Fitness Training Sterling Heights Fire Department HealthQuest Physical Therapy & Wellness Centers

CONTENTS Strength, Flexibility and Stabilization Exercises for: Upper Extremities Strength Flexibility ROM Lower Extremities Flexibility & ROM Trunk and LE’s Core/Spine Strength and Stabilization

SUGGESTED EQUIPMENT Exercise Mat Free Weights Swiss Ball Theraband (optional) Varying Surface Heights Step Box Weighted Balls (optional) Grid for Floor (create with masking tape)

TERMINOLOGY & ABBREVIATIONS UE=Upper Extremities LE=Lower Extremities ROM=Range of Motion IR=Internal Rotation ER=External Rotation EXS=Exercise SLS=Single Leg Stance TB=Theraband (Colors least tension to greatest: yellow, red, green, blue, black, grey) 90/90=90˚ position of bend at the hip and knee joints. Keep joint “soft”=slight bend, joint not locked or fully extended. Prone=Position on stomach. Supine=Position on back.

TERMINOLOGY & ABBREVIATIONS RTC=Rotator cuff, group of endurance muscles around the scapular and shoulder joints. Hip Hinge=Squat position with neutral spine, bend occurs through hips and knees; knees behind toes. APT=Anterior Pelvic Tilt; forward tilt of the pelvis which increases the low back curvature. PPT=Posterior Pelvic Tilt; backward tilt of pelvis which decreases/flattens the low back curve. BOS=Base of support, position of LE and foot contact with ground. “Set the scapula”=Prior to the exercise movement, stabilize the shoulder blades by pulling inward/together and slightly down.

GENERAL EXERCISE GUIDELINES NOTE: If you experience pain, question technique, need help with program development, design or progression, seek help from a Peer Fitness Trainer in your department. For further assessment of pain or to clarify exercise, contact a physical therapist at HQ (see contact list). If at any time while performing the exercises you experience atypical musculoskeletal pain or discomfort, chest pain, lightheadedness, confusion, clamminess or any other abnormal symptom please immediately stop the exercise and seek professional help. TRAINING RECOMMENDATIONS: Exercise most days of the week. Include all training components for a balanced program: cardiovascular (aerobic and anaerobic), strength training and flexibility/ROM. If you participated in the fitness testing program, spend more time in the areas which showed deficit or were rated average or below. OPTIMIZE in 45: You have a 45 minute window post workout where your body uses food and nutrients optimally, refuel your body with 4:1 ratio of good carbohydrates to protein (good carbs=fruit, vegetables, etc.).

GENERAL EXERCISE GUIDELINES CARDIOVASCULAR: Research shows that fire fighters must be able to work at a VO2max ≥ 42 ml/kg/min. See the Gerkin protocol and VO2max conversion table in the reference section of the manual. Work at MET levels 11+ (See reference section for MET information). Do an adequate warm up and cool down (i.e. warm up with lighter version of activity plan to partake in); at least 5-10 minutes recommended. Perform cardiovascular training for 30+ minutes/day. Due to the physical demands of fire fighting, train at 70-100% of your Maximal Heart Rate (220-AGE). (Target Heart Rate=MAX HR x desired % work at). Use variety with aerobic training to challenge the cardiovascular system. Incorporate both aerobic and anaerobic training. Examples of anaerobic exs: biking with frequent hills, basketball, circuit training with high intensity spurts. Your anaerobic threshold may change each exercise session. To determine this, take 10-15 minutes to increase your HR and reach the point where you must breath through your mouth, drop jaw, and speak short word sentences. Use this HR or feeling to guide training that day. If you exercise within 30 BPM below this level, you will burn fat and some sugar, if you exercise above this level you will burn mostly sugar.

GENERAL EXERCISE GUIDELINES STRENGTH: Choose at least one exercise for each major muscle group. Consider the speed of the exercise, lifting at a slower pace requires a more even application of muscle force throughout the ROM. Consider the type of muscle contraction you are performing (most difficult to least: Eccentric>Isometric>Concentric). Start with 3 sets of 8-12 reps, adjust the weight based on goals of the muscle group or 70-80% of maximum resistance. Increase the weight when the muscles adapt or the exercise is not fatiguing by the last rep. For endurance muscles (i.e. RTC) do increased reps with less weight, for strength (i.e. chest) do fewer reps with heavier weights. Be sure to use proper technique. You may need to decrease weight in order to perform the exercise properly and minimize momentum or use of uninvolved body parts. Schedule strength workouts to avoid working the same muscle groups on consecutive days.

