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Phase 1 – Diabetes Protocols

Start with the first exercise in each movement category, which are denoted by the red headings. Perform one exercise until you are satisfied with the form of the patient and feel they have begun to master the movement as part of muscle memory. With some movements this will only be a matter of minutes, while others may take longer. Use your judgment. To move on, you can either complete all movements in one category or move to the first movement in the next category (red header).

To maximize aerobic benefit, transition from one exercise to another as quickly as possible. The combination of developing movement skills and aerobic exercise is the most effective way to promote neuroplasticity – providing you with maximum benefit!


Balance & Stability

Athletic Position

The position of the body in a flexed (bent) hip and knee position. The foot position is based on the athlete’s natural landing position. The head is set in a neutral/natural spine position (looking through the eyebrows). The shoulders are retracted back and the chest is expanded (proud position). The shoulders will be slightly over the toes. The arms are flexed at the elbow, and the hands are at the hip. The palms are neutral (facing hip) with the thumbs up. The lower back is isometrically contracted as is the abdominal region. The majority of the athlete’s weight is distributed on the mid-foot to the heels. Level 2.
This is the starting position of all athletic events. This position is also lost with time or lack of use. The foot position can be described as “jump width” apart. This may be slightly different for different body types. The athlete should also feel this as a comfortable position, if they are working to assume the position, then technique is poor.
Balance & Stability. An athletic stance is a standing position which allows you to maximize your strength, power, and speed, while decreasing risk of injury.

Shoulder Shrug

From Athletic Position, move your shoulders upwards toward your ears, then back to normal position. 3 sets of 10 reps. Level 2.
Balance & Stability. The movement activates the upper Trapezius muscle, which is a component of all explosive movements. It also makes sure baseline cervical stability is activated before an event.
This can be done with or without dumbbells. Height of shoulders to horizontal is adequate. Do not let younger students use dumbbells (below 12).

Bent Arm Swing (Seated)

Sit on a bench or the floor, with back straight. Bend the arms at a 90° angle and alternately swing your left and right arms in front of you. The thumb should be at eye level while the rear upper arm should be as high as the shoulder. Level 1.
Balance & Stability. Teaches the maintaining of a linear plane with arm swing. Important in developing proper run technique.
Make sure the arm swing is on a linear plane – not outside the plane or across the body. The hands and fingers should be straight and on plane. The bent elbows help promote relaxation during the athletic event, and promotes speed with movement.

Bend (F/B/L/R)

From athletic position, bend body forward, backward and to each side. 3 sets of 10 reps. Level 1.
Balance & Stability: The movement activates the lumbar spine in all planes and is a good precursor to activity.
Keep evenly balanced on both feet.

Balance – One Leg

Stand with both feet on the ground, then raise one foot and remain in balance for 5 seconds. Perform bilaterally. 2 sets of 6 reps. Level 1.
Balance & Stability. Being able to stand comfortably on one leg is an important piece of the puzzle to staying injury free. While there is a difference between static single leg stability (just standing on one leg) to dynamic single leg stability (i.e. running), static stance is a good starting point. If you can’t control yourself while balancing on one foot, it is going to be difficult to dynamically perform a single leg squat jump over the course of a few miles while you are running.
Raised leg should be in sagittal plane with hip and 45 degrees and knee at 90 degrees. Look for minimal movement during the activity. Large movements or hopping should end the activity.

Dynamic Movement

March – High Knees/Arm Swing

March with high knees and alternating arms held in a 90° bend. Level 2.
Dynamic Movement: This is an important pre-gait and pre-run activity. It is important in establishing the linear plane for both arms and legs.
Be sure the arms remain at a 90° bend and that both the arms and legs stay in the linear plane. Correct any lateral movement.

Inch Worms

Stand with feet shoulder width. Bend over, placing palms on the floor. Step forward with the hands until you reach pushup position, then step back with the hands until you get back to the starting position. 3 sets of 6. Level 3.
Dynamic Movement: Develops core strength. Great for hamstring flexibility.
Be sure to keep the legs straight. Can also step forward with the feet when returning to starting position.

Object Control – Volleyball/Soccer

Ball – Toss & Catch – Underhand – Self

With a lightweight ball or a balloon, hold ball in palm of hand with hand by waist, toss up underhanded. Catch the ball with both hands at the waist in front of the body. 3 sets of 6 tosses. Level 1.
Object Control: This activity develops hand-eye coordination, gross and fine motor control, and the ability to track moving objects in the air.
Have the students try to remain in the same spot. They will certainly drop the ball, so encourage them to keep trying.

