POSTURAL HEALTH SCHEDULE OF EXERCISES IN SPINAL DORSAL CERVICAL AND Cervical SCHEDULE OF EXERCISES IN DORSAL COLUMN SCHEDULE OF EXERCISES

IN LUMBAR REGION SCHEDULE OF EXERCISES ABDOMINAL SUPPORT Laura Pacheco Arajol Monné Guasch Laia Pujol Montse Arrieta Araolaza March Maial en The backbone, our vital axis AUTHORS: Laura Pacheco Arajol physiotherapist Consell Català de l'Esport Associa te Professor of the Universitat Internacional de Catalunya "Monné Guasch Laia ph ysiotherapist Consell Català de l'Esport Associate Professor of the Universitat Internacional de Catalunya" Montse Pujol March physiotherapist Consell Català de l'Esport Maialen Araolaza Arrieta physiotherapist Consell Català de l'Esport Acknowledgments: We thank the collaboration: • our model Monica Riba, who afectu osamete and regard as "the muse of Recuperat-ion." • By Dr. Ramón Balius Matas f or advice. • A company Recuperat-ion, for supporting our proposals and excited a t all times to carry them out. CONTENTS INTRODUCTION POSTURAL HEALTH • Basic Stances • Basic rules for handling loads • Other standards to consider SCHEDULE OF EXERCISES IN COLUMN AND CERVICAL DORSAL Cervical flexibilizing • • Stretching exercises of the cervical muscle • Muscle toning and strengthening SCHEDULE OF EXERCISES DORSAL COLUMN • • Stretching Exer cises flexibilizing muscular cervico-dorsal region • toning and strengthening ex ercises SCHEDULE OF EXERCISES IN LUMBAR AREA flexibilizing • • Stretching exerci ses of the lumbar muscle • Muscle toning and strengthening abdominal exercises S CHEDULE OF SUPPORT • base position and placement pelvic contraction • Proposal • Examples of abdominal contraction REFERENCES 2 3 4 5 8 9 9 11 13 14 14 15 17 19 19 19 20 22 22 23 24 28 1 INTRODUCTION Sometime in our lives we have suffered pain in our spine, this has conditioned a number of limitations to develop our normal activity. Affect its prevention is an indispensable feature. Today we can see that in our habits of life tend incre asingly sedentary lifestyle. It is therefore necessary, make a habit of a daily regimen tailored to our needs, and follow basic rules of healthy posture. This h as been our goal in developing the manual, ask for a hand to improve flexibility , enhance and the other with both a better energy saving gesture developing and maintaining healthy our vital axis. The exercises we propose will not be the onl y indicator, we could add more, depending on patient characteristics, age, sex, sedentary lifestyle or active. To implement them, is necessary to consult the ph ysiotherapist who will adapt the schedule according to individual needs, focusin g more on a spinal segment or another, marking the progression to follow. The co mpletion of these exercises should never cause pain or discomfort. Avoid all tho se positions that could entail risks for its incorrect performance or cause exce ssive emphasis on the natural curvatures of the spine. We recommend conducting t hese exercises in the mirror, particularly in the case of the neck, for the rema ining years will be interesting to learn them and try them with the therapist re sponsible for this pattern then perform exercises on our own, either at home or our usual gymnasia. The number of repetitions and intensity will be scheduled an

d programmed by the therapist responsible to monitor and adapt the program to to lerance and individual needs. We must always respect the rule of "no pain", both in execution and recovery after completion of their realization. We have put th e manual in the following order: • Hygiene • Cervical spine and postural cervico -thoracic dorsal column • Column • lumbar • abdominal job 2 POSTURAL HEALTH The spine is the axis of the body, provides support and protection to the noble elements of the central nervous system that run through it, we refer to the spin al cord and spinal nerves that emerge from it. The column meets the paradox of b eing both rigid and flexible. Rigid to respond to such protection as necessary a nd, in turn, be the axis of the body, allowing the proper movement of limbs and the correct orientation of the head in space. Flexible, to achieve thanks to the addition of small movements of its segments as a whole, a larger movement. In o ur daily life activities,€our spine is constantly applied in both the static (or maintain the position like being seated), and in the dynamics (or development o f movements, eg walking). For this reason, the position or attitude that takes o ur body must be correct and aligned during our daily activities, recruiting our active elements (or elements muscular) and passive (ligaments and joint capsules ) to get the balance and continually adapt to changes brought about by the movem ent. Good posture keeps the body segments correctly located, painless, provides maximum efficiency with minimum effort gesture. When we flee from pain, we becom e accustomed to poor posture, when we do not exercise the body produce adaptatio ns in the musculature weak, they will weaken further and the muscles have to wit hstand greater load and voltage will become more rigid and short . With this we enter a vicious cycle that will worsen still further increasing our attitude bod y the pain, stiffness and lack of strength. In response to the issues raised and to give a possible solution or basic advice, we will try to meet the following objectives: 1. Learning the basics of proper posture. 2. Provide an exercise reg imen that allows the different segments that make up our spine chapters will dif ferentiate cervical, thoracic and lumbar; he mentioned the strengthening of the abdominal wall. We make this distinction because they are segments that behave d ifferently in static and dynamic. Therefore, the implementation and objectives o f the exercises will vary. 3. Relax the tight muscles, strengthen the weak, thus achieving balance and harmony between them. 4. Correctly apply a basic understa nding of healthy posture to adopt in static positions, as well as interaction wi th the environment or workplace and in the correct way of moving masses or weigh ts. Why do bad things? Frequently suffer back pain, both in the workplace and in the development of other activities. Many times or in general, we are not aware or not aware of it. We have not been taught to squat, sit, move and therefore w e have no reference of what is right or wrong. This aspect will be even more pro nounced when the stress and lack of time can lead to overexertion and bad attitu des that have to be modified. (Is not that what I can do the same, fast, but wel l with?). Many times our work environment as both domestic labor is inadequate: see where I work, how to cook, how to transfer the weight, where I sleep are, in ter alia, a series of questions we should ask to start changing our attitude and bring solutions. The tension and stress involves an increased tone of our muscl es, excessive tension can manifest itself in an attitude of raising the shoulder s and jaw clenching, which eventually will give the sensation of fatigue loading and back muscles, the trapezius and aches, fatigue can increase this tension, n ot recover from the load that have been submitted the previous day, ie not a res tful sleep, not knowing how to pause and relaxation during the 3 During the day, are issues that "pass bill" short or long term. We do things wel l and use aid as required. At first a bit difficult to apply what they learn, bu t with the constant repetition and will automate the gesture spontaneously: we c

