1. Lab 4 – Back & Pelvis Exercise Prescription Tyler Hyvarinen (0308368) Allison Pruys (0310660) Kelly Heikkila (0305975)

2. CASE STUDY # 1 Flexibility Balance & Stability Strength Agility & Coordination

3. Flexibility Exercise #1 DescriptionRepetitionsFrequencyRestExercise Mechanics Cat Stretch Have the patient knee on the floor on their hands and knees. Have patient sag their back while keeping their head up. Then have them arch their back like a cat while lowering their head. 2 repetitions Hold for 25-35 seconds until muscle seems less tense. Daily A rest of 20-30 seconds should be done in between stretches to allow muscles to relax. This exercise allows the erector spinae to elongate while arching the back. The initial sag of the back allows the muscle to relax and shorten before it is stretched.

5. Flexibility Exercise #2 DescriptionRepetitionsFrequencyRestExercise Mechanics Squatting Lower Back Stretch Have the patient grasp a bar of a table roughly at hip height. Standing arm lengths away and keeping their feet on the floor have the patient move into a squatting position keeping the arms straight. 2 repetitions Hold for 25-35 seconds until muscle seems less tense. Daily A rest of 20-30 seconds should be done in between stretches to allow muscles to relax. This stretch allows for elongation of the erector spinae while the patient is squatting. The arms create a pull on the erector spinae and back muscles and allow for a greater stretch on the back.

7. Balance & Stability #1 DescriptionRepetitionsFrequencyRestExercise Mechanics The Bird-Dog Have patient being on their hands and knees. With their back in neutral, have the patient lift one of their legs and the opposite side arm. Hold for 20 seconds and use opposite limbs. -3 sets of 5-10 repetitions on each side -Exercise should be stopped if any pain occurs 3-5 times per week 30 seconds between each set This exercise requires the patient to recruit the abdominals, back stabilizers, hip extensor and shoulder extensors. With all those muscles contracting it is good for core stability and body strength.

9. Balance & Stability #2 DescriptionRepetitionsFrequencyRestExercise Mechanics Superman Have the patient lying on their stomach on the floor with their feet together and arms extended. Have the patient simultaneously lift their upper body and legs off the floor and hold for 2 seconds. -3 sets of 5-10 repetitions -Exercise should be stopped if any pain occurs 3-5 times per week 30 seconds between each set This exercise allows the erector spinae to contract to lift the upper body and legs. This will create good core stability and strength of the erector spinae. This action is also assisted by the gluteus maximus muscles and hamstring group.

11. Strength Exercise – #1 DescriptionRepetitionsFrequencyRestExercise Mechanics Bridging The patient will lie on the floor on their back with their feet planted flat on the ground, hands at their sides. Lift the hips off of the floor until the thighs and trunk are in a straight line. To increase the difficulty, straighten one knee into full extension while hips are off the ground, then switch feet. The position is held for 15-60 seconds (depending on difficulty level and progression). Two to four repetitions should be performed. Rest approximately 30 seconds between each repetition. This exercise is great at strengthening the back extensors and abdominals, which work as antagonists. While bringing their hips off the ground, the patient is tightening the abdominals and gluteals. For the more difficult version, the lower back and other active muscles need to work at an increased level to maintain stability. The hips should not drop or roll throughout the exercise.

13. Strength Exercise – #2 DescriptionRepetitionsFrequencyRestExercise Mechanics Prone Trunk Extension The patient will kneel on the ground with the Swiss Ball under their stomach (trunk flexed approx. 30 degrees). With the hands at the sides, the patient will lift their trunk at the hips – not by curling the back backward. To increase the difficulty, the hand position can be changed to hands behind the head, or extended above the head. Weights can also be used, however this is only once the patient has increased their strength and can perform the exercise without pain. 10-12 repetitions Two to three sets.Rest approximately one minute between sets. Perform on alternate days of the week. The muscles used in this exercise are the lower back extensors and the gluteals. To raise the trunk, the patient must flex the gluteals and use the lower back muscles to stabilize (erector spinae primarily). An important note is the patient should not start in full extension because this may put stress on the intervertebral discs.

