Exercises for tendinopathies
1. Useful exercise for recovery of shoulder rotation and abduction
Degree of difficulty
2/5
Starting position: The exercise is performed in a sitting position, with the spine erect. The arms are abducted at 90°, with fists closed and the back of the hands facing upwards.
Execution: While inhaling, perform a slow and controlled external rotation movement. While exhaling, return with the arms to a position of shoulder internal rotation.
Pay attention: Respect the respiratory phases previously described during the exercise. Perform the movements in the absence of pain.
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2. Useful exercise for rotator cuff tendinopathy
Degree of difficulty
3/5
Starting position: In a semi-squat position with one foot slightly advanced with respect to the other and the trunk leaning forward, grab a dumbbell or equivalent weight with one hand and keep the other hand resting on the knee of the forward leg for support.
Execution: Keeping the other hand resting on the knee, perform oscillating movements with the affected arm, making a full excursion encompassing flexion, extension and abdu-adduction of the shoulder. This exercise is attributable to the Codman method.
Pay attention: Avoid compensation by lifting the shoulder thereby overloading of the trapezius muscles and by extending the knees. Avoid misalignment of the trunk and head by flexing of the head and dorsal hyper-kyphosis and causing consequent overload of the spine.
3. Codman pendular exercises
Degree of difficulty
2/5
Starting position: Prone position on a medical bed with the shoulder out fully relaxed. It can be performed with or without a small weight.
Execution: Relax the shoulder while making circular movements inwards and outwards
Pay attention: Be careful to position the head in a comfortable position turned towards the shoulder. For those suffering from low back pain place a pillow under the abdomen.
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4. Scapular clock
Degree of difficulty
2/5
Starting position: Standing, while having reached a good balance in the lower limbs, facing a vertical wall. The arm which performs the exercise is flexed at about 90°, keeping the elbow extended with the hand fixed against the wall using a ball, placed between the hand and the wall. Contralateral arm is placed by the side.
Execution: By sliding the ball adherent to the wall, the hand is oriented in different positions by performing rotational movements of the wrist in a clockwise and counterclockwise direction.
Pay attention: Keep the spine aligned.
5. Exercise for shoulder external rotator muscle tendinopathy
Degree of difficulty
3/5
Starting position: Perform the exercise in an upright position with legs slightly apart and maintaining balance in the lower limbs. Position the affected upper limb with the elbow flexed at 90°, keeping it close to the trunk. With the hand facing up, grab an elastic band attached to the wall.
Execution: From the initial position, perform an external rotation of the shoulder, thus bringing the forearm outwards. The elbow during such movement must remain close to the trunk. Afterwards, return to the starting position and repeat the exercise.
Pay attention: Perform without any pain.
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6. Exercise for should internal rotator muscle tendinopathy
Degree of difficulty
3/5
Starting position: Stand with legs slightly apart and well balanced on both limbs. The upper limb under training is positioned with the elbow flexed. The hand grasps an elastic band fixed to the wall.
Execution: From the starting position, perform an internal rotation movement of the shoulder. Then slowly return to the starting position and repeat the exercise. This exercise is useful for training for the internal rotator muscles of the shoulder.
Pay attention: Be careful to keep the elbow adherent to the trunk, while performing the exercise.
7. Stretching of the forearm and hand extensor muscles
Degree of difficulty
2/5
Starting position: Standing or sitting, arm and elbow extended, hand flexed.
Execution: With the other hand, force the flexion of the hand, until you feel the forearm muscles pull slightly, then hold the position for 5 seconds, and finally return to the starting position.
Pay attention: Be careful not to experience any pain and not to flex your elbow during the movement.
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8. Strengthening of the carpal extensor muscles
Degree of difficulty
2/5
Starting position: Rest the forearm on a medical bed, with the elbow flexed at 90° and the hand closed in a fist. Place the other hand on the fist.
Execution: Perform wrist extension by opposing a slight resistance to the hand movement with the other hand.
Pay attention: Be careful not to experience any pain and not to detach the forearm from the surface of the medical bed.
9. Stretching exercise for wrist and forearm muscles
Degree of difficulty
2/5
Starting position: Start from a standing position or sitting on a chair with a rigid back and a good support for your back. The palms of the hands are to be positioned in front of the sternum against each other, keeping the forearms parallel to the ground.
Execution: Push your hands against each other until you feel a slight tension in the forearms, hold this position for 5 seconds, then return to the starting position. Breathe out while pushing the hands against one another and breathe in as you release your hands.
Pay attention: Avoid shoulders anteposition. Avoid the incorrect position of the elbows, which must be positioned at the same height as the carpus. Avoid excessive distance of the hands from the breastbone. Do not perform the exercise in apnea or with inadequate breathing.
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10. Exercise for reinforcement of the carpal extensor muscles
Degree of difficulty
3/5
Starting position: Sitting, forearm resting on a medical bed with one hand hanging from it. Place an elastic band on the back of the hand, after anchoring it to the foot of the medical bed.
