self hip knee - be fit for health...90 degree angle. 2. place your l leg across the mid-line, turned...

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SELF

HIP

&

KNEE

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All of the stretches described in this chapter are detailed to stretch the right side.

Key Points for Success:

Keep your pelvis in a neutral position.

Keep your movements slow and precise.

Keep both sides of your pelvis flat to the floor.

Breathe in before you move and breathe out while you move.

Body Awareness:

• Alternately focus on the muscles moving the joint and the muscles being stretched.

• Check for tension during the movement.

Remember to move your hip or knee first and then assist yourself.

Never force your assist.

Never strain with your movement.

If your muscles are shaking, you are working too hard; breathe and relax.

For any movement in which your exercising leg crosses your body, rotate the non-exercising leg internally and place it across the midline of the body as far as you comfortably can.

For any movement in which your exercising leg moves away from the midline of your body turn your opposite outward position it away from your midline.

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Movement Tips

Correct:

Keep your head relaxed on the floor.

Keep your pelvis in neutral.

Do not arch your back.

Incorrect:

Lifting your head

Incorrect:

Tilting your pelvis anterior.

Incorrect:

Tilting your pelvis posterior.

Incorrect:

Jutting your chin.

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Strap Use

There are a number of ways to utilize your strap. Each page details how to wrap and hold your strap. The pictures below are provided for easy reference.

Strap neutral Strap wrapped inside to

outside Strap wrapped outside

to inside

Strap neutral Strap wrapped inside to outside

Strap wrapped outside to inside

You may find this method particularly useful if you have ankle instability or if

the strap slips off your foot:

Fold the strap in half. Wrap the loop around your ankle and heel. Then, slip

both ends through the loop.

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What are “stacked hips”?

Your hips need to be “stacked”, one on top of the other, in order to stabilize your upper body for certain stretches. Lie on your side with both hips lined up evenly and pointing straight ahead. Your torso should be in a straight line, from your hips to your head. Do not allow your torso to move forward or backward. Keep your shoulders centered; do not allow them to roll forward or backward.

For added balance and stability, bend the hip and knee you are lying on.

General Precautions –

General Precautions -

If you are suffering from a disc condition and/or muscle spasms in your lower back, please observe the following modifications to your body positioning.

When you are doing any movement that involves hip flexion (lifting your thigh off the floor), bend your non-exercising knee so your foot rests flat on the floor. This will help you avoid muscle fatigue and aggravation of your lower back pain.

When any of these movements cross the mid-line of your body, bring the knee of your non-exercising leg towards your other knee. This will still allow for excellent stability of your pelvis and isolation of your movement with greater ease to your back and hips.

When using this positioning, be sure not to push off with your foot. This will not give you a better stretch; it will simply tilt your pelvis, which may irritate your lower back. Also, pushing off too aggressively may cause your hamstrings to cramp.

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Repetitions: Two Sets of 8-10

Hip Flexion 1 Area Being Stretched: Buttocks

Muscle Emphasized: Gluteus Maximus

Body Mechanics:

Keep your neck relaxed; do not lift your head during the movement.

Use your hip flexors to move your leg; do not engage your gluteals.

Keep your leg close to your body, alongside your ribs, not off to the side.

Helpful Hints:

As your flexibility improves, assist by reaching your R hand to your calf or ankle.

Precautions:

If you have lower back pain keep your L leg bent with your foot flat on the table.

Be careful not to push off with your L foot.

Mr. Stretchy:

If you feel pain in the front of your hip while doing this stretch, stop and stretch your hip flexors first. (see pp. 22 & 23).

1. Lie on your back with your R hip and knee bent at a 90 degree angle.

2. Hold the back of your thigh with your R hand. If needed, wrap the strap around the sole of your foot and hold both ends with your L hand. Flex your R hip, bringing your knee towards your R armpit. Keep your knee open to a 90 degree angle.

3. When you cannot move farther on your own, assist yourself gently with your R hand.

4. Hold for 2 seconds. 5. Return to the starting position.

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Hip Flexion 2 & 3 Areas Being Stretched: Buttocks and Outside of Hip


Body Mechanics:


Use your inner thigh muscles to move your leg, not your gluteals.

Helpful Hints:

Do not allow your hip or back to roll into the stretch; keep them both on the floor.

Mr. Stretchy:

If you feel pain in your groin while doing this stretch, stop and stretch your hip flexors first (see pp. 22 & 23).

1. Lie on your back with your R hip and knee bent to a 90 degree angle.

2. Place your L leg across the mid-line, turned inward. 3. Hold the outside of your R knee with your L hand. 4. Bring your R thigh across your body and let your R

knee drop down towards your L hip. 5. Keep your pelvis neutral; do not roll your R hip as you

move. 6. When you cannot move farther on your own, assist

yourself gently with your L hand. 7. Hold for 2 seconds. 8. Return to the starting position.

#3 - REPEAT the above sequence bringing your R thigh towards the bottom of your L rib.

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Hip Flexion 4 Areas Being Stretched: Buttocks and Hip Joint


Body Mechanics:


Helpful Hints:

Keep your hip rotated inward at least 45 degrees.


Precautions:

Do not force the hip rotation. If your hip does not rotate to 45 degrees easily, do External Rotation, position 1, first (see p. 10). Health Tips:

Mr. Stretchy:

Keep both sides of your pelvis touching the floor in order to achieve complete isolation with this stretch.


