Level 1 Deep hip rotators lying face-down
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- Frederick Nelson
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1 Level 1 Deep hip rotators lying face-down Lie on your stomach with your knees apart. Bend your knees so that they are at 90 degrees. Place the sole of the foot on your nonoperated leg against the inner surface of your ankle on your operated side. Keeping your thigh on bed, gently press the ankle on your operated side against the sole of the other foot. Relax hamstrings. Relax buttock muscles. Breathe. Place your fingers on the bony part of your bottom called the ischial tuberosity. Then move your fingers 2cm out then 2cm up. Feel a gentle contraction of QF muscle underneath your fingers. Hold for 3 seconds then relax for 2 seconds (approximately 12 repetitions in one minute) Pre surgery: 1 minute at least 6 times per day After surgery: 1 minute, 3-4 times per day When able to do 12 contractions in one minute with good technique
2 Level 2 Deep hip rotators on all fours 4 point kneeling with the lower back in a neutral position. Relax hamstrings. Relax buttock muscles. Breathe. Place your fingers on the bony part of your bottom called the ischial tuberosity. Move your fingers 2cm out then 2cm up. Feel a gentle contraction of QF muscle underneath your fingers. Hold for 3 seconds then relax for 2 seconds. It may help to think of pulling your thigh up towards your pelvis. Pre surgery: 1 minute, at least 6 times per day After surgery: 1 minute, 3-4 times per day When able to do 12 contractions in one minute with good technique Variations: If shoulder pain or fatigue are a problem, support your chest on the seat of a chair
3 Level 3 - Deep hip rotators on hands and knees with hip external rotation (twisting foot inwards) 4 point kneeling with the lower back in a neutral position. The operated leg should be parallel to the opposite side, in a relaxed position (ie not twisted inward or outward) Activate QF muscle, and then gently rotate the foot on the operated leg inwards. Aim for your foot to be above your calf on your non-operated side at the end of the movement. Slowly return to the starting position. Continue to hold the QF contraction whilst performing a total of 5 repetitions of the movement. Rest for 3 seconds then repeat, continuing for one minute. One minute, 3-4 times per day When able to perform exercise for one minute maintaining good technique and with no pain. External rotation, twisting thigh to take foot inwards
4 Level 4 - Deep hip rotators in 4-point-kneeling with hip internal rotation (twisting foot outwards) 4 point kneeling with the lower back in a neutral position. The operated leg should be parallel to the opposite side, in a relaxed position (ie not twisted inward or outward) Relax hamstrings. Relax gluteals. Continue to breathe throughout the exercise. Activate QF muscle on the operated side. Keep the muscle tightened while you gently rotate the foot on the operated leg outwards. Take the foot as far as you can go comfortably. Slowly return to the starting position. Continue to hold the QF contraction whilst performing a total of 5 repetitions of the movement. Rest for 3 seconds then repeat, continuing for one minute. 5 reps then rest, repeat for one minute When able to perform exercise for one minute maintaining good technique and with no pain. Internal rotation, twisting thigh to take foot outwards
5 Level 5, 1 - Hip external rotation on hands and knees with resistance band (Theraband ) Kneel on all fours with your lower back in a neutral position. Your operated leg should be parallel to the opposite leg, in a relaxed position (ie not twisted inward or outward). Place resistance band around your ankle on your operated side as shown. Activate the QF muscle on your operated side. Gently twist your leg to take your foot on the operated side inwards against the pull of the elastic band. Aim for your foot to be above your calf on your non-operated side at the end of the movement. Slowly return to the starting position, carefully controlling the speed of the movement. Rest for 3 seconds then repeat, continuing this process for one minute. One minute, 3-4 times per day Able to perform exercise for one minute pain-free; able to maintain good technique, with smooth, controlled movement. External rotation starting position External rotation exercise Resistance band: NONE YELLOW RED GREEN
6 Level 5, 2 - Hip internal rotation on hands and knees with resistance band (Theraband ) Kneel on all fours with your lower back in a neutral position. Your operated leg should be parallel to the opposite leg, in a relaxed position (ie not twisted inward or outward). Place resistance band around your ankle on your operated side as shown. Activate the QF muscle on your operated side. Keep the muscle tightened. Gently twist your leg to take your foot outwards, away from your other leg, against the pull of the elastic band. Take your foot as far as you can go comfortably. Slowly return to the starting position, carefully controlling the speed of the movement. Rest for 3 seconds then repeat, continuing this process for one minute. One minute, 3-4 times per day Able to perform exercise for one minute pain-free; able to maintain good technique, with smooth, controlled movement Internal rotation exercise Resistance band: NONE YELLOW RED GREEN
