Supine Heel slide

TFL Self Stretch – Kneeling

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TFL Self Stretch – Kneeling

TFL Self Stretch – Kneeling

To Stretch the Left TFL:

The patient starts in half kneeling with a pillow or towel under the left knee and the hip externally rotated (foot turned in). Their right hand may be placed on a chair or against the wall for balance.
Have them place their left hand on their left buttocks. They are instructed to tighten the left buttocks muscle and tuck the hips under (12:00). They draw the belly button in and keep the shoulders centered over the hips so that they don’t arch the back.
Instruct the patient to translate their hips to the left while maintaining a strong buttocks contraction and posterior pelvic tilt.
The patient should report feeling a stretch on the outside or lateral portion of the left thigh.
They hold the stretch for 30 seconds 2-3 times or use a series of isometric contract/relax stretches repeated several times.
Then instruct the patient to switch sides and repeat on the right side.

Stretch the Left Iliopsoas

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Stretch the Left Iliopsoas

To Stretch the Left Iliopsoas:

The patient starts in half kneeling with the left knee placed on a towel or pillow on the floor with the hip internally rotated and the right hip and knee flexed to 90º. Their right hand may be placed on a chair or against the wall for support.
Have them place their left hand on their left buttocks. They are instructed to tighten the left buttocks muscle and tuck the hips under (12:00). They draw the belly button in and keep the shoulders centered over the hips so that they don’t arch the back.
Instruct the patient to use their right leg to pull the pelvis forward leading with the front of the left hip. They should feel a stretch in the front of the left leg/thigh. Further stretch can be obtained by maintaining this stretch position and side bending the trunk away (toward the right).
They are instructed to hold the stretch for 30 seconds 2-3 times or perform a series of isometric contractions attempting to pull the left hip forward for 5-7 seconds then relaxing and stretching further.
Then have the patient switch sides and repeat with the right leg.

Half Kneeling Chops and Lifts

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Half Kneeling Chops and Lifts

The patient starts in half kneeling with the left knee down and right knee up, with their right knee bent to a right angle so that their right knee is position over the right ankle.
The patient grasps a dowel in both hands with the palm of the right hand facing upwards (supinated) and the palm of the left hand facing down (pronated).
The patient is instructed to raise the dowel upwards to the right (lift). Then bring the dowel downwards towards the left (chop) so that they always lift towards the upside knee and always chop toward the downside knee.
Ask the patient to keep their head and eyes facing forward as they raise (lift) and lower (chop) the dowel in front of their body, keeping their trunk tall.
The trunk should remain still and the patient should try to maintain a neutral lumbar spine during the movement
Instruct the patient to repeat the movements 6-8 times then reverse their leg and hand positions to repeat the chop and lift to the left side.
The patient can begin this exercise with their knees initially separated for a more stable base and then bring the knees close together to increase the level of difficulty.

Tall Kneeling Chops and Lifts

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Tall Kneeling Chops and Lifts

Chopping is the downward movement across the body from a high position to a low position and lifting is the upward movement from a low position to a high position.
The patient starts in kneeling with a dowel in both hands with the palm of the top hand facing upwards (supinated) and the palm of the lower hand facing down (pronated).
Ask the patient to keep their eyes and head facing forward as they raise and lower the dowel in front of their body with both arms.
Their trunk should remain still and their spine in neutral as they perform 6-8 repetitions.
Then have them switch their hand positions and repeat the chop and lifting motions in the opposite direction.
The patient can begin this exercise with their knees initially separated for a more stable base and then bring the knees close together to increase the level of difficulty.

Prone Planks

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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

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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

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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.

Advanced Transversus Abdominis Retraining (Dead Bugs)

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Advanced Transversus Abdominis Retraining (Dead Bugs)

The patient is lying on their back with both hips flexed to approximately 90º. Ask the patient to find a neutral lumbar spine by having them roll the pelvis from 12 to 6 and find the midpoint.
The patient monitors the ASISs with their thumbs to keep them level.
Instruct the patient to slowly touch one heel to the table, alternating between the right and left sides while monitoring the ASISs and not allowing an ASIS to drop inferiorly on either side.
As their strength improves, they can start extending the hip out further to touch the heel (bottom picture).
Have them repeat 3-5 times and increase repetitions as their strength improves.

Supine Heel Slides

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Supine Heel Slides

The patient is lying supine with their hips and knees flexed and the feet flat on the table.
Instruct the patient to find a neutral lumbar spine position, midway between 12:00 and 6:00, monitoring the ASISs with their thumbs.
Have the patient draw their belly in without flattening the low back (the ASISs should not move when they draw the belly in).
Instruct the patient to slowly slide their right heel along the table while monitoring the ASISs. The right ASIS should remain stable as the right leg is extended. If the ASIS moves inferiorly, the patient should stop, and bring the leg back up to the starting position.
Goal – the patient should be able to fully straighten either leg without the ASISs moving while maintaining a neutral lumbar spine.
They repeat the exercise 3-5 times initially and increase repetitions as their performance improves.

Transversus Abdominis Retraining

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Transversus Abdominis Retraining

The patient is lying on their back with the hips and knees flexed and feet flat on the table.
Have the patient place their hands on both sides of the lower rib cage.
Ask the patient to find a neutral lumbar spine by rolling the pelvis towards 6 and 12 o’clock and finding the midpoint in the range.
Instruct the patient to draw the belly in without flattening their lower back maintaining a neutral lumbar spine. The patient monitors the ASISs to make sure that they remain level throughout this exercise.
Instruct the patient to slowly inhale through the nose allowing their lungs to fill with air as the rib cage expands out to the sides as they draw the navel in. Their chest and shoulders should remain relaxed and they should not feel that their belly pushes out or that the lower ribs are pulled down and medially by the obliques which can often substitute with transversus abdominis dysfunction.
The patient exhales through pursed lips and allows the ribs to fall down and in. Their upper chest should continue to remain relaxed.
If they are having difficulty recruiting the transversus have them blow out as much air as possible during exhalation using their abdominal muscles to assist and hold for 3-5 seconds. Then have them slowly inhale while continuing to draw the belly in and hold for 10 seconds.
Have them repeat up to 10 times holding for 10 seconds each time.