2. Place your L leg across the mid-line, turned inward. 3. Wrap your strap around the sole of your R foot with

both strands wrapping around your ankle from the outside to the inside. Hold both ends of the strap in your L hand.

4. Hold the outside of your R knee with your R hand. 5. Turn your R hip, bringing your R ankle inward towards

your head 45 degrees. 6. Bring your R thigh across your body towards the

bottom of your L breast while keeping your leg turned inward.

7. When you cannot move farther on your own, assist yourself gently with your L hand.


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Hip External Rotation 1 – 4 Area Being Stretched: Hip Joint

Muscles Emphasized: 1 - All Gluteals, 2 - Gluteus Medius, 3 - Gluteus Minimus, 4 - TFL

Body Mechanics:


Keep your knee at a 90 degree angle to avoid any aggravation.

Keep a firm hold with a light outward pressure on your knee to help stabilize your thigh as you rotate your hip.

Helpful Hints:





4. Hold your R thigh with your R hand, on the inside of your R knee.

5. Turn your R hip, bringing your ankle inward towards your head.



REPEAT the above sequence bringing your thigh #2 - 15, #3 - 30 and then #4 - 45 degrees across your body towards your L hip.

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Health Tips:

Mr. Stretchy: Do you have sciatica? Well this stretch is a key component in treating it.


Body Mechanics:



Keep a firm hold with a light downward pressure on your knee in order to maintain the position of your thigh as you rotate your hip.

Helpful Hints:


Hip External Rotation 5 Area Being Stretched: Hip Joint Muscle Emphasized: Piriformis




4. Hold the outside of your R knee with your R hand. 5. Bring your R thigh across your body towards the

bottom of your L breast. Hold your R thigh in position with your R hand.

6. Turn your R hip, bringing your ankle inward towards your head.



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Hip Internal Rotation 1 – 4 Area Being Stretched: Hip Joint

Muscles Emphasized: External Rotators

Body Mechanics:



Keep a firm hold with a light inward pressure on your knee to help stabilize your thigh as you rotate your hip.

Helpful Hints:


Precautions:

Be careful not to engage your lower back muscles by “hiking”, your R hip as you stretch.

Mr. Stretchy:

These muscles are often so tight they have become inhibited. Stretching these muscles thoroughly is often a very important step to restoring the balance in your hips.


2. Place your L leg away from the mid-line, turned outward.

3. Wrap your strap around the sole of your R foot with both strands wrapping around your ankle from the inside to the outside. Hold both ends of the strap in your R hand.

4. Hold the outside of your R knee with your L hand. 5. Turn your R hip, bringing your ankle outward towards

your head, 6. When you cannot move farther on your own, assist

yourself gently with your R hand. 7. Hold for 2 seconds. 8. Return to the starting position.

REPEAT the above sequence bringing your thigh #2 - 15, #3 - 30 and then #4 - 45 degrees away from your body.

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Body Mechanics:

Keep your foot and ankle relaxed in a neutral position to avoid stretching your calf muscles.

Do not move your thigh; the only movement is straightening your lower leg until your knee locks.

Keep your knee locked for the full two seconds of the stretch.

Keep your gluteals relaxed; do not push up with your hips to gain an extra inch at the end of the movement.

Helpful Hints:

If your knee cannot lock, lower your thigh closer to the floor and try again. Change the angle of your thigh until you find a position in which you can lock your knee.

Your lower leg must fully extend in order to stretch the entire length of the hamstrings.

Mr. Stretchy:

You shouldn’t feel this stretch in your calf. If you do, relax your ankle and try again.

Health Tips:

This stretch is good prevention against developing a Baker’s Cyst.

Knee Extension 1 Area Being Stretched: Back of Knee

Muscles Emphasized: Distal attachments of Hamstrings

1. Lie on your back with your strap wrapped around the sole of your R foot. Wrap both ends of the strap around your L palm and place your R hand on your R thigh.

2. Bend your R hip and knee 90 degrees. 3. Straighten your R knee until it reaches a locked

position, assisting yourself gently with your L hand. 4. Hold for 2 seconds. 5. Return to the starting position.

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Knee Extension 2; Turned Out Area Being Stretched: Back of Knee


Body Mechanics:

Keep your lower leg rotated away.

Keep your ankle relaxed to avoid stretching your calf muscles.




Helpful Hints:

Only rotate your ankle, do not rotate your thigh.



Health Tips:


Mr. Stretchy: No Cheating!

Do not bring your thigh any closer to your hip unless you can fully lock your knee.

1. Lie on your back with your strap around the sole of your R foot and both strands wrapping from the inside to the outside of your R ankle. Wrap both ends of the strap around your L palm.

2. Bend your R hip and knee 90 degrees and place your R hand on your R thigh.

3. Turn your lower leg outward, away from your body, by pointing your pinky toe towards your R.

6. Straighten your R knee until it reaches a locked position, assisting yourself gently with your L hand.


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Knee Extension 3; Turned In Area Being Stretched: Back of Knee


Body Mechanics:

Keep your lower leg rotated inward.

Keep your ankle relaxed to avoid stretching your calf muscles.




Helpful Hints:

Only rotate your ankle, do not rotate your thigh.



