Chapter Eight

Exercises to Correct Movement Impairment Syndromes

Forward Bending: Hip Flexion With Flat Lumbar Spine (Figures A-F)

Purposes:

• To decrease low back flexibility

• To increase hip joint flexibility

• To improve ability to move in hips without excessive bending of the lumbar spine

• To improve the performance of the gluteal muscles

Starting position: Stand with feet spaced comfortably apart.

Level 1: With hand support (see Figures A-D)

Method:

 Perform variation if box is checkedd

Down

Place your hands on a table

Try to put the weight of your upper body on your hands

Bend in the hip joints; “think about sticking your seat out”

Do not bend your back

Do not arch your back (see incorrect posture in Figure D)

 Bend in the knee joints

Let your elbows bend

Bend as far as possible or STOP if pain is experienced

Return

Tighten your buttocks muscles

Move in your hips throughout the return to an erect position

Avoid swaying pelvis forward

Repetitions: ______

Level 2: Without hand support (see Figures E-F)

Reach toward the floor with your hands as you bend forward in the hip joints

Continue as instructed in “Level 1: With hand support”

Repetitions: ______

Forward Bending With Spinal and Hip Flexion (Figures A-B)

Purposes:

• To increase thoracic or lumbar flexibility

• To improve the performance of the gluteal muscles

Starting position: Stand with feet spaced comfortably apart.

Method:

 Perform variation if box is checked

 Let your upper and lower back bend as you bend forward

 Try to bend in just your low back as you bend forward

 Contract your abdominal muscles as you bend forward

Return by contracting the gluteal muscles

Move in the hip joints and move throughout the return to the erect position

Repetitions: ______

Lateral Spinal Flexion—Side-Bending Position (Figures A-C)

Purposes:

• To increase the flexibility of the paraspinal muscles

• To increase the flexibility of the abdominal muscles

• To decrease the excessive flexibility of some spinal segments

Starting position: Stand with both feet spaced comfortably apart. Raise arms overhead and clasp hands together.

Method:

 Perform variation if box is checked

Stand with your back against a wall to avoid rotating

Place your hands on the top of your head (see Figure A)

Lean to the side (see Figure B)

Think about TILTING your shoulders rather than moving from your waist; STOP if pain is experienced

Return to an erect standing position

 Take a deep breath and lift your chest

 Place your hand on your side at waist level and continue as before

Repetitions: ______

Single-Leg Stance: Unilateral Hip and Knee Flexion (Figures A-D)

Purposes:

• To improve the performance of the gluteal hip muscles

• To improve the isometric control by the abdominal muscles

• To prevent compensatory movements of the hip, pelvis, and spine

• To prevent the thigh from turning inward

Starting position: Stand with both feet relatively close together to keep from shifting to the side of the stance leg.

Method:

 Perform variation if box is checked

Shift your weight to stance leg

Tighten your buttock muscle on the side of your stance leg

Lift your alternate thigh in front of your body while bending your knee

 Contract your abdominal muscles

 Keep your pelvis level

 Place your hands on your pelvis to monitor your movement

 Do not let your opposite hip drop (see Figure B)

 Do not let your knee turn inward (see Figure C)

 Do not let your shoulders lean to the side (see Figure D); keep your trunk still

 Do not let your ankle pronate (i.e., arch collapsed or turned in)

Repetitions: ______

Hip and Knee Extension With Contralateral Hip and Knee Maximally Flexed (Figures A-C)

Purposes:

• To stretch the hip flexor muscles

• To improve the control of the pelvis by the abdominal muscles

Starting position: Bend hips and knees; feet are on the floor.

Method:

 Perform variation if box is checked

Place fingers on abdominal muscles (i.e., on outside of abdomen between pelvis and ribs)

Contract your abdominal muscles by pulling your “navel toward your spine”

Lift one knee toward your chest

Use your hand to hold your knee to your chest

If necessary, reinforce abdominal contraction

Slide your other leg down, STOP if pain is experienced in your back

 Slide your leg down, while contracting your abdominal muscles

STOP if pelvis tilts; return to the starting position

 Place your hand on your pelvis; and prevent forward tilting movement of your pelvis

 Slide your leg out to side; with repetitions, bring your leg in toward your other leg

Return by sliding your leg back to the starting position while contracting your abdominal muscles

Repetitions: ______ Repeat with your alternate leg

Hip and Knee Extension From Hip and Knee Flexion (Figures A-C)

Purposes:

• To improve the control of pelvic tilt by the abdominal muscles

• To stretch the hip flexors

Starting position: Bend hips and knees; feet are on the floor.

