Mr. X (50+ year old) was diagnosed with Cancer about 10 years ago and he had a substantial amount of muscles and various structures removed on the anterior and posterior right side of his neck. According to him, he did not have any sort of Rehab following that and he restricted most of his neck movements because someone told him that he should not move or it will cause his wound to open up.
His right UL is generally weak. An observable right UFT, MFT and rhomboid atrophy. His main goal was to regain some amount of strength but most importantly he would want to increase his muscle bulk as the surgery has affected his appearance.
I told him honestly that it is possible to improve his function and muscle bulk but it will not be as good as his left side since a considerable amount of his muscles has been removed on his right side.
His interventions:
We started doing some general light exercise without any external load to work on his scapular elevation, adduction and LR. That was his main HEP.
We moved on to improve his shoulder stability by using elastic bands and body weight exercises in Quadrapod position.
After about five months, I started incorporating the Barbell into his Rehab. We did things like 20-40kg barbell shoulder shrugs or just assisted barbell bicep curls. He also did a couple of bench presses a few weeks ago. His RPE for these exercise were 6-8/10.
My reasoning:
I progressed my exercises slowly across his programme. I gave him a variety of exercises to do to keep him engaged and interested. The barbell was definitely a confidence booster; I wished you could see his desire to push more and lift more. Physiotherapy is often very boring in Malaysia as most of our approach is still very conventional. For example, let's do some SLRs with ankle weights or let's stretch some therabands.
Before I end, there are a few questions I hope we ask ourselves:
- How long can one exercise with sand bags or therabands?
- Will I be doing my clients a disservice if this is all I could offer?
- Is the barbell too extreme for Rehab?
- Why are some of us so afraid of loading our clients with weights that requires their sub-maximal effort.
Thank you for reading!
-Physiogeek-