Mr. Stretchy: Watch it!

You shouldn’t feel this stretch in your calf. If you do, relax your ankle and try again.

.

1. Lie on your back with your strap around the sole of your R foot and both strands wrapping from the outside to the inside of your R ankle. Wrap both ends of the strap around your L palm.

2. Bend your R hip and knee 90 degrees and place your R hand on your R thigh.

3. Turn your lower leg inward, toward your body, by pointing your big toe towards your L.

4. Straighten your R knee until it reaches a locked position, assisting yourself gently with your L hand.


Health Tips:


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Body Mechanics:

Keep your lower back relaxed and your abdominals engaged throughout the movement.

Your knee must remain locked throughout the movement.

Use your quadriceps and not your strap to lift your leg.


Helpful Hints:

Lengthening your leg all the way to your heel will help keep your knee locked. Be sure not to flex your ankle at the same time.

Mr. Stretchy: Nothing to worry about!

You may feel this stretch all the way into your lower back.

1. Lie on your back with your strap wrapped around the sole of your R foot. Wrap both ends of the strap around your L palm.

2. Lock your R knee by extending through your heel. 3. Lift your R leg up towards the ceiling, keeping your knee

locked throughout the movement. 4. As you lift, walk your hands up the strap. 5. When you cannot move farther on your own, assist yourself

gently with your R hand. 6. Hold for 2 seconds. 7. Return to the starting position.

Straight Leg Hip Flexion 1 Area Being Stretched: Back of Thigh

Muscles Emphasized: Proximal attachments of Hamstrings

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Body Mechanics:


The knee must remain locked throughout the movement.

Maintain rotation and use your quadriceps, not your strap, to lift your leg.


Helpful Hints:


Mr. Stretchy: Easy does it!

Don’t pull hard with your strap, the semitendinosis is the most commonly pulled hamstring.

1. Lie on your back with your strap around the sole of your R foot and both strands wrapping from the inside to the outside of your R ankle. Wrap both ends of the strap around your L palm.

2. Lock your R knee by extending through your heel. 3. Turn your R knee inward, toward your L knee. 4. Lift your R leg up towards the ceiling, keeping your knee

locked throughout the movement. 5. As you flex your hip, aim your ankle towards the outside of

your R shoulder. 6. As you lift, walk your hands up the strap. 7. When you cannot move farther on your own, assist yourself


Straight Leg Hip Flexion 2 & 3; Turned In Area Being Stretched: Back of Thigh

Muscle Emphasized: Proximal attachments of Semitendinosis

#3 - REPEAT the above sequence bringing your R ankle towards your breastbone.

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Body Mechanics:


The knee must remain locked throughout the movement.

Maintain rotation and use your quadriceps not your strap, to lift your leg.


Helpful Hints:


Mr. Stretchy:

This is an excellent stretch to relieve outer hip pain.

1. Lie on your back with your strap around the sole of your R foot and both strands wrapping from the outside to the inside of your R ankle. Wrap both ends of the strap around your L palm.

2. Lock your R knee by extending through your heel. 3. Turn your R knee outward, away from your L knee. 4. Lift your R leg up towards the ceiling, keeping your knee

locked throughout the movement. 5. When you reach a 90 degree angle, bring your R ankle

towards your L shoulder. 6. As you lift, walk your hands up the strap. 7. When you cannot move farther on your own, assist


Straight Leg Hip Flexion 4; Turned Out Area Being Stretched: Back of Thigh

Muscle Emphasized: Proximal attachments of Biceps Femoris

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Hip Abduction 1 Areas Being Stretched: Inner Thigh and Groin

Muscles Emphasized: Adductors

Body Mechanics:

Do not lift your leg up. Slide it across the floor in both directions, keeping your heel touching the floor throughout the movement.

Extend your arm out as your leg moves.

Be sure the assistance is away from and not towards your body.

Keep your knee locked throughout the movement.

Helpful Hints:


If you experience pain on the same side as you are stretching to, bend your torso to the other side. This will give your lower back muscles more room to move.

Precautions:

Be careful not to engage your lower back muscles by “hiking”, your R hip as you stretch.

Health Tips:

This movement is excellent for improving circulation in the leg.

1. Lie on your back with your strap around the sole of your R foot and both strands wrapping from the inside to the outside of your R ankle.

2. Place your L leg away from the mid-line, turned outward.

3. Wrap both ends of the strap around your L palm. 4. Lock your R knee by extending through your heel. 5. Turn your R hip inward so that your R knee is turned

towards your L knee. 6. Tighten your abdominals and move your R leg away from

your body. 7. As your leg moves away from your body, grab the strap

with your R hand to help with the assistance. 8. When you cannot move farther on your own, assist


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Hip Abduction 2 & 3 Areas Being Stretched: Inner Thigh and Groin

Muscle Emphasized: Gracilis

Body Mechanics:

Do not engage your upper body. Keep your lower back relaxed and your abdominals engaged throughout the movement.




Helpful Hints:


Precautions:

Be careful not to arch your lower back as you move.

Health Tips:

This movement is excellent for better leg circulation.

Mr. Stretchy: Steady as you go!

If you feel a pull or tightness on the opposite side of your lower back make sure to tighten your abs and back off a little on the stretch.

