Exercise Prescription

(Supine) Hip Flexion PROM

Procedure

• One hand under heel

• Other hand bottom of thigh

• DO NOT jam knee

Muscles:

• Glute max

Reasoning:

• Bi-articular muscle stretched at both joints limits both joints

  • Do hip flexion for tight hip

(Supine) Hip Manual Stretch: Flexion (Glute Max)

Procedure

• One hand under heel

• Other hand bottom of thigh

• DO NOT jam knee

• Put hand on heel and push

  • Use towel or own hands

Stretches

• posterior capsule

• stretch glute max

(Supine) Hip Flexion with Knee Extended

Procedure

• Hand on ankle

• Stabilize other hand on knee

• Put right knee on table

• Medial rotate (stretch lateral hamstring)

• Lateral rotate (stretch medial hamstring)

Stretches

• posterior capsule

• stretch hamstrings

(Supine) Hip Flexion Self Stretch SKC (Single Knee to Chest)

Procedure:

• Pull knee to chest

Stretches

• posterior capsule

• stretch glute max

(Supine) Hip Flexion Self Stretch SKC Knee Extended (Single Knee to Chest)

• Use strap or put leg on table (hinge forward)

Stretches

• Hamstring

• posterior capsule

Hip Flexion AAROM

• Heel slides

• Use strap

• Use PT assistance

Stretches:

• posterior capsule

• Glute max

(Supine) Hip Abduction/Adduction PROM

• Move UNINVOLVED side out of way

• Hand under heel

• Other hand under knee

• Bring out/in

• Push hand down

Muscles:

• Abductors

  • Glute med/min, TFL

  • Medial, inferior capsule

• Adductors

  • Longus, magnus, brevis, pectineus, gracicils

  • Superior, lateral capsule

(Side lying) IT Band Manual Stretch

• Hand on iliac

• Hand under knee

• Put hip into flexion

• “Circle” around

• Push down on leg during hip extension

Stretches:

• IT band

(Self Stretch) IT Band Stretches

First: (Supine)

• Belt

• Hamstring stretch

• let leg fall across body

Second: (Supine)

• Bend knees

• Wrap ankle around other ankle

Third: (Sidelying)

• Let leg fall off behind

Fourth: (Standing)

• Stick hip out

Stretches:

• IT band

Adductor/Groin Stretch

• Butterfly stretch

• Toes forward and lean to side

Muscles:

• Adductors

  • Longus, magnus, brevis, pectineus, gracicils

  • Medial/inferior capsule

AAROM Abduction/Adduction

• Powder board (Snow angles)

• Wrap towel around foot

• Slide foot in and out (No gravity involved)

Muscles:

• Groin

• Medial/inferior

(Supine) ER/IR (PROM)

Method 1:

• “Log rolling”

• Hand under heel and other under thigh

• IR and ER alternate

Method 2:

• “More control”

• Hand under heel and on thigh

• Flex hip to 90

• ER and IR

Good for FAI

• Flexion and abduction would irritate FAI

• Groin pain = FAI

Manual Stretch: Piriformis and External Rotators

Method One:

• “Lo”

• Supine

• Cross leg over (flex to 90)

• Hand across ASIS to hold other hip down

• Push knee

Method Two:

• “Hi”

• Hand on heel and knee

• Flex hip to 90

• Fully ER

• Push knee to other shoulder

Piriformis Self-Stretch

Stretch One:

• Bend affected knee over other knee

• Pull to chest with hands

Stretch Two:

• Have patient flex hip to 90

• Grab knee

• Pull to chest

(Prone) Hip Extension PROM

• Hand on glute and under thigh

Stretches:

• Iliopsoas

(Side-lying) Hip Extension PROM

• Hand on glute and thigh (above knee)

Stretches:

• Iliopsoas

(Prone and Sidelying) Iliopsoas Manual Stretch

• Hand on glute and under thigh

Stretches:

• Iliopsoas

• Anterior capsule

(Prone and Sidelying) Rectus Femoris Manual Stretch

• Hand on glute and under thigh

• Have patient bend knee

Stretches:

• Rectus femoris

  • Crosses both joints so gets stretched

• Anterior capsule

(Supine/Prone) Hip Self Stretch

Thomas Test

Method One: (Supine)

• Pull/push leg back

• Other leg off edge

• Keep leg straight or bend knee

Method Two: (Prone)

• Prone

• Wrap belt around ankle

• Pull knee toward back

Muscles: Iliopsoas/rectus femoris

Iliopsoas Lunge Stretch

• Lunge

Muscles:

• Iliopsoas

• Anterior capsule

Supine - Straight Leg Raise (Hip Flexion AROM)

• Supine

• Cuff weight around ankle

• Straight leg

• Flex hip

• (Bend other leg to push into table)

Muscles

• Rect fem, iliopsoas

Sitting/Standing - Marches (Hip Flexion AROM)

• Standing

• Add cuff weight

• Flex hip to 90

Muscles:

• Rect fem, Iliopsoas

Sitting/Standing - T-band (Hip Flexor AROM)

