TEX FINALLY THE FINAL OP. for practice

S T R E T C H Tensor Fasciae Latae: "Tensor Fasciae Latae, Glute Medius and Min, all ABduct the leg and help to turn it in!"

1) Cross-over Lunge: standing lunge position with back leg adducted across midline with either Medial or Lateral rotation of hip and slight side bend of tors

S T R E T C H I N G LUMBAR ERECTORS

1) Full Forward fold in either standing or long-sit position with knees slightly flexed

ADDUCTORS S T R E T C H I N G

1) Seated Butterfly Stretch: soles of feet together and knees relaxed out to sides, flex torso forward over legs

S T R E T C H I N G TRANSVERSE ABDOMINUS

1) Seated, rotate torso to one side while applying an over pressure with contralateral arm against thigh or knee. Repeat other side

GLUTEUS MEDI/MIN S t r e t c h i n g

1) Supine or seated Figure 4 Stretch

S T R E T C H I N G GLUTE MAX

1) Supine, pull knee to chest ONE AT A TIME OR BOTH

S T R E T C H Gastrocnemius:

2) Stand facing a wall, place the toes on the wall a few inches from the floor. Using your supporting leg, push your body and stretching leg (straight) closer to the wall. (I LIKE THIS ONE BETTER)

S T R E T C H I N G ILIOPSOAS

2) Supine, Allow stretching leg to hang off edge of table (or bed, or couch, etc), be sure to tilt pelvis posteriorly and engage core muscles to prevent hyperlordosis.

CORE STABILITY MARCHING WITH CHAIR

...

Quadratus Lumborum S T R E T C H I N G

1) Banana Stretch in either Prone or side-lying ( hang top leg off table)

STRENTHEN GASTROCNEMIUS

2) CLOSED CHAIN - standing with feet hip width apart lift heels all the way up and back down. Prescription: dynamic with resistance STAND ON TOES

S T R E T C H I N G Internal and External Obliques:

2) Lying supine in hook lying position, drop both knees to one side and then the other. Can extend knee of the top leg for more stretch.

S T R E T C H I N G PIRIFORMIS

2) Pigeon Stretch: from a quadruped position, bend one knee and place the lateral thigh to the ground so that the foot is aligned with the opposite shoulder. Extend the other leg posteriorly and relax the body ver the front leg.

STRENGTHEN Soleus STRENGTHEN

2) CLOSED CHAIN - standing with feet hip width apart and both knees bent lift heels all the way up and back down. Prescription: dynamic with resistance

PROM for hip extension

put theraband thand to extend leg back.

S T R E T C H RECTUS FEMORIS

3) Prone, pull heel of stretching leg to the buttock and extend hip by lifting knee away from table/floor

S T R E T C H HAMSTRINGS

3) Standing with hip flexed and foot on step, chair, or table either bend torso forward OR bend supporting leg to further flex hip passively.

STRENGTHEN Latissimus Dorsi:

: this exercise requires a theraband with a high and secure attachment or a pull down bar. In a standing, seated or kneeling position with one end of the theraband in each hand the client pulls downward so that the hands pull to or past the shoulders and elbows are pulling toward the posterior hip region. Prescription: Dynamic with resistance

S T R E T C H I N G LATISSIMUS DORSI

Arm Pull Stretch: in a kneeling or seated position, abduct the stretching arm fully and grasp the wrist with the opposite hand. Pull the stretching arm up and over to the opposite side being sure to stabilize the pelvis. If kneeling, the hips can be dropping to the same side as the stretching arm to increase the side flexion of the torso.

CORE BILAT STRAIGHT LEG LOWERING

Bilateral straight-leg lowering can be performed if the bilateral SLR is difficult. Have the patient begin with the hips at 90° and knees extended; then, lower the extremities as far as possible while maintaining stability in the lumbar spine (should not increase the lordosis), followed by raising the legs back to 90°.

