Return to My Pain Management Program

I was really concerned about what my pacing plan was going to look like when I left the 4 week program. At that time I didn’t have a job so I was looking at a much more relaxed pace. I could spend most of my days just concentrating on the plan. What concerned me was what was going to happen once I got a job. Would I be able to do 40 hours per week and still keep up the program or was I going to need to just work part time. So far, working 40 hours is working. Longer term though, I think I’m going to try to find something to do part time. Mostly because I want to have more time to do the things that I want to do. So here’s my current schedule.

Weekdays

6:10 am – Stretching exercises start first thing in the morning. The only thing before that is starting the coffee.

6:40 am – Coffee and get the ice packs out of the freezer

6:45 am – Icing

8:00 am to noon – Work and Stairs (8 flights)

12:00 noon – I eat lunch and take a 30 minute walk.

1:00 – 5:00 pm – More stairs. and more work. Same pace.

After 5:00 pm – In the evening, depending on how I’m feeling, I may ice, take a warm bath or an evening walk.

Weekends

The weekends I’ll keep up most of the things that I do through the week except for the stairs. I’ll substitute yard chores or fun activities for the work activities I do throughout the week.. I think the key here is I try to keep it as consistent as possible so I don’t have significant changes to the amount or type of activities that I do. It’s hard because I like to get things done on the weekends. I have to keep myself under control.

And that’s pretty much it. I am pretty militant about my schedule. If I don’t get my way it gets ugly.

My Drug Free Pain Management Program

One of the reasons that I am posting all of this information is because I think it is important that people with chronic pain have an idea that there is another way to treat their pain besides drugs. And if they work with their doctor and physical therapist now, they can very possibly dodge the inevitable crash. It is very possible that you could effectively implement this plan and start improvement.

But I do want to highly recommend the UNMC PM Program as it will provide much more knowledge and medical support than could ever be done on your own. In four weeks you could be living a life that you thought you had left behind long ago.

So here goes a description of the way I am executing my program…

Pacing

There’s a whole new attitude you have to come to terms with when it comes to living with chronic pain. And part of it is pacing. Learning to do a consistent level of activity whether you hurt or not. Here is my current plan of attack. I set this plan up and follow it religiously. If I skip part of it I pay. So it’s up to me to maintain a consistent activity level which results in a consistent state in my chronic pain.

Exercise

As part of my exit planning from the Pain Management Program at UNMC. I learned that exercise is important and the focus of the exercise is really important. For those with chronic pain they should consider exercising with these outcomes by priority:

Relaxation – coming soon

Desensitization – coming soon

Return to My Pain Management Program

For the flexibility exercises we were all started out at 5 repetitions and then increased by one each day until we reached 10.  So let’s get started with that. I am using the routines that were provided by the PMP. The are beginning, advanced, advanced II and aquatic.

The beginning flexibility exercises are obviously where you should start. As I indicated before you should start with 5 repetitions when repetitions are indicated. And work your way up to 10 the first week. Then continue this program for the next week.

Then you can do the same thing with the advanced flexibility exercises. Start at 5 work up to 10 and stay at them at least two weeks. After that it will be up to you and your Doctor or Physical Therapist of when to go to the Advanced II flexibility exercises.

Another really good routine for flexibility is the aquatic exercises. These are done in a pool and if you have access to a therapeutic pool all the better. In some cases you can get your doctor to write a prescription to get you access to the pool. The plan here is to start out with 5 repetitions and increase to 10. In the beginning this can be done up to 3 times a week and then decreased as you feel more confident in the other flexibility routines.

So there you have it. 4 routines to help you stay flexible. And just so you know, I am currently doing the Advanced II exercises every morning. I make coffee, and go to the basement to start my day.

Return to My Pain Management Program

Return to flexibility exercises

Advanced exercises emphasize additional increases in flexibility, muscle control (coordination) and balance. Not everyone will be able to progress to the advanced exercise routine. Advanced exercises are for persons with the appropriate abilities. The progression to the advanced exercise routine is not viewed as a pass/fail system for persons doing the beginning level exercises. Persons starting the advanced level of exercises will begin with five repetitions of most exercises and increase the repetitions by one per day until ten repetitions are reached. The exceptions are the repetitions followed by a prolonged stretch exercise, i.e., repetitions followed by a 30 second hold. This means that those exercises will be performed twice; once for the designated number of repetitions on each side during, moving in and out of a stretch position, then a second time held for 30 seconds on each side. This method of stretching provides both beneficial mobilization to the nervous system, as well as a sustained stretch designed to improve muscle length. Be sure to breathe during the sustained stretch exercises. Holding the breath does not allow for a complete stretch of the muscle or fascia (after all, this is the reason for doing stretching exercises!). Be sure to stretch a little further as the initial stretch sensation decreases during the 30 second – stretch period.

 ADVANCED EXERCISES

1. Breathing Exercise (3 Times; 15 Seconds Each)

2. Facial Exercises

3. Chin to Shoulder

4. Chicken

5. Alternating Shoulder Rolls

6. Stand on One Foot (20-30 seconds TWICE each leg)

7. Large Arm Circles (Circle Forward Then Backward)

POLE/TOWEL EXERCISES

8. Pole Swing

9. Over Head and Behind Neck

10. Up Down/Back Down

11. Lean Back

STANDING STRETCHES

12. Calf Stretch (TWICE for each leg: first do reps, then 30 second

hold)

FLOOR EXERCISES

13. Hamstring Stretch (TWICE for each leg: first do reps, then 30 sec hold) .

14. Front Thigh Stretch (TWICE each leg: first do reps, then 30 sec hold)

15. Side Leg Lift

16. Groin Stretch (Do TWICE: first do reps, then 30 second hold)

17. Thigh Dives and Head Rolling

18. One Leg Fanny Lift

19. Pull the Knee Across

20. Toe Pointer

21. RoIling Angel

22. Side Pivot

23. The Seal

24. Press Up and Hold (Stretch for 5 seconds each time)

1. BREATHING EXERCISE: Place one hand on your abdomen and the other hand on your chest. To do correct abdominal breathing, your stomach should expand as you inhale. You may assist your exhalation by pushing your abdomen ¡n as you exhale. The hand on your chest is to help you to be aware of how much your abdomen moves relative you your chest. Inhale for five seconds and exhale for ten seconds. Don’t hold your breath at any point during this exercise. Repeat 3 times.

