INERTIA: A Therapist's Thoughts

Time to get the upper extremities involved in the "Exercises I Love" series.  We treat a lot of shoulder injuries in the Sports Medicine Center, so I want to make sure to include some of the exercises that I use a lot for these injuries also.

Prone Scapular Strengthening

Some call these “Y,” “I” and “T” exercises, and I understand that I am kind of cheating adding three exercises into one here, but they go together well and I usually give them out all at once. Most people do not address the posterior shoulder stabilizers with workouts, and combining that with poor posture, leads to weakness around the shoulder blade.  I hate to say all, but I’m pretty sure that all of my patients with shoulder issues get these exercises (or some variation) as part of their home program.

Prone Extension



Lie on stomach with involved arm hanging off the table. Set shoulder blades back and hold position. In a thumb-up position, slowly raise your arm behind you to table height keeping your elbow straight.

Prone Shoulder Abduction



Lie on stomach with the involved arm hanging off the table. Keeping the elbow straight, pull the shoulder blades back and hold. In a thumb-out position, slowly lift arm sideways to table height and maintain the retracted position as you return to the starting position.

Prone Shoulder Flexion



Lie on stomach with the involved arm hanging off the table. Keeping the elbow straight, pull the shoulder blades backward and hold. Slowly lift arm forward to table height and maintain the retracted position as you return to the starting position.

It's time for the next exercise in my list of exercises that I love.  I hope everyone has had a chance to do the first one from last week.  The next one is another one for the lower extremity, and works a lot of different muscles at once which is what I like.  If you don't have a resistance band to use at home, you can also do it with a cable column machine at the gym. 

Steamboats:  I’m not sure where this one got its name, but as far as I know, it has always been called this.  I love this exercise because it addresses many issues and most of my patients with hip, knee, or ankle problems will do this at some point in their rehab.  It’s also great one to give as part of their home program.  Basically it is a balance exercise on one leg while the other leg kicks against a resistance band.  It can be repeated in multiple directions to address stability and strength in all planes of motion.


Secure one end of a theraband to an immovable object. Tie the other end to ankle of UNINVOLVED leg. Balance on the slightly bent INVOLVED leg. Keeping the knee of the uninvolved leg straight, wave it back and forth as fast as possible while maintaining balance on the involved leg. Keep tension on the theraband. Perform a set of “kicks” facing each direction; North, South, East West.

I have had a student with me for the past 8 weeks which has given me the opportunity to share some of the insight and knowledge gained in the last 11 years of practicing as a PT. It opened my eyes a little to the fact I tend to do a lot of the same exercises with patients. I guess there are just some exercises that I gravitate to for different reasons. Some address areas that are often forgotten, some work many different muscle groups so you get more bang for your buck, and some translate easy to a home program for the patient to continue with when his or her therapy is done. It gave me the idea to do a series on exercises that I love. I’m sure other physical therapists might argue for some other exercises, but these were the first ones to come to mind. So here we go with the first one, check back soon for the others.  

Step Up with Rotation:  This is an exercise that I use a lot with patients after an ACL injury as part of the post operative rehab. Once they are able start doing some higher level strengthening, this is a good one to work on balance and leg alignment.  After they perform the normal step up, I have them hold the other leg up and then do some trunk rotation while keeping the knee pointed over the toe. You can have them hold onto a medicine ball also to make it a little harder to control the motion.

View the video.

Recently a patient brought me a newspaper article that talked about the difference between doing surgery and physical therapy for a mensicus tear in the knee. Not surprisingly, she was in this predicament herself as she had been diagnosed with a meniscus tear and was wondering if PT was going to help or if she should have surgery done.

This is a common question that we address here.  Meniscal injuries are quite a regular occurrence in sports due to the cutting and pivoting demands of the activity. Physical therapy is often prescribed prior to doing surgery, and sometimes people are upset as they figure if there is a tear, then just go in and fix it. The recently published study referenced in the newspaper article found that there was not a big difference in outcomes at 6 and 12 months for patients who had surgery or those who only did a comprehensive PT program.

If you look only at those results, it would make sense that doing PT is a good option at a significantly decreased cost to the patient and insurance companies. As a PT, I like these results. It will help me to answer my patients' questions and be able to justify what I do.

However, it is important to note that this study does have some flaws to it, and we can't make too many generalizations from it. If we do, then some patients may not get the appropriate care that they need.  There are many factors to consider and because of this, a team approach with an orthopaedic surgeon, physical therapists and the patient, should guide the decision, rather than basing it solely on the public opinion from a newspaper article.

Naturally, at this time of the year, there is a lot of discussion in the clinic related to sports. Conversations about March Madness basketball and the beginning of the Brewers' season are everywhere this week. 

As a Marquette fan, I have enjoyed the run they made in the tournament and spent a good amount of time talking about their surprising run to the Elite 8. However, the thing most people wanted to talk about was the injury to Kevin Ware, the Louisville player whose leg exploded during their game against Duke over the weekend, resulting in a compound fracture.

I was driving and listening to the game on the radio, and even without seeing it, I could tell from the commentators it was pretty serious.  The fact that the arena fell silent and even the Duke players and coaches began to cry meant that it was not good.

They started speculating on the radio that his career may be done.  My wife felt terrible and couldn't stop saying how horrible it was. I agreed with her for a moment, but then I let my medical background and experience as a PT take over. Then I started to feel a little callous to the situation because I know he'll be able to come back. 

I know this because we get to see it every day here at the Sports Medicine Center. We see horrible injuries where people come in distraught that they won't be able to return to their favorite activities, but after going through rehab, life starts to return to normal.  It's long and hard at times (like it will be for Kevin Ware), but ultimately our clients can achieve their goals. It's the part of the job that we all love.