GENERAL EXERCISE GUIDELINES FLEXIBILITY: Perform a moderate stretch, hold ~30 sec., do 2-3 reps on each major muscle group post workouts. Focus more time on muscle groups which had greater deficits with testing to create balance around joints and avoid injury. For tight muscles requiring an increase in ROM at a joint, do a prolonged stretch, hold 3-5 + minutes. Stretches can be both static (those shown in manual, nonmoving) and dynamic (moving/active). Determine the muscle to stretch, its functional use and use the appropriate type of stretch. If you are short on time, use stretches which incorporate multiple muscle groups (i.e. triangle, down dog, etc.).

MUSCULAR STRENGTH UPPER EXTREMITIES Sidelying ER Pushouts Theraband IR/ER Empty Can Hand in Pocket Standing Rows Serratus Modified Push-Ups Scapular T’s and Y’s Sidelying Horizontal Abduction Shoulder Diagonals Wrist Flexion and Extension

SIDELYING EXTERNAL ROTATION Target Muscles: Rotator Cuff (Infraspinatus, Teres Minor) Start Position: Lying on side with knees bent, shoulder hip and elbow in straight line, elbow bent 90˚, forearm parallel to floor, wrist neutral, towel roll between upper arm and trunk. Movement: Set the scapula, keep arm at side, rotate shoulder by bringing hand toward ceiling maintaining the 90˚ elbow bend. Progression: Increase weight, increase ROM (< 90˚).

PUSH-OUTS Target Muscles: RTC (Supraspinatus), Middle Deltoid Start Position: Standing, arms in front of thighs, palms facing body, wrists neutral, holding TB or free weight. Movement: Set the scapula, push arms to side 3-5 inches. Progression: Increase weight or resistance of TB.

EMPTY CAN Target Muscles: Rotator Cuff (Supraspinatus) Start Position: Standing, arms by side holding weights with thumbs facing downward. Movement: Set the scapula, lift the arms at 45˚ angle to ≤ shoulder height parallel to floor; avoid elevating/shrugging the shoulders. Progression: Increase weight.

THERABAND- EXTERNAL ROTATION Target Muscles: Rotator Cuff (Infraspinatus, Teres Minor) Start Position: Standing, upper arm by side, towel roll between UE and trunk, elbow bent 90˚, wrist neutral, holding TB (attached to wall on opposite side of exs arm). Movement: Set the scapula, maintain 90˚ elbow bend, rotate hand outward away from body<90˚. Progression: Increase ROM (≤90˚), increase TB resistance.

THERABAND-INTERNAL ROTATION Target Muscles: Rotator Cuff (Subscapularis) Start Position: Standing, upper arm by side, towel roll between UE and trunk, elbow bent 90˚, wrist neutral, body at 45˚ angle from wall holding TB (attached to wall on same side as exs arm). Movement: Set the scapula, maintain 90˚ elbow bend, rotate hand inward toward the body. Progression: Increase TB resistance.

HAND IN POCKET Target Muscles: Shoulder Internal Rotators (Subscapularis) Start Position: Standing, hand placed in small of back, set the scapula, forearm parallel to floor, elbow bent to 90˚. Movement: Lift hand off small of back maintaining 90˚ bend at elbow. Hold 5 seconds, repeat 10 times.

STANDING ROWS Target Muscles: Rhomboids, Middle Trapezius Start Position: Feet and hands shoulder width apart, grasp bar or other resistive equipment, hinge at hips, neutral spine, draw abdominals in, set the scapula. Movement: Draw the arms back until elbows in line with trunk, maintain set scapula, squeeze blades together; avoid elevating/shrugging shoulders. Progression: Increase weight, change hand hold (widen or narrow).

SERRATUS MODIFIED PUSHUPS Target Muscles: Serratus Anterior Start Position: Push-up position, hands shoulder width apart, body on incline, flat back/neutral spine. Movement: Draw in abdominals, drop chest in and allow shoulder blades to come together, press back up and separate shoulder blades. Progression: Use lower surface height, progress to floor.