2. FACIAL EXERCISES: Open your mouth wide and shut your eyes tight. Repeat the proper number of repetitions.

3. CHIN TO SHOULDER: Turn your head and neck to the right and try to touch your chin to the right shoulder. Turn your head and neck to the left and try to touch your chin to the left shoulder. Turning the head and neck is more important than simply trying to touch the chin to the shoulder. Turning the head to the right and to the left count is one repetition. Repeat the proper number of repetitions.

4. CHICKEN: Move your head forward by moving your chin forward. Now move your chin back by tucking it in toward your neck, the head movement should be parallel to the floor. Repeat the proper number of repetitions.

5. ALTERNATING SHOULDER ROLLS: While standing with your arms at your sides roll the right shoulder backward in a circular motion then do the same for the left shoulder. Repeat. Next roll one shoulder at a time in the circular motion in the forward direction. Rolling the right shoulder then the left shoulder count is one repetition. Repeat the proper number of  repetitions.

6. STAND ON ONE FOOT: Balance on one foot for 20-30 seconds without touching the wall or furniture. Do the same on the other leg. Balance twice on each leg.

7. LARGE ARM CIRCLES: While standing move both arms in large circles in the forward direction making sure that your elbows come as close to your ears as possible. Repeat the proper number of repetitions. Complete the large circles in the reverse direction. Repeat the proper number of repetitions.

8. POLE SWING: Standing with the exercise pole in front of the thighs and the hands toward he ends of the pole, swing the pole up and back to the right while twisting from the waist. Be sure to look with your whole head and neck to the right while you do this. Swing your pole down to the front of the thighs and then up and back to the left, looking to the left while twisting from the waist. This should be one sweeping motion without stopping in the middle. Also be sure to turn your head to the left as you twist to the left. Repeat the proper number of repetitions.

9. OVER HEAD AND BEHIND NECK: Hold the pole down and in front of your thighs with both hands toward the ends of the pole. KEEP YOUR ARMS STRAIGHT (but not stiff) as you raise the pole over your head. Bend your arms and rest the pole behind your neck. Straighten your arms again and raise the pole over your head and return to the starting position. Repeat the proper number of repetitions.

10. UP DOWN BACK DOWN: Hold the pole at each end behind your thighs with your palms facing forward. 1) Bend your elbows and slide the pole up your back, 2) Slide the pole down your back, 3) Raise the pole backward and away from your back and legs as high as you can, 5) Then return to the starting position. Steps l—4 count as ONE REPETITION. Be sure to relax your shoulders each time the pole goes down. Repeat the proper number of repetitions

11. LEAN BACK: Stand with the pole behind your hips. Secure the pole by placing the pole behind your back in the bend of your with your hands on your hips. Push down on your hips to decrease the pressure on your low back. Keep your knees straight as you lean backward from the waist. It helps a great deal to tilt your head back as you lean back. Repeat the proper number of repetitions.

 STANDING STRETCHES

+ NOTE: ALL PROLONGED STRETCHES SHOULD BE DONE WHILE YOU ARE BREATHING. DO NOT HOLD YOUR BREATH!!!! MOVE INTO MORE OF A STRETCH ONCE THE INITIAL STRETCH SENSATION LESSENS.

12. CALF STRETCH: Stand facing a wall. Place the toes of the left foot against the wall with the right foot and leg behind you. The right calf behind you will be the one stretched. Place the right foot so that the right foot is perpendicular (90 degrees) to the wall you are facing. Keep the heel of the right foot down and the right knee straight as you lean against the wall in front of you. (Some people find resting the left knee on the wall helpful.) If you do not feel a stretch in the right calf, move the heel of the right foot back an inch at a time and attempt the stretch again. The further back the right heel is, the more of a stretch is required of the right calf muscles. Begin repetitions by bending the right knee and then straightening the right knee. Then hold the stretch for 30 seconds with the right knee straight. Then do the stretch for the left calf, beginning with repetitions and ending with a 30 second hold.

 FLOOR EXERCISES

 13. HAMSTRING STRETCH: Lay on the mat on your back. Grab the back of your right knee with both hands. If you cannot reach around your knee, wrap a towel behind your knee with each end in each hand. Try to keep your left leg flat on the mat or floor. While holding on to your right knee, straighten your right knee so that the right foot moves upward toward the ceiling. Perform the correct number of repetitions, straightening and bending the right knee. Then hold the stretch with right leg straight for 30 seconds. Repeat the correct number of repetitions and then the sustained stretch while holding on to the left knee.

 14. FRONT THIGH STRETCH: Lie on your right side and grab your left ankle with your left hand. Keep your thigh parallel to the floor as you pull your ankle back away from your hip — NOT TOWARD YOUR HIP. You should feel the stretch in the front of your thigh.  erform the correct number of repetitions then hold the stretch, ankle pulled away from the hip, for 30 seconds. Roll over onto your other side, change hand positions and stretch the other thigh. Perform the correct number of repetitions followed by a sustained stretch of 30 seconds.

 15. SIDE LEG LIFT: Lie square on your right side with your legs straight and the top leg on the floor behind the bottom leg with the toes pointing down and touching the floor. The heel should be pointed up toward the ceiling. Raise your top leg straight up toward the ceiling and back down. Be sure that your foot points down to the floor and not up toward the ceiling or your face. Repeat. Roll over on to the other side and repeat the proper number of repetitions.