an compare it to learning how to drive. The novice driver is aware, at the begin ning of a series of steps to take "clutch, first ..." but then steps out without thinking. Thus, we can begin to use the stairs to the kitchen every time that w e take an object from a top cabinet and thus avoid whiplash "not to get" also us e a sidewalk where one foot when we get some time in the same position bipedal a nd thus relax the lower back. It is very important to be educated and aware abou t the correct handling of loads. We show the basic positions and the rules to su ch manipulation. Figure 2 shows an example of incorrect posture. It looks comfortable, but is act ually asymmetric overloading of the intervertebral discs, cross-legged produce a symmetric rotation in the lumbar region and also by compreFig circulatory overlo ad. 2 sion of blood vessels in the popliteal fossa, the weight-bearing zone occu rs in the lower dorsal and lumbar€amount shoulders and neck region is heading fo rward. This antepulsion, will result in an overload of trapezius and other muscl es. • standing (Fig. 3) The correct standing position is distributed evenly from hea d to foot with the weight of our body by preventing hyperextension of the joints . We place your feet apart with the same as our hips, knees semiflexed. Activate the abdominal region directing the belly button in and up smoothly to avoid int erference with the breath, the gluteal region also remain active. This ensures t hat the ribs move up, breathe slowly, shoulders relaxed, arms along the body, re spect the natural curvatures of the spine to keep it aligned, the eyes look stra ight ahead to avoid falling or bending forward the cervical region. Basic Stances • Seating (Fig. 1) To get a correct sitting position, we stand on a chair that a llows the triple flexion of the lower limbs at an angle of 90 degrees between fo ot, knee and hip (hip), the feet are resting flat on the ground, lumbar region c an be reFig. One side or not in the seat, depending on their characteristics. Li ght activity contraction in the transverse abdominal and buttocks, so we try to steer the navel inward and slightly upward. This contraction must be maintained and allow breathing. Therefore, it is light and should not change the position o f the ribs. We respect the natural curves of our spine, hands resting on your la p or on a table to prevent overloading the dorsal cervical region. Keep your sho ulders relaxed while avoiding its ascent. Fig 3 Figure 4 Fig 5 4 Figure 4 shows an example of incorrect posture, for an asymmetrical side support on the lower extremities resulting in an asymmetrical load primarily in the lum bar region, also produces an increase in curvature in this region or low back pa in, abdominal region is too relaxed. Figure 5 shows that although the load is sp read uniformly in the lower extremities, there is a hyperextension of knees, beh aving burden, by continuity if you look at the abdominal and lumbar lordosis is an excessive and muscle relaxation, with increased thoracic and cervical curvatu re. In the lateral position (Figure 7) we semiflexed knees, rest your head on your a rm or cushion. Choose a mattress and a mattress that will maintain good alignmen t of the different segments, as our body exerts pressure asymmetric. Avoid overl y hard or soft surfaces, ideally mattresses sheets are adaptable to different an atomical regions and breathable mattress to optimize the adaptation (eg latex),

avoiding wool or soft foam. Basic rules for handling loads 1. Standing basic position; activation of abdominal and gluteal muscles, segment s aligned. 2. Distribute the weight on the maximum possible number of joints. 3. The spine becomes a stable shaft that flexes forward, back and torsional nor, t herefore MOVES IN BLOCK. 4. With the upper extremities, we must make a consisten t and always prey, before lifting action will make a load closer to the body. 5. The legs do the lifting force and direction of loading. It stands to reason and understand why the volume of lower limb muscle groups is much larger and strong er than the volume of the trunk muscles. Therefore, the legs have to bear the bu rden. Thus, we must bend your legs and not the trunk, and girarnos move the legs , while the trunk moves in the block. 6. To have more balance, our support base is broader, ie feet apart and one will be in the direction of the movement we ma ke. To improve further, we will take appropriate footwear, which hold the foot a nd with good traction, avoiding high heels, clogs and the like. 7. We will use t he counter of our body when moving or lifting loads. 8. Faced with heavy loads w ill not try to see if we can, always ask for help. Do not make sudden movements or twists, twisting of the trunk is not important move by the action of the legs . 9. Try regular physical activity, to keep in good physical and psychological. • supine positions we take for the rest should be the most adequate for the heal th of our spine. Thus,€positions of choice will be the supine (or back) and late ral (fetal position). We must avoid the prone position or face down as it presen ts a burden for the lumbar region and especially for the neck, since the turn of the head we do to get the breath creates an overload. If we face up, put a smal l pillow under the neck region aligned back, legs bent to protect the lumbar spi ne as shown in Figure 6. We can also place a large pillow under your knees to ke ep this deflection. Figure 6 Figure 7 5 EXAMPLES OF CARGO HANDLING OF HYGIENE AND POSTURAL: close to the body weight ver sus body weight away We bring the load to the body. This managed to avoid overlo ad in the cervical and thoracic region, since the weight is not supported by the upper extremities, but is spread across more joints (Figures 8 and 9). The force must be produced by the action of the lower extremities A closer view of the body and the load through a dam safe and consistent, we must close as pos sible to our center of gravity, ie, the midline of the body. The trunk acts as a block always precontracción stabilized by the abdominal muscles (Fig. 12). Fig 11 Fig 8 Fig 9 Fig 12 Trunk flexion versus knee flexion Figure 10 again shows a clear example in which we are requesting only the action of the upper limb and thus overload the dorsa l cervical region. The position of the trunk at the time of lifting the burden, overloading the lumbar region because we are canceling the action of the lower e xtremity. Fig 13 Fig 14 To lift the burden, we must make a full extension of the lower limbs of a slow a nd controlled, to keep enabled and stabilized the spine. Never any sudden moveme nts, fast or twisting the body. We always work through the strength of the lower

