Supine Curl Up

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Muscle Energy Technique for the L Iliopsoas

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, All Lower Quarter, All Manual Therapy, Hip EXT Firing Pattern, Muscle Energy, Pelvic Clocks, Supine Curl Up

Muscle Energy Technique for the L Iliopsoas

Muscle Energy Technique for the L Iliopsoas
  • The L leg is taken to the end range of hip extension
  • Subject attempts to flex the L hip which the therapist resists at the distal femur
  • Upon relaxation the hip is taken into further extension
  • Repeat 3-4 times

Muscle Energy Technique for the Iliopsoas

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, All Lower Quarter, All Manual Therapy, Hip EXT Firing Pattern, Muscle Energy, Pelvic Clocks, Supine Curl Up, Supine Heel slide

Muscle Energy Technique for the Iliopsoas

Muscle Energy Technique for the Iliopsoas

  • Therapist blocks subject’s left foot with his left foot
  • Therapist stabilizes the right ischial tuberosity with his left hand and IR the femur with his right
  • Therapist then applies traction and lifts the hip into extension
  • Subject attempts to flex the hip for 5-7 seconds
  • Upon relaxation the therapist lifts the leg into further hip extension to a new barrier while maintaining IR of the femur
  • This is repeated 3-4 times
 

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.

Belt Assisted Eccentric Curl Backs and Curl Ups

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Retraining, Self-mobilization, Supine Curl Up

Belt Assisted Eccentric Curl Backs and Curl Ups

  • The patient starts in the long sitting position with a belt wrapped around the balls of the feet.
  • Instruct the patient to slowly slump back as though trying to touch their spine to the table segmentally from below up (S1, then L5, L4 etc.).
  • Emphasis is placed on posterior translation at each segmental level.
  • They’re only allowed to roll back as far as they can while maintaining spinal flexion.
  • Once they are able to control segmental flexion eccentrically then they can roll all the way back to the table and then come back up using the belt to assist as needed.
  • Have the patient repeat the exercise 8 to 10 times trying to work a little further back each time.
  • Goal – Eventually the patient should be able to roll all the way back and curl back up with segmental flexion without needing to use a belt to assist and without extending the spine while curling up.

Belt Assisted Eccentric Curl Backs with Therapist Assist

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Retraining, Supine Curl Up

Belt Assisted Eccentric Curl Backs with Therapist Assist

  • The patient starts sitting upright with a belt wrapped around the balls of the feet.
  • The patient is instructed to slowly slump back as though they are trying to touch their spine to the table segmentally from below up (S1, then L5, L4 etc.).
  • The therapist uses manual contacts to the abdominals and also to the spine to bring sensory awareness to specific levels of the spine as the patient proceeds.
  • Emphasis is placed on posterior translation at each segmental level.
  • The patient is only allowed to roll back as far as they can while maintaining spinal flexion.
  • Once they can control segmental flexion eccentrically then they can roll all the way back to the table and then come back up using the belt to assist as needed.

Dysfunctional Supine Curl Up Test

in 2 Movement Tests Lower Quarter, All Lower Quarter, Supine Curl Up

Dysfunctional Supine Curl Up Test

Anatomy and Biomechanics:

The inability to perform a supine curl up is often due to an ERS dysfunction in the lower thoracic spine or upper lumbar spine and should always be addressed first before attempting to retrain this movement test. (Refer to Module #3). When patients perform abdominal “crunches” with the hips and knees flexed they are working the abdominals in a shortened position and often results in substitution by the hip flexors. We need to consider that working the abdominals with the hips and knees flexed is not really functional as we need abdominal tension/tone through the full range of flexion of our spine. This is especially true when we are standing upright with the hips and knees in a neutral or extended position. Often what we see in the clinic are people who are unable to perform an unassisted full range supine curl up without extending the lumbar spine when the hip flexors kick in at mid range.

Working the abdominals eccentrically with the assistance of a belt helps to not only activate the abdominals throughout the full spinal flexion range of motion, but also can be used to segmentally self mobilize the thoracolumbar spine for flexion. In addition, this exercise stretches the thoracolumbar spinal extensors that are prone to hypertonicity as a response to abnormal afferent information in the lower quarter. We see this especially in patients complaining of low back pain.

When working the abdominals eccentrically, emphasis is placed on instructing the patient to posteriorly translate the spine segmentally from below up and to stop when they reach a spinal level that they are unable to flex (posteriorly translate). This exercise is therefore ideal for patients with spondylolisthesis who need to strengthen their abdominals and avoid exercises that can cause or contribute to anterior translation of L5 or L4. This exercise is also helpful for patients with lumbar central and lateral stenosis as spinal flexion increases spinal canal volume and opens the intervertebral foramen respectively.

Substitution Patterns to watch out for during retraining:

When instructing a patient in this exercise focus on encouraging the patient to draw the belly in and push their spine back to maximally posteriorly translate the spine at each spinal level beginning at L5 and working segmentally up the spine. Look for a loss of flexion at a spinal level when there is a tendency to extend rather than flex through this level. When this occurs the patient should be instructed to return upright by curling back up to the starting position and repeat the exercise. The patient should be able to gradually lower themselves further and further until eventually they are able to touch the floor.

Forward Bending in Right Step Standing

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Pelvic Clocks, Self-mobilization, Supine Curl Up

Forward Bending in Right Step Standing

Forward Bending in Right Step Standing

For an ERS Left and or high tone in the Left Erector Spinae:

  • The patient starts in standing and places their right foot up on a chair.
  • Instruct the patient to place their hands around each side of their right knee and slide their hands down the leg towards the ankle attempting to bring the chest down towards the right knee.
  • They hold the stretch for 5 to 10 seconds then return to upright standing.
  • Have the patient repeat this sequence 8 to 10 times.
  • For an ERS Right they place the left foot up on a chair.
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