STRENGTHEN ILIOPSOAS

Bilateral straight-leg raising: Have the patient begin with legs extended; then perform a posterior pelvic tilt followed by flexing both hips, keeping the knees extended. If the pelvis and spine cannot be kept stable, the knees should be flexed to a degree that allows control. If the hips are abducted before initiating this exercise, greater challenge is placed on the oblique abdominal muscles

CORE EXERCISES

CURL UP DIAGONAL CURL UP DOUBLE KNEE TO CHEST BILATERAL STRAIGHT LEG RAISE BILATERAL STRAIGHT LEG LOWERING SIDE LYING GRAVITY RESISTED SIDE FLEXION DEAD BUG SIDE PLANK STABILITY MARCHING ON CHAIR

STRENGTHEN Gluteus Maximus:

Quadruped Leg Lifts: Patient position and procedure: In the quadruped position, have the patient alternately extend each hip while keeping the knee flexed (Fig. 20.22). Combine this exercise with trunk stabilization by first having the patient find the neutral pelvic position, drawing in the abdominal muscles, then extending the hip

STRENGTHEN HAMSTRINGS

Single-Limb Deadlift: In unilateral stance with the weight-bearing hip and knee in 30° flexion. Have the patient bend forward at the hips and reach for the toes of the stance leg with the contralateral hand while extending the hip and knee of the nonweight-bearing leg behind. Then return to the upright starting position. This strengthens the hip extensors of the weight-bearing extremity eccentrically and concentrically. Prescription: Isometric or dynamic with or without resistance

PROM of Adbuction

HOOK TOWEL AROUND FOOT, AND PULL INTO ABDUCTION

PROM for adduction

HOOK TOWEL AROUND FOOT, AND PULL INTO ADDUCTION

PROM FOR KNEE FLEXION

HOOK TOWEL ON ANKLE IN PRONE AND USE HAND TO BEND KNEE TO BUM

CORE BILATERAL STRAIGHT LEG RAISE

Have the patient begin with legs extended; then perform a posterior pelvic tilt followed by flexing both hips, keeping the knees extended. If the pelvis and spine cannot be kept stable, the knees should be flexed to a degree that allows control. If the hips are abducted before initiating this exercise, greater challenge is placed on the oblique abdominal muscles

CORE DIAGONAL CURL UPS

Have the patient reach one hand toward the outside of the opposite knee while curling up; then alternate. Reverse the muscle action by bringing one knee up toward the opposite shoulder; then repeat with the other knee. Diagonal exercises emphasize the oblique muscles.

STRENGTHEN Internal and External Obliques:

Diagonal curl-ups: Have the patient reach one hand toward the outside of the opposite knee while curling up; then alternate. Reverse the muscle action by bringing one knee up toward the opposite shoulder; then repeat with the other knee. Diagonal exercises emphasize the oblique muscles. Prescription: Dynamic with or without resistance

STRENGHEN RECTUS ABDOMINUS

Double knee-to-chest: To emphasize the lower rectus abdominis and oblique muscles, have the patient set a posterior pelvic tilt, bring both knees to the chest, and return. Progress the difficulty by decreasing the angle of hip and knee flexion (Fig. 16.64).

CORE CURL UPS

First, instruct the patient to perform the drawing in maneuver to cause a stabilizing contraction of the abdominal muscles and then lift the head. Progress by lifting the shoulders until the scapulae and thorax clear the mat, keeping the arms horizontal (Fig. 16.62). A full sit-up is not necessary, because once the thorax clears the mat, the rest of the motion is performed by the hip flexor muscles. ■ Further progress the difficulty of the curl-up by having the patient change the arm position from horizontal to folded across the chest and then to behind the head; then by holding a weight or medicine ball. The weight is held with the shoulders at 90° flexion.

MOBILITY EXERCISE FOR INT /EXT ROTATION OF HIP

LAY ON BACK KNEES BENT; LET ONE LEG FALL TO SIDE; THEN OTHER. photo not accurate......only one knee at a time

STRENGTHEN Transverse Abdominus:

Let your client lay down on the floor or on a treatment table in a supine hook-lying position. Ask the client to put both of their hand on their lower abdominal region at he level of their belly button. With permission from the client put your hand on top of their hand as if covering their belly button. Note: if you stand on their right side, use your right hand. If on their left side, use your left hand.

