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
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.
The patient is lying on the back, with their thumbs placed above the ASISs to monitor pelvic stability.
The patient is instructed to find the midpoint between 12:00 and 6:00 o’clock then draw the belly in towards the spine without flattening the low back so that they maintain a neutral lumbar spine.
The patient continues to monitor the position of the ASISs as they slowly drop the right knee out to the side.
The patient is instructed that if the R ASIS drops inferiorly when compared to the L ASIS while abducting and externally rotating the R hip they are to return back to the midline and start over.
The patient is instructed not to drop the R knee out to the side further than they can maintain leveling at the ASISs.
Repeat on both sides for 3-5 repetitions to start, increasing to 10 reps.
Bilateral Hip Abduction and External Rotation with a Neutral Lumbar Spine
The patient is lying on their back and instructed to find neutral, midway between 12:00 and 6:00 while monitoring the ASISs with their thumbs.
Instruct the patient to maintain neutral and draw the belly in towards the spine without flattening the low back.
While monitoring the ASISs with their thumbs ask the patient to slowly separate the knees while keeping the ASISs still/level.
If either ASIS begins to move inferiorly (towards the feet) instruct the patient to stop and bring the knees back to the midline and start over.
Repeat 3-5 times
The goal is for the patient to be able to maintain a neutral lumbar spine and symmetrically abduct and externally rotate both hips without either ASIS moving inferiorly.
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.
Starting in hands and knees with the hips positioned directly over the knees and the shoulders positioned directly over the hands, the patient is instructed to bend their elbows so that the shoulders are the same height as the hips.
The patient is instructed to find a neutral lumbar spine by rocking the pelvis from 12:00 to 6:00 and finding the midrange position.
The therapist monitors the PSISs to insure that they are level in the frontal plane before starting and during the performance of this exercise.
Instruct the patient to draw the belly up and in towards the spine without changing the lumbar neutral position. The therapist monitors the PSISs to insure that they remain stable and provides verbal feedback to the patient if any deviation should occur. The therapist should watch for any loss of the neutral lumbar spine position during the exercise.
The patient is instructed to hold for 10 seconds and repeat 3-5 times.
The patient is lying on their back with both knees bent up and the feet flat on the floor with their arms straight out in front and with palms together.
Instruct the patient to take their arms to the right and turn their head to the right as far as they can comfortably, then repeat to the left side to determine which side is easier to do.
Then if they found it was easier to turn to the right side, have them take their arms to the right while they turn their head to the left as far as they can comfortably and without straining, then have them bring the head and arms back to the midline starting position and repeat 5 times, rotating their head and arms in opposite directions.
Then ask them to recheck their ability to turn to the right while looking to the right and see if it’s even easier than before.
Then repeat these movements going the opposite way with their arms going to the left as they turn the head to the right, repeat 5 times, then they stop and recheck their ability to bring their arms to the left as they look to the left.
They patient is instructed to finish by bringing their arms to the right as they look to the right and arms to the left as they look to the left, back and forth 5 times each way.
Then have the patient recheck their ability to rotate the pelvis towards 3 and 9 o’clock to see if it’s easier to perform.
Unilateral bridging on the left side to re-educate 9 o’clock control:
The patient is lying flat on their back with their left knee bent and the left foot flat on the floor with their arms resting on the floor at the sides.
Instruct the patient to imagine that there is a string attached to their left knee that is pulling the knee forward over their left big toe as they slowly lift their left hip, then pelvis and finally the spine off the floor shifting their weight onto the right buttocks.
The patient should not lift any further than is comfortable while keeping their shoulders flat on the floor.
Then instruct the patient to slowly lower back to the floor initiating the movement from above down, first touching the middle back, then the lower back, then the pelvis and finally the hip to the floor.
Have them repeat this exercise slowly 6-8 times trying to get them to feel that their hip, pelvis and spine can move independently from each other rather than as a block.
Have them repeat the exercise on the right side to re-educate 3 o’clock control. Instruct the patient to always start with the easiest side first
Retraining Exercise to Restore Symmetrical 12 to 6 o’clock
Patient is positioned supine with hips and knees flexed and feet hip width apart.
The patient palpates the ASISs with their fingers or thumbs to assess for symmetry of the ASISs in the frontal plane before they initiate movement. The therapist observes the ASISs and gives the patient verbal cues if needed to level the ASISs before movement is initiated. The most common initial instruction to the patient is to bring the R ASIS up superiorly in order for the ASISs to start from a position of symmetry before movement begins.
The patient is then instructed to inhale as they roll the pelvis down towards 6 o’clock attempting to keep the ASISs level by continuing to monitor with their fingers. If during the initial movement assessment it was found that the R ASIS moved farther inferiorly than the L ASIS the therapist instructs the patient to focus on pushing the L ASIS a little further inferiorly to keep the ASISs level in the frontal plane.
The patient is then instructed to exhale and roll the pelvis up towards 12 o’clock while still maintaining contact at the ASISs. If during the initial movement assessment it was found that the L ASIS moved farther superiorly than the R ASIS, the therapist instructs the patient to focus on drawing the R ASIS up further superiorly in order to keep the ASISs level. The patient repeats the movements toward 6 and 12 o’clock 6 to 8 times trying to maintain symmetry by continuing to monitor at the ASISs and making any adjustments as needed.
The goal is for the patient to be able to roll the pelvis towards 6 and 12 o’clock with symmetry of the ASISs maintained throughout the full range of motion and eventually without the patient having “to think” about maintaining this symmetry.
Have the patient in long sitting with a belt or towel wrapped around the balls of the feet.
Instruct the patient to keep their toes pointing down and their head up as they bring their trunk forward as far as possible.
Instruct the patient to use the belt/towel to pull their toes up as they lower the head. This places maximum stretch on their nervous system. This position is held only momentarily.
Then have them release the stretch by letting the toes point down as they lift their head back up and they attempt to increase their trunk flexion.
They repeat these movements back and forth 8-10 times.
After this stretch, always remember to instruct the patient to lie on their back with the knees up and perform 12:00 to 6:00 pelvic rocking 10 times to release any tension across their lower back.