1. Lie on your back on a surface high enough off the floor for you to extend your leg downward. Wrap your strap around the sole of your R foot with both strands wrapping from the outside to the inside of your R ankle.

2. Wrap both ends of the strap around your R palm. 3. Place your L leg away from the mid-line, turned

outward. 4. Lock your R knee by extending through your heel. 5. Turn your R hip outward so that your R knee is turned

away from your L knee. 6. Tighten your abdominals and move your R leg off the

table, towards the floor, angling down and towards your head at a 45 degree angle.



#3 - REPEAT the above sequence with your hip turned inward so your R knee is turned towards your L knee.

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Hip Abduction 4 Areas Being Stretched: Inner Thigh and Groin

Muscle Emphasized: Adductor Magnus

Body Mechanics:




Keep your knee turned inward through the movement.


Helpful Hints:

At the end of the movement, observe if the stretch is felt in your hamstrings or groin. If the stretch is in your hamstrings, lower the angle of your leg and repeat the movement until the stretch is felt in your groin.

Precautions:

Be careful not to engage your lower back muscles by “hiking”, your R hip during this stretch.

Health Tips:

This movement is excellent for better leg circulation.

Mr. Stretchy:

Remember; bring your leg up towards your head, not down towards the floor.


2. Wrap both ends of the strap around your R palm. 3. Place your L leg away from the mid-line, turned

outward. 4. Lock your R knee by extending through your heel. 5. Turn your R hip inward so your R knee is turned

towards your L knee. 6. Tighten your abdominals and lift your R leg up to a 90

degree angle. 7. When you reach a 90 degree angle; grab the back of

your thigh with your R hand and bring your leg out and down towards your R elbow.



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Hip Adduction 1 & 2 Areas Being Stretched: Outer Thigh and Hip

Muscles Emphasized: 1 - TFL, 2 - Gluteus Medius and Minimus

Body Mechanics:


Extend your L arm out with your leg; making sure the assist continues out, and across your body.

Maintain hip rotation throughout the movement.


Helpful Hints:


Mr. Stretchy:

To help keep your leg rotated, focus on your heel and let it lead the movement.

1. Lie on your back with your strap around the sole of your R foot and both strands wrapping from the outside to the inside of your R ankle.

2. Wrap both ends of the strap around your R palm. 3. Place your L leg across the mid-line, turned inward. 4. Lock your R knee by extending through your heel. 5. Turn your R hip outward so your R knee is facing away

from your L knee. 6. Lifting your R thigh just high enough to clear your L

leg, bring your R thigh across your L thigh. 7. When you cannot move farther on your own, assist


#2 - REPEAT the above sequence bringing your R thigh across your L thigh at a 45 degree angle up towards the ceiling.

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Hip Adduction 3 & 4 Areas Being Stretched: Hip Joint, Outside of Hip and Thigh

Muscles Emphasized: Gluteus Medius and Minimus

Body Mechanics:

Keep your upper body relaxed. Keep your lower back relaxed and your abdominals engaged throughout the movement.




Helpful Hints:


1. Lie on your back with your strap around the sole of your R foot and both strands wrapping from the outside to the inside of your R ankle.

2. Wrap both ends of the strap around your L palm. 3. Place your L leg across the mid-line, turned inward. 4. Lock your R knee by extending through your heel. 5. Turn your R hip outward so your R knee turns away

from your L knee. 6. Tighten your abdominals and lift your R leg up to a 90

degree angle. 7. When you reach a 90 degree angle, bring your leg

across your body and down towards your L hip. 8. When you cannot move farther on your own, assist


#4 - REPEAT the above sequence lifting your R thigh to a 110 degree angle, before bringing it across your body, towards the bottom of your ribcage.

Mr. Stretchy:

To help keep your leg rotated, focus on your heel and let it lead the movement.


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Hip Adduction 5 & 6 Areas Being Stretched: Hip Joint, Outside of Hip and Thigh

Muscles Emphasized: External Rotators

Helpful Hints:



2. Wrap both ends of the strap around your R palm. 3. Place your L leg across the mid-line, turned inward. 4. Lock your R knee by extending through your heel. 5. Turn your hip inward so that your R knee is facing towards

your L knee. 6. Tighten your abdominals and lift your R leg up to a 90

degree angle. 7. When you reach a 90 degree angle, bring your leg across

your body and down towards your L hip. 8. When you cannot move farther on your own, assist


#6 - REPEAT the above sequence lifting your R thigh to a 110 degree angle, before bringing it across your body, towards the bottom of your ribcage.

Body Mechanics:

Keep your upper body relaxed. Keep your lower back relaxed and your abdominals engaged throughout the movement.




Mr. Stretchy:

This is an excellent stretch to help create or improve space in your hip joint.

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Hip Extension 1 – 3 Area Being Stretched: Front to Outside of Hip

Muscles Emphasized: 1 - Psoas Major, 2 - Iliacus 3 - Sartorius and TFL

Body Mechanics:

Keep your abdominals tight. Do not arch your back.

Keep your hips facing forward.

Keep your chest up; do not lean forward, backward or sideways.

Do not allow your knee to move in front of your ankle.

Helpful Hints:

If you are strong enough, lift yourself up with your hands using the chairs for balance. This takes all of your weight off your knee as you stretch.

