Purpose & Benefits

Purpose: Strengthen obliques and improve rotational mobility; support daily twisting tasks such as reaching behind or turning in wheelchair.
Why it matters: Enhances core stability and spinal rotation, reducing risk of back strain and improving posture.
Place in session: Core/trunk day. Balance with forward/back movements.

Exercise Details

Target muscles: Obliques, transverse abdominis, erector spinae.
Equipment: Sturdy wheelchair with back support; non-slip surface (optional resistance band or medicine ball for progression).

Duration / Intensity (RPE)

Level	Sets × Reps (each side)	RPE
Beginner	2×8–10	5–6
Intermediate	3×10–12	6–7
Advanced	4×12–15	7–8

Tempo: 2–1–2 (twist — 1 s pause — 2 s return) • Rest: 60–90 s

Pre-Session Checklist (✓)

Wheelchair safety: Brakes locked, anti-tippers engaged, footrests positioned.
Trunk status: If limited control or pain, shorten ROM.
Skin/seating pressure: Cushion comfortable; no sliding.
Breathing/BP: Exhale on twist; avoid Valsalva.

Step-by-Step Execution

Sit tall in wheelchair, hands across chest or holding shoulders.
Posture: Hips back, core engaged; feet stable on footrests.
Inhale; keep pelvis neutral.
Exhale and twist upper body to one side, leading with shoulders.
Pause 1 s, then return slowly for 2 s.
Alternate sides; rest 60–90 s between sets.

Quick cues: “Twist from core • Shoulders lead • Pelvis still • Slow return.”

Scaling Tree

Regressions (make easier): Shorter twist / hands on lap. Lumbar roll for support.
Base prescription: Beginner: 2×8–10 @ RPE 5–6 • Intermediate: 3×10–12 @ RPE 6–7 • Advanced: 4×12–15 @ RPE 7–8.
Progressions (make harder): Add 1-second pause, hold medicine ball, or use resistance band anchored behind.

Success Criteria

Full controlled twist without pelvis shift; tempo maintained; RPE reached. Pain ≤ 3/10.

Common Faults & Fixes

Common Fault	Fix
Twists hips	“Anchor pelvis; core tight.”
Jerks motion	“Smooth twist; control it.”
Slumps forward	“Chest up; tall posture.”
Holds breath	“Exhale on effort.”

Safety / Stop

Sharp back pain, dizziness → STOP IMMEDIATELY. Shorten ROM if needed. Maintain rhythmic breathing.

4-Week Progression

Week	Prescription
W1	2×8–10 each @ RPE 5–6, tempo 2–1–2
W2	3×10–12 each @ RPE 6–7
W3	Same + pause or ball
W4	4×12–15 each or resistance

Applicability

Use when condition is stable and pain ≤ 3/10.
Suitable for: Wheelchair users (SCI, spina bifida, lower-limb amputation, etc.), hemiparesis, balance impairments, MS, obesity.
Note: Defer if acute back issues or uncontrolled BP.

Disability-Specific Modifications

Wheelchair users (SCI): Short ROM if trunk weak; add lumbar support.
Hemiparesis: Twist toward stronger side first; assist with hand.
Balance impairment: Helper for stability.
MS: Short sets, longer rest; scale to energy levels.
Obesity: Emphasize posture; use arms for support if needed.

Paired Exercise & Tracking

• Pair with side bends (1:1).
• Log sides, sets, RPE.

Resource Library

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