Keith Physical Therapy

Exercise in Scleroderma

SCLERODERMA information

Exercise is imperative

Use it or lose it 

Research – 25-35% decrease in ATP in quad muscles, increased recovery time

            Indicates magnesium may play important role in improving muscle contraction potential

Be aware of physical limitations and/or precautions based on internal organ involvement (heart, lungs etc)

            Diagnostics required to monitor your lung function are:

– Pulmonary function tests (PFTs) at baseline and serially at six months to one year intervals

– Echocardiogram at baseline and then annually

– Chest x-ray at baseline and then annually

– High-resolution computed tomography (CTScan) of the lungs may also be conducted

Components of Exercise

Frequency

            Stretch every day

                        5-10 repetitions

            Strengthen 3-5 days a week

                        5-10 repetitions

                        if doing sets, work up to 3

            Cardiovascular 5-7 days a week

                        Start with 5-10 minutes, work up to 20-30

                        Monitor heart rate

Mode

PROM

AROM

strengthening

cardiovascular

Duration

            Stretches held 10-20 seconds

            Strengthening is done at a slow pace

            Cardiovascular progresses from a predetermined baseline to 20-30 minutes

Intensity of exercise

            push into mild-moderate pain and hold

            be aggressive on areas that are tightest using heat often and stretching more often but        pain should not remain increased after your stretching activity

            back off for a couple of days if joints or muscles become hot, swollen and painful

Be aware of sharp or burning pains that radiate, or make the arm/legs feel extremely heavy after stretching

Record

            Set reasonable goals and keep track of them

            Estimate ROM improvement by function or sight

            Obtain baseline from PT

Morning

Warm Shower

Stretch all joints

Afternoon

Take medication Tylenol 1 hour before exercising

Warm application 15-20 minutes

                        Moist heating pad - Thermophore

                        microwaveable hot packs

                        Paraffin

Stretch

                        15-20 second holds into mild pain

                        avoid bouncing

                        have someone help you stretch

Strengthen weak muscles

                        upper body even days

                        lower body odd days

                        use gravity RROM

                        Theraband with loops

Cardiovascular

                        Heated swimming pool – use glycerine based moisturizer

                        Recumbant biking

                        walking

                        Group therapy - PACE YMCA aquatics- Bethany

                        work up to 20-30 minutes

Common areas of tightness

face

jaw

neck

shoulders

legs

Exercise

WHILE LAYING ON YOUR BACK

Warm up

            gluteal pinch

            quad set

Neck

            Chin tuck

Arms

            Shoulder flexion (rod)

            Snow angels

            Arm rotations at 90 degrees

            Elbow flexion and opposite knee reach

            Active wrist flexion and extension

                        more aggressive - prayer stretch

            Shoulder blade squeezes

Legs and feet

            Heel slides

            Single leg snow angel with opposite leg bent

            Straight leg internal and external rotation

            Ankle pumps

Jaw stretch

            tongue blades (wide)

In front of a mirror

Face

            Eyebrow raise

            Hard frown and wrinkle nose

            open as wide as possible

            smile as wide as possible with lips together

            puff cheeks and press on one cheek at a time

            look up with mouth closed

            pucker lips, make kissing sound

            exaggerate all your vowels

            stick tongue out then move it in all directions slowly (mirror)

            Suck lips into mouth and realease with a loud smack

The following list of facial exercises has been prepared by the Physical Therapy Department of PresbyterianUniversity Hospital of Pittsburgh.

Exercises for the Lips

Open your mouth as wide as possible and hold it for two seconds; close mouth, making sure your lips are closed. Practice slowly 10 times.

Pucker your lips and hold for two seconds, then relax. Practice slowly 10 times.

Spread your lips into a smile and hold for two seconds, then relax. Practice slowly 10 times.

Alternately pucker lips then spread lips as though saying, oooo-eeee-oooo-eeee. Practice slowly, repeating each series 10 times.

Open your mouth wide, then try to pucker lips as though saying "oh" for two seconds, then relax. Practice slowly 10 times.

Pucker your lips and make a kissing sound. Practice slowly 10 times.

Suck your lips into your mouth, then release in a loud smacking noise. Practice slowly 10 times.

Keeping teeth together, say these sounds: "ba bi bu," exaggerating the lip movements. Practice slowly 10 times.

Exercises for the Tongue

Open your mouth and protrude your tongue. Be sure your tongue is straight out, not resting on your lips or pointing to one side. Maintain this position for two seconds. Practice slowly 10 times.

Protrude your tongue and move it slowly from corner to corner of your lips.

Repeat step 2, as rapidly as possible, still touching each corner of your lips. Practice repeating each series 10 times.

Protrude tongue and point it downward toward chin; hold for two seconds, then relax. Practice slowly 10 times.

Protrude tongue and point it upward toward nose; hold for two seconds, then relax. Practice slowly 10 times.

Protrude and point your tongue to touch the top, bottom, and corners of your lips. Practice slowly 10 times.

Repeat step 4, as rapidly as possible. Practice repeating each series 10 times.

Protrude tongue and move it down then up as though licking an ice cream cone; relax. Practice slowly 10 times.

Move tongue around your lips in a circle, touching all of upper lip, corners, and lower lip; relax. Practice slowly 10 times.

Raise the tip of the tongue and touch the upper lip, the upper teeth, and the ridge behind the teeth and the hard palate. Practice slowly 10 times.

With your mouth open, suck up hard on your tongue, drawing in the sides of the tongue as hard as possible to the hard palate. Hold for five seconds and relax. Practice slowly 10 times.

Exercises for the Palate

Puff out the cheeks and press the fingers against one cheek without allowing the air to escape through the mouth or nose. Practice slowly 10 times.

Blow on a straw keeping a finger on one end and maintain the air in the straw for 5 to 10 seconds. Practice five times.

Say the (s) sound "ssss" without allowing the air to come through the nose. Practice slowly 10 times.

Repeat "ka" 20 times, "ga" 20 times, and "sss" 20 times.