Precautions:

This movement can be aggravating for those with lower back muscle spasm. Be sure to keep your pelvis in neutral.

Health Tips:

If you have deterioration in your knee joint or experience pain when kneeling, place a pillow under your knee.

1. Kneel on your R knee on the floor with a chair on either side of you for balance.

2. Extend your L foot out in front of you and place it flat on the floor. Your foot must be far enough in front of you so that your knee is at a 90 degree angle at the end of your movement.

3. Adjust your hips so they are facing forward. 4. Engage the gluteals of your R hip to push yourself

forward. 5. Keep your back straight and your pelvis neutral. 6. Hold for 2 seconds. 7. Return to the starting position.

REPEAT the above sequence bringing your R knee towards your L knee #2 - 15 and then #3 - 30 degrees.

Mr. Stretchy:

Visualize the movement as if someone is pushing you from your tailbone.

!

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Hip Extension 4 – 6 Areas Being Stretched: Front of Hip and Groin

Muscles Emphasized: 4 - Pectineus, 5 - Adductor Brevis 6 - Adductor Longus

Helpful Hints:

Lift yourself up with your hands using the chairs for balance. This takes all of your weight off your knee as you stretch.

Precautions:

This movement can be aggravating those with lower back muscle spasm. Be sure to keep your pelvis in neutral.

Health Tips:

If you have deterioration in your knee joint or experience pain when kneeling, place a pillow under your knee.

under it.

1. Kneel on your R knee on the floor with a chair on either side of you for balance.

2. Extend your L foot out in front of you and place it flat on the floor. Your foot must be far enough in front of you so that your knee is at a 90 degree angle at the end of your movement.

3. Adjust your hips so they are facing forward. 4. Move your R knee 15 degrees away from your L knee. 5. Engage the gluteals of your R hip to push yourself forward. 6. Keep your back straight and your pelvis neutral. 7. Hold for 2 seconds. 8. Return to the starting position.

REPEAT the above sequence by bringing your R knee away from your L knee #5 - 30 degrees and then #6 - 45 degrees.

Body Mechanics:

Keep your abdominals tight. Do not arch your back.

Keep your hips facing forward.

Keep your chest up; do not lean forward, backward or sideways.

Do not allow your knee to move in front of your ankle.

Mr. Stretchy:

This stretch is one of the most effective for reducing groin impingement.

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Knee Flexion 1 & 2; Side-Lying Area Being Stretched: Front of Knee

Muscle Emphasized: Distal attachments of Quadriceps

Body Mechanics:


Keep your hips stacked and look straight ahead. Do not lean forward or backward.

Use your hamstrings, not your quadriceps, to move your lower leg.

Helpful Hints:

If you flex your hamstrings too aggressively, they may cramp.

Press your non-exercising leg against a table leg or bedpost to help maintain position.

Precautions:

If you have any instability or structure problems in your knee, be very careful to keep your hips stacked and your thigh in neutral.

Health Tips:

This movement is good prevention against condromalacia patella.

Mr. Stretchy:

To avoid potential ligament irritation, keep your thigh facing forward throughout the movement.

1. Lie on your L side with your L thigh pulled up towards your chest as far as is comfortable.

2. Place a pillow under your head and R knee and bend it to a 90 degree angle. The pillow should be high enough to keep your knee and hip in a straight line, horizontal to the floor.

3. Wrap your strap twice around your R ankle and grab both ends of the strap in your R hand. Hold onto the strap as close to your ankle as is possible.

4. Use your hamstrings to bend your R knee and bring your heel towards your buttock.



#2 - REPEAT the above sequence by taking the pillow out from under your knee and bringing your knee downward towards the floor.


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Knee Flexion 1 & 2; Standing Area Being Stretched: Front of Knee

Muscles Emphasized: Distal attachments of Quadriceps

Body Mechanics:


Keep your knees in line with each other do not let the exercising leg move forward.

Keep your hips forward; do not allow them to rotate.

Do not lean forward, backward or sideways.


Helpful Hints:


Mr. Stretchy:

This method tends to allow for less potential irritation of your knee, however, this method is also less exacting.

1. Stand next to something you can use for balance with your L hand. Keep your knees in line with each other.

2. Wrap your strap twice around your R ankle and grab both ends of the strap in your R hand. Hold onto the strap as close to your ankle as is comfortable.

3. Use your hamstrings to bend your R knee and bring your heel towards your buttock while you keep your knee in line with your R hip.



#2 - REPEAT the above sequence, bringing your R knee closer to your L knee.

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Knee Flexion with Hip Extension 1 & 2; Side-Lying Areas Being Stretched: Front of Knee and Thigh

Muscles Emphasized: Bellies of Quadriceps

Body Mechanics:


Keep your hips stacked and look straight ahead.


Use your hamstrings not your quadriceps to move your lower leg.

Helpful Hints:

If you flex your hamstrings too aggressively they may cramp.

Press your non-exercising leg against a table leg or bedpost to help maintain position

Precautions:

If you experience knee pain let your ankle move away from your buttock.

1. Lie on your L side with both thighs pulled up towards your chest.

2. Place a pillow under your head. 3. Bend your R knee as far as is comfortable, keeping it in

line with your R hip. 4. Grab your R ankle with your R hand. 5. Extend through your knee, keeping your knee bent and use

your gluteals to bring your knee backwards. 6. When you cannot move farther on your own, assist


Mr. Stretchy:

These stretches are excellent for reducing pain in the front of the thigh and anterior hip impingement.

