A recent participant of my comprehensive Treatment and Assessment Strategies for Balance Enhancement and Fall Prevention asked the purpose of the Million Dollar Exercise that I teach.
Here was my response.
The reason that I refer to that exercise as a Million Dollar exercise is because it targets so many areas in one activity and it can be broken down into parts to accommodate various levels of patients. Also it can be used as an evaluation and treatment tool
When you have your arms are in contact with your torso, with elbows bent at a 90 degree angle, pushing into the wall and up to the ceiling will elicit a abdominal core contraction. Alignment is important in the rib cage and pelvis for this to happen, so if it doesn't it tells you that you need to address those areas. For treatment you can apply further stabilization challenge to the pelvis, abs, Lower extremities or torso.
While in the before mentioned position, when you take a step forward with one foot and peel the heel off of the floor with the back foot, the patient is able to practice weight acceptance of the front foot and push off with the back foot. Maintaining the hand contact with the wall and allowing the elbows to bend as you weight accept and push off elicits challenge through the system into the weight bearing legs and feet while providing the patient with security by having hand contact into the wall. At this point you can evaluate, dorsiflexion on the weight acceptance foot, hallux extension to 90 degrees on the push off foot and calcaneal position on the push off foot. Treatment can include the stabilization mentioned before or functional mobilizations to the foot, ankle, pelvis.
With the hand contact the same as the previous step we add a lifting the push off foot up toward our chest and a coming up into the tip toe of the previous steps weight acceptance leg. This increases the challenge of balance in the weight bearing leg, accentuates pelvic depression on the weight bearing leg and, pelvic elevation on the lifted lower extremity that is off of the floor. In this position it is very easy to note compensations through the torso that may be revealed, similar to what we would see in the pelvic dropping test off of the book and leg swing test. You can evaluate the ability of the pelvis to elevate and depress as well as pelvic extension on the push off leg and pelvic flexion of the lifted leg that should be independent of spine. Compensations that you may see are side bend, rotation, trunk flexion or extension. Treatment would include all of the above plus stability challenge to pelvic depression or elevation, and/or weight bearing lower extremity.
Another exercise that I like to do and demonstrated in class is attached to this email. It is similar to the million dollar exercise except you will not get as much of the abdominal core contraction because your hand contact is at your side and not in front. I usually perform it using a step stool or on a stair case.