15. Agility & Coordination #1 DescriptionRepetitionsFrequencyRestExercise Mechanics Trunk Rotations (Medicine Ball) With Partner: -standing with feet shoulder width apart with back against the back of a partner, holding a medicine ball, rotate your trunk to one side (laterally) and pass the ball off to you partner. Rotate your trunk to the other side to receive the ball from your partner to complete one full circle/rotation. Individually: -in a modified supine position with you lower back resting against a stability ball, flex you knees so that they are at 90 degrees. Holding a medicine ball out perpendicular to your chest, contract you abdominals and rotate the medicine ball from side to side, keeping your pelvis in a neutral position 2 sets of 20 repetitions per side. 3-5 times per week 30 seconds between each set. This exercise is designed to work on core strength, agility and coordination, especially in the lower back. The major muscles involved are the Internal & External Abdominal Obliques (trunk rotation) as well as the Multifidus & Lumbar Rotatores (stability) It is important that the abdominals remain contracted throughout rotation and that breathing is consistent during the exercise Keeping the back straight will structure stability around proper posture

17. Agility & Coordination #2 DescriptionRepetitionsFrequencyRestExercise Mechanics Resisted Leg Lifts With the patient in a supine position on the floor or a mat the therapist stands at the patient’s head. For support the patient grabs a hold of the therapists ankles. With knees extended, and hips flexed to about 90 degrees, the patient attempts to lift their legs upward as the therapist attempts to push them back down. The exercise is performed quickly but with control. It is important that the patient’s pelvis remain in a neutral position, and that the back not arch throughout the exercise. 3 sets of 10-15 repetitions 3-5 times per week30 seconds rest in between sets The primary motion involved in this exercise is flexion at the hip. Muscles which allow for this motion are the Psoas Major and the Iliacus together forming the Iliopsoas. The Sartorius is another muscle involved in hip flexion. In order to keep the back stable and flat on the floor, this exercise works to stabilize the abdominals also allowing for the pelvis to remain in a neutral position, preventing any rotation around the vertebral column.

19. CASE STUDY #2 Flexibility Balance & Stability Strength Agility & Coordination

20. Flexibility Exercise #1 DescriptionRepetitionsFrequencyRestExercise Mechanics Single Knee-To-Chest Stretch Have the patient lying on a mat on their back. Have them try to pull on knee up to their chest trying to get the knee to the opposite shoulder. Repeat for each leg. 2 sets each held for 25-35 seconds. Daily20-30 seconds rest between each set This stretch allows for elongation for the gluteus medieus and gluteus maximus as well as the erector spinae muscles.

22. Flexibility Exercise #2 DescriptionRepetitionsFrequencyRestExercise Mechanics Press Up Have the patient lie on a mat on their stomach. Have them press up with their hands while the pelvis remains in contact with the floor. Keep the lower back and buttocks relaxed for a gentle stretch. 2 sets each held for 25-35 seconds DailyA rest of 30-45 seconds should be done between each set. This stretch allows for a stretch on the erector spinae, and multifidus muscles. The back in arched and stretched to elongate the erector spinae. The buttocks are relaxed to ensure there is no tension throughout the stretch on the sacroiliac joint.

24. Balance and Stability – #1 DescriptionRepetitionsFrequencyRestExercise Mechanics Ball Roll/Jack-knife The patient begins the exercise with their hands placed shoulder width apart on the floor, and their shins on the Swiss Ball. Then, they will roll the ball toward their hands (bringing heels to the buttocks). Repeat 7-10 times.Alternate days of the week. Rest approximately 2 seconds between each repetition. The abdominals are worked during this exercise, but also the lower back and erector spinae are stretched. Because the patient is resting on only their hands, it takes increased stability to maintain position on the Swiss Ball, especially in the position where the lower back is stretched.

26. Balance and Stability – #2 DescriptionRepetitionsFrequencyRestExercise Mechanics Pelvic Circles The patient will sit on the ball with their feet firmly on the floor and their back straight. The pelvis should remain in a neutral position. The patient will then rotate the pelvis in a clock wise motion, then switching to a counter clockwise motion. Three to five times in each direction. Perform daily to increase balance and stability. Rest if needed between repetitions. Because the pelvic and trunk muscles produce the movement (and not the legs or arms), these muscles will be worked the most. These muscles include: quadratus femoris, obturators internus and externus, gemelli superior and inferior, piriformis and gluteus maximus (external rotators) as well as gluteus minimus, medius and tensor fascia latea (internal rotators).

