Today s session. Common Problems in Rehab. LOWER BODY REHAB ESSENTIALS TIM KEELEY FILEX 2012

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1 Tim Keeley B.Phty, Cred.MDT, APA Principal Physiotherapist physiofitness.com.au facebook.com/physiofitness Today s session Essential list for the lower body Rehab starting point Focussing on activation, function, strength and control Flexibility is paramount Emphasis on correction of posterior chain Apply principles to training This is not a core workshop 11 exercises, (2 videos, 9 practical - 3 x 3) Common Problems in Rehab Exercising with pain or inflammation Exercising with tissue damage The threat messaging system Muscle inhibition Compensation patterning Muscle tightness and weakness Left vs right, stance leg Using the wrong exercises Doing the right ones wrong!

2 Problems in Lower Body Rehab CORE Breathing and pelvic floor GLUTES Poor hip / pelvis stabilisation QUADS Deactivation of the VMO ITB Muscle and fascia tightness TECHNIQUE Poor awareness bending Maintaining Neutral The spine is meant to move Must be keep stable Teaching of neutral is crucial Prevention of injury Learn where it is Teach others correctly No neutral = no success Maintaining Neutral How much lordotic spinal curve? Pelvic position through movement Weak muscles, tight muscles Underactive / over active muscles Pelvic floor and breathing out Bracing and breath-holding Pivot point of the hip joint Separation of the hips spine Squat to stand movement basis to many exercises

3 Single Leg Prone Glutes Single Leg Prone Glutes Used for: glute activation, SIJ and lower back rehab, building strength in neutral / awareness, hamstring / lumbar extensor balance Watch for: lower back hyperextension, hamstring spasm, pelvic tilt, breath holding, switching off of glutes, one sided weakness Cues: Posterior tilt, plank for abs, push down through arm, clench buttock, slowly raise straight leg, don t arch back. Alternatives: supine glute squeeze, clams Progression: increase isometric hold time, increase leg height Do instead of:? single leg hip extension machine! Cautions: lack of glut activation in leg raise, overactivity of hamstring. Glute Bridge

4 Glute Bridge Used for: glute activation, SIJ and lower back rehab, building strength in neutral / awareness, hamstring / lumbar extensor balance, closed chain glutes (progression from prone glutes) Watch for: lower back hyperextension, hamstring spasm, pelvic tilt, breath holding, switching off of glutes, one sided weakness Cues: push down through heels, posterior tilt, clench buttocks, slowly roll up spine, don t arch back. Alternatives: half-range, glute squeeze and tilt only Progression: increase isometric hold time, theraband around knees, legs on ball Do instead of: normal bridges Cautions: lack of glut activation, overactivity of hamstring BOSU Hip Extension BOSU Hip Extension Used for: glute activation, SIJ and lower back rehab, building strength in neutral / awareness, hamstring / lumbar extensor balance, closed chain glutes, posterior chain correction Watch for: lower back hyperextension, pelvic tilt, breath holding, switching off of glutes, raising of knees Cues: posterior tilt, clench buttocks, slowly tilt back pelvis, dig pubis into BOSU, raise up with long spine, shoulders down and back, don t arch back / lengthen lower back, shorten back of legs Alternatives: over pillows Progression: increase isometric hold time, add in scapula work Do instead of: hip extension machine Cautions: lack of glut activation, tightness in lumbar spine, overactivity of lower back

5 Ball Hip Extension Ball Hip Extension Used for: glute activation, SIJ and lower back rehab, building strength in neutral / awareness, hamstring / lumbar extensor balance, closed chain glutes and hamstrings, postural strengthening, posterior chain correction, pre-cursor to thrust technique in squat and deadlift Watch for: lower back hyperextension, pelvic tilt, switching off of glutes, Cues: push through heels, posterior tilt, clench buttocks, drive heels through floor, don t arch back / lengthen lower back, shorten back of legs Alternatives: shoulders on bench or sofa Progression: increase weight, theraband around knees Do instead of: feet on ball Cautions: lack of glut activation, tightness in lumbar spine, overactivity of lower back Physio Lunges