Execution: Flex the hand dorsally, maintain the contraction for 5 seconds, then return to the starting position.
Pay attention: Be careful not to experience any pain during the exercise and not to lift the forearm from the medical bed.
11. Stretching exercise for flexor muscles of the hand and forearm
Degree of difficulty
2/5
Starting position: Start from a standing position or sitting on a chair with a rigid back and a good support for your back.
Execution: With the arm and forearm bent at 90° from the trunk, passively extend the wrist with the contralateral hand applying slight force. Exercise must not cause any pain.
Pay attention: Avoid excessive force in mobilization while respecting joint physiology.
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12. Strengthening exercise for wrist and forearm muscles
Degree of difficulty
3/5
Starting position: Begin in a sitting position with your arm extended on a table or other rigid support.
Execution: With a weight (or a bottle of water) extend the wrist rhythmically over time. Exercise must not cause any pain. Take long, controlled breaths while exercising.
Starting position: Position yourself on the mat with the trunk on the same vertical axis as the pelvis. A lower limb (or leg) is placed with the hip in a neutral position, with the knee flexed resting on the mat. The contralateral limb is maintained with the knee extended, the hip flexed at 30° and the ankle in a neutral position.
13. Stretching exercise for the hamstrings
Degree of difficulty
4/5
Starting position: Position yourself on the mat with the trunk on the same vertical axis as the pelvis. A lower limb (or leg) is placed with the hip in a neutral position, with the knee flexed resting on the mat. The contralateral limb is maintained with the knee extended, the hip flexed at 30° and the ankle in a neutral position.
Execution: Flex the trunk on the pelvis so as to perceive the tension of the hamstrings.
Pay attention: Avoid knee flexion, hip intra- or extra-rotation of the limb performing the stretching exercise. Avoid hyper-flexion of the contralateral knee.
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14. Stretching exercise for hamstring tendinopathies
Degree of difficulty
3/5
Starting position: Supine position.
Execution: Flex and lift the hip bringing the hands behind the thigh for support. Extend the knee and flex the ankle dorsally, until tension is generated in the hamstrings. Alternate both left and right lower limbs performing this exercise. Take long and controlled breaths during the exercise.
Pay attention: Keep the lumbar spine attached to the ground.
15. Stretching for quadriceps muscle tendinopathies
Degree of difficulty
3/5
Starting position: From a standing position, with feet parallel to one another and aligned to your hips. Lift and place your foot in the middle of the chair seat. The limb resting on the ground must be spaced from the chair to ensure quadriceps elongation.
Execution: Keep your hands crossed on the leg resting on the chair and displace your body weight forward, trying to keep your back straight. This displacement determines quadriceps muscle tension of the leg resting on the ground. Maintain tension (not maximum, but tolerable) for a few seconds. Repeat with the other limb and repeat the exercise 3-4 times per leg.
Pay attention: Do not lift the heel of the limb resting on the ground.
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16. Strengthening for gluteus maximum tendinopathies
Degree of difficulty
3/5
Starting position: Standing position, with feet parallel to one another and shoulder-width apart, facing a wall or a similar stable support to ensure stability during the exercise.
Execution: Keep your body aligned and upright, with contracted abdominal muscles to stabilize the trunk, and, during a slow inhalation, lift posteriorly your leg keeping it extended determining gluteus maximum contraction.
Pay attention: While lifting posteriorly your lower limb, try to maintain a proper standing and aligned position, thus preventing trunk flexions or extensions, or pelvis, hip and foot rotations.
17. Bridge exercise: strengthening for tendinopathies in different body areas: gluteus maximus, hamstrings, quadriceps and deltoid muscles
Degree of difficulty
2/5
Starting position: Supine position, with hips at 120-130°, knees flexed at 90°, feet soles firm on the medical bed. Knees and feet are parallel to one another and slightly apart. Upper limbs along the body with the palms of your hands facing downwards and resting on the medical bed.
Execution: Taking advantage of the support of feet soles, hands and shoulders on the medical bed, lift your bottom and trunk assuming a “bridge” position. Hold this position for a few seconds, then gently go down.
Pay attention: To ensure stability during the lift, avoid keeping your feet too close to one another or not aligned to your body. Avoid an excessive lifting of the pelvis to prevent a disproportionate involvement of cervical and lumbar spine.
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18. Strengthening exercise for gluteal muscles and hamstrings tendinopathies
Degree of difficulty
2/5
Starting position: Lie on the ground or on a medical bed in prone position. Rest the forehead on your crossed hands. If necessary, turn your head on the most comfortable side. In case of lumbar discomfort, a pillow can be placed under the abdomen.
Execution: Lift your leg upwards with extended knee for about 5-6 seconds. Repeat with the other leg.
Pay attention: Do not make an excessive lifting (not beyond 45°) and avoid torsions during the lifting, keeping your body aligned.