SCAPULAR Y’S Target Muscles: Rhomboids, Middle and Lower Trapezius Start Position: Lie prone over ball, tuck chin, lift chest, arms extended, down at floor, thumbs up. Movement: Set the scapula, lift the arms straight up at 45˚ angle until in line with trunk. Progression: Add weight, balance single leg.

SCAPULAR T’S Target Muscles: Rhomboids, Middle Trapezius Start Position: Lie prone over ball, tuck chin, lift chest, arms extended and down at floor, thumbs up. Movement: Set the scapula, lift the arms out to side at 90˚ angle until in line with trunk. Progression: Add weight, balance on one leg.

SIDELYING HORIZONTAL ABDUCTION Target Muscles: Rhomboids, Posterior Deltoid Start Position: Lying on side, knees bent, neutral trunk, hips in line with shoulders, arm straight out 90˚and parallel to floor. Movement: Set the scapula, lift arm up toward ceiling until perpendicular to floor. Progression: Increase weight.

SHOULDER DIAGONALS Target Muscles: Shoulder and UE rotators Start Position: Sitting on ball, feet shoulder width apart, arm near straight, soft elbow, arm across body, thumb down holding weight. Movement: Set the scapula, keep arm near straight, lift arm on a diagonal up across body to the opposite side and overhead turning thumb up. Progression: Increase weight, balance on single leg.

SHOULDER DIAGONALS Target Muscles: Shoulder and UE rotators Start Position: Sitting on ball, feet shoulder width apart, arm at side 45˚angle, near straight, elbow soft, thumb facing out to side holding weight. Movement: Set the scapula, keep arm near straight, lift arm on a diagonal up across body to the opposite side and overhead turning thumb up, palm facing body. Progression: Add weight, balance on single leg.

WRIST FLEXION Target Muscles: Wrist Flexors (Flexor Carpi Ulnaris and Radialis) Start Position: Standing, arm by side, elbow bent 90˚, wrist neutral, palm facing up, holding weight, scapula set. Movement: Bend wrist and bring hand toward ceiling, maintain UE position. Progression: Increase weight, stand on one leg or uneven surface.

WRIST EXTENSION Target Muscles: Wrist Extensors (Extensor Carpi Ulnaris and Radialis) Start Position: Standing, arm by side, elbow bent 90˚, wrist neutral, palm facing down, holding weight, scapula set. Movement: Bend wrist and bring hand toward ceiling, maintain UE position. Progression: Increase weight, stand on one leg or uneven surface.

FLEXIBILITY UPPER EXTREMITIES IR Stretch Pectoral Stretch Doorway or Corner Doorway Stretch Shoulder Elevation-Flexion and Abduction Latissimus Stretch

SHOULDER INTERNAL ROTATION STRETCH Target Area: Shoulder Joint, External Rotator Muscles Start Position: Lie on side of stretch arm, body at ¾ turn, trunk neutral, arm at 45-70˚ angle from trunk, elbow bent 90˚, top hand on wrist/forearm. Movement: Gently pushup UE downward until feel moderate stretch in shoulder, maintain 90˚ elbow bend; hold 30 sec., do 2-3 reps. Progression: Bring stretch arm to 90˚/shoulder height.

PECTORAL STRETCH-DOORWAY Target Muscles: Pectoralis Major/Chest Start Position: Arms on both sides of wall at entrance to door, staggered stance lunge position, neutral spine. Movement: Move body forward through doorway by distributing weight to front leg until feel moderate stretch in chest; hold 30 sec., do 3 reps. Progression: Raise or lower arm position.

SHOULDER OVERHEAD STRETCH -DOORWAY Target Area: Shoulder Joint, Extensor and Rotator Muscles Start Position: Stretch arm overhead on side or top of door frame, LE staggered stance. Movement: Move body forward through doorway by distributing weight to front leg until feel moderate stretch in shoulder or reach end range; hold 30 sec., do 3 reps. Progression: Raise arm position until perpendicular to floor.

LATISSIMUS STRETCH Target Muscles: Shoulder Extensors, Upper Back Start Position: Hands and knees, neutral spine. Movement: Push bottom back toward heels, stretch arms overhead and slightly to side until feel moderate stretch in shoulder and upper back; hold 30 sec., do 3 reps. Progression: Vary UE position by moving arms closer or further away to increase stretch.