STRENGTHEN PIRIFORMIS CLAM EXERCISE

Lower extremities flexed 90 ° at the hips and knees, and the heel of the top leg resting on the heel of the bottom leg. Have the patient lift the knee of the top leg, keeping the heels together. Add resistance by tying an elastic band round the thighs or by placing a cuff weight around the distal thigh of the top leg

MOBILITY EXERCISE FOR HIP: flexor/extensor

PENDULUM USING LEG AND HIP. Make sure you wear stillettos. lol

STRENGTHEN Intrinsic Foot Muscles and Toe Flexors: TOWEL SCRUNCH

PICKING UP TOWEL WITH TOES: Place a folded towel on the floor and ask the client to pick up the towel with their toes and drop it down again. The bulkier the towel the easier this exercise is. You can also ask your client to scrunch up the fully flat towel, lay the towel flat with their foot at one end and they should scrunch it all the way to the other end. CAN USE A GOLF BALL OR SOME OTHER OBJECT.

PROM FOR EVERSION

PULL TOWEL HOOKED ON FOOT INTO EVERSION OPP FOR INVERSION.

AA ROM FOR EVERSION

PULL TOWEL HOOKED ON FOOT INTO EVERSION ACTIVATING FOOT. OPP FOR INVERSION

MOBILITY EXERCISE TO INCREASE LUMBAR lateral flexion

Patient position and procedure: Heel-sitting. Have the patient lean forward so the abdomen rests on the anterior thighs (Fig. 16.18 A); the arms are stretched overhead bilaterally; and the hands are flat on the floor. Then have the patient laterally bend the trunk away from the concavity by walking the hands to the convex side of the curve. Hold the position for a sustained stretch (Fig. 16.12 B)

Drawing-In Maneuver (Abdominal Hollowing Exercise) for Transverse Abdominis Activation

Patient positions: Training may be easiest in the quadruped position in order to use the effects of gravity on the abdominal wall. Hook-lying (with knees 70° to 90° and feet resting on an exercise mat), pronelying, or semi-reclined positions may be used if more comfortable for the patient. It is important to progress training to sitting and standing as soon as possible. Procedure: Teach the patient using demonstration, verbal cues, and tactile facilitation. Explain that the muscle encircles the trunk, and when activated, the waistline draws inward ■ Palpate the transversus abdominis (TrA) muscle just distal to the anterior superior iliac spine (ASIS) and lateral to the rectus abdominis (RA) (Fig. 16.42). When the internal oblique (IO) contracts, a bulge of the muscle is felt; when the TrA contracts, flat tension is felt. The goal is to activate the TrA with minimal or no contraction of the IO. This is a gentle contraction. ■ Have the patient assume a neutral spinal position and attempt to maintain it while gently drawing in and hollowing the abdominal muscles. Instruct the patient to breathe in, breath out, then gently draw the belly button in toward the spine to hollow out the abdominal region. When done properly, there are no substitute patterns; that is, there is minimal to no movement of the pelvis (posterior pelvic tilting), no flaring or depression of the lower ribs, no inspiration or lifting of the rib cage, no bulging out of the abdominal wall, and no increased pressure through the feet. Performing the drawing-in maneuver with the spine in a neutral position results in increased TrA response (measured as increased thickness in ultrasound imaging) compared to slouched sitting or slouched standing postures.

Posterior Pelvic Tilt EXERCISE

Posterior pelvic tilt exercises (see Fig. 16.41 C) principally activate the rectus abdominis muscle, which is used primarily for dynamic trunk flexion activity. It is a superficial muscle that does not have segmental attachments; therefore, it is not emphasized in the training for stabilization. Pelvic tilt exercises are used to teach awareness of the movement of the pelvis and lumbar spine as the patient explores his or her lumbar ROM to find the functional spinal range and the neutral position.

STRENGTHEN Tensor Fasciae Latae:

Resisted Abduction and Internal rotation: 1. Standing with theraband or SIDELYING (PHOTO) against gravity or with theraband, abduct leg while internally rotating the hip.

