideways without letting the body tilt
4. Plank Vertical Trunk Control
A. Stance – wide stance is easy, feet together harder, one foot, head, eyes high or low in the water will
also change difficulty
B. Heavy – TRUNK: tailbone, rib cage, push or combat body floating up or to head ARMS: heavy on
flexion, abduction and, external rotation, and reverse heavy
C. Arms – Circumduction, change hand position, unilateral, bilateral, ipsilateral, overhead
D. Range of motion – UE: long or short lever, reaching behind, Circumduction LE: improve extension,
abduct then lift and lower or circumduct, ad and abduction
E. Posture – head positioned, lift neck, depressed scapulae, externally rotated shoulders, lift rib cage,
external hip rotation
F. Tempo – mix tempos, fast with one arm while slow with the other, use LE the same way
G. Inertia – Stop and start arms on cadence, unpredictable stops, stop at end of range of motion, stop in
middle of movement – use for UE or LE
H. Planes – flex and extend one arm while horizontally abducting and abducting the other, move head
in different plane, circumduct LE while horizontally ad and abducting UE
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Ruth Sova
Progressive Core Drills for Ortho #404
[email protected]
Back Problems
Ankle or belt buoyancy is a compression
precaution
Load and alignment precaution
Benefits of Aquatics
Decrease back pain
Increase mobility
Increase circulation
Water decreases edema
Modifications
Consider arm movements
Begin slowly
Decrease impact
Smaller ROM
Move proximal to distal
Work toning and stretching
Assistive Devices
Shoes
Canes or walkers
Braces
Activity / Exercises / Techniques
Bad Ragaz for trunk stabilization
Feldenkrais for muscle release
Halliwick for stabilization
UCT for open chain trunk stabilization
Ai Chi for trunk mobility and reaching/turning
skills
Pilates for trunk stabilization
Slow motion for balance and proprioception
BackHab for functional movement with
progressions
The Heavy Concept
AquaStretch
Transfers
Non-slip shoes
Ramps and railings for entrance / exit
Positioning
Horizontal or vertical
Guard positional changes
Deep or shallow water for stabilization
Water will allow progressive weight bearing
Considerations
Backstroke precaution
Cool pool water precaution
Eliminate diving or jumping into the pool
Hip Replacement (THR) / Issues
Benefits of Aquatics
Transfers
Offloads injured muscle tissue
Increases function and weight bearing
Ramps for entry / exit
Railings for entry / exit
4” stairs
Assistance on weaker side and descending
Assistive Devices
Canes
Walkers
Wheelchairs
Shoes
Noodles or tube or vest in the water to assist
with offloading or balance
Noodles or EZ Grips as parallel bars
Short-blade fins
Tubing for reciprocal arm movement
Positioning
Seated for ankle / foot exercises
Standing for sit-to-stand skills and walking and
balance
Horizontal for relaxation or pre-weight bearing
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Ruth Sova
Progressive Core Drills for Ortho #404
Considerations
[email protected]
Work balance and ambulation
Use the Heavy Concept and Slow Motion (slow
movement increases proprioceptive feedback)
Decrease weight bearing to create function
without anomalies
Decrease impact
Increase small ROM symmetrical flexion and
extension
Watch for shear forces or torque in turning
skills
Activity / Exercises / Techniques
Ai Chi for relaxation, turning skills and balance
Bad Ragaz for relaxation or pre-weight bearing
or stabilization
PNF for joint function
Feldenkrais / Pilates for movement from the
inside-out
Ai Chi Ne for turning and reaching skills with
minimal assist
AquaStretch
Modifications
Work ankle flexion and extension
Teach rolling heel-to-toe strides
Teach reciprocal arms
Shoulders (TSR)
Considerations
UE equipment precaution
Eliminate hanging on equipment or deck
Scapular displacement radiates down the arm
Benefits of Aquatics
Increased ROM
Decreased pain
Modifications
Assistive Devices
Perform external shoulder rotation
Keep shoulder submerged as much as possible
Use symmetrical movement
Perform scapular depression
Work flexion, extension, rotation and
circumduction
Sling
Transfers
Protect during pool entry and exit
Positioning
Activity / Exercises / Techniques
Submerge shoulder for subluxation
Horizontal works well – submerge shoulder for
decrease in pain and increase in ROM
PNF for function
Bad Ragaz for submerged shoulder PNF and
other exercises
Ai Chi for external rotation
AquaStretch
Ruth Sova
www.ruthsova.com
www.atri.org
[email protected]
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