Therapist Guides

Table of Contents Shoulder Acute Shoulder ...................................................................................................................3 Sub-Acute Shoulder..........................................................................................................4 Chronic Shoulder ...............................................................................................................5

Knee Acute Knee ...........................................................................................................................6 Sub-Acute Knee..................................................................................................................7 Chronic Knee .......................................................................................................................8

Neck Acute Neck ...........................................................................................................................9 Sub-Acute Neck................................................................................................................10 Chronic Neck.....................................................................................................................11

Low Back Pain Acute Low Back Pain ......................................................................................................12 Sub-Acute Low Back Pain .............................................................................................13 Chronic Low Back Pain...................................................................................................14

Disclaimer Nothing contained in this HealthSource presentation should be construed as medical or legal advice. This HealthSource program is for educational purposes only. HealthSource operational systems are designed to improve efficiency within your practice, when appropriately implemented. Most of the training we provide is geared toward system implementation, and none of HealthSource’s systems are designed to be a substitute for your professional judgment. It is important to note that any reference we may make with regard to treatment plans, protocols, diagnosis coding, documentation, frequency of treatment plans, x-rays, duration of treatment plans, types of treatment performed, doctor-patient communications, marketing and advertising is purely for educational purposes only. We do not teach or participate in the design or rendering of chiropractic treatment of patients. Treatment programs, documentation and coding should only be based upon your professional judgment as to medical necessity, as presented via the patient. Under no circumstances should a blanket treatment program be offered to each and every patient that comes into your clinic. That can be considered fraud.

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Acute Shoulder n Therapist Guide Total treatment time: 40-50 minutes if patient can complete all exercises. n Modalities (10-15 minutes): Choose a modality that decreases pain, swelling and increases healing, such as…

• Wall Punch (serratus ant): Strengthen Serratus Anterior and stabilize (WebEx library) • Pullovers: Increase strength and stability of shoulder (Shoulder-Impingement Syndrome – Biceps + Supraspinatus-Acute stage)

• Electrical Stim • Laser • Etc.

• Hitchhiking: Increase stability and ROM of shoulder (Rotator Cuff Strain/Sprain-Supraspinatus, Acute Stage)

n Soft Tissue Work (8-15 minutes):

• Codman’s Exercise: Increase shoulder ROM and strength

• Ice

• Fonzie/Chicken/Jerry Curls ***5 reps each: Increase shoulder ROM, strength and stability (WebEx library)

Passive from Therapist (5 minutes) – Pecs on affected side – Lat on affected side – Teres Minor on affected side – Scapula and sub-scapula on affected side

• Standing Partial ROM Full Can: Increase ROM and flexibility of shoulder (Shoulder-Impingement Syndrome – Biceps + Supraspinatus-Acute stage)

Rock Tape (leave on for 3-5 days, or to patient/skin tolerance) – (3 minutes) – Affected Shoulder – Evaluate scapula of affected side for taping

• Palm Up Front Raise: Increase stability and ROM of shoulder (Shoulder-Impingement Syndrome – Biceps + Supraspinatus-Acute stage) • Band Shearing ***sets of 1-2 minutes on / 1 minute off: Increase shoulder ROM and flexibility (Shoulder-Impingement Syndrome – Biceps + Supraspinatus) side

n Active Rehab Movement: (All movements done for sets of 10 reps unless a “***” is noted) – 20 minutes: NOTE: Proper breathing needs to be monitored throughout each movement (abdomen first, then chest): • Head Retractions: Increase cervical stability and improve scapulothoracic ROM…this is a small, pulsed contraction, not a full ROM retraction

Home Kit: Omega D/A product, Foam Roller, Shearing Band, Lax Balls, Cervical Pillow, MARV kit, Dennerroll

• Isometric Flexion, Rotation and Side Bending of the Cervical Spine: Increase cervical stability and improve scapulothoracic ROM (***8 second holds for each range, 2-3 sets) (Basic Cervical 1) • Scapula Retractions: Increase strength and stability of shoulder (Shoulder-Impingement Syndrome – Biceps + Supraspinatus-Acute stage)

*Sample protocols are for educational purposes only – see disclosures on page 2.

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Sub-Acute Shoulder n Therapist Guide Total Treatment Time: 45-55 Minutes if patient can complete all exercises. n Modalities (10-15 minutes): Choose a modality that decreases pain, swelling and increases healing (if patient can perform all exercises with pain levels of