STRENGTHEN Gluteus Medius and Minimus: -

Resisted Abduction in Standing:

STRENGTH TIBIALIS ANTERIOR

Resisted Dorsiflexion: with one end of a looped theraband around the top of the foot and the other secured on a table leg or stationary post, bring the foot into dorsiflexion. Prescription: Isometric or dynamic with or without resistance

STRENGTHEN Peroneals (Fibularis Longus and Brevis):

Resisted Eversion with or without Plantarflexion: seated with a theraband looped around the forefoot, hold the ends of the band in the opposite hand to the foot being strengthened OR both feet looped in the same short loop, evert and point the toes of the action foot OR both feet. Prescription: Isometric or dynamic with or without resistance

STRENGTHEN Quadriceps: -

Resisted Knee Extension: Seated with theraband looped around ankle and chair leg, extend knee against resisted. You may alter the rotation of the leg to target specific fibres of each muscle (ie: slight ext rotation and terminal extension targets Vastus Medialis) ** will also include Rec. Fem. Prescription: Isometric or dynamic with or without resistance

AA ROM KNEE FLEXION

SAME AS PROM EXCEPT ACTIVATING HAMSTRINGS TO HELP

AA ROM DORSI FLEXION OF FOOT

SAME THING, ACTIVATE FOOT MUSCLES

STRENGTHEN Quadratus Lumborum:

SIDE PLANK

S T R E T CH TIBIALIS ANTERIOR

SIT ON KNEES WITH BOTTOM TO HEELS KEEP HEELS PARALLEL

PROM FOR PLANTAR FLEXION

SIT ON TABLE ; HANGING FEET NATURALLY

STRENGTH AS A GROUP Glutes, Rectus Femoris and Quadricep, hamstrings Step-Ups and Step-Downs:

STEP UP AND STEP DOWN Begin with a low step, 2 to 3 inches in height; increase the height as the patient is able. Have the patient step up and down, forward, laterally, or backward. ■ Be sure the patient places the entire foot on the step and lifts and lowers the body with smooth motion. When stepping up, be certain the patient avoids a lurching motion of the trunk or pushing off with the trailing extremity. ■ Make sure the patient keeps the trunk upright and the knee aligned vertically over the foot to prevent hip adduction and internal rotation and subsequent valgus collapse. ■ Progression: In addition to increasing the step height, add resistance with a weight belt, elastic resistance around the waist (see Fig. 21.28 B), weights in the hands, or a weight around the ankle of the nonweight-bearing leg.

S T R E T C H I N G intrinsic foot muscles; toe extensors

STRETCHING TOE EXTENSORS

S T R E T C H I N G Intrinsic Foot Muscles and Toe TOE FLEXORS

STRETCHING TOE FLEXORS

STRENGTHEN RECTUS FEMORIS

SUPINE or Standing. can be done in supine against gravity or with resistance of theraband, Standing against resistance of theraband. pulling leg to bum.......noticed photo not correct.

MOBILITY EXERCISE TO INCREASE LUMBAR EXTENSION

Self-mobilization ■ Patient position and procedure: Prone, with hands placed under the shoulders. Have the patient extend the elbows and push the thorax up off the mat but keep the pelvis down on the mat. This is a prone press-up

STRENGTHEN ADDUCTORS

Side-Lying Adduction: With the bottom leg aligned in the plane of the trunk (hip extension) and the top leg flexed forward with the foot on the floor or with the thigh resting on a pillow, have the patient lift the bottom leg upward into adduction. Weights can be added to the ankle to progress strengthening (Fig. 20.25 A). A more difficult position is to have the patient hold the top leg in abduction and adduct the bottom leg upward to meet it

CORE SIDELYING GRAVITY RESISTED SIDE FLEXION

Side-lying on the concave side of the curve with the apex at the edge of the table or mat so the thorax is lowered. If you have access to a split table with one end that can be lowered, begin with the apex of the curve at the bend of the table. Have the patient place the lower arm folded across the chest and upper arm along the side of the body and side bend the trunk up against gravity. Progress by having the patient clasp both hands behind the head (Fig. 16.71). Stabilization of the pelvis and lower extremities must be provided. photo not 100 percent accurate, nor will you be in gitch.lol

CORE SIDE PLANK

Similar to Front Plank but you are positioned sideways on one arm and either your knee or foot. Progress from one hand and knees, to one hand and feet, to one elbow and knees, to one elbow and feet, to use of stability ball or Bosu. Repeat on other side, ensure head, shoulder, hip, knees and/or feet are aligned and there is no rotation of the torso, that's cheating or could cause injury.

