Strengthening Exercises

All of the exercises detailed here are for specific problems or injuries. It is always recommended to consult your practitioner before attempting any exercises.

Back of shoulder stretch

The shoulder stretch is performed lying on your side, your upper arm should be out lying perpendicular to your body on the floor in front of you with the elbow bent so your hand is pointing to the ceiling. Remember “90, 90, 90”, use your other arm to pull the back of the forearm of the bent arm to the floor.
The upper portion of your bent arm should rotate only. Maintain the 90,90,90 and do not let the upper arm slide down the floor. Feel the stretch in the back of the shoulder and hold for 30 seconds.
The goal is to be able to stretch the shoulder enough so your palm touches the floor.
After this, try stretching the shoulder by taking the front of the forearm the other way to see if you can get the back of your hand on the floor, if not, hold the stretch here for 30 seconds also.

Repeat these on the opposite side if you wish.

Ankle Proprioception Rehab

Stand on one leg, eyes open, finger on wall. Lean weight 10 times to either side, then 10 forwards and backwards, then 10 across on an opposite corners and then across on the other opposite corners.

The routine stays the same each time as you progress, leaning your weight. However what changes is your eyes and finger position to progress the exercise.

Eyes open, finger off wall
Eyes closed, finger on wall
Eyes closed finger off wall

The next stage is standing on a wobble cushion (Foam block) or other slightly unstable surface. Again the weight shift routine is the same but the eyes and finger change.

Eyes open finger on wall
Eyes open finger off wall
Eyes closed finger on wall
Eyes closed finger off wall

You can also practice using rocker/wobble board with two feet at this stage to practice using the ankle with your other foot. A rocker board is easier to start with, though they are less common at gyms.

It follows the same routine as above, progressed the same. However instead of just leaning, you want to control the rocker/wobble board so that the edge almost touches the floor, then you shift your weight the other way.

Once you can do all the above, you can move on to lunging on to a wobble cushion.

All of the exercises detailed here are for specific problems or injuries. It is always recommended to consult your practitioner before attempting any exercises.

Tibialis Posterior Strengthening Routine

Side Bridge Exercise

Lay on side with knees bent to 90 degrees but so that your hips and thighs are in line with your torso. Have your elbow bent at 90 degrees so that your arm is pointing perpendicular to your body.
Keeping your head in line with your neck, raise up your waist so that you begin to feel the side of your body closest to the floor is beginning to work.
The aim is to hold this position for 90 seconds, if you fail before this then take a break no longer than 10 seconds long and complete the 90 seconds. If you fail again then stop the exercise.

Note: if at any point you feel pain in the region you are working then stop. If you have a shoulder problem then ask me to give you an alternative exercise as this can also be performed similarly using a gym ball.

Functional Stability Exercises

Single Leg Squats

1. Stand 1 foot away from a wall and place your hand upon it for extra balance
2. Engage core 25%, find pelvic neutral, engage pelvic floor and create a strong arch on your standing foot.
3. Sink down on your standing leg until you feel your technique begins to fail and then return to standing. Examples of failing technique are the standing legs’ knee migrating inwards, the hips shifting or dropping on one side, loss of core or pelvic floor or loss of a strong foot arch.
4. Perform 7 good technique squats on each leg.

Lunges

1. Start in a standing position with both feet together,
2. Engage your core 25% , with a neutral pelvis, pelvic floor contracted and good strong arches.
3. Allow yourself to fall forwards until you need to step out and catch yourself into a medium length lunge.
4. Do not allow your knee to bend over your ankle as you catch yourself, do not let your knee bend inward, hips shift or drop and maintain a good strong arch. Use a mirror or have a person watch to help your practice.

Progression

- Perform a lunge on to a labile surface such as a spongy exercise mat or a wobble cushion.

Repeat this routine 3 times, each time increasing the width of the legs so that the second cycle is twice as wide as shoulder width and by the third cycle your legs are almost 3 times wider than shoulder width. The distance between the legs during the lunge routine does not differ each time. The whole routine should take about 20 minutes to complete.

Try to perform the whole routine every day for 2 weeks, then once every few days for a couple of weeks eventually reducing down to once a week so that you can add it in to your weekly exercise regime so that your lower back maintains it’s stability in the future.

Note:

If at any time you feel abnormal discomfort not associated to the hamstrings stretching or your lower back working then discontinue the exercise and inform your practitioner.
Your hamstrings may feel sore in the following hours/days after performing this routine. This is completely normal and is not uncommon as you are essentially stretching (a very mild form of tearing) muscle fibres that have not been stretched for some time. Use 2 Ice packs under each hamstring in a seated position for 10-15 minutes every 2 hours to help calm the soreness. Try to perform the routine again once the discomfort has subsided enough so that you are happy to continue.
You may also feel a mild ache in your lower back muscles, this is also completely normal. The ache is a sign that the muscles been working, Ice and anti-inflammatory gels (Ibuprofen etc.) are great ways to relieve this if you are concerned. With time the aching should lessen and eventually stop as the endurance of the muscles in your back increases. BUT ALWAYS REMEMBER go to the comfortable limit, if pain worsens you must stop.