RANGE OF MOTION UPPER EXTREMITIES Pendulum Pulleys Cane (Supine and Stand)

PENDULUM Target Area: Shoulder Joint Start Position: Bend trunk forward, support body weight with UE on wall, let exercise arm hang, keep it relaxed. Movement: Shift body to create small circles with the exercise arm; this allows shoulder distraction and increased blood flow to joint; do 25 reps or as needed for symptom relief.

ROM-PULLEY FLEXION Target Area: Shoulder Joint and Surrounding Muscles Start Position: Seated, back against wall, hands on pulley handles, involved arm straight with thumb up resting on knee. Movement: Use opposite arm to elevate arm in front of body and overhead until feel moderate stretch or reach end range; hold 10 seconds, repeat 10 times.

ROM-PULLEY SCAPTION Target Area: Shoulder Joint and Surrounding Muscles Start Position: Seated, back against wall, hands on pulley handles, involved arm straight with thumb up resting on knee. Movement: Use opposite arm to elevate exs arm at 45˚ angle from body overhead until feel moderate stretch or reach end range; hold 10 seconds, repeat 10 times. Progression: Move arm out toward side, continue until hand is close to wall through-out the ROM.

ROM-PULLEY INTERNAL ROTATION Target Area: Shoulder Joint and Surrounding Muscles- Focus-Rotators Start Position: Standing, hands on pulley handles (or ends of towel), involved arm in small of back, opposite arm in front of body. Movement: Use opposite arm to lift hand behind back upward until feel moderate stretch or reach end range; hold 10 seconds, repeat 10 times.

CANE RANGE OF MOTION-FLEXION Target Area: Shoulder Joint and Surrounding Muscles Start Position: Lie on back, hold cane/pole with hands slightly wider than shoulder width, arms extended, palms facing one another, thumbs facing up to ceiling. Movement: Lift arms overhead toward ears, keeping them straight, until feel moderate stretch in shoulder or reach end range (~180˚); hold 5 sec., repeat 15 times. Progression: Perform in standing.

CANE RANGE OF MOTION- EXTERNAL ROTATION Target Area: Shoulder Joint and Surrounding Muscles-Focus Rotators Start Position: Lie on back, hold cane/pole with hands, the exercise arm at 45˚ angle from trunk, elbow bent to 90˚, palm facing inward, thumb up. Movement: Maintain the 90˚ elbow bend, rotate the exs arm back and down until feel moderate stretch in the shoulder or reach end range (≤90˚); hold 5 sec., repeat 15 times. Progression: Perform in standing.

CANE RANGE OF MOTION-SCAPTION Target Muscles: Shoulder Joint and Surrounding Muscles Start Position: Lie on back, hold cane/pole with hands slightly wider than shoulder width, exs arm extended, hand at end of cane with thumb facing up toward ceiling. Movement: Keep exs arm straight, lift up and overhead at 45˚ angle until feel moderate stretch in shoulder or reach position parallel to floor; hold 5 sec., repeat 15 times. Progression: Perform in standing.

MUSCULAR STRENGTH LOWER EXTREMITIES Box Step Downs Side Stepping Squats-Swiss Ball Multi-directional Lunges Single Leg Balance-Multidirectional Reach Hip Extension Heel Raises Wall Slide-Abduction 90/90 Wall Bridge 90/90 Heel Tap 90/90 Pistoning Sidelying Hip ER Sidelying Knee-to-Knee Sidelying Hip Adduction Hip Hinge

WALL SLIDE Target Muscles: Gluteus Medius Start Position: On side with hips and shoulders square against wall, bottom knee bent, top knee straight, toes facing down. Movement: Lean top hip slightly forward and slide heel up wall ~45˚, be sure movement occurs at hip vs. torso. Progression: Add cuff weight or TB resistance.

90/90 WALL BRIDGE Target Muscles: Hamstring Start Position: Lie on back, feet on wall, hips and knees 90˚/90˚. Movement: Squeeze bottom to create slight PPT, pull down with back of thigh/hamstring and feet to lift bottom 1 inch off surface. Hold 10 seconds, do 10 reps., 2-3 sets.

90/90 HEEL TAP Target Muscles: Hamstring Start Position: Lie on back, feet on wall, hip and knee of one LE 90˚ bend, other LE knee straight, pelvis level, heel on wall. Movement: Squeeze bottom to create slight PPT, pull down with back of thigh/hamstring and feet to lift bottom 1 inch off surface, tap the heel of the straight leg on the wall then lift away ~6 inches, maintain a level pelvis; repeat 10 times, do 3 sets.