 16. GROIN STRETCH: Get down on the exercise mat on your hands and your knees. While still on your hands and knees, spread your knees as far apart as possible while keeping your spine straight. Move your knees apart to get more of a stretch as needed. Perform repetitions by gently sitting back into the stretch or moving hips backwards to increase the stretch in the inner thigh. Release the stretch by moving the hips forward slightly. End by holding the stretch for 30 seconds. Be sure to breathe while you are stretching.

 17. THIGH DIVES AND HEAD ROLLING: While on your back have your knees bent with the feet flat on the mat. Place the feet as far apart as possible. Try to touch the right knee to the floor between your feet as you turn your head to the right. Then try to touch the left knee to the floor between your feet as you turn your head to the left. Repeat the proper number of repetitions.

 18. ONE LEG FANNY LIFT: While on your back with your knees bent and feet on the floor, cross the right leg over the left leg. Keeping the legs crossed, lift your fanny up off the ground. Be sure to keep your hips level while you raise them up. Repeat the appropriate number of times. Cross the left leg over the right and lift the fanny up and down. Repeat the proper number of repetitions.

 19. PULL THE KNEE ACROSS: While on your back grab the left knee with the right hand and pull the left knee up toward the right shoulder and stretch. Now do the same for the other side by using your left hand to grab the right knee and pull it up toward the left shoulder. Repeat the proper number of repetitions. You may also add a sustained stretch of 30 seconds at the end of repetitions on each leg.

 20. TOE POINTER: Bring your right knee to your chest; straighten your leg and point the heel toward the ceiling (your knee must be straight). Now point your toes toward your face, hold your toes in this position as you lower your leg to the floor, keeping your knee straight. Finish by bending your knee so that the foot is flat on the floor. Then do the same on the left side. Repeat the proper number of repetitions by alternating legs.

 21. ROLLING ANGEL: Lie on your back with your arms on the floor away from your sides at shoulder height. Your legs should be flat on the floor and the feet should be much wider than shoulder-width apart. Keep your feet apart during the exercise. Bring your right arm across your body and touch the floor beneath (or past) your left hand. (Your right shoulder should come up off the floor, as should your right hip.) Return to the starting position and repeat with the left (only one arm should be moving at one time). Try to move so that you are not stiff in the trunk and midsection. Repeat the proper number of repetitions.

 22. SIDE PIVOT: Lie on your side so that your legs and trunk are in a straight line. Cross your arms over your chest and lift your shoulders and both legs off the mat 2 —3 inches using the elbow on the mat for balance. Stay on your side. Do not roll onto your back. Repeat. Roll over and repeat the proper number of repetitions on the other side.

 23. THE SEAL: Lie on your stomach and place your arms down at your sides. 1) Bring your shoulder blades together behind you, 2) Raise your head, shoulder and chest off of the floor while keeping your shoulder blades together, 3) Relax and let your chest, arms and shoulders back down to the floor. Be sure to relax all of your muscles before lifting up for the next repetition. Repeat the proper number of repetitions.

 24. PRESS UP AND HOLD: Starting face down, place your hands under your shoulders. Straighten your arms and push your shoulders and chest up off the floor. BE SURE THAT YOUR HIPS STAY ON THE FLOOR AND THAT YOU LET YOUR TUMMY SAG. THE MUSCLES IN THE HIPS AND BACK SHOULD BE RELAXED! Hold the stretch for 5 seconds and repeat.

• If you are not able to do this exercise and keep your hips on the floor, move your hands more forward and/or out to the side on the floor before straightening your arms.

 25. CHILD’S POSE: Kneel on your hands and knees with the knees separated about as wide as your hips to allow room for your torso. Bring your hips back attempting to sit back onto the heels of your feet. Allow your head to bend down toward the floor while allowing the chest spine and lower back spine curve in the same manner. Breathe and relax into this position for 20-30 seconds once.

Return to flexibility exercises

Return to flexibility exercises

1. Breathing Exercise (3 Times; 15 Seconds Each) ;
2. Facial Exercises
3. Chin to Shoulder :
4. Chicken
5. Reach Overhead
6. Alternating Shoulder Rolls !
7. Stand on One Foot (20-30 seconds TWICE each leg) !

POLE/TOWEL EXERCISES

8. PoleSwing
9. Back Scrubber ;
10. Lean Back

STANDING STRETCHES I

11. Doorway Chest Stretch (TWICE for 30+ seconds – BREATHE!) !
12. Calf Stretch (TWICE for 30+ seconds – each leg) !

FLOOR EXERCISES

13. Hamstring Stretch (Each leg TWICE for 30+ seconds) ;
14. Opposite Limb Pointer
15. Groin Stretch (TWICE for 30 seconds) :
16. Front Thigh Stretch (Each leg TWICE for 30+ seconds) !
17. Pull the Knee Across !
18. One Leg Fanny Lift !
19. Side Pivot
20. Thigh Dives and Head Rolling ¡
21. Press Up and Hold (Stretch for 5 seconds each time) ¡
22. Child’s Pose

ADVANCED EXERCISES

Advanced exercises emphasize additional increases in flexibility, muscle control (coordination) and balance. Not everyone will be able to progress to the advanced exercise routine. Advanced
exercises are for persons with the appropriate abilities. The progression to the advanced exercise routine is not viewed as a pass/fail system for persons doing the beginning level exercises. Persons starting the advanced level of exercises will begin with five repetitions of most exercises and increase the repetitions by one per day until ten repetitions are reached. The exceptions are the prolonged stretch exercises, i.e., 30+ seconds twice. This means that those exercises will be held for 30+ seconds and then repeated once more. Be sure to breathe during these exercises. Holding the breath does not allow for a complete stretch of the muscle or fascia (after all, this is the reason for doing stretching exercises!). Be sure to stretch a little further as the initial stretch sensation decreases during the 30+ second – stretch period.

1. BREATHING EXERCISE: Place one hand on your abdomen and the other hand on your chest. To do correct abdominal breathing, your stomach should expand as you inhale. You may assist your exhalation by pushing your abdomen in as you exhale. The hand on your chest is to help you to be aware of how much your abdomen moves relative you your chest. Inhale for five seconds and exhale for ten seconds. Don’t hold your breath at any point during this exercise. Repeat 3 times.