#2 - REPEAT the above sequence bringing your knee downward towards the floor.

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Mr. Stretchy:


Knee Flexion with Hip Extension 1 & 2; Standing Area Being Stretched: Front of Knee and Thigh

Muscles Emphasized: Bellies of Quadriceps

Body Mechanics:


Keep your hips forward; do not allow them to rotate.



Helpful Hints:


Precautions:

If you experience knee pain, let your ankle move away from your buttock and repeat the movement.

1. Stand next to something you can use for balance with your L hand.

2. Bend your R knee as far as is comfortable while keeping it in line with your R hip and L knee.

3. Grab your R ankle with your R hand. 4. Extend downward through your knee. 5. Keeping your knee bent and your abdominals tight; use your

gluteals to bring your knee backwards. 6. When you cannot move farther on your own, assist yourself


REPEAT the above sequence, bringing your R knee closer to your L knee.

Mr. Stretchy:

Feeling pain in the front / outer area of your pelvis? This stretch will help!

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Hip External Rotation with Extension 1 – 3 Areas Being Stretched: Hip Joint and Groin

Muscles Emphasized: Adductors, Gluteus Medius and Minimus

Body Mechanics:

Keep your abdominals engaged to maintain a neutral pelvis throughout the movement.

Mr. Stretchy:

Remember, the movement starts with your hip muscles pulling your knee towards the floor. Be sure that you do not just push on your knee.

1. Sit in a chair with your R ankle crossed over your L knee.

2. Place your L hand on your R ankle and you R hand on your R knee.

3. Tighten your abdominals and move your R knee down towards the floor.



REPEAT the above sequence with your R ankle moving #2 - 15 and then #3 - 30 degrees across your L knee.

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Body Mechanics:

Keep your back straight.

Keep your toes relaxed.

Helpful Hints:

As your flexibility improves, lean forward from your hips without flexing your back.

Precautions:

If you have hyperextension of your knee, place a firm pad beneath your knee.

Health Tips:

This movement is excellent prevention and treatment for a Baker’s Cyst.

1. Sit with your R leg in front of you and your L leg bent to your side.

2. Wrap your strap around the sole of your R foot. Wrap both ends of the strap around your R hand. Place your L hand on your R thigh, just above your kneecap.

3. Lock your R knee by extending through your heel and move your knee towards the floor.



Terminal Knee Extension Area Being Stretched: Back of knee

Muscle Emphasized: Popliteus

Mr. Stretchy:

If your knee has pain when fully extended, stretch your distal quadriceps first (see pp. 26).

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Key for Protocols of the Hip and Knee -

Name of Stretch Muscles Stretched

Hip Flexion 1-4 Gluteals

Hip External Rotation 1-4 Gluteals

Hip External Rotation 5 Piriformis

Hip Internal Rotation 1-4 External Rotators

Knee Extension 1-3 Distal Hamstrings

Straight Leg Hip Flexion 1-4 Proximal Hamstrings

Hip Adduction 1-4 Adductors

Hip Abduction 1-6 Gluteals, External Rotators

Hip Extension 1-6 Hip Flexors, Adductors

Knee Flexion -

Side Lying 1-2 Distal Quadriceps

Standing 1-2 Distal Quadriceps

Knee Flexion w/Hip Extension -

Side Lying 1-2 Proximal Quadriceps

Standing 1-2 Proximal Quadriceps

Hip External Rotation w/Extension 1-3 Hip Flexors, Adductors

Terminal Knee Extension 1 Popliteus

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Complete Protocol for the Hip and Knee - Expect the complete hip and knee protocol to take 60+ minutes for both sides.

Stretch Page

Hip Flexion 1-4 HK7-HK9

Hip External Rotation 1-5 HK10-HK11

Hip Internal Rotation 1-4 HK12

Knee Extension 1-3 HK13-HK15

Straight Leg Hip Flexion 1-4 HK16-HK18

Hip Abduction 1-4 HK19-HK21

Hip Adduction 1-6 HK22-HK23

Hip Extension 1-6 HK24-HK25

Knee Flexion -

Side Lying 1-2 HK27

Standing 1 HK28

Knee Flexion w/Hip Extension -

Side Lying 1-2 HK29

Standing 1-2 HK30

Hip Extension w/External Rotation 1-2 HK31

Terminal Knee Extension 1 HK32

Ankle Dorsal Flexion 1-3 A4

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Groin Impingement - The timing below considers 1 side.

Primary Purpose - Stretch the adductors (inner thigh and hip) and hip flexors.

Common Challenges - If the adductors are continually tight over a prolonged period, the muscles will weaken and cause increased tension and a cycle of spasm. This is especially noticeable when you bring your leg across your body or lift it too high.

Long Term Goals - The long-term goal is to globally stretch and strengthen throughout the hips, placing emphasis on the adductors and extensors of the hip as well as on the lowest attachments of the abdominal muscles.

Stretch 15 30 Page




Knee Flexion 1-2 HK28

Knee Flexion w/Hip Extension 1-2 HK29

Hip External Rotation w/Extension 1-3 HK31

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ITB Syndrome - The timing below considers 1 side.