7 Level 6, 1 - Hip external rotation with resistance (Theraband ) and abduction with belt on hands and knees Kneel on all fours with your lower back in a neutral position and your knees about two fist-widths apart. Place a Pilates belt or resistance band around both your thighs and a resistance band around your ankle on your operated side as shown. Keep your knee on the bed. Tighten the muscle at the side of your hip by pushing your operated side against the belt (as though trying to take your knees apart). At the same time, activate the QF muscle on your operated side. Gently twist your leg to take your foot inwards against the pull of the elastic band. Aim for your foot to be above your calf on your non-operated side at the end of the movement. Slowly return to the starting position, carefully controlling the speed of the movement. Rest for 3 seconds then repeat, continuing this process for one minute. One minute, 3-4 times per day Able to perform exercise for one minute pain-free; able to maintain good technique, with smooth, controlled movement. External rotation Red Theraband resisting twisting movement and blue Pilates belt providing resistance to thigh movement To be done in conjunction with Level 6, 2 (internal rotation) Resistance band: NONE YELLOW RED GREEN
8 Level 6, 2 - Hip internal rotation with resistance (Theraband ) and abduction with belt in 4-point-kneeling Kneel on all fours with your lower back in a neutral position and your knees comfortably apart. Place a Pilates belt or resistance band around both your thighs and a resistance band around your ankle on your operated side as shown. Keep your knee on the floor. Tighten the muscle at the side of your hip by pushing your operated side against the belt (as though trying to take your knees apart). Activate the QF muscle on your operated side. Gently twist your leg to take your foot outwards, away from your other leg, against the pull of the elastic band. Take your foot as far as you can go comfortably. Slowly return to the starting position, carefully controlling the speed of the movement. Rest for 3 seconds then repeat, continuing this process for one minute. One minute, 3-4 times per day Able to perform exercise for one minute pain-free; able to maintain good technique, with smooth, controlled movement. Internal rotation Red Theraband resisting twisting movement and blue Theraband providing resistance to thigh movement To be done in conjunction with Level 6, 1 (external rotation) Resistance band: NONE YELLOW RED GREEN
9 Level 7, 1 - Arabesque Standing with feet shoulder width apart. Tense the QF muscle on your operated side. Lean your chest forward and take your arms out to the sides as you lift the non-operated side behind you. Hold the position for 3 seconds. Bring your non-operated leg down to take a step forward. Step forward on to your operated side and repeat. Do as many repetitions as you are able to with good technique and no pain. Aim to do 26 repetitions in a row. You may break this up in the initial stages, for example 5 arabesques, 5 times per day. Able to complete 26 repetitions in a row with good technique, and no pain.
10 Level 7, 2 - Duck Walk Have your feet shoulder-width apart. Place a Pilates belt (or other belt) around your thighs, just above your knees. It is best to use a belt rather than exercise band for this exercise. Do a ¼ squat, so that your knees are bent to around 30 degrees. Your knees should be over your big toes. Place your fingers on your QF muscle to check for/improve contraction. Keep your ¼ squat position as you walk forward 10 metres. Keep your QF tense during the exercise. Do one walk of 10 metres, 10 times per day. Able to complete 10 metre walk, with good technique and no pain.
11 Back of hip (posterior capsule) stretch Lie on your non-operated side. Place a folded towel near the edge of the bed as shown in the picture. Bend your operated hip up as close to a right angle as is comfortable. Roll your hip forward and drop your knee over the edge of the bed. Take the stretch to the point of tension (not pain) and hold for 30 seconds. Do this three times. Continue this exercise daily until the external rotation movement (dropping your knee out to the side when lying on your back) is equal to your nonoperated hip
12 Front of hip (anterior capsule) stretch Lying on your back on a bed. Bend up your non-operated leg. Your bottom should be near the edge of the bed on your operated side. Take your operated leg out to the side and allow it to drop over the edge of the bed. Your thigh should still be supported by the bed. You should feel a stretch in the front of your hip. 5 minutes first thing in the morning, every day. This exercise should be performed daily from two weeks after surgery until six weeks after surgery
13 Pendulum hip exercises in 4 point kneeling Kneel on all fours with your lower back in a comfortable, neutral position and your head/neck comfortably relaxed.
14 Shift most of your weight onto your hands and your non-operated knee. Only a little weight should go through your operated side. Gently slide the knee on your operated side along the bed/floor towards your hands as far as comfortable. Then slide it back down the bed as far as comfortable. Imagine that your leg is hanging and slowly swinging back and forth like a pendulum. Shift weight onto your operated side Smooth and slow repetitions for one minute Once you have full pain-free movement of hip flexion (bringing your knee up towards your chest) you may stop including this exercise in your program Slide operated leg forward as far as comfortable Slide your operated leg back as far as comfortable
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