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Abdominals Page 17
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HIP AND PELVIS EXERCISE PROGRAMS
The muscles of the hip and thigh are often thought to consist of only a few very powerful
primary movers of the lower extremities, including the gluteus maximus, quadriceps and
hamstring muscles. However, there is also a network of smaller, intricate muscles that are
responsible for some of the finer movements of the hip and pelvis. These smaller muscles are
often predisposed to injury and dysfunction as a result of tightness, weakness, poor
biomechanics and muscular imbalance. This can often lead to an undue amount of stress and
strain being placed on these smaller muscles. As a result, it is no surprise that there are
biomechanical implications when some or all of these muscles are dysfunctional, compromising
the stability of the pelvis and lower limbs. Whether these muscles have become tight, weak,
painful or any combination of symptoms, there are a number of activities that you can do to
speed their healing and help prevent further injury. In conjunction, regular chiropractic treatment
will help to decrease the resting muscle tension of these muscles and improve their function.
1. Piriformis Stretch
Keep the low back and pelvis flat on the table. Hold for 30 seconds and alternate sides. Repeat
twice.
1. TFL/ITB Stretch #1
3. ITB/TFL Stretch #3
4. Foam Rolling
Assume the same position as picture C in ITB/TFL Stretch #2 but place a 6” diameter high
density foam roll under the affected TFL/ITB. Using the hands and unaffected foot for support,
slowly roll the affected thigh back-and-forth along the foam roll.
8. Sleeping:
a) On your side, avoid the fetal position with the knees and hips strongly flexed. Place a pillow
between your knees and keep your hips at more than 90o of flexion
b) On your back, make sure that a pillow beneath your knees is not too large to cause excessive
hip flexion.
9. Sitting:
a) Avoid sitting in the cross-legged lotus position.
b) Ensure that chairs have an open angle at the hips to minimize prolonged hip flexion. If not, tilt
the backrest backwards and lean against it or slope the front of the seat downwards.
c) When driving for long periods, change the position of the lower limbs as often as possible.
10. Avoid walking or running up and down hills to reduce strenuous hip flexion and further
aggravation of the ITB.
A final key to hip and pelvis stabilization involves improving the performance of the abdominal
muscles to control pelvic rotation during lower limb movements. The following exercises
complement the training of the small muscles of the hips and pelvis but emphasize abdominal
strengthening. This program begins quite simply but you need to progress to a more focused Core
Stability Program. Please ask one of the doctors for a copy of this.
Each of these exercises begins by contracting the abdominals, feeling as though your whole
abdominal area and sides are tightening up. This is referred to as abdominal bracing. Be sure to
maintain this contraction throughout each exercise.
There are both superficial and deep muscles associated with lower torso pain. Superficial muscles
include some of the paraspinal muscles (muscles that run parallel to the spine), as well as all of the
abdominal muscles. The superficial paraspinals travel the entire length of your spine and function to
extend the spine. Conversely, the abdominals generally act to flex the spine, although they also play a
large role in rotation of the spine. The deep muscles of your lower torso include the deep paraspinals,
the quadratus lumborum (QL) and iliopsoas muscles (major hip flexor). Each of these also have a
distinct function. The deep paraspinals primarily rotate the spine; the QL muscles act to stabilize the
lower torso and laterally bend the spine; the iliopsoas muscles act to flex the thigh (knee to chest
movement) at the hip joint and also provide some extension to the lower spine so that an upright posture
is maintained while standing. Together these muscles form the basis of support for your spine, much like
a cylinder, and they endure the majority of the postural stress that keeps your torso upright.
Following are a number of corrective actions and postures for each group of muscles.
Stretch #1
A. Lying on your back, slowly bring one knee up at a time towards the same shoulder and hold
for 30 seconds. Perform stretch for the other side. Repeat stretch 2 times for each side.
B. Lying on your back with both knees together, slowly bring your knees up to your chest while
grasping your thighs. Hold the
stretch for 30 seconds and repeat
the stretch 2 times.
Stretch #2
Resting on your knees on the floor, flex your torso forward with arms outstretched. Reaching as
far as you can, bring your chest toward the ground. Hold this stretch for 30 seconds and repeat 2
times.
These exercises will stretch the paraspinal muscles and strengthen the abdominal muscles at the
same time.
Quadratus Lumborum
The Quadratus Lumboram muscle is one of the most commonly overlooked muscular sources of low back pain. It
functions as a stabilizer of the lumbar spine and can act as a hip hiker and as a lateral flexor of the lumbar spine.
4. Avoid combined trunk flexion and rotation movements when bending forward
or to the side, as well as combined trunk extension and rotation movements.
5. Ensure that you are using a firm mattress that does not sag. Avoid sleeping on your stomach;
rather sleep on your back with a pillow beneath your knees or on your side with a pillow between
your knees. For more information on sleeping proper sleeping habits please ask one of the
health care professionals for a Sleep Hygiene handout.
Stretch #1
Lying on your back near the end of a table, bring both knees up to your chest. Keep
your low back pressed down on the table by contracting your abdominal muscles. Hold on to
the back of one thigh and slowly lower the other leg back to the table so that the lower leg
hangs off of the edge of the table. Alternate sides and hold each stretch for 30 seconds. Repeat
twice.
Stretch #3
For those experiencing lower back pain, place a pillow under the hips to keep the low back in a forward
bent (flexed) position.
Abdominals
In the case of rehabilitating the abdominal muscles, their weakness is very detrimental. As a result,
their strengthening should follow a progressive path from basic isolation of the muscles to combined
movements that involve numerous muscles at a time. The following are a few of the basic exercises
that will build a solid abdominal foundation, but be sure to quickly follow these up with our more
detailed Core Stabilization Program which one of our health care professionals will provide
for you.
1. Abdominal Bracing.
Perform abdominal bracing as described above. Place your fingers on both sides of your
abdomen. Bear down (like you’re straining to go to the washroom) without holding your breath.
Make sure you can feel your oblique muscles contracting under your fingertips at your sides.
Learn to hold this for a few seconds and progress to being able to do this while walking and
talking. Remember, practice makes perfect!
NOTE: It is important for you to follow any specific instructions given to you by your Health Care
Professional. Your active participation in your rehabilitation will dramatically improve your
recovery time and aid in the effectiveness of your in office treatments. If you have any questions
regarding the information provided in this handout, please do not hesitate to contact your Health
Care Professional.