S T R E T C H I N G Rectus Abdominus:

Stretching: 1) Prone, use hands (or elbows) to push upper thorax into Lumbar extension.

S T R E T C H SOLEUS STRETCH

Stretching: 1) In a lunge position, posterior leg is BENT and reach heel toward the floor. 2) Stand facing a wall, place the toes on the wall a few inches from the floor. Using your supporting leg, push your body and stretching leg (BENT) closer to the wall. This can also be done with your foot on a step or block

S T R E T C H Peroneals (Fibularis Longus and Brevis): -Primarily responsible for Eversion and Plantarflexion. NOT ON OP

Stretching: 1) Passive inversion of the ankle. This is not often required as stretching these fibres can lead to over stretching and therefore predispose client to inversion sprain NOT ON OP

S T R E T C H QUADRICEPS

Stretching: 1) Prone or standing , pull heel of stretching leg to the buttock.

STRENGTHEN Lumbar Erectors:

Superman": Progress the extension exercises by having the patient lift both upper and lower extremities simultaneously (Fig. 16.68).

CORE DEAD BUG

Supine with hips and knees flexed to 90 degrees, draw in abdominals and achieve neutral spine. Slowly lower one foot toward but not touching the floor and return leg to starting position, repeat on other side. Do not allow too much lumbar extension, drawing in and neutral spine must be maintained. Can progress this exercise by adding Extended arms in opposition to knees. This exercise is great for clients with hyperlordosis of the lumbar spine or anterior pelvic tilt.

PROM to increase hip flexion

TOWEL BEHIND THIGH HAVE CLIENT PULL HIP INTO FLEXION

Abdominal Bracing; In contrast to the drawing-in maneuver, abdominal bracing occurs by setting the abdominals and actively flaring out laterally around the waist

There is no head or trunk flexion, no elevation of the lower ribs, no protrusion of the abdomen, and no pressure through the feet. The patient should be able to hold the braced position while breathing in a relaxed manner. This technique has been taught for a number of years as the method to stabilize the spine; it has been shown to activate the oblique abdominal muscles consistent with their global stabilization function.

CORE DOUBLE KNEE TO CHEST

To emphasize the lower rectus abdominis and oblique muscles, have the patient set a posterior pelvic tilt, bring both knees to the chest, and return. Progress the difficulty by decreasing the angle of hip and knee flexion

Structures Involved:

Transverse abdominus (drawing in ) Int/ext oblique Rectus abdominus Quadratus lumborum Glute Max Glute med/min Piriformis Iliopsoas Leg ADDuctors Rectus Femoris TFL Quads Hamstrings Gastrocnemeus Soleus Tibialis Anterior Intrinsic Foot muscles PERONEALS

PROM DORSI FLEXION OF FOOT

USE TOWEL AROUND FOOT, PULL INTO DORSI FLEXION

MOBILITY EXERCISE TO INCREASE LUMBAR FLEXION/EXTENSION AT SAME TIME

self mobilization ■ Patient position and procedure: Quadruped (hands and knees). Instruct the patient to allow the spine to sag, creating lumbar extension. Alternating between this motion and a posterior pelvic tilt (as in Fig. 16.14) can be used to teach the patient how to control pelvic motion. (AKA "cat and cow")

AROM for knee extension on left

extend leg 10 x; this is considered a ROM; not strength.

