Home Exercise Program After Manipulation/Mobilization

Why Exercise After Manual Therapy?

Phase 1: Gentle Mobility and Flexibility (Day 1-3)

Tip: Move only within a pain-free range. Mild stiffness is normal; sharp pain is a stop sign.

Phase 2: Stabilization and Core Strengthening (Day 3-7 onward)

Phase 3: Functional Strengthening and Maintenance (Week 2+)

• Walking program - start 10-15 min/day, progressively increase
• Seated row / band pulls - for upper back and postural muscles
• Wall squats / mini squats - for lower extremity and lumbar support
• Hip flexor stretches - address common tightness that stresses the lower back
• Hamstring stretch (seated straddle, standing) - hold 30 sec, repeat 3x
• Posture correction exercises - shoulder blade squeezes, wall angels
• Prone extension (McKenzie press-up) - good for lumbar disc-related mobilization

General Guidelines

1. Warm up first - 5-10 minutes of light walking or cycling before exercising
2. Consistency over intensity - daily gentle movement beats occasional hard effort
3. No pain through exercise - mild muscle soreness is okay, joint/nerve pain is not
4. Posture awareness - practice ergonomic sitting and standing throughout the day
5. Breathe - do not hold breath during any exercise
6. Duration - continue the program 4-6 weeks minimum, or as directed by your physiotherapist; AAOS recommends continuing maintenance exercises long-term

When to Contact Your Physiotherapist

• Pain increases rather than gradually improves
• New numbness, tingling, or weakness appears
• You are unsure about which exercises apply to your specific joint
• Symptoms are not improving within 1-2 weeks

Note: This is a general framework. The exact program should be tailored to the specific joint treated (spine, shoulder, hip, knee, etc.) and your individual condition. Always follow the personalized instructions given by your physiotherapist.

Shoulder Home Exercise Program After Manipulation/Mobilization

Before You Start

• Warm up with 5-10 minutes of light walking or stationary cycling
• Do stretching first, then strengthening, then repeat stretching at the end
• Work within a pain-free range - mild pull is okay, sharp pain means stop
• Program length: 4-6 weeks minimum; continue 2-3 days/week as maintenance

Part 1: Range of Motion (Daily)

1. Pendulum Exercise

• Stand beside a table, support your unaffected arm on it
• Let the injured arm hang freely
• Make small circles (20 clockwise, 20 counterclockwise)
• Do forward/backward swings x20, then side-to-side x20
• Do NOT use shoulder muscles - let gravity do the work

2. Posture Exercise

• Put hands on hips, lean back gently, hold 20 seconds
• Repeat 10-15 times

3. Active-Assisted Flexion (Supine)

• Lie flat on your back
• Use your good arm to help lift the injured arm up overhead
• Progress to lifting the injured arm on its own, then with a small weight

4. Pendulum/Table Slide

• Seated, slide your affected arm across a smooth table surface forward, to the side, and diagonally
• Helps restore range without loading the joint

Part 2: Flexibility/Stretching (Daily)

1. Posterior Capsule Stretch (Cross-Body Stretch)

• Bring the injured arm across your chest
• Use your good arm to gently pull the elbow toward your chest
• Hold 30 seconds, rest 30 seconds - repeat 3x
• You should feel a stretch in the back of the shoulder

2. Sleeper Stretch

• Lie on your side with the injured shoulder underneath
• Raise your arm to shoulder height and bend the elbow 90°
• Use your good arm to gently press the forearm down toward the floor
• Hold 30 seconds, rest 30 seconds - repeat 3x

3. Towel Stretch (Internal Rotation)

• Place good hand behind your neck, injured hand behind your lower back
• Hold a towel with both hands
• Use the good arm to gently pull the injured arm up the back
• Hold until a gentle stretch is felt - repeat 10x

4. Doorway/Chest Stretch

• Stand in a doorway with elbows at 90°
• Step forward gently to stretch the front of the shoulder
• Hold 20-30 seconds, repeat 3x