Ball – Underhand Bump & Catch – Self

Holding a lightweight ball or balloon in one hand, drop the ball and bump it straight up with the other hand. Catch the ball with both hands at the waist in front of the body. 3 sets of 6 tosses. Level 1.
Object Control: This activity develops hand-eye coordination, gross and fine motor control, and the ability to track moving objects in the air.
Be sure the ball is bumped straight into the air so the students can catch it. Explain that the arms must be parallel to the ground in order for the ball to go straight up and not forward.

Plyometrics

Vertical Jump

From Athletic Position, bend the knees and swing the arms backwards. Jump upwards, creating as much force with the legs as possible, swinging the arms in the air and reaching overhead. Level 3.
Plyometrics: The act of raising one’s center of gravity higher in the vertical plane solely with the use of one’s own muscles. It is a measure of how high one can elevate off the ground (jump) from a standstill.
An important component of maximizing height in a vertical jump is attributed to the use of counter-movements of the legs and arm swings prior to take off, as both of these actions have been shown to significantly increase the body’s center of mass rise. The counter-movement of the legs, a quick bend of the knees which lowers the center of mass prior to springing upwards, has been shown to improve jump height by 12% compared to jumping without the counter-movement. Furthermore, jump height can be increased another 10% by executing arm swings during the take off phase of the jump compared to if no arm swings are utilized.

Eccentric Landing Technique

From Athletic Position, jump forward with both feet, landing in a squat position. Level 3.
Plyometrics: The development of the landing technique reduces chances of injury and teaches how to soften the impact of deceleration.
Landing in a solid position is the best way to decrease the chance of injury upon landing. It teaches the eccentric control of the activity. Most injuries occur during the eccentric, or deceleration position.

Linear Speed & Agility

Stationary One Step Lateral

From Athletic Position, take one step to the side, then return that foot to starting position. 3 sets of 6 reps. Perform bilaterally. Level 3.
Speed & Agility – Linear Movement: Lateral movements are motions in which you move from side to side while facing forward. Exercises that step sideways are done in the frontal plane of movement and require your limbs to abduct, or move away from your midline; and adduct, or move in toward your midline. Side-stepping exercises help you develop spatial awareness, balance, strength and flexibility.
Maintain athletic position and be sure the feet remain pointed forward.

Stationary One Step Hip Turn

The hip turn is a quarter turn that occurs with the feet in the air. The player hops off of the lead leg, rotates in the air, and lands on two feet. Level 3.
Speed & Agility – Linear Movement: This develops change of direction speed without creating twisting motion on the knee.
Be sure the player hops into the air and maintains the athletic position upon landing.

Lateral Speed & Agility

Shuffle Technique

From Athletic Position, take a lateral step to the right, then bring the left leg laterally to athletic position. Do not cross the trailing leg in front of the lead leg. Do this slowly for 10 steps in each direction. Level 3.
Speed & Agility – Lateral Movement: Works muscles in the lower body. When done with proper form, the lateral shuffle can improve your flexibility and help strengthen your hip flexors. If you stay in a deep squat throughout the exercise, you can also strengthen the major muscles in your hips and legs.
Keep your back straight, chest up and your eyes looking straight ahead throughout the exercise. Quicken your steps as you get used to the movement.

Lateral Shuffle

Start in good athletic position, with toes forward. In rapid fashion, without crossing your feet, step your legs together and apart moving in one direction. Perform bilaterally. Level 3.
Speed & Agility – Lateral Movement: Lateral shuffles primarily work the muscles in your butt, hips and thighs. This includes the transverse abdominus — the deepest layer of theabdominal muscles — the glutes, hip abductors, quadriceps, hamstrings, hip adductors, calf and shin muscles. The secondary muscles worked are the erector spinae, which are the muscles in your lower back running alongside your spine, and the obliques.
To help with balance, bend and hold your arms in front of your body. Keep your back straight, chest up and your eyes looking straight ahead throughout the exercise. Quicken your steps as you get used to the movement.

Strength – Endurance – Power

Stability Ball

Step onto the stability ball, get your balance, and assume the athletic position. Hold for 20 seconds without falling off. Do this 3 times. Level 3.
Strength – Endurance – Power: Standing on a stability ball is a great core exercise and works the entire core and the legs, including the abdominal, oblique, lower back, inner thigh, hamstring, qu3driceps, and calf muscles.
Be sure to maintain balance and to evenly distribute weight.

Med Ball Throws

Two actions: 1) Med Ball Throw: With Med Ball on ground, squat to pick up ball, thrust upward throwing the ball back over your head. 2) Med Ball Chest Throw: With Med Ball at chest height, throw the ball with a two hand chest pass. Level 2.
Strength – Endurance – Power: These develop core strength and power.
Be sure to keep the back straight and to maintain athletic position. On the chest pass, step into the throw with the lead foot.

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