Method:

 Perform variation if box is checked

Place your fingers on your abdominal muscles (i.e., outside of abdomen between your pelvis and ribs)

Contract your abdominal muscles by “pulling your navel toward your spine”

Slide one leg down while keeping your pelvis from moving

If you experience no pain, slide your alternate leg down

Return by sliding one leg back at a time; make certain to contract your abdominal muscles

 Place a pillow under your upper back and head

Repetitions: ______

Hip and Knee Flexion From Passive and Active Hip and Knee Extension (Figures A-C)

Purposes:

• To increase hip flexion flexibility

• To stretch the hip extensors (gluteus maximus and piriformis)

• To improve the isometric control of the pelvis by the abdominal muscles

• To move the lower extremities without pain

Starting position: Passive: Lie on your back with one leg straight and the other hip and knee bent. Active: Lie on your back with both legs straight.

Method:

 Perform variation if box is checked

Passive (see Figures A-B)

 Use ____ hand(s) or ____ towel(s) under thigh to pull knee to chest

 Be sure to relax the hip muscles as you pull your knee to your chest

STOP if you experience pain in your groin or back

 Place a towel with a few folds under your low back

 Lower your leg so that your foot is on the table and your hip and knee are still bent

 Repeat with the same leg ______ times

 Perform with your alternate leg as above ______ times

 Place a pillow under your upper back and head

Active (see Figures C-E)

 Contract your abdominal muscles by pulling “your navel toward your spine”

 Slide your foot along a table to bend your hip and knee and place your foot on table

 Use your hip muscles to bring your knee to your chest

 Use your hands to pull your knee to your chest when your thigh is vertical or your hip is at 90 degrees

 Do not push down with your alternate leg

 Lower leg and return to starting position

 Return your leg to the starting position

 Place pillow under upper back and head

Repetitions: ______

Alternate legs: ______

Hip and Knee Flexion With Sliding Heel From Hip and Knee Extension (Figures A-B)

Purposes:

• To improve the performance of the abdominal muscles in controlling pelvic motion

• To stretch the hip flexor muscles

Starting position: Lie on the back with legs straight.

Method:

 Perform variation if box is checked

Place your hands on your abdominal muscles (i.e., outside of your abdomen between pelvis and ribs)

Contract your abdominal muscles by “pulling your navel to your spine”

Slide one foot along the table until your hip and knee are bent and your foot is resting on the table

Relax

Contract your abdominal muscles

Slide your foot down, returning it to the rest position

Repeat the movement with your alternate leg

 Place a pillow under your upper back and head

Repetitions: ______

Lower Abdominal Progression—Unilateral Hip Flexion (Figures A-B)

Purposes:

To improve the performance of abdominal muscles (external obliques, rectus abdominis, transversus)

To learn to prevent lumbar spine motions associated with leg motion

Starting position: Bend your hips and knees with your feet on floor. Place your fingers on your abdominal muscles (i.e., outside of abdomen between pelvis and ribs).

Level 0.3: Lift one foot with alternate foot on floor

Method:

 Perform variation if box is checked

Contract your abdominal muscles by “pulling your navel toward your spine”

Lift one foot off the table

Maintain your abdominal contraction and lower your foot back to the table

 If pain is experienced, push down into table with one foot, while lifting the alternate foot off the table

 Use a pillow under upper back and head

Repeat the movement with your alternate foot

Repetitions: ______

Lower Abdominal Progression—Hip and Knee Held to Chest During Hip Flexion (Figures A-B)

Purposes:

• To improve the isometric performance of the abdominal muscles (e.g., external obliques, rectus abdominis, transversus)

• To move the lower extremity without movement of the spine or pelvis

Starting position: Bend hips and knees with feet on floor.