90/90 PISTONING Target Area: Pelvic and hip ROM Start Position: Lie on back, feet on wall, hips and knees 90˚/90˚. Movement: Squeeze bottom to create slight PPT, pull down with back of thigh/hamstring and feet to lift bottom 1 inch off surface, shift left hip down toward surface; repeat 10 times, do 2-3 sets both LE’s.

SIDELYING HIP EXTERNAL ROTATION Target Muscles: Hip External Rotators (Piriformis, Obturator Internus) Start Position: Lie on side, hips and knees bent to 90˚, feet on wall, shoulders and hips in line, roll top hip slightly forward. Movement: Draw the abdominals in, keep the pelvis and trunk stable, lift the top knee up toward the ceiling keeping feet together and on wall. Progression: Add weight to top leg or TB resistance.

SIDELYING KNEE-TO-KNEE Target Muscles: Inner Thigh, Hip Internal Rotators and Adductors Start Position: Lie on side, hips and knees bent to 90˚, feet together, shoulders and hips in line, roll top hip slightly forward. Movement: Draw the abdominals in, keep the pelvis and trunk stable, top hip slightly forward, lift the top knee and hold this position, lift the bottom knee up to the top keeping feet together. Progression: Add cuff weight to bottom leg.

SIDELYING HIP ADDUCTION Target Muscles: Inner Thigh-Hip Adductors Start Position: Lie on side, hips and knees straight, top foot resting on elevated surface (i.e. chair), other LE on floor, shoulders and hips in line. Movement: Draw the abdominals in, keep the pelvis and trunk stable, lift the bottom leg up to the top; hold 5 seconds, repeat 10 times, 2-3 sets. Progression: Lift the pelvis and hips off the surface prior to lifting the bottom leg, maintain hip position thoughout exs.

HIP HINGE Target Area: Spine and Pelvis Start Position: Standing, neutral spine. Movement: Perform a mini squat, bend through hips and knees, maintain neutral spine. Progression: Increase ROM with squat, add UE weight.

STEP BOX- 3 WAY STEP DOWNS Target Muscles: Quadriceps Start Position: Standing, one foot on step box, other hanging to side. Movement: Bend the knee of foot on the step box, lower the other leg bringing it forward, to the side, then back (3 directions = 1 rep), keep knees behind toes. Progression: Use higher step box, perform deeper squat/step down.

SIDE STEPPING WITH RESISTANCE Target Muscles: Buttocks, Hip Abductors (Gluteus Medius) Start Position: Standing hip hinge/mini squat, TB around ankles. Movement: Step to side against resistance maintaining squat position, maintain tension in TB. Progression: Take larger steps; increase TB resistance; stand on one leg with TB around ankles, perform repeated reps on one side.

SQUATS-SWISS BALL Target muscles: Quads, Gluts Start position: Standing with feet shoulder width apart and ~4 ft. from wall, ball positioned comfortably in the low back curve. Movement: Keep a neutral spine/anterior tilt and abdominals drawn in, perform a squat by bending the hips and knees to ≤ 90°, keep knees behind toes. Progression: Perform single leg squat.

MULTI-DIRECTIONAL LUNGES Target Muscles: Quads, Buttocks Start Position: Standing near center of grid. Movement: Step forward and shift weight onto one LE along a grid line, keep trunk and hips facing forward as change LE position, keep knees behind toes. Progression: Take larger steps/lunge further, add UE weights or reach.

SINGLE LEG BALANCE LOWER EXTREMITY MULTI-DIRECTIONAL REACH Target Muscles: Quads, Buttocks Start Position: Stand on single leg. Movement: Bend the stance leg and reach the other LE outward along a grid line without touching the floor, keep the hips facing forward as the LE position changes, keep knees of stance leg behind toes. Progression: Rotate body on stance leg to face the direction of the LE reach.

HIP EXTENSION Target Muscles: Gluteus Maximus, Hamstring Start Position: Lie prone over ball, keep one leg on floor, turn foot inward on exs leg. Movement: Draw abdominals in, squeeze buttocks, lift one LE up until parallel to floor, maintain inward foot turn. Progression: Lift both LE’s simultaneously, add cuff weight.