• Standing

• Can use chair for balance

• Put t-band around table

• Step forward for resistance

• Flex hip forward

Muscles

• Rect fem, iliopsoas

Glute Sets (Isometrics) (Hip Extensors) (AROM)

• Supine

• “Squeeze” butt

• Hold 10-15 seconds

Muscles

• Glutes

Standing Cuff Weight or T-band (Hip Extensors) (AROM)

• Prone

• Cuff weight on ankle

• Lift leg up - keep leg straight

• Case example (4/5 hip ext) (Straight leg)

• Case example (3/5 hip ext) (Don't use cuff weight)

Muscles

• Glute max

• Hamstrings

• Adductor magnus

• Posterior glute med

SLR Knee Flexed (AROM) (Hip extension)

• Prone

• Put ankle cuff on ankle

• Flex knee

• Extend leg up

• (Flexing knee shortens hamstrings - Active insufficiency

• Case example - 4/5 Glute - Bend knee!

• Case example (3/5 glute) (Don't use cuff weight)

• Case example (2/5 glute) (Use isometrics)

Resistance is greatest at start (Moment arm)

• (Is good because always has resistance to start)

Muscles

• Glute max

Bridge (Hip extension) (AROM)

• Supine

• Knees bent

• Thrust hips up

Muscles

• Hamstrings

• Glute max

• Adductor magnus

• Posterior glute med

Unilateral Bridge (Hip Extensors) (AROM)

• Supine

• Single leg bent

• Other leg has ankle cuff

• Thrust hips up - keep leg straight

• Brings transverse plane in

Muscles

• Hamstrings

• Glute max

• Adductor magnus

• Posterior glute med

Standing Hip Extension (AROM) (Hip extension)

• Standing

• Use cuff weight or use T-band from table

• Use table

• Kick leg backwards

• Resistance is greatest at end feel (Moment arm)

Muscles

• Hamstrings

• Glute max

• Adductor magnus

• Posterior glute med

Isometric Ball Squeezes (Adductors)

• Supine

• Squeeze ball between thighs

• Have them count out loud to prevent valsalva

2/5 Hip Adductor

Muscles

• Adductor magnus

• Adductor longus

• Adductor brevis

• Pectineus

• Gracilis

Side Lying Cuff Weight (Hip Adduction) (AROM)

• Sidelying

• Uppermost leg crossover lowermost

• Put cuff weight on lowermost leg

  • Could also put uppermost leg on chair

2/5 Grade

Muscles

• Adductor magnus

• Adductor longus

• Adductor brevis

• Pectineus

• Gracilis

Snow Angels (Hip Adduction)(AROM)

• Supine

• Pillowcase around foot

  • Gravity minimize

2/5, 2+/5, 3/5 Grade

Muscles

• Adductor magnus

• Adductor longus

• Adductor brevis

• Pectineus

• Gracilis

Standing T- Band (Adductors)(AROM)

• Standing

• Use chair

• Wrap T-band around ankle

  • Also good for hip abduction on the opposite side (keeping pelvis level)

2/5, 2+/5, 3/5 Grade

Muscles

• Adductor magnus

• Adductor longus

• Adductor brevis

• Pectineus

• Gracilis

• Glute med/glute min/TFL

Clamshells Supine (Abductor) (AROM)

• Supine

• Isometric

• Use gait belt

• Knees bent

• Push thighs out

• 10 seconds hold - 10 times

Clamshells Sidelying (Abductors)(AROM)

• Sidelying

• Both legs have bent knee

• Put T-band around

• Abduct uppermost leg

Side-Lying Cuff Weight (Abductors)(Adductors)(AROM)

• Side-lying

• Uppermost leg has cuffweight

• Flex lowermost leg for stability

• Keep knee extended and abduct leg

Active Assisted:

• Help patient leg’s up

  • Let them work eccentrically down

• Vice versa

Grade 2/5

Monster Walks (AROM)

• Muscles

  • Abductors

• T-band around thighs

• Athletic stance

• Walk sideways

  • T-band around ankles would make it harder (longer moment arm)

Seated Hip External Rotation/Internal Rotation (AROM)

• Seated

• T-Band around ankle

• For ER —> start in IR

• For IR —> start in ER

Standing Hip External Rotation/Internal Rotation (AROM)

• Standing

• Kneel on stool

• ER and IR

• Band at ankle

Good for FAI

Knee Flexion (PROM)

• Supine

• Hand under foot

• Hand under knee

Lengthens

• Vasti

• Anterior capsule

Knee Flexion Stretches

• Supine

  • Heel slide

• Prone

  • Stretches rect fem

  • Towel roll under patella

  • Hand under ankle

    • Push up to butt

Stretches:

• Vasti

• Anterior capsule

Knee Flexion Self Stretches (AAROM)

Heel Slide

• Supine

• Use gait belt

• Slide heel towards butt

Knee Extension (PROM)

• Supine

• Hand above and below knee

• Push down lightly

  • Could prop the heel with a towel

Bag Hang (Extension) (PROM)

• Prone

• Weight on ankle

• 5 minutes

AAROM assist with other LE (Extension)

• Supine

• Put leg on top of other