extremities while the trunk acts as a stable axis moving block (Figures 13 and 14). Fig 10 To protect the spine must bend the knees, the trunk line, move block, the load c loser to the body before lifting, and moving one foot for balance (Figure 11). 6 Torsion of the body versus leg action in this case the action and cargo handling is incorrect since we are printing a rotation involving a surcharge on structur es not ready. The lower extremities are not involved in this action, the upper l imbs holding the load too far from the central axis of the body. The muscle stra in, joint and ligament structures is assured (Figure 15.) We must always remember the activation of the abdominal muscles. It's interestin g how correcting the lower back with this simple correction. MAINTAINED sitting in an office when we should sit a long time, we must consider the importance of maintaining proper alignment of body segments and the need to get up and stretch every hour to remain in the seat and the need realiFig. 19 T sar a brief pause every 3 to 4 hours to walk around the room and rest. Figure 19 shows a bad workplace. We see that the seating is incorrect and also the upper extremities not rest on the table but are suspended in the air overloading the d orsal cervical region. We must avoid at all costs to hold the phone without the aid of hand. If this is done continuously, causing an overload cervical very imp ortant (Figure 20). Fig 15 Fig 16 In this case (Figure 16) the handling is correct. The load is close to the body, which acts as a stable block. The load transfer occurs through the action of th e lower extremities. Standing MAINTAINED AND BENCH When we should spend a long period of time in a st atic standing position, to properly maintain stabilized the lumbar region, will support a small foot stool and go alternating one leg and the other (Figures 17 and 18). Fig 20 Fig 17 Fig 18 Figure 21 shows the correct placement for working at a desk in front of a comput er. The base in the sitting position is met, the upper limbs are suspended but n ot resting on the desktop, the screen 7 computer is at the proper height, ie the same eye level. The work table shows cl ear and fully accessible with the phone. When we do answer the phone by holding it by hand (Figure 22). moving the burden to know where the object will go, how many steps we will, who moves to rotate and all aspects related to the trajectory of it. One of the two heads the movement, ie, make the steps to the other, it must obey to avoid inter

ference. It is better to stopping and resting, they want to "finish as soon as p ossible." We must also remember the basic rules: abdominal activation (the trunk is the hub and leg movement), to avoid drafts, the load closer to the body ... Drivers must avoid excessive wear seat reclined. In Figure 23 we see too advance d cervical region. This antepulsion cervical, coupled with the increase in the t horacic lead (never better), a significant surge higher, the longer you drive th e vehicle. The same applies if the seat is too low and our height is too small f or the vehicle. This forces us to move the body to see the road, keeping in tens ion across the back (figure 24). The excessive elbow flexion combined with the e levation of the cervical region overloaded shoulders. Figure 25 shows the correc t body positioning when driving, the position is comfortable, aligned, respects the natural curves, the distance between the seat and steering wheel allows a co rrect positioning of the upper extremity, the field of driver's vision is broad due to the correct seat height. See the section Sleeping "basic positions - supi ne" (p. 5). Fig 25 Fig 21 Fig 22 Other standards to take into account To get an object whiplash Avoid high, is essential to use a stool or a ladder to approach the object. This avoids risk of injury and drop the object. Rest on th e couch to rest, we must choose the appropriate surface. The nap on the sofa can be very harmful if our region remains excessive cervical flexion, or whether th e sleep surface is too soft. Broom, vacuum cleaners and the height of the stick when we buy a broom, mop, vacuum cleaner etc., we must assess whether the handle is adjustable. This will get adapted to each level and avoid excessive work and trunk flexion that occurs if the handle is short. Symmetrical versus asymmetric al loading in the case that we should move several bags, try to distribute the l oad between the two extremities. Carrying the load on only one side for asymmetr y favors overload. It is also important to unify several small bags in two large r bags, thereby avoiding excessive forced prey hands. Moving weights between two people in case of having to move a heavy load or high volume, we will require t he assistance of another person. In this case we must coordinate with it before Fig 23 Fig 24 8 SCHEDULE OF EXERCISES IN SPINAL DORSAL CERVICAL AND Cervical Flexibilizing Exercises The proposed flexibilizing exercises allow us to improve joint range, since they mobilize spinal segments that make up the neck area and relax the muscles of th e neck and shoulder girdle, improving its elasticity. Consequently we obtain gre ater stability of the joints involved. 2. EXERCISE OF ROTATION IN NECK FLEXIBILI ZATION Patient position: seated is recommended. During exercise: Turn head to on e side wearing the nose to the shoulder, without raising the shoulders. Hold the position 6-10 seconds and return to the starting position to neutral. Repeat th e exercise to the opposite side. Repetitions and frequency: a series of 10 repet itions. Increase a number every week to make a maximum of three series, as long as there is no pain. Compensation to avoid: Raise your shoulders. Comment: Each repetition consists of a rotation left and right. 1. FLEXIBILIZATION EXERCISE IN ANTERIOR NECK FLEXION Patient Position: We recomm end seated in front of a mirror. During exercise: Bend head forward until the ch in contact with the sternum. Return to starting position to neutral. Repetitions