Part 3: Strengthening (3-4 Days per Week)

1. Pendulum Circles (Active - no weights, progress to small weight)

2. Internal Rotation with Resistance Band

• Attach a band to a door at elbow height
• Stand sideways, elbow bent 90° at your side
• Rotate forearm inward across your body
• 3 sets x 10-15 reps

3. External Rotation with Resistance Band

• Same position, rotate forearm outward away from body
• Keep elbow locked at side
• 3 sets x 10-15 reps
• This is the most important rotator cuff exercise

4. Scapular Retraction (Band Rows)

• Hold a band at shoulder height, arms outstretched
• Pull elbows back, squeezing shoulder blades together
• 3 sets x 10-15 reps

5. Shoulder Shrugs

• Elevate both shoulders toward ears, hold 2 seconds, release
• 3 sets x 10 reps
• Strengthens upper trapezius

6. Side-Lying External Rotation

• Lie on the unaffected side
• Hold a light weight, elbow bent 90°
• Rotate the forearm upward (like opening a door)
• 3 sets x 10 reps

7. Empty Can / Full Can (Supraspinatus)

• Stand and raise arm at 45° in front of the body (scapular plane)
• Thumb down = empty can; thumb up = full can
• Raise to shoulder height only
• 3 sets x 10 reps with light weight

8. Standing Row

• Band attached at chest height
• Pull elbows back squeezing shoulder blades
• Hold 2 seconds at end range
• 3 sets x 10-15 reps

Part 4: Scapular Stabilization (3-4 Days/Week)

Summary Schedule

Red Flags - Contact Your Physiotherapist If:

• Pain increases or does not improve within 1-2 weeks
• New numbness or tingling down the arm appears
• Significant swelling or warmth develops
• You hear or feel a new clicking/clunking

The AAOS shoulder conditioning program and the Vanderbilt MOON Shoulder protocol both confirm this three-part structure (ROM + flexibility + strengthening) as the standard approach for shoulder rehabilitation. Always follow the specific guidance given by your treating physiotherapist, as exercises may need to be modified based on your diagnosis (e.g., frozen shoulder, rotator cuff tear, impingement, instability).

Knee Home Exercise Program After Manipulation/Mobilization

Before You Start

• Warm up with 5-10 minutes of gentle walking or stationary cycling
• Do stretches first, then strengthening, then repeat stretches at the end
• Work within a pain-free range - mild pull/effort is okay, sharp pain means stop
• Frequency: Stretching daily; strengthening 2-3x/day or as directed
• Program length: 4-6 weeks minimum; continue 2-3x/week as maintenance thereafter

Part 1: Range of Motion (Daily - Every Session)

1. Ankle Pumps and Circles

• Lie on your back, pump feet up and down (pull toes toward you, then push away)
• Then rotate feet clockwise and counterclockwise
• 20 reps each direction
• Improves circulation and reduces swelling

2. Heel Slides

• Lie on your back with legs straight
• Slowly slide your heel up toward your buttocks, bending the knee as far as comfortable
• Hold 5 seconds, then slide back down
• 3 sets x 10-15 reps
• Key exercise to regain knee flexion

3. Knee Bending Stretch (Seated)

• Sit in a chair with feet flat on the floor
• Scoot forward, slowly bending your knee further back under the chair
• Hold 20-30 seconds when you feel a gentle stretch
• Repeat 3 times per session

4. Knee Straightening Stretch (Prone Hang or Supine)

• Lie on your back with a rolled towel under your ankle
• Relax and let gravity gently extend the knee fully straight
• Hold 5-10 minutes; or
• Lie face down with knee hanging off bed edge for passive extension
• Critical after mobilization to restore full extension

Part 2: Flexibility/Stretching (Daily)

1. Heel Cord Stretch (Calf Stretch)

• Stand facing a wall, step affected leg back, heel flat on floor
• Lean forward until you feel a stretch in the calf
• Hold 30 seconds, repeat 2-4x per side
• 6-7 days/week