Primary Purpose - Stretch the abductors (outer thigh and hip), gluteals, outer hamstring and quadriceps.

Common Challenges – If a groin impingement is present, you may need to work on that problem first before addressing the lateral tissues of your hip.

Long Term Goals - Stretch all the muscles of the hip, knee and calf to reduce potential stress on the hip and knee. Follow this work up with global strengthening of the hip, placing emphasis on the abductors of the hip and the stabilizers of the pelvis as well as the lowest attachments of the abdominal muscles.

Stretch 15 30 Page


Hip External Rotation 1-4 HK10




Hip Adduction 1-3 HK22




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Piriformis Syndrome - The timing below considers 1 side.

Primary Purpose - Lengthen and strengthen the piriformis, external rotators, and all of the gluteals.

Common Challenges - If a groin impingement is present, you may need to work on that problem first before addressing the lateral tissues of your hip.

Long Term Goals - As the primary goal is realized progress, add movements for the entire hip and pelvis. In addition include specific strengthening exercises to create stability in the hip and pelvis.

Stretch 15 30 Page









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S/I Dysfunction - The timing below considers both sides.

Anteriorly Tilted Pelvis -

Primary Purpose - Return the pelvis to a neutral position by eliminating the anterior pull of tight muscles and creating anterior strength to hold up the pelvis.

Common Challenges - A spastic quadratus lumborum (lower back muscle) can make movements of extension (moving backward) and/or lateral flexion (moving sideways) painful. Creating strength in the lowest attachments of the abdominal muscles may be too challenging to accomplish quickly on your own. If this is the case, find a qualified practitioner to initially help you through the exercises so that you can do the exercise on your own.

Long Term Goals - Stretch all musculature of the hip and pelvis, followed up by creating strength and stability to keep the pelvis in its anatomically neutral position.

Stretch 15 30 60+ Page




Back Flexion; Supine 1-2 B15-B16






Hip Extension w/External Rotation 1-3 HK31

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Posteriorly Tilted Pelvis - The timing below considers both sides.

Primary Purpose - Bring the pelvis to a neutral position by eliminating the posterior pull of tight muscles and creating anterior strength to hold up the pelvis.

Common Challenges - If a groin impingement is present, you may need to work on that problem first before addressing the lateral tissues of your hip.














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Internally Rotated Pelvis - The timing below considers both sides.

Primary Purpose - Return the pelvis to a neutral position by eliminating the inward pull of tight muscles and creating anterior strength to hold up the pelvis. You will also need to develop strength in the lateral muscles to pull the pelvis out of its inward position.

Common Challenges - Weak abdominals and hip impingements can create difficulties in resolving this problem.












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Externally Rotated Pelvis - The timing below considers both sides.

Primary Purpose - Return the pelvis to a neutral position by eliminating the outward pull of tight muscles and creating anterior strength to hold up the pelvis. You will also need to develop strength in the medial muscles to pull the pelvis out of its outward position

Common Challenges- Weak abdominals and hip impingements can create difficulties in resolving this problem.

Long Term Goals- As the primary goal is realized progress, add movements for the entire hip and pelvis. In addition include specific strengthening exercises to create stability in the hip and pelvis.




Straight Leg Hip Flexion 1-2 B20-B21









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Leg Length Inequality “L.L.I.” -

Primary Purpose - Create length in the short leg by opening up all of the shortened tissues.

Common Challenges - Hip impingements and weakness are often stumbling blocks to achieving lasting success.

Long Term Goals - Strengthen all of the tissues that have been overly and chronically lengthened (typically found in the “long” leg) and also in the atrophied muscles of the “short” le3 in order to help them maintain their new positioning.

There is no specific protocol to follow for this condition other than freeing up the entire hip and pelvis in order to reestablish matching leg length. Leg length can be an issue of function and/or structure. Structural LLI cannot be overcome by manual therapy. It can be helped, but ultimately it will require a heel lift, orthotic or perhaps an orthopedic shoe. However, a functional LLI can often be resolved with thorough stretching and a lot of strengthening.

Spurring –

Spurring may or may not be helped with manual treatment. The body has the potential to reabsorb the calcium it has laid down provided a healthy environment can be created. This requires not only stretching but a lot of strengthening. The body requires stability in order to feel confident enough to disintegrate the spur.

Be careful when applying rotation; there is increased potential for the tissues to be shredded by the spur with rotational movements. X-rays and good communication with your doctor will usually give you the information you need to understand which movements are safe and which are not.

In order to have the highest chance for success, it is vital that each movement is done precisely. Be very diligent in maintaining form. There is nothing more important than form when exercising.

For example, when doing a rotation, it is very important to sequence the muscle movements properly.

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Hip Replacement -

Primary Purpose - Create stability first and foremost. Flexibility will automatically return as your body heals and your muscles regain their strength. Your doctor should let you know when you are ready to begin a strengthening program and advance into stretching. Your doctor will let you know what movements to avoid. We recommend that you seek the assistance of a highly knowledgeable and skilled practitioner to help you.

Common Challenges - Adhesions and scarring left over from surgery can create restrictions that may require manual therapy from a practitioner.

Long Term Goals - Stretch and strengthen all of the muscles of the knee and hip.