and frequency: a series of 10 repetitions. Increase a number every week to make a maximum of three series, as long as there is no pain. Compensation to be avoi ded: is contraindicated extension (backward movement) of the cervical spine. Not e: The exercises are performed slowly and without causing pain during his execut ion. 3. Flexibilizing EXERCISE IN TILT WITH REQUEST OF THE CERVICAL visual input The objective of this exercise is to integrate mobility cervical visual and labyrint hine afferents.€Patient position: Seating in front of a wall with a reference po int (eg a painting), arms relaxed and aligned body segments. 9 Performing the exercise: The patient will choose on the wall a reference point, such as a painting on it, at a similar height to the position of the head. Tilt the head to the side bringing the ear toward the shoulder, still staring at the reference point. Maintain position 610 seconds and return to the starting positi on to neutral. Repetitions and frequency: a series of 10 repetitions. Increase a number every week to make a maximum of three series, as long as there is no pai n. Compensation to avoid: Do not raise your shoulders. Comment: Each repetition consists of a tilt left and right. 5. Flexibilizing EXERCISE OF THE DORSAL COLUMN WITH Cervical-RAISING AND LOWERIN G OF SHOULDER 4. FLEXIBILIZATION EXERCISE IN ROTATION WITH REQUEST OF THE CERVICAL visual inpu t The objective of this exercise is to integrate mobility cervical visual and la byrinthine afferents. Patient position: Seating in front of a wall with a refere nce point. Performing the exercise: The patient will choose on the wall a refere nce point, such as a painting on it, at a similar height to the position of the head. You have to turn his head to one side wearing the nose to the shoulder, st ill staring at the reference point. Hold the position 6-10 seconds and return to the starting position to neutral. Repetitions and frequency: a series of 10 rep etitions. Increase a number every week to make a maximum of three series, as lon g as there is no pain. Compensation to avoid: Raise your shoulders. Comment: Eac h repetition consists of a rotation left and right. Patient Position: We recommend seated in front of a mirror. Performing the exerc ise: Lift both shoulders (both) and fall, following a slow pace. Repetitions and frequency: a series of 10 repetitions. Increase a number every week to make a m aximum of three series, as long as there is no pain. Compensation to avoid: Poss ible side inclinations. It is important to keep the segments aligned. Comment: E ach repetition consists of a lifting and descent. Can be combined with breathing . 10 6. Circumduction flexibilizing EXERCISE OF SHOULDER Repetitions and frequency: a series of 10 repetitions. Increase a number every w eek to make a maximum of three series, as long as there is no pain. Compensation to avoid: asymmetric movements. Notes: Each set consists of a antepulsion (forw ard) and a retraction (backward). We can work with arms along the body. Stretching muscles in the cervical region 1. AXIAL STRETCH OF THE CERVICAL SPINE Patient Position: We recommend seated in front of a mirror. Performing the exercise: Make forward circles with both shoul ders at once, following a slow pace. Repeat the exercise circumduction directing the movement of the shoulders back. Repetitions and frequency: a series of 10 r epetitions. Increase a number every week to make a maximum of three series, as l

ong as there is no pain. Compensation to avoid: asymmetric movements. Notes: Eac h set consists of 10 forwards and 10 circumduction back. We can work with arms a long the body. 7. FLEXIBILIZATION EXERCISE IN APPROACH AND SEPARATION OF THE Sca pula Position of patient in the sitting position is recommended in front of a mi rror. During exercise: Advance both shoulders forward while following a slower p ace back then both shoulders back. Patient position: seated is recommended. Perf orming the exercise: From a starting position, trying to separate the head from the body as if to grow toward the ceiling. Hold this position for 6-10 seconds o f the year so that should be corrected cervical lordosis. Repetitions and freque ncy: a series of 10 repetitions. Increase a number every week to make a maximum of three series, as long as there is no pain. Compensation to avoid: Raise your shoulders. Comment: You left your arms relaxed along the trunk to feel better th e stretch. 11 2. KEYSTONE SUPERIOR STRETCH FIBERS Patient Position: We recommend seated in fro nt of a mirror. During exercise: Tilt head to one side wearing the ear toward th e ceiling. Hold for 30 seconds and return to the starting position to neutral. R epeat the exercise to the opposite side. Repetitions and frequency: a series of 10 repetitions.€Compensation to avoid: Raise your shoulders. Comment: Each repet ition consists of a tilt left and right. 4. KEYSTONE STRETCH FIBERS WITH MAYOR OVER IMPACT ON THE DISTAL INSERTS (Male) P osition of patient: It is recommended in sitting in front of a mirror. During ex ercise: Tilt head to one side (left) wearing the right ear toward the ceiling. W ith your left hand will do a dam on the wrist of the opposite arm (right) to pul l the left arm, taking a position as a "parenthesis." Hold for 30 seconds and re turn to the starting position. Repeat the exercise to the opposite side. Repetit ions and frequency: a series of 10 repetitions. Compensation to avoid: Lift the shoulder of the side that is not being stretched. Comment: Each repetition consi sts of a tilt left and right. 3. KEYSTONE SUPERIOR STRETCH FIBERS WITH MORE IMPACT ON THE INSERTS Nuchal Patie nt Position: We recommend seated in front of a mirror. During exercise: Tilt hea d to one side (left) wearing the ear toward the ceiling. With his hand on the si de of the slope (right) in the head, increased the pressure by stretching to you r right shoulder. Hold for 30 seconds and return to the starting position to neu tral. Repetitions and frequency: a series of 10 repetitions. Increase a number e very week to make a maximum of three series, as long as there is no pain. Compen sation to avoid: Lift the shoulder. Comment: Each repetition consists of a tilt left and right. 5. STRETCH OF THE COLLAR EXTENDERS Patient position: seated is recommended. Exer cise performance: With both hands on the head performed a forward flexion of the neck, bringing your chin toward your chest with helping hands. Maintain the per formance of 10-15 seconds and slowly return to the starting position. Repetition s and frequency: a series of 10 repetitions. Compensation to avoid: Raise your s houlders. Comments: No cause pain during the execution of the stretch. 12 Toning and strengthening exercises 1. TONING EXERCISES IN BENDING BY ISOMETRIC Patient position: seated is recommen ded. Performing the exercise: Place your hand in the face to our face pressure a gainst the hand. Maintain exercise and rest for 6-10 seconds. Repetitions and fr equency: a series of 10 repetitions. Increase a number every week to make a maxi mum of three series, as long as there is no pain. Compensation to avoid: Raise y our shoulders. Comments: No head movement. In each year changed hands to be as s ymmetrical as possible. 2. ISOMETRIC EXERCISE IN LATERAL TILT Patient Position:

We recommend seated in front of a mirror. Performing the exercise: Place your ha nd on the side of your head to make a lateral pressure with the head against the hand simulating a lateral inclination. Maintain exercise and rest for 6-10 seco nds. Changed hands for the lateral contraction to the opposite side. Repetitions and frequency: a series of 10 repetitions. Increase a number every week to make a maximum of three series, as long as there is no pain. Compensation to avoid: Raise your shoulders. Comments: No head movement. In each year changed hands to be as symmetrical as possible. 3. ISOMETRIC EXERCISE IN ROTATION Patient Position: We recommend seated in front of a mirror. Performing the exercise: Place your hand on one side of the front of our head to make a pressure against the hand simulating a rotation. Maintain exercise and rest for 6-10 seconds. Changed hands for rotation to the opposite s ide. Repetitions and frequency: a series of 10 repetitions. Increase a number ev ery week to make a maximum of three series, as long as there is no pain. Compens ation to avoid: Raise your shoulders. Comments: No head movement. In each year c hanged hands to be as symmetrical as possible. 13 SCHEDULE OF EXERCISES IN DORSAL COLUMN Flexibilizing Exercises 1. EXERCISE OF AXIAL FLEXIBILIZATION patient position: standing. Implementation period: Interlace the fingers and make traction with the palms facing the ceilin g. Hold the stretch for 2030 seconds. Repetition and frequency: 3-5 repetitions twice daily. Compensation to avoid: hyperlordosis. Comment: Important to keep yo ur eye on the horizontal. 3.€FINANCIAL POSITION OF FLEXIBILIZATION "CAT HORSE" P osition patient fours. Implementation period: Mobilizing the segment dorsal, lum bar and pelvic. Repetition and frequency: 10 repetitions twice daily. Compensati on to avoid: Movement of the neck. Comments: The stretch is levied on the latera l side of the trunk. 2. EXERCISE IN INCLINE FLEXIBILIZATION patient position: standing. Implementatio n period: Interlace the fingers and make traction with the palms facing the ceil ing by tilting the trunk to one side. Hold the stretch for 20-30 seconds. Repeti tion and frequency: 3-5 repetitions twice daily. Compensation to avoid: Keep the weight on one limb. 14 4. FINANCIAL POSITION OF FLEXIBILIZATION "MOHAMMED" both hands. Perform anterior traction of the arms and back while the dorsal regi on. Hold this position for 10-15 seconds. Repetition and frequency: 3-5 repetiti ons twice daily. Compensation to avoid: Creating excessive tension at the neck. Comments: The stretch will be charged at the dorsal. 2. STRETCH OF BILATERAL interscapular and paraspinal muscles DORSAL patient posi tion: standing. Implementation period: Interlace the fingers by placing the arms in a horizontal position and perform anterior and lateral traction of the arms and back while the dorsal region (as if we embrace a balloon). Hold this positio n for 10-15 seconds. Repetition and frequency: 3-5 repetitions twice daily. Comp ensation to avoid: Creating excessive tension on the collar. Comments: The stret ch will be charged at the dorsal. Position patient: fours. Making Exercise: Moving arms and go pull the pelvis tow ards your feet until you feel the tension. Hold this position for 20-30 seconds. Repetition and frequency: 3-5 repetitions twice daily. Compensation to avoid: D o not keep the spine aligned and arching the neck region.

Muscle stretching cervico-dorsal region 1. STRETCH OF BILATERAL interscapular and paraspinal muscles DORSAL patient posi tion: standing. Making exercise: Place a horizontal position with arms outstretc hed elbows contacting the backs of 15 3. BACK STRETCH CERVIC paravertebral patient position: standing. Making exercise : Place your arms slightly flexed, backs of your hands in contact. Make a drive toward the floor while back and top of the cervico-dorsal region. The neck remai ns in slight flexion. Hold the stretch for 10-15 seconds. Repetition and frequen cy: 3-5 repetitions twice daily. Comments: The stretch is collected cervico-dors al level. 5. MAJOR CHEST STRETCH Position patient upright. Making exercise: Place your for earms against the wall, with the elbow flexed at right angles. Forward leg on th e same side and for a small contralateral rotation of the trunk, until you feel the stretch. Hold the stretch for 1015 seconds. Repetition and frequency: 10 rep etitions with each arm twice daily. Compensation to avoid: Losing the alignment of the lumbar region. Comments: The stretch is collected at the front of the sho ulder. 4. STRETCH-BACK LUMBAR paravertebral patient position: standing. Making exercise : Place your arms in flexion, backs of your hands in contact, directed towards t he ceiling and make a drive in the same direction, while the posterior and lower back-lumbar region. Place the belly button inward and upward, achieving a highe r voltage and a flattening of the lumbar region. Hold the stretch for 10-15 seco nds. Repetition and frequency: 3-5 repetitions twice daily. Comments: The stretc h is collected cervico-dorsal level. 6. MAYOR AND CHEST STRETCH SERRATO patient position: standing. Making exercise: Raise the arm laterally and posteriorizar and to make a drive towards the ceilin g. Hold the stretch for 10-15 seconds. Repetition and frequency: 3-5 repetitions with each arm twice daily. Compensation to avoid: Rotate the body and tension i n the neck. Comments: The stretch is collected at the front of the shoulder. 16 7. MAYOR AND STRETCH CHEST BICEPS patient position: standing. Making exercise: R aise and posteriorizar arm laterally until horizontal, and make traction. Hold t he stretch for 1015 seconds. Repetition and frequency: 3-5 repetitions with each arm twice daily.€Compensation to avoid: Rotate the body. Comments: The stretch is collected in the anterior shoulder and arm. Toning and strengthening exercises 1. Paravertebral toning exercises fours Position patient: fours. Making exercise: Raise your leg and arm on the opposite side to the horizontal while maintaining the elbow and knee in extension parall el to the ground. Hold for six seconds. Repetition and frequency: 10 repetitions with each foot twice a day. Compensation to avoid: Arch your back and elevate t he limb beyond the horizontal. 8. CHEST STRETCH maximus, biceps and deltoid patient position: standing. Impleme ntation period: Posteriorizar arm laterally and to make a drive towards the grou nd. Hold the stretch for 10-15 seconds. 2. Paravertebral toning exercises Supine Position patient: Supine. Making exerci se: Exert pressure maintained in all upper limb to the ground. Maintain this pre