CORE PROTOCOL

introduction 1. warm up; 10 to 15 minutes of jumping jacks or a brisk walk 2. CORE EXERICISE_______________________________ 3. Benefits: IMPROVE POSTURE; BALANCE AND STRENGTHEN CORE MUSCLES. 4. Risks/side effects; muscle strain or pain 5. If you are experiencing pain, please stop 6. describe exercise in lay terms, permission for hands on 7. Explain sensation they should feel; ie;TIGHTNESS IN ABS 8. have client repeat the exercise protocol 9. CORRECT CHEATING; verbalize possible cheats 10. Ask client where THEY feel the exercise 11. make sure client understands exercise; encourage questions 12. make sure activity is safe and stable. 13; Ensure client is BREATHING properly; exhale on CONTRACTION. 14. 3 sets; 10-12 reps; 2x per day 15. ADVISE CLIENT they should come back for modifications/progression; Come back in two weeks so we can see how you are progressing and make any modifications if need be.

ROM AND MOBILITY PROTOCOL

introduction 1. warm up; 10 to 15 minutes of jumping jacks or a brisk walk 2. ROM or MOBILITY; ie. AROM, PROM, AA ROM for ______ 3. Benefits: to maintain or increase movement in joints 4. Risks/side effects; joint achiness or pain 5. If you are experiencing pain, please stop 6. describe exercise in lay terms, permission for hands on 7. Explain sensation they should feel; ie; stretch in joint; possible discomfort, but still should be pain free. 8. have client repeat the exercise protocol 9. CORRECT CHEATING; verbalize possible cheats 10. Ask client where THEY feel the exercise 11. make sure client understands exercise; encourage questions 12. make sure activity is safe and stable. 13; Ensure client is BREATHING properly; exhale on rom 14. 1 set; 7-10 x day; 2x per day 15. ADVISE CLIENT they should come back for modifications/progression; Come back in two weeks so we can see how you are progressing and make any modifications if need be.

STRENGTHENING PROTOCOL

introduction 1. warm up; 10 to 15 minutes of jumping jacks or a brisk walk 2. STRENGTHENING EXERICISE_______________________________ 3. Benefits: MAINTAIN OR IMPROVE STRENGTH TO HELP WITH POWER AND ENDURANCE WHICH HELPS WITH ADL'S 4. Risks/side effects; MILD TO SEVERE MUSCLE SORENESS OR STRAIN. 5. If you are experiencing pain, please stop 6. describe exercise in lay terms, permission for hands on 7. Explain sensation they should feel; ie; STRENGTHENING LUMBAR 8. have client repeat the exercise protocol 9. CORRECT CHEATING; verbalize possible cheats 10. Ask client where THEY feel the exercise 11. make sure client understands exercise; encourage questions 12. make sure activity is safe and stable. 13; Ensure client is BREATHING properly; exhale on contraction 14. 3 SETS; 10-12x a DAY; 2x per day 15. ADVISE CLIENT they should come back for modifications/progression; Come back in two weeks so we can see how you are progressing and make any modifications if need be.

stretching protocol

introduction 1. warm up; 10 to 15 minutes of jumping jacks or a brisk walk 2. STRETCHING EXERICISE_______________________________ 3. Benefits: Increase Flexibility & release muscle tension 4. Risks/side effects; muscle strain or pain 5. If you are experiencing pain, please stop 6. describe exercise in lay terms, permission for hands on 7. Explain sensation they should feel; ie; stretch in glutes. 8. have client repeat the exercise protocol 9. CORRECT CHEATING; verbalize possible cheats 10. Ask client where THEY feel the exercise 11. make sure client understands exercise; encourage questions 12. make sure activity is safe and stable. 13; Ensure client is BREATHING properly; exhale on stretch 14. STRETCH FOR 30 SECONDS; 3 X each side; twice a day. 15. ADVISE CLIENT they should come back for modifications/progression; Come back in two weeks so we can see how you are progressing and make any modifications if need be.

prom with knee extension on left

use right leg to extend bent knee into extension

AA rom for knee extension on left

use right leg to extend bent knee into extension but activating left quads to "ASSIST" as therapist; FEEL the quads to show that they are activating quads to help

MOBILITY EXERCISE TO INCREASE LUMBAR FLEXION

■ Patient position and procedure: Hook-lying. Have the patient first bring one knee and then the other toward the chest, clasp the hands around the thighs, and pull them to the chest, elevating the sacrum off the mat (Fig. 16.13). The patientshould not grasp around the tibia; it places stress on the knee joints as the stretch force is applied.