Foundation Training Routine

These exercises are designed for people with lower back pain so consult your practitioner regarding any concerns or modifications that are applicable before you start. Technique is crucial during these exercises so your practitioner will continue to check your technique during each session. These exercises are designed to increase the endurance of the muscles of your lower back so that they are able to cope with the day to day stresses of life! By reducing the stresses put upon all structures in the back (joints ligaments discs etc.) we can reduce the chance of back pain recurrence.

Founder

Squat position with hands out to the sides behind you palms down, bend knees but do not allow knees to go over the toes, keep them as far back as possible without losing your balance. Push your bottom out backwards as you sink down until you feel your hamstrings begin to stretch on both sides. Hold 10 seconds.
Transfer hands straight out in front of you again palms down. Due to the counter balance of the arms out in front of yourself this now means you can sit back and down more with your bottom. Once you feel you have pushed your bottom back and down as far as you can try to straighten your legs a little so that the stretch in the hamstrings increases. Hold 10 seconds again.
Now allow your back to arch as you bend forward, allow your arms to be out in front of your body as far as possible still to counter balance your bottom that is still pushing backwards. You should still feel the stretch in the hamstrings while you are holding this position. Hold this for 10 seconds and then return to a standing position by keeping your back straight as you work your way up your shins with your hands whilst on your way to standing.

Dynamic Founder Squats

Starting position is stood up with your bottom pushed out backwards slightly and knees slightly bent but again not letting the knees to go forwards at all, keeping your back straight so that you are prepared to go into the squat position. Your arms are crossed across your chest towards the opposite shoulder.
Squat down into the founder position till you feel your hamstrings stretch, your arms go from across your chest to being straight out in front of you as in Number 1 above and then return straight back up to the standing position.
Repeat this 10 times holding the hamstring stretch for 5 seconds on the 9th and 10th holds respectively.

Lunge routine part 1

Adopt a lunge position with your right leg forward and your front leg slightly bent with your feet straight in line pointing forwards. Raise your arms above your head and lean back. Push your hips forwards whilst leaning back so that a stretch is felt on the front of the pelvis at the left groin region. Hold 10 seconds.
In this position, Lean across to the right (away from the back leg), hold stretch for a further 10 seconds.
In this position, bring your left shoulder back so that the stretch increases again, hold for further 10 seconds.
Return to normal lunge position.

Lunge routine part 2

Still in the lunge position with your right leg forward and front leg slightly bent cross your arms across your chest. Whilst keeping your knees and ankles completely still bend forwards from the hips only (similar to a plank of wood falling forwards) keeping your back nice and straight till you feel a stretch in the hamstring on the back of the front leg. Hold 10 seconds.
Now put your arms out straight in front of yourself and raise them up to increase the stretch of the hamstring. Hold 10 seconds.
Now rotate so that your arms point to the right (away from back leg). Hold 10 seconds.
Return arms back in front of self, hands up and then stand up.
Repeat Lunge routine parts 1 and 2, this time with the left leg forwards.

The Windmill

Adopt the ‘Founder’ position that we covered at the start of number 1, with your arms out to the back and sides behind you with palms face down. Squat down so that you feel the hamstring stretch for 10 seconds.
Now bend forwards allowing the back to arch, push the arms out in front of you as a counter balance and maintain the hamstring stretch in the legs. From this position, rotate to the right and reach up to the sky whilst in the bent over position. Make sure that the opposite hand stays out in front of you so that you can continue to counter balance your bottom that is still pushing out behind you. You should feel a stretch in the left hamstring at this time. Hold for 5 seconds.
Return to arched over position, briefly contract the lower back so that you are less arched for 2 seconds. Then return to fully arched position (continue to maintain hamstring stretch the whole time)
Now reach up with the left hand towards the sky so that stretch is felt in right hamstring. Hold 5 seconds.
Return to normal arched position, slide hands up shins and keep back straight as you return to a standing position.

Try to perform the whole routine every day for 2 weeks, then once every few days for a couple of weeks eventually reducing down to once a week so that you can add it in to your weekly exercise regime. This is so that your lower back maintains good stability in the future.

Note:

If at any time you feel abnormal discomfort not associated to the hamstrings stretching or your lower back working then discontinue the exercise and inform your practitioner.
Your hamstrings may feel sore in the following hours/days after performing this routine. This is completely normal and is not uncommon as you are essentially stretching (a very mild form of tearing) muscle fibres that have not been stretched for some time. Use 2 Ice packs under each hamstring in a seated position for 10-15 minutes every 2 hours to help calm the soreness. Try to perform the routine again once the discomfort has subsided enough so that you are happy to continue.
You may also feel a mild ache in your lower back muscles, this is also completely normal. The ache is a sign that the muscles been working, Ice and anti-inflammatory gels (Ibuprofen etc.) are great ways to relieve this if you are concerned. With time the aching should lessen and eventually stop as the endurance of the muscles in your back increases. BUT ALWAYS REMEMBER go to the comfortable limit, if pain worsens you must stop.