28. Strength Exercise – #1 DescriptionRepetitionsFrequencyRestExercise Mechanics Lunges The patient will begin standing with the feel shoulder width apart, then moves to a lunge position (one foot steps forward, and with keeping that knee behind the toes, a deep bend is achieved) – see following slide for picture. The movement should be smooth going down into the lunge, as well as back into standing position. Perform 10 – 15 lunges per leg. Alternate days of the week. Rest about 2-5 seconds between lunge. This exercise will work the abdominals, thighs (rectus femoris, vastus lateralis and medialis) and gluteal muscles. While stepping into the lunge position, the spine should be neutral and the abdominals tightened. The trunk should also be held neither flexed or rotated – working the abdominals to maintain correct position.

30. Strength Exercise #2 DescriptionRepetitionsFrequencyRestExercise Mechanics Supine Leg Lift Lying on a mat in a supine position, the patient flexes one knee to about 90 degrees keeping their foot flat on the floor. The other leg is flexed at the hip and extended at the knee with foot pointing toward the ceiling. This leg is slowly lowered keeping the spine in a neutral position and the abdominals contracted. The leg is lowered to a point where the foot remains slightly off the floor and then elevated again to a point where parallel with the opposite thigh. The arms should remain crossed over the chest however if this is too difficult for the patient, arms can rest at their sides. 3 sets of 10 repetitions per leg 3-5 times per week 30 seconds rest in between sets This exercise is designed to strengthen the lower abdominal muscles and facilitate strength and stability to provide a neutral pelvic position. The major muscles involved in this exercise are the Rectus Abdominis, the Abdominal Obliques and especially the Transversus Abdominis. As the patient lowers their leg gradually, he or she must progressively contract and tighten the abdominals to maintain a neutral pelvic position. The lower back needs to remain flat on the floor throughout the entire exercise to promote an erect neutral posture. Strengthening the abdominals may alleviate back pain, and maintaining neutral pelvic positioning will strengthen the pelvic muscles and relieve stress at the SI joint.

32. Agility & Coordination #1 DescriptionRepetitionsFrequencyRestExercise Mechanics Hip Rotation (Swiss Ball) The patient lies in a supine position on the floor with his or her lower legs (below knee) on the Swiss ball. Arms are positioned perpendicular to the trunk at the side. The patient rolls the knees from side to side as far as possible without falling off of the ball. The back should not arch throughout the motion and shoulders must remain flat on the floor. The abdominals are kept tight throughout the exercise and movement is initiated at the hips. To improve and accommodate more for agility, the patient should be instructed to rotate at a quicker speed from side to side, without compromising the mechanics and technique of the exercise. 3 sets of 20 rotations (10 to each side) 3-5 times per week 30 seconds rest in between sets This exercise is centered around the mechanics of hip rotation, and designed for strengthening of the Abdominal Oblique muscles. The use of the Swiss ball allows for the contraction of stabilizing muscles and contributes to the overall stability of the spine. This exercise is fairly low impact and ideal for individuals with low back pain. A certain amount of flexibility is also achieved through rotation at the hips.

34. Agility & Coordination #2 DescriptionRepetitionsFrequencyRestExercise Mechanics Bounce & Kick (Swiss Ball) Sitting on the Swiss ball with the pelvis in a neutral position, the patient bounces on the ball without rotating the spine or the hips. While bouncing, the patient alternates kicking out one leg and then the other (one kick/bounce). To add a greater stabilizing, agility and coordination component, the patient can simultaneously raise the opposite arm with each bounce. 3 sets of 20 repetitions (10 kicks per side) 3-5 times per week 30 seconds rest in between sets In addition to having a strong coordination component, this is also a stability exercise. Keeping the spine erect with no rotation around the vertebral column or at the hips, forces stabilization within the Erector Spinae. The pelvis remains in a neutral position to emphasize stability. Kicking the leg out with each bounce consists of flexion at the hip, activating the Psoas Major, the Iliacus and the Tensor Fascia Latae.