2. FACIAL EXERCISES: Open your mouth wide and shut your eyes tight. Repeat the proper number of repetitions.

3. CHIN TO SHOULDER: Turn your head and neck to the right and try to touch your chin to the right shoulder. Turn your head and neck to the left and try to touch your chin to the left shoulder. Turning the head and neck is more important than simply trying to touch the chin to the shoulder. Turning the head to the right and to the left count is one repetition. Repeat the proper number of repetitions.

4. CHICKEN: Move your head forward by moving your chin forward. Now move your chin back by tucking it in toward your neck, the head movement should be parallel to the floor. Repeat the proper number of repetitions.

5. REACH OVERHEAD: Stand with your arms at your sides. Reach with both hands overhead as you breathe in. Be sure to bring your elbows as close to your ears as possible. Let your arms down as you exhale. Repeat the proper number of repetitions.

6. ALTERNATING SHOULDER ROLLS: While standing with your arms at your sides roll the right shoulder backward in a circular motion then do the same for the left shoulder. Repeat. Next roll one shoulder at a time in the circular motion in the forward direction. Rolling the right shoulder then the left shoulder count is one repetition. Repeat the proper number of repetitions.

7. STAND ON ONE FOOT: Balance on one foot for 20-30 seconds without touching the wall or furniture. Do the same on the other leg. Balance twice on each leg.

POLE/TOWEL EXERCISES

8. POLE SWING: Standing with the exercise pole in front of the thighs and the hands toward the ends of the pole, swing the pole up and back to the right while twisting from the waist. Be sure to look with your whole head and neck to the right while you do this. Swing your pole down to the front of the thighs and then up and back to the left, looking to the left while twisting from the waist. This should be one sweeping motion without stopping ¡n the middle. Also be sure to turn your head to the left as you twist to the left. Repeat the proper number of repetitions.

9. BACK SCRUBBER: Stand and hold the pole as you would hold a towel to dry your back (one hand behind your head and the other behind your lower back). Move your hands as close together as possible on the pole. Scrub your back up and down with the pole. Make sure to keep your head up and facing straight ahead, rather than looking down at the floor. Switch hand positions and repeat the proper number of repetitions.

10. LEAN BACK: Stand with the pole behind your hips. Secure the pole by placing the pole behind yóur back in the bend of your with your hands on your hips. Push down on your hips to decrease the pressure on your low back. Keep your knees straight as you lean backward from the waist. It helps a great deal to tilt your head back as you lean back. Repeat the proper number of repetitions.

STANDING STRETCHES –
+ NOTE: ALL PROLONGED STRETCHES SHOULD BE DONE WHILE YOU ARE BREATHING. DO NOT HOLD YOUR BREATH!!!! MOVE INTO MORE OFASTRETCH ONCE THE INITIAL STRETH SENSATION LESSENS

11. DOORWAY CHEST STRETCH: Stand in a doorway with your hands overhead on the edges of the open doorway. Hold on to the edges of the doorway while you lean forward. You should feel a stretch in the front of your chest or in your arms. Hold the stretch for a minimum of 30 seconds WHILE BREATHING and repeat once more.

12. CALF STRETCH: Stand facing a wall. Place the toes of the left foot against the wall with the right foot and leg behind you. The right calf behind you will be the one stretched. Place the right foot so that the right foot is perpendicular (90 degrees) to the wall you are facing. Keep the heel of the right foot down and the right knee straight as you lean against the wall in front of you. (Some people find resting the left knee on the wall helpful.) If you do not feel a stretch in the right calf, move the heel of the right foot back an inch at a time and attempt the stretch again. The further back the right heel is, the more of a stretch is required of the right calf muscles. BREATHE Hold the stretch for a minimum of 30 seconds then do the stretch for the left calf. Repeat once more for each leg.
FLOOR EXERCISES
13. HAMSTRING STRETCH: Lay on the floor on your back either by a piece of furniture that can support your leg or in a doorway. Straighten your right leg and place the right heel on the piece of furniture so that the heel is pointing toward the ceiling. Be sure to keep the knee straight while in this position. Keep your left leg flat on the mat or floor. You get more of a stretch if you move your hips closer to the doorway or the piece of furniture. Hold the stretch for a minimum of 30 seconds. While you are stretching, it is a good practice to move into more of a stretch as the initial stretch sensation decreases. Release the stretch after the appropriate time has passed, then do the stretch a second time. Repeat the stretch twice on the left leg by changing leg positions.
•. REMINDER: ALL PROLONGED STRETCHES SHOULD BE DONE WHILE YOU ARE BREATHING.
DO NOT HOLD YOUR BREATH!!!! MOVE INTO MORE OF A STRETCH ONCE THE INITIAL
STRETCH SENSATION DECREASES.

14. OPPOSITE LIMB POINTER: Get down on the exercise mat on your hands and your knees. Raise the right arm and the left leg off the floor so that they are in a straight line with your body and parallel to the floor. Place the arm and the leg back down. Turn your head and look at the hand that ¡s being raised off of the floor. Raise the left arm and the right leg off the floor and place them back down. Turn your head appropriately. BE SURE TO RELAX YOUR MUSCLES BEFORE DOING THE NEXT REPETITION! Alternate the limbs. Pointing one set of limbs and then the other alternately count as one repetition. Repeat the proper number of repetitions.

15. GROIN STRETCH: Get down on the exercise mat on your hands and your knees. While still on your hands and knees, spread your knees as far apart as possible while keeping your spine straight. Move your knees apart to get more of a stretch as needed. Hold the stretch for a minimum of 30 seconds and repeat once more. Be sure to breathe while you are stretching.

16. FRONT THIGH STRETCH: Lie on your right side and grab your left ankle with your left hand. Keep your thigh parallel to the floor as you pull your ankle back away from your hip — NOT TOWARD YOUR HIP. You should feel the stretch in the front of your thigh. Hold the stretch for 30 seconds and repeat once more. Roll over onto your other side, change hand positions and stretch the other thigh. Hold the stretch and repeat twice on each side for a minimum of 30 seconds each time.