HEEL RAISES Target Muscles: Calves (Gastroc, Soleus) Start Position: Toes/front part of foot on step box, hand on wall for support if needed. Movement: Lift heels upward shifting weight onto balls of feet, keep LE straight. Progression: Hold UE weights.

FLEXIBILITY/ROM TRUNK & LOWER EXTREMITIES Hamstring-Doorway Iliopsoas (stand and ½ kneel) Piriformis/Hip External Rotators Triangle Reverse Triangle Down Dog Warrior 1 Scissoring

FLEXIBILITY-HAMSTRING STRETCH Target Muscles: Hamstring Position: Lie on back between door entrance, stretch leg straight on wall, foot straight ahead and ankle bent down. Progression: Turn foot inward to focus on the outer part of the muscle, turn foot outward to stretch the inner part of the muscle, move closer to wall to increase overall stretch.

FLEXIBILITY-ILIOPSOAS STRETCH Target Muscles: Iliopsoas, Hip Flexors Position: Standing in lunge position, stretch leg back, draw abdominals in/PPT, back leg turned inward with heel down and out, lower body down until feel moderate stretch across front of stretch hip. Alternate position: Half kneeling, same hip position as above, stretch leg back and turned inward, PPT, heel/lower leg turned out. Progression: Increase squat/lower body, progress body forward as a unit, increase inward rotation of stretch leg, lean trunk to opposite side of stretch leg.

FLEXIBILITY-HIP ROTATOR STRETCH Target Muscles: Hip External Rotators, Gluts Start Position: Hands and Knees Stretch Position: Stretch leg forward, UE’s on surface, knee bent to comfort, back leg extended straight, neutral spine, abdominals drawn in, lower body toward ground until feel moderate stretch in hip of front leg. Progression: Rotate stretch leg until lower leg is perpendicular to body, bend elbows and lower trunk toward floor.

FLEXIBILITY-HIP ROTATOR STRETCH Target Muscles: Hip External Rotators, Gluts Position: Lie on back, knees bent, place ankle of stretch leg over other knee, draw abdominals in, gently press knee down until feel moderate stretch in hip. Progression: Increase bend in hip opposite of stretch leg, i.e elevate supportive leg onto step box.

FLEXIBILITY-TRIANGLE Target Muscles: Trunk, Buttock, Hamstring and Inner LE Position: Stand in staggered stance, stretch leg forward, hinge forward at hips to bring same side arm to lower leg (higher up leg easier), arms in line and perpendicular to floor, scapula set, abdominals drawn in, knees soft, back foot on 45° angle; hold moderate stretch for 30 sec., do 2-3 reps. Progression: Lower hand to floor, open chest and pelvis to face outward, raise top arm overhead toward ear.

FLEXIBILITY-REVERSE TRAINGLE Target Muscles: Trunk, Buttock and Outer LE Position: Stand in staggered stance, stretch leg forward, hinge forward at hips to bring opposite side arm as stretch leg to lower leg (higher up leg easier), arms in line and perpendicular to floor, scapula set, abdominals drawn in, knees soft, back foot on 45° angle; hold moderate stretch for 30 sec., do 2-3 reps. Progression: Lower hand to floor, open chest and pelvis to face inward, raise top arm overhead toward ear.

FLEXIBILITY-DOWN DOG Target Muscles: Calves (Gastroc, Soleus), Hamstring Position: Start on hands and knees, pushup into straight leg position, hinge through hips, neutral spine, feet point straight, heels on ground, elbows soft; hold moderate stretch 30 sec., do 2-3 reps. Progression: Bring hands closer to feet, maintain neutral spine hip hinge.

FLEXIBILITY-WARRIOR 1 Target Muscles: Hip Flexors Position: Assume a lunge position with stretch leg back, front leg knee bent to 90˚, back foot at 45˚ angle, back knee soft, draw abdominals in/PPT, squeeze buttocks, hold moderate stretch on front part of stretch leg 30 sec., do 2-3 reps. Progression: Progress body forward as a unit, lower body down, maintain PPT.

SCISSORING Target Area: Pelvic ROM Start Position: Lie on side, hips and knees bent to 90˚, feet on wall, shoulders and hips in line, place towel roll between legs (optional). Movement: Draw the abdominals in, keep the trunk stable, feet on the wall, shift the top leg backward along the line of the thigh bone.