19. Leg-cross, for quadriceps muscles and hamstrings
Degree of difficulty
2/5
Starting position: Seated on a medical bed with dangling feet and hands resting on the bed to keep the trunk straight; legs crossed at the ankles in resting position.
Execution: Lift the foot placed below extending the corresponding knee and determining quadriceps muscles contraction. Simultaneously “apply a resistance” with the foot placed above with a flexion of the contralateral knee, determining hamstrings contraction. Hold contractions in an intermediate flexion-extension position for 4-5 seconds. Repeat the exercise by switching the position of your feet.
Pay attention: Do not flex or extend the trunk while performing the exercise.
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20. Stretching for quadriceps muscle and patellar and quadriceps tendons
Degree of difficulty
3/5
Starting position: Patient lying prone. Fix your foot to an elastic band or to a rope long enough to be held by the patient’s hands.
Execution: Apply tension on the elastic band in order to determine the passive flexion of the knee. This flexion will determine the elongation of quadriceps muscle fibers and its relative tendon. Once a bearable tension has been reached, hold the position for a few seconds waiting for a progressive and slow lengthening that will result in a proportional increase in knee flexion. Release the tension created through the elastic band, returning gradually to the starting position. Perform the exercise while maintaining a slow and deep breathing.
Pay attention: Avoid performing a too rapid and intense elongation, trying to respect the initial “resistance barrier” of the quadriceps muscle to be stretched. Avoid lifting of the thigh being stretched, leg rotations, hip abductions and adductions.
21. Stretching for quadriceps muscle and patellar and quadriceps tendons
Degree of difficulty
5/5
Starting position: Standing position.
Execution: Flex your left leg on your thigh and hold the position by holding your foot with your hand of the same side. Inhale and bring your heel closer to the gluteus. If possible, hold the position for several seconds. Relax and repeat with the contralateral leg.
Pay attention: Keep the thigh in axis. Be careful not to flex anteriorly the trunk.
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22. Eccentric exercise for gastrocnemius muscle
Degree of difficulty
5/5
Starting position: Standing position, extended knees, with your forefeet resting on the edge of a step.
Execution: A plantar flexion is performed, so as to go on the tip of your toes. At this point, raise the contralateral limb to the one to be trained and, slowly, bring the foot to the initial position, controlling the movement with an eccentric contraction. The contralateral limb is kept raised for the entire duration of the movement.
Pay attention: Make sure that the eccentric phase of the movement is slow and controlled. Be careful not to bend your knee. Check that the step is stable and if it is necessary, rest laterally your hand to a support to avoid loss of balance.
23. Eccentric exercise for soleus muscle
Degree of difficulty
5/5
Starting position: Standing position, knees slightly flexed, with your forefeet resting on the edge of a step.
Execution: Perform a plantar flexion, so as to go on the tip of your toes. At this point, raise the contralateral limb to the one that we want to train and, through a slow eccentric phase, return the foot to the initial position, keeping the knee flexed. The contralateral limb is kept raised for the entire duration of the movement.
Pay attention: Make sure that the eccentric phase of the movement is slow and controlled. Be careful not to extend the knee. Check that the step is stable and if necessary, rest laterally your hand to a support to avoid loss of balance.
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24. Stretching for posterior kinetic chain and Achille’s tendon
Degree of difficulty
3/5
Starting position: Supine position.
Execution: Place an elastic band or a rope below your foot, at metatarsal area level. With the upper limbs, pull the rope or the elastic band bringing the hip in flexion, with the knee extended and the ankle in dorsal flexion, until you feel a passive lengthening sensation of the posterior muscles of the limb and of the plantar fascia. Hold the position, if possible, for several seconds and slowly return to the starting position. Take long, deep breaths.
Pay attention: Avoid knee flexion. Avoid excessive lordosis of the spine and abduction of the leg. Do not perform the exercise in apnea or with inadequate breathing.
25. Strengthening for antigravity muscles
Degree of difficulty
4/5
Starting position: In an upright position go on your forefeet (on the tip of your toes).
Execution: Perform some steps while maintaining the position on your forefeet.
Pay attention: Do not flex your knee for the entire duration of the exercise.
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26. Plantar fascia lengthening
Degree of difficulty
2/5
Starting position: Sitting position.
Execution: Flex the knee and reach a position of metatarsal support of the foot (on the tips of your feet-forefoot), performing an ankle plantar flexion. Apply, with the hand of the same side, a concomitant pressure from top to bottom at the level of the popliteal fossa, until you feel an elongation sensation on the plantar fascia. If possible, hold the position for several seconds.
Pay attention: Keep the forefoot attached to the ground.
27. Stretching exercise for plantar fascia
Degree of difficulty
2/5
Starting position: Sitting position, with the leg to be treated with flexed knee and placed above the healthy contralateral knee.
Execution: Grab the base of your toes and perform a forced extension of your toes until you feel a tension of the plantar fascia. If possible, hold the position for several seconds.
Pay attention: Grab the base of the toes of the affected foot and not the metatarsals.
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