Hip EXT Firing Pattern

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Trunk Rotation Over a Swiss Ball

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, Active Trunk Rotation, All Home Exercises, All Lower Quarter, Functional Integration, Hip EXT Firing Pattern, Rolling

Trunk Rotation Over a Swiss Ball

  • The patient begins this exercise by lying on their back with both legs supported over a swiss ball and with the arms abducted to 90 degrees and both palms facing the ceiling. The ball should be right up against the thighs. If the front of the ball were a clock the left leg is positioned at 10 o’clock and the right leg at 2 o’clock to begin this exercise.
  • Instruct the patient to take a deep breath as they slowly lower their legs to the left side, only lowering as far as they can while keeping the right shoulder blade on the ground. Ideally the outside of the left leg should touch the floor.
  • To complete the entire pattern ask the patient to look to the right as they externally rotate the right arm and internally rotate the left arm so that the left palm is now facing the ground.
  • Instruct the patient to exhale and use their abdominals to bring the legs back to the midline.
  • Have them repeat the rotation to the right side ideally touching the outside of the right leg to the floor.
  • The patient is instructed to work slowly back and forth 3 to 5 times initially, coordinating the arm rotations with the lower trunk rotation.
  • The patient increases the number of repetitions as their strength and control improves.

Trunk Rotation

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, Active Trunk Rotation, All Home Exercises, All Lower Quarter, Functional Integration, Hip EXT Firing Pattern, Rolling

Trunk Rotation

  • The patient begins this exercise by lying on their back with both knees bent and feet flat on the floor with the arms abducted to 90 degrees and both palms facing the ceiling.
  • Place a small ball between the patient’s knees and ask them to hold the ball between the knees as they flex the hips up to 90 degrees.
  • Ask the patient to find a neutral lumbar spine with the hips flexed by rotating the pelvis to 6 and 12 o’clock and finding the midpoint.
  • Instruct the patient to take a deep breath as they slowly lower their legs to the left side, only lowering as far as they can while keeping the right shoulder blade on the ground.
  • To complete the entire pattern ask the patient to turn their head to the right, and externally rotate the right arm and internally rotate the left arm so that the left palm is now facing the ground.
  • Instruct the patient to exhale and use their abdominals to bring the legs back to the midline.
  • Have them repeat the rotation to the right side, working slowly back and forth 3 to 5 times coordinating the head and arm rotations with the lower trunk rotation.
  • The patient increases the number of repetitions as their strength and control improves.

Prone Planks with Alternating Hip Extension

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Hip ABD Firing Pattern, Hip EXT Firing Pattern, Retraining

Prone Planks with Alternating Hip Extension

  • The patient starts in prone lying resting on their elbows that are positioned under the shoulders.
  • Instruct the patient to rise up on their toes and forearms until they feel that their spine is straight. Observe their spinal position and provide feedback as indicated to make sure they are able to achieve and hold a neutral lumbar spine for 10 seconds.
  • Once the patient can perform 10 repetitions holding each one for 10 seconds they can increase the level of difficulty by lifting and holding one foot off the table for 10 seconds, then they reverse and lift the other foot off the table for 10 seconds before lowering back down to the floor.
  • An EMG analysis of 18 exercises designed to strengthen the gluteal muscles found that the prone plank with hip extension with the knee flexed had the highest % of MVIC of any of the exercises tested (Boren et al., 2011.) Caution is therefore advised when prescribing this exercise especially early on in the rehabilitation of a patient.

Prone Planks

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Functional Integration, Hip EXT Firing Pattern, Retraining, Supine Curl Up, Supine Heel slide, Supine Hip ABD and ER

Prone Planks

  • The patient starts in prone lying resting on their elbows that are positioned under the shoulders.
  • Instruct the patient to rise up on their toes and forearms until they feel that their spine is straight. Observe their spinal position and provide feedback as indicated to make sure they are able to achieve and hold a neutral lumbar spine for 10 seconds.
  • They work up to 10 repetitions, holding each one for 10 seconds.

Heel Sitting to Kneeling

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Functional Integration, Hip ABD Firing Pattern, Hip EXT Firing Pattern, Retraining, Supine Curl Up, Supine Heel slide, Supine Hip ABD and ER

Heel Sitting to Kneeling

  • The patient starts by sitting on their heels with the trunk erect.
  • Ask the patient to find a neutral lumbar spine by rotating the pelvis toward 12:00 then 6:00 and find the midpoint.
  • Instruct the patient to draw the belly in and hold a neutral lumbar spine.
  • From this position and while maintaining a neutral lumbar spine, instruct the patient to rise up to a kneeling position by extending through their hips and not through the lumbar spine.
  • Once in the kneeling position the patient slowly reverses back to heel sitting, again by moving through the hips and not through the back.
  • Instruct the patient to repeat 3-5 times and increase the reps as their strength improves.
  • This exercise helps to improve a patient’s standing tolerance and strengthen the quadriceps.
  • Make sure that the patient’s lumbar spine stays neutral throughout the exercise.

