There are many advantages to exercising the patient in a variety of positions. These include the patient's ability to see his or her leg, adding or eliminating the effect of gravity from a motion, and putting two-joint muscles on stretch. There are also disadvantages for each position. Choose the positions that give the most advantages with the fewest drawbacks. We illustrate four of these positions.
The sitting position allows the therapist to work with the legs when hip extension is restricted by an outside force. This position lets the patient see the foot and knee while exercising. In addition, working in this position challenges the patient's sitting balance and stability. Using timing for emphasis, this is an easy way to stabilize one leg and exercise the other with reciprocal motions. The number of lower extremity exercises that you can do with your patient in sitting is limited only by the patient's abilities and your imagination. We have pictured three examples in O Fig. 8.20.
8.7.2 Leg Patterns in a Prone Position
Working with the patient in a prone position allows you to exercise the hip extension against gravity. This can be good position in which to exercise the combination of hip extension with knee flexion (O Fig. 8.21).
Be careful to restrict the motion to the hip. Do not allow the lumbar spine to hyper-extend. To help stabilize the lumbar spine you can position the patient with one leg off the table, hip flexed and foot on the floor (O Fig. 8.21 c).
The table can be used to resist hip flexion when exercising the knee extension with gravity assistance (O Fig. 8.21 d, e).
To exercise hip flexion in a prone position the patient must be positioned with the legs over the end of the table (O Fig. 8.21 f, g).
8.7.3 Leg Patterns in a Side Lying Position (O Fig. 8.22)
When working with the patient in side lying, take care that the patient does not substitute trunk motion or pelvic rolling for the leg motions you want to exercise. You may stabilize the patient's trunk with external support or let the patient do the work of stabilizing the trunk independently. In this position the abductor muscles of the upper leg and the adductor muscles of the lower leg work against gravity. This position is also useful for exercising hip hy-
perextension. Use approximation and resistance to rotation to facilitate the motion. Resisted posterior depression of the ipsilateral pelvis will help prevent hyperextension of the lumbar spine.
8.7.4 Leg Patterns in a Quadruped Position (o Fig. 8.23)
Working in this position requires that the patient stabilizes the trunk and bears weight on the arms as well as on the non-moving leg. As in the prone po-
O Fig. 8.23. Leg patterns in quadruped. c, d Extension-adduction-external rotation. e, f Flexion-adduction-external rotation. g, h Extension-abduction-internal rotation d c f e h g sition, the hip extensor muscles work against gravity. The hip flexion can move through its full range with gravity eliminated.
Do not allow the spine to move into undesired positions or postures.
8.7.5 Leg Patterns in the Standing Position (o Fig. 8.24)
Standing or a modified standing position in which patients leans on their hands can be a good position for working with the leg patterns. Resisting the strong leg in flexion-abduction stimulates stability in the hip and knee of the stance leg.
Kendall FP, McCreary EK (1993) Muscles, testing and function. Williams and Wilkins, Baltimore
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