Ask the Physical Therapist: What are the best exercises for different muscles?

The following is part of the transcript of a question-and-answer session, conducted over the FSH Society’s Facebook page, with Julie Hershberg, PT, DPT, NCS. Hershberg is a physical therapist who is a Board Certified Neurologic Specialist.  She practices at [re+active] physical therapy & wellness and is an instructor in Doctor of Physical Therapy program at USC.

Q. What’s the best exercise for arms unable to move above shoulder height?

A. Best exercise for arms unable to move above shoulder height: oh, yes—a very big question! Again, this depends on how much movement and strength you have, so I cannot give specific advice, but I will offer these general suggestions. I often recommend exercises in which you do not have to move against gravity. A good example is a shoulder exercise lifting the arm to the side while lying down. This provides good scapular support, and you don’t have to lift against the force of gravity.

I also love using supports such as mobile arm supports, TRX, or even new technology such as Redcord (I haven’t used this, and I don’t have it, but I have seen it used in other facilities): http://www.redcord.com/Portal.aspx?m=546. In the TRX or Redcord, you can take up the weight of the arm in order to perform more exercises in the ideal alignment or posture.

One thing to consider is that, depending on the degree of weakness of a person with FSHD, some muscles may be working or exercising to their maximum just to perform everyday activities. A weak scapular muscle such as the serratus anterior or middle trapezius, for example, will be challenged to complete daily showering, hair washing, and hair combing tasks. These specific muscles may need to rest and not perform additional resistive exercises.

I don’t think that PT is actually necessary forever—maybe for a short time to get you started on a good program, then getting started with a therapist and transitioning to work on your own or at a gym. The CDC recommendations for exercise are for a total of 150 minutes a week for healthy living.

Q. What the best exercise for weak leg causing strain in calf muscle?

A. Best exercise for weak leg causing strain in calf muscle: This is a tough one. There are many reasons why the calf can be strained, so this requires assessment by a PT. For example, calf strain can be due to hip weakness (and therefore overuse of the calf muscle to propel the leg forward). Calf strain can also be due to calf weakness or tightness as well. Again, I recommend an individualized evaluation to help discern the best place to start.

Q. Best exercise for weak stomach muscle?

A. Best exercise for weak stomach muscle. Alas—one more time where I will say that this really requires a thorough assessment of your strengths. In general, I recommend strengthening of the deeper abdominal muscles because these are key to stability and decreasing pain (and can often be intact when some of the larger muscles are weakened in FSHD).

I like this PT video about how to contract the deep abdominal muscles as a starting point (there are many variations and progressions to this exercise): https://www.youtube.com/watch?v=p8O04WLXFt8. In general, PTs are very good at identifying the control you have and then progressing and strengthening it in various postures and positions. I have also worked with Pilates instructors and trainers who have good applications of these methods.

Another thing to consider is using an abdominal binder to help support the abdominal muscles and put you in a better alignment for using them in function.