17. PULL THE KNEE ACROSS: While on your back grab the left knee with the right hand and pull the left knee up toward the right shoulder and stretch. Now do the same for the other side by using your left hand to grab the right knee and pull it up toward the left shoulder. Repeat the proper number of repetitions.

18. ONE LEG FANNY LIFT: While on your back with your knees bent and feet on the floor, cross the right leg over the left leg. Keeping the legs crossed, lift your fanny up off the ground. Be sure to keep your hips level while you raise them up. Repeat the appropriate number of times. Cross the left leg over the right and lift the fanny up and down. Repeat the proper number of repetitions.

19. SIDE PIVOT: Lie on your side so that your legs and trunk are in a straight line. Cross your arms over your chest and lift your shoulders and both legs off the mat 2 —3 inches using the elbow on the mat for balance. Stay on your side. Do not roll onto your back. Repeat. Roll over and repeat the proper number of repetitions on the other side.

20. THIGH DIVES AND HEAD ROLLING: While on your back have your knees bent with the feet flat on the mat. Place the feet as far apart as possible. Try to touch the right knee to the floor between your feet as you turn your head to the right. Then try to touch the left knee to the floor between your feet as you turn your head to the left. Repeat the proper number of repetitions.

21. PRESS UP AND HOLD: Starting face down, place your hands under your shoulders. Straighten your arms and push your shoulders and chest up off the floor. BE SURE THAT YOUR HIPS STAY ON THE FLOOR AND THAT YOU LET YOUR TUMMY SAG. THE MUSCLES IN THE HIPS AND BACK SHOULD BE RELAXED! Hold the stretch for 5 seconds and repeat. •• If you are not able to do this exercise and keep your hips on the floor, move your hands more forward and/or out to the side on the floor before straightening your arms

22. CHILD’S POSE: Kneel on your hands and knees with the knees separated about as wide as your hips to allow room for your torso. Bring your hips back attempting to sit back onto the heels of your feet. Allow your head to bend down toward the floor while allowing the chest spine and lower back spine curve in the same manner. Breathe and relax into this position for 20-30 seconds once.

Return to flexibility exercises

Return to flexibility exercises

1. Breathing Exercise (Breathe Three Times; 15 Seconds Each)
2. Facial Exercises :
3. Chin to Shoulder
4. Chicken I
5. Shoulder Rolls (Roll Forward Then Backward)
6. Heel /Toe Rocking
7. Large Arm Circles (Circle Forward Then Backward)
POLE/TOWEL EXERCISES:
8. Trunk Twister (Turning to the Right and Left Count as One Repetition)
9. Over Head and Behind Neck :
10. Up Down/Back Down :
ii. Lean Back !
FLOOR EXERCISES: !
12. Groin Stretch
13. Hamstring Stretch (On your Back) (Stretch TWICE for a minimum of 30 Seconds While BREATHING)
14. Tummy Tucker :
15. Front Thigh Stretch
16. Side Leg Lift !
17. Both Knees to Shoulders ¡
18. Knee and Head Opposite Rolling
19. Thigh and Arm Slide (Lie first on the Right Side then the Left Side)
20. Fanny Lift :
21. Toe Pointer !
22. Rolling Angel !
23. TheSeal ¡
24. Arm Flapping
25. Elbow Propping (Stretch TWICE for a minimum of 30 Seconds : While BREATHING) :

1. BREATHING EXERCISE: Place one hand on your abdomen and the other hand on your chest. To do correct abdominal breathing, your abdomen should expand as you inhale. You may assist your exhalation by pushing your abdomen in as you exhale. The hand on your chest is to help you be aware of how little your chest moves when proper abdominal breathing is done. Inhale for five seconds and exhale for ten seconds. Don’t hold your breath at any point during this exercise. Repeat three times only.

2. FACIAL EXERCISES: Open your mouth wide and shut your eyes tight. When you finish the repetition, your eyes should be open and your mouth should be closed. Repeat the proper number of repetitions.

3. CHIN TO SHOULDER: Turn your head and neck to the right and try to touch your chin to the right shoulder. Turn your head and neck to the left and try to touch your chin to the left shoulder. Turning the head and neck is more important than simply trying to touch the chin to the shoulder. Turning your head to the right AND to the left count is ONE REPETITION. Repeat the proper number of repetitions.

4. CHICKEN: Move your head forward by moving your chin forward. Now move your chin back by tucking it in toward your neck, the movements should be parallel to the floor. Repeat the proper number of repetitions.

5. SHOULDER ROLLS: Stand with your arms at your sides and your hands on the sides of your thighs. Without moving your hands, move both shoulders (not the elbows) ¡n a circular motion forward. Repeat. Then move your shoulders ¡n a circular motion in the reverse direction. Repeat the proper number of repetitions.

6. HEEL/TOE ROCKING: While standing raise up on both toes and then back on both heels. Repeat the proper number of repetitions.

7. LARGE ARM CIRCLES: While standing move both arms ¡n large circles in the forward direction making sure that your elbows come as close to your ears as possible. Repeat the proper number of repetitions. Complete the large circles in the reverse direction. Repeat the proper number of repetitions.

POLE/TOWEL EXERCISES: You will need a small wooden pole or an old broomstick for the followinj exercises. If you don’t have a pole, a towel can be used.