6 Physio Lunges Used for: glute max activation, VMO, quads, co-contraction activation, single leg knee pain and injury rehab, core and lower back rehab. Watch for: loss of neutral, spine-shin angle, knee position, pelvic drop, lack of hip extension. Cues: 80% weight front leg, 20% back leg, weight down into heel, drive through heel / push ground away from you, knees and hips move together, don t left heel lift, spine shin same angle. Alternatives: less knee flexion, more hip. Progression: exercise tubing, increase weight, step down to lunge, travelling physio lunges. Do instead of: normal lunges, split lunges. Cautions: severe patello-femoral pain and injury, atrophy VMO, post surgical. Single Leg Step Down Single Leg Step Down Used for: gluteal stability: glute med and min, and VMO, quads, knee pain and injury rehab, single leg stability and pelvic control into hip flexion dissociation of hip and pelvis Watch for: loss of neutral top and bottom, spine-shin angle, knee position, pelvic drop, lack of hip extension, lower back extension overcorrection. Cues: Sit bum down and back, thrust tilt at top, glutes on, knees and hips move together. tap the floor, weight over heel. Alternatives: less knee flexion, more hip Progression: exercise tubing, BOSU, increase weight, step down to lunge. Do instead of: step ups, single leg squats. Cautions: severe patello-femoral pain and injury, atrophy VMO, post surgical.

7 Front Squats Front Squats Used for: squat pattern correction, lower back rehab, core strength, quads, glutes, hamstrings, knee pain and injury rehab. Watch for: loss of neutral top and bottom, spine-shin angle, knee position, breathing / holding, lack of hip extension, lower back extension over-correction, lateral shift, thoracic kyphosis Cues: Sit on chair, bum down and back, breath out before bottom, thrust tilt at top, glutes on, knees and hips move together. Progression: exercise tubing, BOSU, increase weight. Do instead of: back squats. Alternatives: kettle bells / dumbbells Cautions: disc injury, ankle ROM, one-sided muscle weakness Single Leg Rehab Press

8 Single Leg Rehab Press Used for: closed chain strength on single leg: quads, VMO, glutes, hamstrings, knee pain and injury rehab. Watch for: foot position, internal knee rotation, lifting of heel Cues: Weight through heel, push plate away on press, drive through heel and glutes, breath out before bottom Progression: increase weight. Do instead of: open chain leg press, hack squat Alternatives: top range only, work in pain-free range, open chain leg press Cautions: knee pain, ankle ROM, post knee surgery, patella tendon pain Hamstring Deadlifts Hamstring Deadlifts Used for: hamstring strength, lower back rehab, core strength, glutes Watch for: loss of neutral top and bottom, knee position, breathing / holding, lack of hip extension, lower back extension over-correction Cues: bum backwards, arms straight down, weight through heels, thrust tilt at top, glutes on Progression: exercise tubing, BOSU, increase weight. Alternatives: kettle bells / dumbbells Cautions: disc injury, spondylolithesis, avoid loading

9 Single Leg Hamstring Deadlifts Single Leg Hamstring Deadlifts Used for: single leg hamstring strength, SIJ and lower back rehab, one sided gluteal weakness Watch for: loss of neutral top and bottom, knee position, breathing / holding, lack of hip extension, lower back extension over-correction, pelvic drop. Cues: bum backwards, arms straight down, weight through heel, thrust tilt at top, glutes on Progression: exercise tubing, BOSU, increase weight. Alternatives: kettle bells / dumbbells, medicine balls Cautions: knee stability, foot and glute fatigue Eccentric Hamstring Curl

10 Eccentric Hamstring Curl Used for: single leg hamstring strength, SIJ and lower back rehab, building strength in neutral / awareness, hamstring / lumbar extensor balance Watch for: hyperextension, too heavy weight, breathing / holding Cues: posterior tilt, clench glutes, reset Progression: increase weight, single leg concentric Alternatives: Theraband curls, swiss ball curls Cautions: lower back overactivity Correct activation and pelvic posture Stabilisation over power Think FUNCTION SLOWLY build spinal, core and leg strength Watch loss of neutral Axial loading rule for squats and lifting Intra-abdominal pressure Don t return to impact too early Pain and injury seek Physio treatment Continuation of the rehab exercises Do s and DONT S Thank you! physiofitness.com.au facebook.com/physiofitness