2. Quadriceps Stretch (Standing or Side-Lying)

• Stand on good leg, bend affected knee and hold ankle behind you
• Keep knees together, stand tall
• Hold 30 seconds, repeat 3x
• Feel this in the front of your thigh

3. Hamstring Stretch (Supine)

• Lie on back, both knees bent
• Lift one leg, clasp hands behind the thigh (below the knee)
• Straighten the leg and gently pull toward your head
• Hold 30-60 seconds, repeat each side
• Feel this at the back of the thigh and behind the knee

4. IT Band / Hip Flexor Stretch

• Standing, cross the affected leg behind the good leg
• Lean gently to the opposite side until a stretch is felt on the outer thigh
• Hold 20-30 seconds, repeat 3x

Part 3: Strengthening (2-3x Daily or 3-4x/Week)

1. Quadriceps Sets (Quads Set)

• Lie on back or sit, knee straight
• Tighten the thigh muscle (press back of knee down into the bed)
• Hold 5-10 seconds, relax
• 10 reps, rest 1 min, repeat
• The most fundamental knee exercise - do this immediately

2. Straight Leg Raises

• Lie on back, one knee bent (foot flat)
• Tighten the thigh of the straight leg, lift it to the height of the opposite knee
• Hold 5 seconds, slowly lower
• 3 sets x 10-15 reps

3. Short Arc Quads

• Lie on back with a rolled towel or bolster under the knee (30° bend)
• Tighten thigh and straighten the knee fully
• Hold 5 seconds, slowly lower
• 3 sets x 10 reps

4. Terminal Knee Extension (TKE) with Band

• Loop a resistance band around something fixed at knee height
• Face the anchor, loop band around the back of your knee, step back slightly
• Bend and straighten the knee against the band's resistance
• 3 sets x 15 reps - excellent for VMO activation

5. Half Squats (Mini Squats)

• Stand with feet shoulder-width apart, hold a chair for balance if needed
• Bend knees to about 45° only (no deeper initially)
• Hold 5 seconds, return to standing
• 3 sets x 10 reps
• Feel this in the front and back of both thighs and buttocks

6. Wall Squats (Wall Slides)

• Stand with back against a wall, feet 12 inches out
• Slowly slide down until knees are at 45-60° (not past 90°)
• Hold 5-10 seconds, slide back up
• 3 sets x 10 reps

7. Leg Presses with Resistance Band

• Lie on floor, band looped around the arch of the foot
• Bring knee toward chest, then press leg straight against the band
• Hold 2 seconds, return slowly
• 3 sets x 10-15 reps

8. Prone Knee Curls (Hamstring)

• Lie on stomach, bend the knee slowly toward your buttocks
• Add light ankle weights as strength improves (1-2 lbs to start)
• 3 sets x 10-15 reps

9. Glute Bridges

• Lie on back, feet flat on floor, knees bent
• Lift hips off the floor, squeeze glutes at the top
• Hold 5 seconds, slowly lower
• 3 sets x 10-15 reps

10. Calf Raises (Standing)

• Stand behind a chair for support
• Rise up onto toes, hold 2 seconds, lower slowly
• 3 sets x 10-15 reps

Part 4: Functional Progressions (Week 2-4 onward)

Swelling Management (Important After Mobilization)

• ICE the knee 15-20 min after exercise sessions
• Elevate the leg (above heart level) when resting
• Avoid sitting with the knee bent over a pillow for long periods
• Compression bandage if swelling is present

Summary Schedule

Red Flags - Contact Your Physiotherapist If:

• Significant swelling that is not reducing
• Pain that increases rather than gradually improving
• New locking, giving way, or instability of the knee
• Numbness or tingling in the lower leg/foot

The AAOS Knee Conditioning Program and AAOS Total Knee Exercise Guide both support this phased approach. The principles apply broadly whether the mobilization was for stiffness, osteoarthritis, post-surgical recovery, or ligament-related restriction. Always follow specific modifications given by your physiotherapist based on your diagnosis.