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.
Closed kinetic chain facilitation of the gluteal muscles:
With the patient’s arms at their sides instruct the patient to advance the right leg as far forward as possible keeping their right foot approximately an inch off the floor as they bend the left knee. The patient then reaches back as far as they can with the right foot staying an inch off the floor.
Then ask the patient to reach with their right foot out to the side and finally to draw a star taking the right foot behind and to the left and forward to the right and finally back to the right keeping the right foot an inch off the floor each time and bending their left knee as far as possible.
Repeat in each direction 4 to 5 times, then repeat standing on the right leg.
Make sure to watch for any valgus deviation of the stance knee during this retraining, which should be avoided.
The patient is lying supine and places a belt around the ball of the left foot.
Starting with the L knee flexed and with the left hip flexed to 90 degrees, instruct the patient to try to straighten the L knee as much as possible while maintaining dorsiflexion at the left ankle using the belt.
The stretch is only held for 5 seconds and then released by bending the left knee.
Instruct the patient to repeat this on/off stretch 10 times while keeping the left knee pointing straight up towards the ceiling.