MUSCULAR STRENGTH CORE/SPINE Ab Roll LE’s on Ball Ball Walk-Outs Deep Squat with UE Weights Deep Squat to Weighted Overhead Lift Hip Hinge UE Crossed Row Hip Hinge Runner Arms Hip Hinge UE Reach with Weights SLB UE Rotational Reach ½ Kneel UE Rotational Reach Wall Angel Pelvic Tilt Hip Hike Bridge Plank Side Plank Alternating UE/LE-Ball Superman-Ball Abs-Ball Abs-Ball with Resistance Ab Roll UE’s on Ball

POSTURAL WALL ANGEL Target Muscles: Postural muscles that hold body erect. Start Position: Standing against wall, feet shoulder width apart, palms facing forward. Movement: With moderate pressure, press into the wall with the: head, shoulders, set the scapula, back of hand, abdominals in, buttock squeezed, thighs tensed, ankles toward one another; hold for 10 seconds, repeat 10 times.

POSTURAL WALL ANGEL -PROGRESSION Target Muscles: Postural muscles that hold body erect. Start Position: Standing against wall, feet shoulder width apart, arms at shoulder height, elbows bent to 90˚, palms facing forward. Movement: With moderate pressure, press into the wall with the: head, shoulders, set the scapula, back of hand, abdominals in, buttock squeezed, thighs tensed, ankles toward one another; hold for 10 seconds, repeat 10 times.

POSTERIOR PELVIC TILT Target Area: Pelvic ROM, Abdominal and Buttock Muscles Start Position: Lie on back, knees bent to 90˚. Movement: Draw abdominals in, exhale and squeeze buttocks to create PPT/flatten back.

HIP HIKE Target Muscles: Muscles that Lift the Pelvis/Sidebend (Quadratus Lumborum) Start Position: Standing one foot on step box, stance knee soft, other leg hanging to side. Movement: Draw abdominals in, keep pelvis facing forward, lift exs hip up toward same side shoulder. Progression: Add cuff weight to ankle of hanging leg.

BRIDGE – SWISS BALL Target Muscles: Hip Extensors (Gluteus Maximus) Start Position: Upper back on ball, feet shoulder width apart, bottom down, low back supported by ball curve. Movement: Draw the abdominals in, squeeze the buttocks and lift up until parallel to floor, hold 5 sec., repeat 10 times, 3 sets. Progression: Use single leg balance, place weight in UE’s.

PLANK Target Muscles: Core, Trunk Stabilizers (Abdominal and Back Muscles) Exercise position: Assume a position parallel to the floor placing the elbows directly under the shoulders, weight through toes, abdominals drawn in and trunk stable; hold this position for ≤30 sec., do 5-10 reps. Progression: Alternate leg lift maintaining neutral spine and stable trunk position, increase hold time.

SIDE PLANK Target Muscles: Trunk and Shoulder Stabilizers, LE’s Start Position: Sidelying, feet stacked, one arm by side, other hand on floor. Movement: Draw abdominals in, keep hips and shoulders in line, straighten arm to lift body off surface, outside of bottom foot in contact with floor. Progression: Lift top arm up toward ceiling, lift top leg up toward ceiling, maintain stable trunk position.

4-POINT ALTERNATING ARM & LEG-SWISS BALL Target Muscles: Trunk and Hip Extensors (Erector Spinae and Gluteus Maximus) Start Position: Lie stomach on ball, feet and hands in contact with ground, neutral spine. Movement: Draw abdominals in, keep neutral spine, lift opposite arm and leg until parallel to floor; hold 5 sec., do 10 reps, 2-3 sets. Progression: Add cuff or UE weights, lessen area of contact, hold position longer.

SUPERMAN-SWISS BALL Target Muscles: Trunk and Hip Extensors (Erector Spinae and Gluteus Maximus) Start Position: Lie stomach on ball, feet and hands in contact with ground, neutral spine. Movement: Draw abdominals in, keep neutral spine, lift trunk upward toward ceiling; hold 5 sec., do 10 reps, 2-3 sets. Progression: Add UE weights, balance on single leg, hold position longer.

ABS-SWISS BALL Target Muscles: Abdominals Start Position: Lie on ball, low back supported by ball curve, feet shoulder width apart, hands cupped behind ears. Movement: Draw abdominals in, lift trunk upward to 45˚ angle. Progression: Balance on single leg, use UE weights, roll backward on ball to increase trunk lever arm, increase ROM.

