These combinations use bilateral, asymmetrical, lower extremity patterns to exercise trunk muscles. Hold the legs together and resist them as a unit. Successful use of these combinations requires that at least one leg be strong.
You may use any knee motion with the hip patterns. The typical combination is hip flexion with knee flexion and hip extension with knee extension.
10.3.1 Bilateral Lower Extremity
Flexion, with Knee Flexion, for Lower Trunk Flexion (Right)
Position at Start
Position the patient close to the edge of the table. The patient's legs are together with the left leg in extension-abduction-internal rotation and the right leg in extension-adduction-external rotation.
Stand in a stride facing the diagonal. Lean back to elongate and stretch the pattern. As the patient's legs move up into flexion, step forward with your rear leg. Use your body weight to resist the motion.
Your left hand holds both of the patients feet with contact on the dorsal and lateral surfaces of both feet. Do not put your finger between the patient's feet. If the feet are too large for your grasp, cross one foot partially over the other to decrease the width.
Your right arm is underneath the patient's thighs. Hold the thighs together with this arm.
The trunk is extended and elongated to the left with left rotation and sidebending.
Avoid hyperextension in the lumbar spine.
Traction and rotate the legs to elongate and stretch the lower extremity and trunk flexor muscles.
Do not pull the lumbar spine into hyperextension. Command
"Feet up, bend your legs up and away. Bring your knees to your right shoulder."
As the feet dorsiflex the trunk flexor muscles begin to contract. The legs flex together, the right leg into flexion-abduction-internal rotation, the left leg into flexion-adduction-external rotation. When the legs reach the end of their range, the motion continues as lower trunk flexion with rotation and side-bending to the right.
This hand resists the trunk and hip rotation with traction back toward the starting position. Resist the knee motion with this hand as you did with the single leg patterns. If the knees remain straight, give traction through the line of the tibia. If using knee flexion, resistance to that motion will control the trunk.
Continue to hold the thighs together with this arm. Use your hand to resist rotation and lateral motion with pressure on the lateral border of the thigh. Give traction through the line of the femur.
Too much resistance to hip flexion will cause the lumbar spine to hyperextend.
The right leg is in full flexion-abduction-internal rotation, the left leg in full flexion-adduction-external rotation. The lower trunk is flexed with rotation and lateral flexion to the right.
Fig. 10.7. Bilateral lower extremity flexion with knee flexion for lower trunk flexion. a, b Supine; c, d sitting d
Fig. 10.7. Bilateral lower extremity flexion with knee flexion for lower trunk flexion. a, b Supine; c, d sitting a c
As soon as or just before the feet begin to dorsi-flex the trunk flexor muscles contract. After the hips have reached their end range, the motion continues with lower trunk flexion.
Do not allow the lumbar spine to be pulled into hyperextension. Start with the legs flexed if the trunk flexor muscles cannot stabilize the pelvis at the beginning of the motion.
Timing for Emphasis
Lock in the lower extremities in their end position. Use the legs as a handle to exercise the trunk motion. You may use static or dynamic exercises.
In the end position the legs are the handle. Only the pelvis moves while you exercise the trunk. The pivot of emphasis can be changed to trunk lateral flexion. See 7 Sect. 10.3.3.
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