Pelvic See Saw: Combining lumbar extension with hip flexion and lumbar flexion with hip extension

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Functional Integration, Hip EXT Firing Pattern, Pelvic Clocks, Supine Curl Up, Supine Heel slide

Pelvic See Saw: Combining lumbar extension with hip flexion and lumbar flexion with hip extension

  • The patient is lying on their back with the knees bent and feet flat on the table.
  • Ask the patient to roll the pelvis toward 6:00 extending through the lumbar spine up into the thoracic spine and increasing flexion of the hips. (Top)
  • Then instruct the patient to relax the erector spinae and slowly reverse the position by touching the spine down to the table, rolling the pelvis up toward 12:00 and adding extension through the hips by bridging and lifting the hips up off the table. (Bottom)
  • From the bridge position ask the patient to slowly touch the spine down to the table working from above down segmentally, i.e., T11, T12, L1, L2, etc. until the sacrum touches the table. They then reverse directions by rolling the pelvis towards 6:00 and extending the spine segmentally from below up.
  • The patient is instructed to repeat this movement 4-5 times.

Single-Limb Deadlift with Straight Knee

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Hip EXT Firing Pattern, Retraining

Single-Limb Deadlift with Straight Knee

To strengthen the Right Gluteus Maximus:

  • The patient is standing with their hands at their sides.
  • Ask the patient to reach down with their left hand towards the outside of their right foot while keeping their right leg as straight as possible.
  • The patient should bend forward from the waist and trunk and avoid bending the right knee as much as possible.
  • Instruct the patient to try to touch their left fingers to the outside of their right foot.
  • They then return to upright standing and repeat 3 to 5 times initially, working up to 10 repetitions on each leg.
  • This exercise requires good extensibility of the hamstrings which should be stretched prior to doing this exercise.
  • Single-limb deadlift with a straight knee was reported to produce the highest % of MVIC for the gluteus maximus out of 12 exercises that are commonly prescribed for gluteal strengthening (DiStefano et al. 2009).

Single-Limb Deadlift with Bent Knee

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Hip EXT Firing Pattern, Retraining

Single-Limb Deadlift with Bent Knee

To strengthen the Right Gluteus Maximus:

  • The patient is standing with their hands at their sides.
  • Ask the patient to reach down with their left hand towards the outside of their right foot while keeping their right leg as straight as possible.
  • The patient should bend forward from the waist and trunk and avoid bending their right knee as much as possible.
  • Instruct the patient to try to touch their left fingers to the outside of their right foot.
  • They then return to upright standing and repeat 3 to 5 times initially, working up to 10 repetitions on each leg.
  • This exercise requires good flexibility of the hamstrings so the patient is allowed to bend the right knee if the hamstrings are tight.

Single Leg Bridge

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Hip EXT Firing Pattern, Retraining, Supine Hip ABD and ER

Single Leg Bridge

To strengthen the L gluteus maximus:

  • The patient is lying on their back with both knees bent up and feet resting flat on the floor.
  • Ask the patient to bring their right knee up to the chest and hold with their hands.
  • Instruct the patient to draw the toes of the L foot up and gently push the left heel away to inhibit the left hamstrings.
  • Now ask the patient to bridge up on their L foot as high as they can while they hold their R knee to chest.
  • Have the patient hold for 10 seconds then slowly lower their L hip back down to the table.
  • Have them repeat for 3 to 5 reps initially working up to 10 reps on each leg.

Supine Bridging – Bilateral and Unilateral

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Hip EXT Firing Pattern, Retraining

Supine Bridging – Bilateral and Unilateral

To activate and strengthen the gluteus maximus:

  • The patient is lying on their back with knees bent and feet hip width apart.
  • Instruct the patient to find a neutral lumbar spine, midway between the end range of 12:00 and 6:00 then draw the belly in towards the spine.
  • Ask the patient to lift the toes up and push the heels away to tighten the quadriceps, then lift the hips up off the table while maintaining a neutral spine.
  • Instruct the patient to tighten the buttocks muscles as they bridge up.
  • Don’t let the patient lift up so high that they arch the lower back and lose the neutral position.
  • Have the patient hold for 10 seconds and repeat initially 3-5 times.
  • As the patient become stronger, they can attempt to straighten one knee while in the bridge position. They hold for 10 seconds and alternate with the opposite leg before lowering to the table. Make sure the pelvis doesn’t drop and the hamstrings do not cramp. Cramping of the hamstrings is an indication that the gluteus maximus is not engaged enough and that this exercise is too advanced for the patient.
  • Pushing away with the heels activates the quadriceps to inhibit the hamstrings from working to hard.
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