ssure for 6 seconds. Repetition and frequency: 10 repetitions twice daily. Compe nsation to avoid: Missing eyes to the ceiling. Comment: Being an isometric work, no movement can be seen, however there will be a muscular work. Repetition and frequency: 3-5 repetitions with each arm twice daily. Compensatio n to avoid: Rotate the body. Comments: The stretch is collected in the anterior shoulder and arm. 17 3. El Serrat toning exercises supine Repetition and frequency: 10 repeteciones twice daily. Compensation to avoid: st ress the cervical region. 5. Toning exercises pectoralis Position patient: Seating with legs crossed (in s oil) if tolerated. Implementation period: Interlace forearms and submit them to the horizontal. Print a counterforce. Hold for six seconds. Position patient: Su pine. Making exercise: Take a weight of 1 or 2 pounds or so and put the arm perp endicular to the ground and slightly lateral. From here make a drive towards the ceiling. Repetition and frequency: 10 repetitions with each arm twice daily. Co mpensation to avoid: Detach the shoulder blades on the ground. Repetition and fr equency: 10 repeteciones twice daily. 4. Toning exercises the latissimus dorsi Position patient: Supine. Making exercise: Separate the arms of the body, bend y our elbows in line by placing the forearms perpendicular to the ground. Make a d ownward pressure with your arms. Hold for six seconds. 18 SCHEDULE OF EXERCISES IN LUMBAR AREA Flexibilizing Exercises 1. EXERCISE IN LUMBAR POSITION FLEXIBILIZATION "MOHAMMED" Making exercise: Move the knees of both legs toward your chest, placing your hands on the back of the thigh, maintaining this position for 20-30 seconds. Repetition and frequency: 35 repetitions twice daily. Compensation to avoid: Losing contact back and should ers to the ground and lift the pelvis. Stretches lower back muscle 1. Stretch the psoas muscle Position patient: fours. Making Exercise: Moving arms and go pull the pelvis tow ards your feet until you feel the tension. Hold this position for 20-30 seconds. Repetition and frequency: 3-5 repeticioines twice daily. Compensation to avoid: Losing the alignment of the spine and arch the neck. 2. EXERCISE FLEXIBILIZATIO N Supine Position patient: Supine. Making exercise: Move the knees of one of the extremit ies to the chest, placing your hands on the back of the thigh of the same limb. The other spread on the ground. Hold this position for 20-30 seconds. Repetition and frequency: 3-5 repetitions twice daily. Compensation to avoid: Losing the a lignment of the back and leg straight, arching the neck and losing contact soil back. Comment: Do not exceed the strain point of the stretch to avoid raising th e knee of the extended tip. Stretching should be collected in the anterior thigh of the extended tip. Position patient: Supine.

19 2. GLUTEAL MUSCLE STRETCH 4. Stretch lateral hip rotators Position patient: Supine. Making Exercise: Bring one knee toward your chest limb s, place the opposite hand on the knee flexed and exert a force on the same side of the arm. Hold for 2030 seconds. Repetition and frequency: 3-5 repetitions tw ice daily. Compensation to avoid: Losing contact with the ground back.€Comments: The stretch is levied on the hip of the bent leg. 3. Hamstring muscle stretch T OWEL Position patient: Supine. Implementation period: Support the ankle in the f ront of the opposite knee. Bringing the same knee to chest helped by the hands p laced on the back of the thigh until you feel the tension of the stretch. Hold f or 20-30 seconds. Repetition and frequency: 3-5 repetitions twice daily. Compens ation to avoid: Losing the alignment of the spine. Comments: The stretch is coll ected at the proximal thigh. Toning and strengthening exercises 1. Paravertebral toning exercises Position patient: Supine. Making exercise: Take a towel with both hands and slid e over the sole. Then perform a knee extension until you feel the stretch and pu ll the heel toward the ceiling with your toes toward your face. Hold for 2030 se conds. Repetition and frequency: 3-5 repetitions twice daily. Compensation to av oid: full knee extension. Comments: The stretch is collected at the back of the thigh. Position patient: fours. Making exercise: Raise your leg and arm on the opposite side to the horizontal, keeping your elbow and knee in extension parallel to th e ground. Hold for six seconds. Repetition and frequency: 10 repetitions with ea ch foot twice a day. Compensation to avoid: Arch your back and elevate the limb beyond the horizontal. 20 2. TONING EXERCISE IN MIDDLE fours GLUTEAL 3. Gluteus medius toning exercises in sitting ISOMETRIC A B Position patient: Seating, abdominal activation. Making exercise: Place a rubber (in the absence of a towel) wrapped around the knees and exert a lateral force of the thighs against the towel. Hold for six seconds. Repetition and frequency: 10 repetitions twice daily. 4. Gluteus maximus toning exercises Position patient: fours. Implementation period: A) Raise the floor keeping the k nee flexed to 90 degrees up to have it at the same height of the pelvis. Here yo u have a small movement of the heel toward the ceiling. B) Lift the leg keeping the knee laterally at 90 ° of flexion. Repetition and frequency: 10 repetitions with each foot twice a day. Compensation to avoid: Allow the decay and back wais t lose alignment when lifting the leg. Maintain at all times the thigh perpendic ular to the ground. Patient Position: Supine, abdominal activation. Making exercise: Taking off the pelvis on the floor to align with the spine and thighs. Hold for six seconds. Re petition and frequency: 10 repetitions twice daily. Compensation to avoid: Takin