 Perform variation if box is checked

Level 0.4: Hold knee to chest and lift the alternate foot

Method:

Contract your abdominal muscles by “pulling your navel toward your spine”

Lift one knee toward your chest

Hold your knee toward your chest with your hand

If able to hold your knee with one hand, place your alternate hand on the abdominal muscle (i.e., outside of abdomen between your pelvis and ribs)

Make certain your abdominal muscles are contracted

Lift your alternate foot off the table

Lower your foot to the table while maintaining a contraction of your abdominal muscles

Repeat ______ times

Repeat this movement with your alternate leg

Repetitions: ______

 Perform variation if box is checked

Level 0.5: Lightly hold one knee toward chest and lift the alternate foot

 Start if no pain is experienced when performing previous level 10 times

 Do not hold your knee toward your chest as tightly as previously while lifting your leg off table

 Let your knee move away from your chest and hold it lightly with your hand while lifting your leg off the table

Repetitions: ______

Lower Abdominal Progression—Hip and Knee Flexion With Alternate Foot Unsupported (Figures A-E)

Purposes:

• To improve the performance of the abdominal muscles (e.g., external obliques, rectus abdominis, and transversus)

• To move the lower limb without moving the pelvis or spine

Starting position: Bend hips and knees with feet on floor. Place fingers on abdominal muscles (i.e., outside of abdomen between pelvis and ribs).

Level 1A: Hip flexed to greater than 90 degrees and the alternate foot lifted (Figures A-C)

Method:

Contract abdominal muscles by “pulling navel toward spine”

Lift one foot off the floor and bring your knee toward your chest to more than 90 degrees

If necessary, contract your abdominal muscles again

Lift the alternate foot off the floor

Do not let your back move

Lower your last leg lifted while maintaining the abdominal contraction

Lower your alternate leg back to the starting position

Repeat starting with your alternate leg

Level 1B: Hip flexed to 90 degrees and lift the alternate foot (Figures D-E)

Method:

Contract abdominal muscles by “pulling navel toward spine”

Lift one foot off the floor and stop when your hip is bent 90 degrees and your thigh is pointing toward ceiling

If necessary, again contract your abdominal muscles

Lift the alternate foot off the table

Do not let your back move

Lower your last leg lifted so it returns to starting position

Lower your alternate leg to the starting position

Repetitions: ______

Lower Abdominal Progression—Hip and Knee Extension (Figures A-D)

Purposes:

• To improve the isometric performance of the abdominal muscles (e.g., external obliques, rectus abdominis, transversus)

• To move your leg without movement of your spine or pelvis

Starting position: Bend hips and knees with feet on floor. Place fingers on your abdominal muscles (i.e., outside abdomen between pelvis and ribs).

Level 2: One hip flexed to 90 degrees, the alternate foot lifted and slid to extend the hip and knee (see Figures A-B)

Method:

 Perform variation if box is checked

Contract abdominal muscles by “pulling your navel toward your spine”

Lift one leg up until your hip is bent to 90 degrees and your thigh is pointing toward ceiling

If necessary, reinforce the contraction of your abdominal muscles

Do not let your abdomen distend

Do not push your head back into supporting surface

Breathe

Lift your alternate foot off the table

Slide your foot down the table, while lightly touching the table

Straighten your leg completely

 Relax

Reinforce your abdominal contraction

Slide your foot back to the starting position

 Repeat with the same leg

 Lower your nonmoving leg to table, so both feet are on table

 Repeat starting with your opposite leg

Level 3: One hip flexed to 90 degrees, foot lifted and then extend without the leg touching the supporting surface (see Figures C-D)

Method:

Perform the same movements as outlined in Level 2 except the following:

Hold your foot off table while straightening your leg out

Set your leg down on table

Bring your leg back to starting position by holding your foot off the table

Make certain to contract your abdominal muscles

Do not let your back move

Repeat with the opposite leg

Repetitions: ______

Lower Abdominal Progression: Bilateral Hip and Knee Flexion (Figures A-B)

Purpose:

• To improve the performance of the abdominal muscles (e.g., external obliques, rectus abdominis, transversus)

Starting position: Lie down with both hips and knees straight.

Level 4: Slide both feet along the supporting surface into extension and return to flexion

Method:

Contract your abdominal muscles by “pulling your abdomen toward your spine”

Bend your hips and knees and slide your heels along the table

Lift both feet off table when your hips are bent to 90 degrees

Reverse the movement to return to the starting position

Repetitions: ______

Level 5: Lift both feet off the supporting surface; with hips flexed to 90 degrees, extend the knees and lower both lower extremities to the supporting surface

Method:

Contract your abdominal muscles by “pulling your abdomen toward your spine”

Bend your hips and knees by lifting both your feet off the table and bringing your knees to your chest

Hold your hips at 90 degrees and straighten your knees

Lower your legs to the table, returning to starting position

Repetitions: ______

Upper Abdominal Progression: Trunk Curl–Sit Up (Figures A-D)

Purpose:

• To improve the performance of the upper abdominal muscles (e.g., internal obliques, rectus abdominis)

Starting position: Bend hips and knees with a pillow under your knees and with your arms in front of body (see Figure A). Straighten hips and knees, and position arms in front of body (see Figure B).