8. TRUNK TWISTER: Stand with your feet shoulder width apart. Place the pole behind your neck by resting it on your shoulders with your hands holding on to the ends of the pole. Your feet should be a little farther apart than shoulder width. Bend your knees slightly and keep them bent slightly through the entire exercise. Twist from the waist and turn your head in the same direction as you twist from right to left. Do not lean from side to side. Keep your spine vertical as you rotate. Repeat the proper number of repetitions

9. OVER HEAD AND BEHIND NECK: Hold the pole down and in front of your thighs with both hands toward the ends of the pole. KEEP YOUR ARMS STRAIGHT (but not stiff) as you raise the pole over your head. Bend your arms and rest the pole behind your neck. Straighten your arms again and raise the pole over your head and return to the starting position. Repeat the proper number of repetitions
10. UP DOWN/BACK DOWN: Hold the pole at each end behind your thighs with your palms facing forward. 1) Bend your elbows and slide the pole up your back, 2) Slide the pole down your back, 3) Raise the pole backward and away from your back and legs as high as you can, 5) Then return to the starting position. Steps 1 —4 count as ONE REPETITION. Be sure to relax your shoulders each time the pole goes down. Repeat the proper number of repetitions.

11. LEAN BACK: Stand with the pole behind your hips. Secure the pole by placing the pole behind your back in the bend of your with your hands on your hips. Push down on your hips to decrease the pressure on your low back. Keep your knees straight as you lean backward from the waist. It helps a great deal to tilt your head back as you lean back. Repeat the proper number of repetitions.

FLOOR EXERCISES

+ NOTE: ALL PROLONGED STRETCHES SHOULD BE DONE WHILE YOU ARE BREATHING. DO NOT HOLD YOUR BREATH!!!! MOVE INTO MORE OF A STRETCH ONCE THE INITIAL STRETCH SENSATION LESSENS

12. GROIN STRETCH: Sit on the mat with the soles of your feet touching each other. Grab your ankles with both hands as you place your elbows on your knees. Spread your knees apart by pushing them down with your elbows as you bend forward at the waist and bring your chin to your chest. Repeat the proper number of repetitions. + ALTERNATE GROIN STRETCH: Get down on the exercise mat on your hands and your knees. While still on your hands and knees, spread your knees as far apart as possible while keeping your spine straight. Move your knees apart to get more of a stretch as needed. It is easier on your low back if you move your hips slightly toward your heels. Hold the stretch for 30 seconds and repeat once more. Be sure to breathe while you are stretching.

13. HAMSTRING STRETCH: Lay on the mat on your back. Grab the back of your right knee with both hands. If you cannot reach around your knee, wrap a towel behind your knee with each end ¡n each hand. Try to keep your left leg flat on the mat or floor. While holding on to your right knee, straighten your right knee so that the right foot moves upward toward the ceiling. Hold that stretch for a minimum of 30 seconds. Release the stretch then do it on the other leg. Repeat the stretch once more for each leg.

14. TUMMY TUCKER: Lay on the mat on your back. Spread your feet slightly wider than shoulder width apart. Place your fingertips on the lower outside of your abdomen (have your physical therapist show you exactly where). Use your fingertips to tell you that your muscles are working properly. Turn your legs and feet slightly inward. Now ‘tuck your tummy’ (tensing those muscles) while raising your head and shoulders up off the mat by no more than 1 – 3 inches. Then let your head and shoulders back down. Be sure to breathe when you raise up. Repeat the proper number of repetitions.

15. FRONT THIGH STRETCH: Lie on your right side and grab your left ankle with your left hand. Keep your thigh parallel to the floor as you pull your ankle back and AWAY from your bottom. (Do not pull your foot toward your rear-end) You should feel the stretch in the front of your thigh. Repeat the proper number of repetitions. Roll over onto your other side, change hand positions and stretch the other thigh. Repeat the proper number of repetitions.

16. SIDE LEG LIFT: Lie square on your right side with your legs straight and the top leg on the floor behind the bottom leg with the toes pointing down and touching the floor. The heel should be pointed up toward the ceiling. Raise your top leg straight up toward the ceiling and back down. Be sure that your foot points down to the floor and not up toward the ceiling or your.face. Repeat. Roll over on to the other side and repeat the proper number of repetitions.

17. BOTH KNEES TO SHOULDERS: With both hands, grab your knees and pull the right knee to the right shoulder and the left knee to the left shoulder at the same time. Do this in a manner that makes your rear-end come up off the floor slightly. Repeat. If you cannot reach or hold onto your knees, wrap a towel behind both knees and hold on to each end with your hands. Complete the exercise as described above. Repeat the proper number of repetitions.

18. KNEE AND HEAD OPPOSITE ROLLING: While on your back with both knees bent and the feet flat on the floor, lay both knees to the right while you turn your head and neck to the left. Then lay your knees to the left while you turn your head and neck to the right. Be sure to allow one of your hips to roll up and off of the mat. Your feet should still be on the floor and may roll from one side to the other also. Repeat.

19. THIGH AND ARM SLIDE: Lay on your side with your arms out in front of you laying one on top of the other with the palms touching each other. The legs should be laying one on top of the other as well with the hips and knees bent at a 90 degree angle. Slide the top thigh and top arm forward simultaneously over the thigh and arm respectively without lifting them up. The top hand should only reach slightly past the bottom hand. Then slide your top arm and leg back to the starting position. Repeat. Roll over onto the other side. Repeat.

20. FANNY LIFT: As you lie on your back, bend your knees and have your feet flat on the mat. Raise your fanny up and off of the floor as high as you can, keeping your trunk in a straight line from the shoulders to the knees. (Your shoulders must remain on the mat). Repeat the proper number of repetitions.

21. TOE POINTER: Lie on your back with your knees bent and both feet flat on the floor. There is more of a stretch with the arms spread as far as possible away from your sides.  Five Steps
i. Bring your right knee to your chest
ii. straighten your leg and point the heel toward the ceiling (your knee should be straight)
iii. point your toes toward your face, hold your toes in this position
iv. lower your leg to the floor, keeping your knee straight
v. finish by bending your knee so that the foot ¡s flat on the floor
ALTERNATE BETWEEN RIGHT AND LEFT, Repeating the proper number of repetitions by alternating legs; right! left one, right / left two, right left three, etc.

