Lower Limb Exercise and Education

This leaflet can also be used for you to self-manage your condition independently if you are unable to attend the class.

Why do I need yo come to this class?

To enable you to increase your fitness and activity levels to help you achieve your goals. It aims to increase your confidence to independently exercise, giving you the correct advice and guidance to allow long term self-management and improve your quality of life.

How long will it last?

The class will last 1 hour and will run over a 6-week period. This will take place in a gym environment and you will be expected to wear clothes appropriate for exercise (e.g. training shoes, tracksuit bottoms, not overly loose fitting clothing). There will be facilities provided for water breaks during exercise, but you may wish to bring your own bottle of water.

What does the ‘Lower Limb’ class involve?

During the class all exercises are adapted to your individual needs and you will be expected to take part in physical exercise. Some of the exercises may include:

While waiting to attend the ‘Lower Limb’ class, please continue to follow the advice and exercises provided to you by your physiotherapist / clinician.

Why Participate in Exercise?

Research shows improved sleep helps pain management.

The following steps will help to improve sleep:

Reduce caffeine intake (Tea, Coffee, Cola, Chocolate)

• Caffeine reduces melatonin, which is a hormone released by your body to help you get to sleep.
• Reduce daily caffeine intake: No caffeine after 12 noon.

Reduce alcohol

While it may help you get off to sleep, it reduces quality of sleep.

Have a Sleep Routine – use an alarm clock if needed.

Going to sleep and waking at a set time allows your internal body clock to set a routine. You will find getting to sleep a lot easier.

Reduce light exposure 1 hour before bed

Light tricks your brain into thinking it is morning. This reduces the hormone melatonin which is key to getting to sleep.

• Dim lights leading up to going to bed.
• Don’t look at TV, computers and smart phones.

Optimal bedroom conditions

• A cool room helps sleep as it simulates night-time conditions.
• Block out any light with blackout blinds or a face-mask.

Cannot switch off / Overthinking / Watching Clock?

• Busy mind and a restless body.
• Turn the clock around, or put it somewhere you cannot see it.
• Try ear plugs to drown out the noise.

Food

• Don’t go to bed on a full stomach
• Try eating 2 kiwi fruits an hour before bed. This increases melatonin hormone which helps you get to sleep.

What if I can get to sleep but wake and can’t settle?

Get out of bed and sit downstairs with a dim light and read. Try relaxation and once you begin to feel tired go back to bed.

Suggested exercises

(ONLY to be completed if discussed with physiotherapist)

Some exercises have a progression, so please check with your clinician for your start point and then work through them as able.

1) Glute Bridge: 5 – 10 sec hold. 8 – 12 repetitions, 2 – 3 times per day

Lie on your back with your knees bent. Contract your buttocks to lift your hips off the ground until your trunk is aligned with your legs. 5 – 10 second hold. Slowly return to the initial position and repeat.

Progression 1: This time, stagger your foot stance and do 10 repetitions on each side:

Progression 2: This time, have one foot raised as demonstrated below.

2) Sit to stand / squat 8 – 12 repetitions. 3-4 sets. 3 – 5 days per week

Sit on a chair that has been placed against a wall to prevent it from moving. Fold your arms across your chest. With your feet slightly apart, lean forward, so your shoulders are over your feet and stand up fully. Slowly return to sitting.

Progression 1: This time without the chair:

Progression 2: With resistance band:

3) Forward lunge: 8 – 12 repetitions, 3 – 4 sets per day. 3 – 5 days per week.

Stand with both feet hip width apart. Lunge forward, making sure you land with the heel and your knee stays over the foot, with your knee cap in line with the 2nd toe.

Move straight down, creating a 90^o angle at both knees and at the hip.

Push through the heel and return to the standing position. Repeat with the other leg if indicated.

4) Double leg heel raise – to progress to single leg. 8 – 12 repetitions. 3 – 4 sets. 3 – 5 days per week.

Stand upright and raise on the tip of your toes. Lower yourself and repeat.

Progression 1:

Progression 2:

5) Balance

Stand on a mattress with your feet comfortably apart. Lift one foot and balance yourself on the other leg.

Aim to hold for 1 – 2 minutes.

Get back on two feet and repeat.

6) Step down: 8 – 12 repetitions. 3 – 4 sets. 3 – 5 days per week.

Stand up straight on a step supported on one leg.

Align your knee cap with your second toe and lower slowly your unsupported leg on the ground while maintaining this alignment on the supporting leg.

Lightly touch the ground with your heel and lift the leg up to the starting position.

Prevent your support knee from turning inward by squeezing your buttocks together.

All pictures supplied by Physiotec. Accessible at: https://physiotec.ca/ca/en/

Where will the ‘Lower Limb’ Class take place?

1.         University Hospital of Hartlepool

2.         Stockton -Tatchell Centre, North Tees University Hospital, TS19PE

You will have discussed with your physiotherapist which class you opted to attend and you will have been placed on a waiting list. The physiotherapist taking the class will either send you a letter or you will receive a telephone call when there is an available slot to attend.

Contact numbers

If you are unable to attend the class or have any queries prior to attending, please contact the Physiotherapy Administration Team on 01429 522471.

Other Useful links:

Website to help you understand pain: Retrain Pain Foundation (2018): http://www.retrainpain.org/

Video link which explains pain in 5 minutes: https://www.youtube.com/watch?v=5KrUL8tOaQs&t=8s

Website link to help sleep: Seven steps to help sleep:

https://sleepcouncil.org.uk/seven-steps-to-a-better-nights-sleep/

Further exercise advice: NHS website – Strength and Flex exercise plan:

https://www.nhs.uk/live-well/exercise/strength-and-flex-exercise-plan/

https://www.nhs.uk/conditions/nhs-fitness-studio/

References

Nødtvedt, Ø.O., Hansen, A.L., Bjorvatn, B. and Pallesen, S., (2017) The effects of kiwi fruit consumption in students with chronic insomnia symptoms: a randomized controlled trial. Sleep and Biological Rhythms, 15(2), pp.159-166.

UK Chief Medical Officers Guidelines (2011) Start Active, Stay Active: A report on physical activity for health from the four home countries’ Chief Medical Office. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf. (Accessed on: 1st October 2018)

The Sleep Council Organisation (2017) Seven Steps to get a better night’s sleep. Available at: https://sleepcouncil.org.uk/seven-steps-to-a-better-nights-sleep/ (Accessed on: 1st October 2018)

All pictures supplied by Physiotec. Accessible at: https://physiotec.ca/ca/en/

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]