Level 1A: Trunk curl: spinal flexion (easiest)

Method:

 Perform variation if box is checked

Bring your chin toward your the base of your neck

Curl your trunk as far as possible

Stop just before your hips start to bend or your feet lift off table

Level 1B: Trunk curl–sit up: spinal and hip flexion (least difficult)

Method:

 Perform variation if box is checked

Bring chin toward your the base of your neck

Curl your trunk as far as possible

Maintain the curl

Continue until sitting up

Level 2: Trunk curl–sit up: spinal and hip flexion (difficult)

Method:

 Perform variation if box is checked

Fold your arms on your chest (see Figure C)

Bring your chin toward your your the base of your neck

Curl your trunk as far as possible

Maintain the curl

Continue until sitting up

Level 3: Trunk curl-sit up: spinal and hip flexion (most difficult)

Method:

 Perform variation if box is checked

Place hands on top of head (not behind head) (see Figure D)

Bring chin toward your the base of your neck

Curl trunk as far as possible

Maintain the curl

Continue until sitting up

Repetitions: ______

Hip Abduction—Lateral Rotation From Flexion Position: Bent Knee Fallouts (Figures A-D)

Purposes:

• To improve the isometric performance of the abdominal muscles in preventing pelvic rotation

• To move the leg without moving the pelvis

• To stretch the hip adductor muscles (e.g., inner thigh muscles)

Starting position: Place hands on pelvis. Bend one knee with foot on the floor. Straighten alternate leg. Place a pillow along side the leg that is bent.

Level 1

Method:

 Perform variation if box is checked

Contract your abdominal muscles by pulling “your navel toward your spine”

Let your knee move toward, outside, and away from your body (see Figures B-C)

Keep your pelvis still

Bring your knee back to the starting position

 Bring your knee toward the inside of your body toward your opposite leg (see Figure D)

Return to the starting position

Repeat the movement ______ times

Perform with alternate leg

 Place pillow under the knee of the leg that is straight

 Place a pillow along side the leg that is bent at the level of the knee

Repetitions: ______

Hip Abduction—Lateral Rotation From Flexion Position: Knee Extended (Figures A-D)

Purposes:

• To improve the isometric performance of the abdominal muscles, controlling rotation of the pelvis

• To move leg without movement of pelvis or spine

Starting position: Place your hands on your pelvis. Straighten one leg. Bend one hip and knee with your foot on floor.

Level 2 (Difficult)

Method:

 Perform variation if box is checked

Contract your abdominal muscles by “pulling your navel toward your spine”

Let your knee move away from your body (see Figure B)

From that position, straighten your knee (see Figure C)

Try not to push down with your nonmoving leg

 Bend your knee

 Return to the starting position

 Repeat straightening and bending your knee while maintaining this position of your leg ______ times

 Return to the starting position

 Repeat as above

 Straighten your knee, keep your knee straight, and bring your leg toward opposite shoulder by moving at hip (see Figure D)

Repeat the movement with your alternate leg

Straight-Leg Raises: Hip Flexion With Knee Extended (Figures A-D)

Purposes:

• To improve the performance of the abdominal muscles

• To improve the performance of the hip flexor muscles

• To stretch the hamstring muscles

Starting position: Straighten hips and knees. Place fingers on abdominal muscles (i.e., outside of abdomen between pelvis and ribs).

Method:

 Perform variation if box is checked

Contract your abdominal muscles by “pulling your navel toward your spine”

Keep your knee straight

Raise your leg straight up while keeping your knee straight

Do not push down with your nonmoving extremity

Lower your leg back to the starting position while keeping your abdominal muscles contracted

OR

 Bend your hip and knee, bringing your knee toward your chest (see Figure C)

 Straighten your knee while keeping your hip at 90 degrees (i.e., thigh pointing toward ceiling) (see Figure D)

 Hold your thigh with your hand, while straightening your knee

 Keep your knee straight and lower your leg back to the starting position

Repeat the movement with your alternate leg

Repetitions: ______

Two-Joint Hip Flexor Stretch (Figures A-E)

Purposes:

• To stretch the hip flexors (e.g., tensor fascia lata, rectus femoris, iliopsoas)

• To prevent compensatory anterior pelvic tilt or rotation

• To prevent compensatory tibial rotation

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