22. ROLLING ANGEL: Lie on your back with your arms on the floor away from your sides at shoulder height. Your legs should be flat on the floor and the feet should be much wider than shoulder-width apart. Keep your feet apart during the exercise. Bring your right arm across your body and touch the floor beneath (or past) your left hand. (Your right shoulder should come up off the floor, as should your right hip.) Return to the starting position and repeat with the left (only one arm should be moving at one time). Try to move so that you are not stiff in the trunk and midsection. Repeat the proper number of repetitions.

23. THE SEAL: Lie on your stomach and place your arms down at your sides. 1) Bring your shoulder blades together behind you, 2) Raise your head, shoulder and chest off of the floor while keeping your shoulder blades together, 3) Relax and let your chest, arms and shoulders back down to the floor. Be sure to relax all of your muscles before lifting up for the next repetition. Repeat the proper number of repetitions.

24. ARM FLAPPING: Lie on your stomach with your arms straight out away from your sides at shoulder height, resting them on the floor palms down. Raise both arms up off of the floor toward the ceiling (not down toward the feet). Repeat the proper number of repetitions.

25. ELBOW PROPPING: Lie face down with your elbows under your shoulders. Let your tummy sag down toward the floor by relaxing your back, hip muscles and leg muscles. Be sure that your head is held up and not hanging down. Rest your chin on tips of your straightened fingers. Your nose should be pointed downward slightly. Hold the stretch for a minimum of 30 seconds then repeat once more. Be sure to breathe while you stretch.

Return to flexibility exercises

Return to flexibility exercises

1. Nods
2. Small Arm Circles
3. Push-offs
4. Forward Rowing
5. Reverse Rowing
6. Bubbles
7. Barn Door
8. Hugs (Do to the right and left twice for 30 seconds each)
9. Arms Up (Do twice for 30 seconds each)
10. Arms Down (Do twice for 30 seconds each)
11. Hand Holding (Do twice for 30 seconds each)
12. Arms in Back (Do twice for 30 seconds each)
13. The 007
14. Elbow to Opposite Knee
15. Ballerina (Do to the right and left twice for a minimum of 30 seconds each)
16. Climb the Wall (Do twice for a minimum of 30 seconds each)
17. Spider Man (Do to the right and left twice for a minimum of 30 seconds each)
18. Calf Stretch (Do twice for a minimum of 30 seconds each)
19. Front Flutter Kick
20. Body Twist
21. Rockette
22. Front – Back Kick
23. In – Out Kick
24. Front Thigh Stretch (Do right and left twice for 30+ sec each)
25. Back Thigh Stretch (Do right and left twice fôr 30+ sec each)

1. NODS: Turn your head as far as you can to the right and as you hold your head turned, nod your head as if you were saying “yes”. Repeat. Turn your head to the left and repeat.

2. SMALL ARM CIRCLES: Squat down so that your shoulders are in the water. Place your hands on your shoulders and hold them there as you draw circles shoulder height at your sides with your elbows. Repeat first clock-wise and then repeat counter clock-wise.

3. PUSH OFFS: Squat down into the water. Hold your hands together in front of your chest. Push the water away from you by ctraightening both arms to the front. Move both arms through the water backward parallel to the floor with the elbows straight so that they are now pointing behind you. Now move your arms through the water so that they are pointing forward again. Return both hands to your chest and repeat.

4. FORWARD ROWING: Squat down so that your shoulders are in the water. Start with your arms straight behind you parallel to the floor. Move them though the water so that they are pointing straight in front of you. Now move them down to your sides into the water and back to the starting point. Repeat.

5. REVERSE ROWING: Squat down as in FORWARD ROWING. Start with your arms stretched out in front of you. Move them through the water parallel to the floor so that your arms are now pointing behind you. Now, move your arms down toward the floor of the pool along your sides and forward to the starting position. Repeat.

6. BUBBLES: Squat down into the water. Hold your arms out away from your sides but still in the water. Move both arms down to the floor of the pooi and cross them in front of your body. Uncross your arms and raise them just out of the water. Repeat.

7. BARN DOOR: Squat down into the water. Hold your arms out away from your sides with them parallel to the floor of the pool. Move your right arm through the water in front of you and touch the left hand. Return to the starting position. Now, move the left arm through the water so as to touch the right hand. Return to the starting position and repeat. Be sure to move only one arm at a time.

8. HUGS: Reach with the right arm across your upper chest and reach down your back over the left shoulder. Use the left hand to help stretch by pushing at the right elbow. Hold for 30 seconds be sure to breathe and repeat with the other arm. Complete two stretches per arm.

9. ARMS UP: Raise both arms up over your head and stretch toward the ceiling. Be sure to breathe as you hold the stretch for a minimum of 30 seconds. Repeat once more.

10. ARMS DOWN: Clasp your hand behind your back and stretch down and back by straightening your elbows. Bring your shoulder blades together. Hold the stretch for 30 seconds and be sure to breathe. Repeat once more.

11. HAND HOLDING: Raise your right hand up toward the ceiling. Then bend your right elbow and place your right hand behind your neck. With the left arm down by your side, bend your left elbow and move your left hand up your back toward the other hand. Clasp your hands if possible. Hold the stretch for a minimum of 30 seconds and be sure to breathe. Switch hand positions and stretch the other side. Complete two repetitions in each position. If you need assistance you may use a towel or wash rag to grab with your hands and work them closer together for improved stretching.

12. ARMS IN BACK: With your back to the railing or wall of the pool, place your hands either on the railing or top of wall with the palms down. Work your hands as close together until you begin to feel a stretch. Keep your elbows straight as you walk away from the wall or railing and sit down into the water with your legs in front of you. Hold the stretch for a minimum of 30 seconds and be sure to breathe. To come out of the stretch, slide your hands apart along the railing or the wall. Repeat once more.

13. THE 007: Stand up in the water or kneel in the water so that the water is chest high. Clasp your hands in front of you with your arms straight. Holding your hands together, draw a half circle in the water by twisting at the waist first to the right, then to the left. Turn your head in the same direction that your hands are pointing. KEEP YOUR SPINE VERTICAL AND DO NOT BEND FORWARD. Turning to the right and left count as one repetition. Repeat.