g off the ground and arching blades waist. 21 SCHEDULE OF EXERCISES ABDOMINAL SUPPORT The abdominal muscle is composed of a series of muscle groups include the rectus abdominis, obliques and goats, and the transverse abdominal. Taken together lin e the wall of the trunk and are largely responsible for the "health" of our spin e. Its good protects us from suffering pain at the lumbar level. This muscle has a predominance of slow muscle fibers or also called phasic. His poor solicitati on tends to lead to a strain or hypotonia. A clear example is in sedentary perso ns in which there is a decrease in abdominal tone and bulges: the "curve of happ iness", not so much a functional level. Our goal is to show the proper working o f the muscles, as their good behavior to get a "belt" very healthy natural addit ion to its aesthetic connotations. Fig 26 this, we look at our back and neck area, which should rest well aligned. Looking great tension in the neck that allows us to flatten slightly into the ground, w e place a small cushion in the occipital region. The shoulders do not rise but s hould remain flat and as far away as possible from the ears (Figure 26 and 27). Base position and pelvic placement We will discuss the basic position supine or back, since in this position is eas ier to maintain proper alignment of the spine in the development of muscle contr action. We lie on a floor or too soft or too hard. Ideally, on a mat or thick bl anket. We are going to triple flexion of the lower limbs so that the soles of th e feet are flat on the floor, knees at the same width as the hips. Fig 28 Fig 27 Alternative basic position by placing their hands behind his head, look towards the ceiling (Figure 28). The pelvis will be in a neutral position before and retroversion. That is, we wi ll lift your buttocks and back to place the lumbar segment flat on the ground, c orrecting the lumbar curve has to rest on the floor. Keeping Figure 29 shows the incorrect placement often adopted for abdominal work: the le gs are excessively separated, the lower back does not rest entirely on 22 the ground and is making an unnecessary solicitation will overload the cervical region easily avoidable, if you then look toward the ceiling, elbows open as sho wn in the picture above. When standing or standing, we can perform the same exercise as much as we are st ill as when we conduct our daily activities. This priming muscular ensure the he alth of our lumbar spine (Figure 32 and 33). Figure 29 We shall also show two examples of activation and abdominal strengthening into e veryday activities, simple but also very effective. With them we note that there is no need to go to a gym to achieve our goal, but the mere fact of the positio n to properly maintain and manage to keep our muscles in good condition. Seated, that is to be seated, place the body segments aligned. We can activate the abdo minal muscles gently directing the navel inward and upward to activate the trans verse abdominus. You will notice also how our whole column automatically aligns with this simple contraction (Figure 30 and 31). We must avoid to do the exercis

e to the rising of ribs breathing should be smooth and natural. This activation must be maintained constantly while we are sitting. Figure 32 Figure 33 Proposal of contraction For a healthy abdominal tone and responsive to the demands of daily life, both i n static positions as in the dynamics, our proposal in relation to the type of c ontraction to develop, is based on isometric exercises dominance is ie, exercise s that contraction produces increased tension without any displacement. Try to c ontract the abdominal and not cause any movement associated. The simplest way to do it when they voluntarily hide the belly inward (this "reflection" aesthetic is often a very important form of reinforcement). As an example we can sit in a chair, completely relaxed and print an isometric contraction to maintain the nav el inward and slightly upward; at this time activate the transverse abdominal an d we can see how automatically, our lumbar spine is properly aligned, and be res ponsible good position in the static and the moving masses, as their pre-activat ion before exercise is a guarantee of protection of the lumbar segment. Another type of exercise that we propose are those in which we develop a concentric work . We refer to this type of muscle contraction in the increased tension produces an approximation Figure 30 Fig 31 23 tion of fiber origin and insertion. That is, the pubis is close to the ribs or v ice versa. This action helps to normalize the hypotony that often occurs because of the lack of training. In developing these exercises, is of great importance to correctly breathe. Never made without breathing is apnea. The abdominal is re sponsible for cough and forced expiration. Therefore, when we exhaled contractio n and when we return to the resting position we will take the air, never by forc e. It is taking the air through the nose and release through your mouth as if br eathe. breathing. The contraction is held for the duration of expiration or air outlet. 2. Abdominal and gluteal ACTIVATION WITH CLOSURE OF PELVIC FLOOR Examples of abdominal contraction 1. ACTIVATION OF TRANSVERSE AND CLOSING OF THE PELVIC FLOOR Patient position: We started the exercise with proper placement in the base posi tion. Performance of the year: Will the same steps as in the previous year. Once activated the transverse abdominal and pelvic floor closed will raise your butt ocks slightly off the floor without losing the contraction, while gently expel t he air through the mouth. Repetitions and frequency: Maintain the contraction fo r 6-10 seconds. Perform a series of 10 repetitions to be increased as tolerated. Compensation to avoid: Sudden movements.€Comment: It is important to recover th e base position once the contraction slowly. Holding back at this time for calm, relaxed and lower back in contact with the ground, before starting a new Repeti tion breathe two or three times slowly. Patient Position: Located in the base position supine. Performing the exercise: Print a slow and controlled contraction of transversus directing the navel to th e floor and above without changing the position of the rib cage, while we close

the pelvic floor. That is, print a slight reduction "as if we tried to hold urin e inside the body." Repetitions and frequency: Maintain the contraction for 6-10 seconds. Perform a series of 10 repetitions to be increased as tolerated. Compe nsation to avoid: Avoid the loss of starting position. Comment: While this contr action occurs gently release the air through the mouth, without forcing the 24 3. ACTIVATION OF TRANSVERSE AND CLOSING OF PELVIC FLOOR IN quadrupedal position 4. Supine ISOMETRIC: rectus abdominis Patient Position: Start the exercise with supine position base, then the hip fle xed to 90 degrees and rest your hands on your knees. Performing the exercise: Th e contraction is done by directing the belly button in and up, while the rib cag e closer to the pubis, with this action by dragging the lower extremities, which are resisted by the upper extremities. Feel a slight pressure on our hands who will resist this movement. Repetitions and frequency: We maintain the contractio n for 6-8 seconds while the duration of the expiration or exit of air through th e mouth. Comment: It is important to maintain the closure of the pelvic floor wh ile performing this exercise. Patient position: fours. Lets work the transverse abdominal against slight resis tance which gives us the force of gravity. It also allows learning to feel the c ontraction in the case of having difficulty in performing in the supine position . For the correct implementation will check that the opening of the knees is equ al to the width of the hips, like the opening of the hands to match the width of the shoulders. The spine remains aligned and avoid cervical flexion, ie the fal l of the head. Performing the exercise: The contraction is achieved by the navel gently inwards and upwards (as if we stick to the lower back and then upload it to the ribs). During this contraction, we must close the pelvic floor and relea se the air slowly through your mouth. Repetitions and frequency: Maintain the co ntraction for 6-10 seconds. Perform a series of 10 repetitions to be increased a s tolerated. Compensation to avoid: The lumbar region must not be moved because it is not the objective of this exercise. 5. Supine ISOMETRIC: ABDOMINAL OBLIQUE This is equal to the previous year as regards the implementation. The only thing that varies is the resistance applied since, as shown, the hand resists the opp osite knee, thereby activate the abdominal oblique muscle. 25 6. UPPER ABDOMINAL Repetitions and frequency: Maintain the contraction for 6-10 seconds. Perform a series of 10 repetitions to be increased as tolerated. Compensation to avoid: It is very important to maintain contact in the lumbar region and the activation o f the closure of the pelvic floor during this exercise. If this is not possible we will by the previous financial year to achieve a sufficient reinforcement to enable us to evolve to this position with assurances that its implementation wil l be correct and without compensation. Patient position: We started the exercise from the point guard position. Perform ing the exercise: Activate the transverse abdominal contraction leading the nave l inward and upward, close the pelvic floor and then slightly increased the body to print a contraction on the ribs to the pubis. Repetitions and frequency: Mai ntain the contraction for 6-10 seconds. Perform a series of 10 repetitions to be increased as tolerated. Compensation to avoid: To avoid them, we must keep your