ABS-SWISS BALL WITH RESISTANCE Target Muscles: Abdominals Start Position: Lie on ball, low back supported by ball curve, feet shoulder width apart, hold free weight overhead with arms extended. Movement: Draw abdominals in, bring UE’s forward and lift trunk upward to 45˚ angle. Progression: Balance on single leg, increase UE weight, roll backward on ball to increase trunk lever arm, increase ROM.

AB ROLL UE’S ON SWISS BALL Target Muscles: Abdominals Start Position: Kneeling, elbows and forearms on ball, neutral spine. Movement: Draw abdominals in, roll ball forward until trunk and hip are in a line/straight, hold 10 sec., do 10 reps. Progression: Lift feet off floor balance on knees, lift knees off surface at end range so weight is supported on toes, increase balance time, use single leg balance.

AB ROLL LE’S ON SWISS BALL Target Muscles: Trunk Stablizers, Abdominals Start Position: Hands on floor, lower legs supported by ball, neutral spine, scapula set, abdominals drawn in. Movement: Maintain stable trunk, abdominals in, bend hips, roll knees up an in. Progression: Start with feet contacting ball.

BALL WALK-OUTS Target Muscles: Scapular and Trunk Stabilizers Start Position: Stomach on ball, arms and legs in contact with floor, neutral spine. Movement: Set the scapula, keep stable trunk and neutral spine, walk UE’s forward until ball contacts lower leg. Progression: Stop at end and balance on one UE, alternate leg lift from ball, do push-ups at end range.

DEEP SQUAT WITH UE WEIGHTS Target Muscles: Quadriceps, Buttocks, UE’s Start Position: Standing, feet shoulder width apart, weights in hands. Movement: Perform a squat hip hinge (≤ 90˚), maintain neutral spine, lift UE’s forward or to the side at shoulder height. Progression: Stand on uneven surface, stand in SLS, increase UE weights.

DEEP SQUAT TO WEIGHTED OVERHEAD LIFT Target Muscles: Quadriceps, Buttocks, UE’s Start Position: Standing, feet shoulder width apart, weights in hands. Movement: Maintain a neutral spine, perform a deep squat, use hip hinge, weights in front of body, progress to standing with weights stomach height to overhead lift. Progression: Increase UE weight, use SLS with smaller range squat.

HIP HINGE CROSSED ROW Target Muscles: Upper Back, Scapular Stabilizers (Rhomboids, Trapezius) Start Position: Hip hinge, neutral spine, feet shoulder width apart, holding TB in each hand. Movement: Set the scapula, perform a row, pull elbows back by trunk to 90˚ bend. Progression: Alternate UE row, increase TB resistance, stand on single leg.

HIP HINGE RUNNER ARMS Target Muscles: Trunk Stabilizers/Core Start Position: SLS, hip hinge, neutral spine, weights in hands, one arm extended to front and other pulled back in a row position, elbow at 90˚ bend. Movement: Maintain neutral spine, alternate UE position one forward and straight, the other pulled back. Progression: Stand on uneven terrain, increase UE weight, increase hip hinge squat.

HIP HINGE SQUAT UE REACH WITH WEIGHT Target Muscles: Trunk Stabilizers/Core Start Position: Hip hinge mini squat, neutral spine, feet shoulder width apart, hold weight at stomach level. Movement: Draw abdominals in, maintain neutral spine, extend arms out holding weight. Progression: Increase weight, assume SLS.

½ KNEEL UE ROTATIONAL REACH Target Muscles: Trunk Stabilizers, Core Start Position: ½ kneeling, abdominals drawn in, UE’s holding weight down and inside knee on surface. Movement: Maintain neutral spine and stable LE’s, lift UE’s on a diagonal up and over the opposite shoulder. Progression: Assume standing position, increase UE weights, increase UE ROM.

SINGLE LEG BALANCE UE ROTATIONAL REACH Target Muscles: Trunk Stabilizers/Core Start Position: SLS, hip hinge, abdominals drawn in, UE’s holding weight down and inside stance leg. Movement: Maintain neutral spine, lift UE’s on a diagonal up and over the opposite shoulder. Progression: Stand on uneven terrain, increase ROM with UE’s, increase UE weight.