There is no specific protocol for treating a hip replacement other than going through the entire protocol, observing specific precautions and paying special attention to building strength.

Precautions - All rotational movements should be done with the thigh flat on the table. This is especially important in the initial phases of rehabilitation as weakness may allow for dislocation to occur. The hip should not be brought into more than 90 degrees of hip flexion until stability has been established and you have the approval of your supervising physician. Also be very careful when performing hip adduction. Too much hip flexion with adduction can place the hip in danger of dislocation.

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Protocols for the Knee -

Condromalacia Patella - The timing below considers 1 side.

Primary Purpose - Create balanced tracking of the kneecap and space in the joint.

Common Challenges – Lateral (to the outside) tracking of the knee cap due to the muscles on the outside of your thigh being too tight and/or the muscles of your inner thigh being too weak can be the biggest hurdle to fixing this problem. One common issue is improper strengthening of the quadriceps, in particular when performing knee extension exercises. In order for the innermost quadricep, the vastus medialis, to reach its maximal potential, the muscular contraction must be held for no less than 5 seconds. Improper training of your quadriceps may lead to an imbalance in the strength from one to the other. This will lead to faulty tracking of your knee cap.

Long Term Goals - Stretch and strengthen all of the hip and knee muscles.











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Oshgood Slaughters -

Primary Purpose - In this condition the bones are growing faster than the muscles can stretch to accommodate the growth of the bone. The quadriceps will require intensive stretching to quickly eliminate the stress to the bone and muscle attachments at the tibial tuberosity.

Common Challenges - Working with children can be difficult if it is not easy to get them to cooperate.

Long Term Goals - Stretch all of the muscles of the hips and knees to accommodate the rapid growth of the child.

Focus on HE, KF, KFHE and then expand out globally according to the protocols set up for the entire hip and knee.

Baker’s Cyst - The timing below considers 1 side.

Primary Purpose - Reduce the cyst that has formed in the back of your knee.

Common Challenges – Restoring the ability to completely lock your knee.

Long Term Goals - Stretch all of the muscles of your posterior knee.

Stretch 15 30+ Page




Knee Flexion 1-2 HK16-HK18

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Knee Replacement -

Primary Purpose - Create stability and flexibility throughout the entire joint.

Common Challenges - Adhesions and scarring left over from the surgery. Manual scar tissue release work may be required to loosen the scarring and adhesions and to correct deviations in movement.

Long Term Goals - Stretch and strengthen all of the muscles of the knee and hip.

Special Considerations - The primary issue that may arise is the angle of the knee as you move through the various stretches. It is imperative to keep your knee at a 90 degree angle through out any of the rotatory stretches.

As time allows complete the entire hip and knee protocol with initial emphasis placed on the Baker’s Cyst protocol.

Patellar Tendinitis - The timing below considers 1 side.

Primary Purpose - Reduce inflammation of the patellar tendon.

Common Challenges – Pain, especially with movement, due to swelling. If this is the case, be sure to keep all of your movements slow.

Long Term Goals - Stretch all of the muscles of the knee.

Stretch 15 30 Page

Knee Flexion 1-2 HK27 Knee Flexion w/Hip Extension 1-2 HK29





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Lateral Patella - The timing below considers 1 side.

Primary Purpose - Restore the appropriate tracking of the kneecap.

Common Challenges - Overly developed and tight muscles on the outside of the knee and thigh will create a tracking problem over time. Typically the imbalance of strength between the muscles of the inner and outer knee is very far off. Developing strength to maintain balance is often the biggest challenge.

Long Term Goals - Stretch and strengthen all of the hip and knee muscles.

Stretch 15 30 Page






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Meniscus - The same protocol used for ACL/PCL applies here although you will likely find that you have no need to use TKE.

Primary Purpose - Create space in the joint with stretching to take the pressure off of the meniscus. The next priority is to create stability in the joint.

Common Challenges - Strengthening the rotators of the knee is often overlooked during the presurgery or rehabilitation process.

Create strength in your hip rotators to take further weight off of your knee joint.

Long Term Goals - Stretch and strengthen all of the muscles surrounding the knee. Stretch and strengthen the muscles of the hip as well. Hip instability can easily transfer into the knee if left unchecked.

ACL/PCL - The timing below considers 1 side.

Primary Purpose - Whether your treatment is pre-surgery or rehabilitation, the purpose is still the same. Create stability first and foremost and then restore flexibility. This will quickly bring about a reduction in inflammation, which will enable you to have much faster progress. In pre-surgery, strength is a much greater concern.

Common Challenges - Pain and joint instability often lead to apprehension in the muscles surrounding your knee. This can lead to your knee taking on a position of being bent all the time to protect itself. Restoring complete knee extension can sometimes be difficult because of this. If this is a problem, proceed with two extra sets of TKE, ADF and KE before continuing with the rest of the protocol.

Strengthening the rotators of the knee is often overlooked during the pre-surgery or rehabilitation process. Create strength in your hip rotators to take further weight off of your knee joint.

Long Term Goals - Stretch and strengthen all of the muscles surrounding the knee. Stretch and strengthen the muscles of the hip as well. Hip instability can easily transfer into the knee if left unchecked.

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Knee Flexion 1-2 HK16-HK18








self hip knee - be fit for health...90 degree angle. 2. place your l leg across the mid-line, turned...

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