elbows open and look at the ceiling during contraction. Comment: During the con traction will release the air slowly through your mouth. We must avoid hold, ie, absence of abdominal exercises in apnea. 8. Activating the muscles SKEW Supine Patient position: Position as a basis for abdominal work. We put one hand behind the occipital region,€must rest on her head, eyes toward the ceiling. Performin g the exercise: The contraction is a result of running oblique abdominal muscles first, then closing the pelvic floor and bringing the ribs toward the pubis pri nting a slight rotation of the shoulder to the opposite hip. Repetitions and fre quency: Maintain the contraction for 6-10 seconds. Perform a series of 10 repeti tions to be increased as tolerated. Comment: You must breathe gently through you r mouth during the contraction, and make sure that before each repetition are ho lding position correctly. The opposite hand resting on the ground as a fulcrum t o facilitate the implementation of the exercise. 7. REQUEST TO UPPER ABDOMINAL Adductor (YEAR OF THE FROG) Patient position: We put the soles of the feet against each other, without archi ng the lower back. Performing the exercise: This exercise is performed following the same steps as above. Varies the playing position as shown. 26 9. LOWER ABDOMINAL ACTIVATION OF KNEE FLEXION 10. LOWER ABDOMINAL ACTIVATION OF KNEE EXTENDED Patient Position: Position of base. We performed a hip flexion at 90 degrees, ha nds behind his neck, head relaxed on them and look toward the ceiling. Performin g the exercise: We conducted a pre-activation of the transversus abdominis and p elvic floor closure. During exhalation the ribs to the pubic approach, slightly raising the buttocks from the floor. The return to the starting position will be slow and controlled. Repetitions and frequency: Maintain the contraction for 610 seconds. Perform a series of 10 repetitions to be increased as tolerated. Com pensation to avoid: sudden gestures. We also avoid playing with or counter the i nertia of the lower limb, because then we can make the contraction of the psoas muscle (which is not the objective of this exercise), overloading our lower back . Comments: This exercise will be introduced in the pattern, once the above have been properly implemented. Its implementation is difficult, so if there are com plaints or compensation in the course of its implementation we will not. Patient Position: Supine. During exercise: This exercise is carried out followin g the same steps as above but in this case as shown, the legs are fully extended . Repetitions and frequency: Maintain the contraction for 6-10 seconds. Perform a series of 10 repetitions to be increased as tolerated. Compensation to avoid: Like the previous one and because of its difficulty, is ignored at the beginning of this pattern or if they occur compensation or pain in their implementation. Comment: The image shows the movement that takes place during contraction is min imal. 11. ACTIVATION OF THE ABDOMINAL OBLIQUE knee extended ("TWIST") Patient Po sition: Supine. During exercise: This exercise is the same as before, in this ca se during the course of contraction pelvis inclined to one side and another, ask ing also the oblique abdominal. Repetitions and frequency: Maintain the contract ion for 6-10 seconds. Perform a series of 10 repetitions to be increased as tole rated. Comments: The range of motion is small to achieve good control of contrac tion and avoid compensation. 27 REFERENCES • E. Viel Lumbago and cervical pain from sitting Tips ergonomics and physiothera

py. Barcelona: Masson, 2001. • Kapandji AJ. Articular Physiology 3: trunk and ba ck pain: mechanical schemes discussed human. 5th ed. Madrid: Médica Panamericana , 1998. • RC Miralles Marrero, M. Puig Cunillera Clinical biomechanics of the mu sculoskeletal system. Barcelona: Masson, 1998. • Busquet L. Muscle chains: trunk and cervical spine. 4th ed. Barcelona: paidotribes, 1999. • Busquet L. Muscle c hains: lordosis, kyphosis, scoliosis and thoracic deformities. 4th ed. Barcelona : paidotribes, 1999. • Voegeli Viladot A. Basic Lessons locomotor biomechanics. Barcelona: Springer, 2001. • Alter MJ. Stretching, exercise development. 4th ed. Barcelona: paidotribes. • B. Anderson Stretching. Special comprehensive monogra ph. Barcelona: Integral, 1989. • Esnault F, Viel E. Stretching (Stretching miote ndinosos) muscle and joint self-maintenance. Barcelona: Masson, 1999. • M. Esnau lt Stretching analytical active physiotherapy. Collection rehabilitation and rep lacement. Barcelona: Masson, 1994. • Norris CM. Complete guide to stretching. Ba rcelona: paidotribes, 2001. • Souchard E.€Stretching active global: the perfecti on muscle sports scores. Barcelona: paidotribes, 2000. • Cahors B. Stretching, d ossier spécial. Sport Med 1991, 34: 27-31. • Calvert López F, López C. Calvert M arc teòricopràctic the correct per treball execució of abdominal I. Apunts i esp orts of Physical Education, 1995, 42: 35-45. • Calvert López F, López C. Calvert Marc teòricopràctic the correct per treball execució of abdominal II. Apunts i esports of Physical Education, 1996, 43: 25-41. • Benavides F, Ruiz C, García A. Concepts and techniques for the prevention of occupational hazards. Barcelona: Masson, 1997. • Benavides F, E Castejon, Mira M, Benach J, Moncada L. Glossary o f occupational risk prevention. Barcelona: Masson, 1998. 28

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