14. ELBOW TO KNEE: Stand up in the pool. Place your hands on your shoulders. Raise your left knee up and touch it with the right elbow. Return to the starting position. Raise your right knee up and touch it with the left elbow. Repeat.

15. BALLERINA: Stand up with your feet apart so that the water level is waist high. DO NOT STAND IN THE DEEP END OF THE POOL! Raise your right arm over your head and place the left hand on your left hip. Lean toward the left from the waist. Don’t bend forward – just sideways. Also, be sure to tilt your head to the left. Hold the stretch for a minimum of 30 seconds and breathe. Switch to the other side and repeat. Complete two repetitions for each side.

16. CLIMB THE WALL: Face the railing of the pool and grab it with both hands. Place your feet on the wall in front of you keeping your knees straight. Slowly walk your feet up the wall until you begin to feel a stretch. Hold the stretch for a minimum of 30 seconds and be sure to breathe. Walk your feet back down the wall and repeat once more.

17. SPIDERMAN: Face the railing and grab it with both hands. Put both feet as wide apart as you can flat on the wall in front of you (keep your knees straight at first). While in this position bend the right knee and shift your body to the right. Turn the toes of the right foot so that they point in the same direction as the right knee and the inside arch of the foot is next to the side wall of the pooi. The toes of the left foot should point towards the ceiling. You should feel a stretch on the inside of the left (straight) leg. Hold the stretch for a minimum of 30 seconds while you breathe. Switch over to the left side and stretch. Change your foot position accordingly, so the toes of the left foot are now pointing in the same direction as the left knee and the toes of the right foot point towards the ceiling. Repeat two repetitions for each side.

18. CALF STRETCH: Face the railing with your feet approximately 1.5 feet away from the wall. BE SURE THAT YOUR FEETARE POINTING STRAIGHT AHEAD ANDARE NOTTURNED OUT FROM THE MIDDLE. Your feet should be no more than 12 inches apart. Keep your heels on the ground and your knees straight as you bring your hips forward toward the railing. DO NOT BEND FORWARD ATTHE WAIST. You should feel a stretch in the calf muscles. If you do not, move your feet backward slightly and try again. (Be sure that your feet point straight ahead!) Hold the stretch for a minimum of 30 seconds while you breathe. Repeat once more.

19. FRONT FLUTTER KICK: With your back to the wall or railing of the pool, rest both arms on the rail or top of the wall. Kick your legs as if you were swimming on your back. Repeat.

20. BODY TWIST: With your back to the wall or railing of the pool, rest both arms on the railing or the top of the wall. Raise both knees together just Out of the water. Hold them together as you twist from the waist first to the right and then to the left. Place both feet on the floor of the pool and repeat.

21. ROCKETTE: With your back to the railing and your arms resting on the railing or top of the wall, bring the right foot over to the left hand resting on the railing. Return to the starting position and raise the left foot to the right hand. Repeat.

22. FRONT BACK KICK: Stand with the railing or wall on one side and place your hand on it. Stand on one leg as you kick your other leg forward and back as far as possible, keeping the knee straight. Be sure not to bend forward or backward from the waist. Turn around and repeat on the other side.

23. IN – OUT KICK: Stand with the railing or wall on the right side and place your hand on it. Cross your left leg in front of your ankle and touch the wall of the pool on the right side. Cross the left leg back and raise the left leg sideways to the top of the water. Repeat. Turn around so that the wall ¡s on the left side and repeat with the right leg.

24. FRONT THIGH STRETCH: Stand with the railing or wall on your right side and hold it with the right hand. Grab your left ankle with your left hand. Stretch by pointing your left knee straight down toward the floor and a bit back (don’t lean forward with your body). Hold the stretch for a minimum of 30 seconds while you breathe. Turn around and switch arm positions to stretch the right leg. Complete two stretches on each leg.

25. BACK THIGH STRETCH: Face the wall or railing and raise your right leg to hook the heel over the railing or the edge of the wall. Your knee must be straight as you reach down the raised leg toward your toes. Hold the stretch for a minimum of 30 seconds while you breathe. Switch legs and complete two stretches for each leg.

Return to flexibility exercises

I have struggled with the symptoms of Fibromyalgia for 8+ years. I have tried all sorts of drugs and other treatments and never seemed to get better. During that time I also developed sleep apnea which I attribute to taking Ambien. In March of 2013, I finally hit a wall. The pain, fatigue and cognitive issues were more than I could handle and I stopped working.

During the next 6 months I was going down the path of declaring myself as disabled so I could get benefits to help keep my household going and continue getting care. That’s when I found the Pain Management Program at UNMC.

During and since graduating from the program, I have quit using Lyrica, Cymbalta and Ambien CR. I have also stopped using my CPAP. I am using the techniques that I have learned in the program almost to the point of being militant about them. In a good way! Within 30 days of leaving the program I started working again as a Project Manager, but things are different.

My first priority is me. I have a job where I work 40 hours and no more. No on call. No late nights. I may decide that I don’t want to work this much. Time will tell.  I stretch before I go to work, walk at lunch and take the stairs instead of the elevator. I’m still learning how to do that relaxation thing. I do make sure that I get down time. I watch football when I want. But I’m not very good at letting the mind rest yet. I’ll get it one of these days.

My interests are starting to come back to me. I have picked up the guitar, worked on websites that I have built for recreation, become politically active and am just loving life so much more.

Do I still have pain and other Fibromyalgia symptoms? Yes, but not nearly as bad.

Am I improving? Yes.

Am I taking drugs? No.

What are my favorite take-aways from PMP?

* I don’t listen to “Shoulds”.

* I love to walk. (it’s the endocannabinoids!)

* My whole life is at a new “pace”!

* I’m going to buy an RV before I retire!

* My friendship with Skipper!

I blogged my experience at PMP at https://www.the-jacobsens.com/articles/  feel free to check it out!