Core Stability Exercises

How to engage your ‘core’, also known as ‘co-contraction’

Imagine someone is about to hit you in your abdominal region, tense up to protect your self, now back the tension off a half and then a half again. Hold this but continue to breathe normally. Your core is now engaged.

How to find ‘pelvic neutral’

Rock your pelvis back and fourth as far as it can go so you find the end range of anterior tilt and posterior tilt. Now find the mid way point between the two where the pelvis sits freely, this is ‘pelvic neutral’. Hold this position when performing core stability exercises.

How to get in to the ‘Hook Lying Position’

Lay on the floor on your back with arms out to the sides and the back of your hands slightly under your pelvis, both knees bent up and shoulder width apart.

‘Dead bug’ exercise (1st level)

Adopt the Hook Lying Position on the floor
Now engage your core and find pelvic neutral following the instructions at the start of the page.
Now the first difficulty level of this exercise is marching. Raise your right foot off the ground so that your knee reaches 90 degrees to your body. If you lose your core or pelvic neutral then reset and try again.
Perform 15-20 repetitions with each leg. Use your hands to feel if your pelvis rotates back at all, stop this movement if it occurs.

If you found this level too easy then progress to level two, however, remember it is about quality and not quantity. It is recommended to observe yourself in a mirror or have someone watch you to make sure your body is not performing the actions incorrectly and so that you can correct your self.

Dead bug exercise (2nd level)

The next level of difficulty is to again start in the hook lying position, engage your core and find pelvic neutral.
Again, lift your feet so your knee reaches 90 degrees. However, with the opposite arm, begin with it straight up over your head. Lift your opposite arm up over your head as you raise the opposite leg as before. If you lose pelvic neutral or your core then reset and start again. Keep the other hand under the pelvis to monitor any unwanted pelvic rotation. Repeat on other leg and arm.
Perform 15-20 repetitions per side

‘Bird/Dog’ AKA ‘The Superman’

Starting on all fours on the floor, engage your core and find pelvic neutral.
Extend your right leg back straight from the all four position, if you lose pelvic neutral or your core then reset and perform again.
Perform 15-20 repetitions. Repeat on opposite leg.
Progress on to opposite leg and arm.

Water Exercise - Hydrotherapy!

‘Clam shell’ Routine For The Hips

Lay on your side, knees bent to 90 degrees, hips bent to 45 degrees. Keep your hips square and do not allow them to move when the legs are moving. Engage abdominal muscles (abs) 25% of maximum but ensure your hips and abs are set like this for all the exercises. Open legs as if opening a clam shell. Repeat 15 times, progress by using a theraband as resistance.
While in the same position, lift your foot toward the ceiling as if turning you hip in, repeat 15 times and progress by using a theraband as resistance.
(For the same leg) turn on to opposite side and flex bottom hip to 90 degrees, keep the other leg straight and prop up on a pillow. Push the thigh down in to the ground as you raise your foot to the ceiling, repeat 15 times and progress by using an ankle weight as resistance.

Bilateral Eccentric Decline Squats

This exercise is an adapted version of ‘single decline’ wall squats which is used when both knees are suffering from patellar tendonitis.

Lean with you back against the wall and feet out in front so that when you squat, your knees are bent to 90 degrees.
From this position, slide down the wall, controlling your descent
When your knees reach 90 degrees the squat is complete.
Lean forwards to come away from the wall and comfortably stand back up
Lean back on to the wall and repeat the steps above.

Repeat these 30 times, once per day. You may feel some discomfort at the front of the knee or just behind it whilst performing this exercise. As long as the pain is a dull achy, warm sensation, this is fine. ANYTHING more severe, stop and consult your practitioner.

Ice is generally recommended once per day after the exercise if mildly sore, followed by a gentle walk.

Do not apply ice to your knees before going to bed as this can cause the knees to stiffen up during sleep.

This routine is designed to be carried out over a long period of time to build up the tissue at the patellar tendons. Eccentric training is the key to treating tendon problems, though the recovery does take time (around 12 weeks). The long duration is due to the strengthening and tissue rebuilding of the tendon that is required.

Glute Max Muscle Firing Exercise

All exercises to be performed once daily but never within the first hour of waking up. Stop immediately if any pain, nausea or dizziness is experienced and if symptoms persist stop the exercises and consult your practitioner.

The Superman

Place the gym ball on the floor under your chest and stomach, place the soles of both your feet up against a wall to help support your body weight ready for the next step. The wider your feet are, the more support you’ll get.
Extend your knees so that the gym ball rolls down your body, when your knees are fully extended the ball should be under your lower stomach and hips. The top half of your body should stay straight in line with the rest of your body. Your arms will move from around the ball to out to your sides, with palm down at 30 degrees.
When your body is fully straight hold for 10 seconds, repeat this 10 times, “10 for 10”

Leg Extensions

Lay on the gym ball so that your waist is supported centrally and your hands are on the floor in a press up position.
Put your feet together and lower them till they touch the floor.
Raise them again till they are in line with the rest of your body hold this position for 10 seconds.
Repeat 10 times or “10 for 10”

Side Raises

Lay on your side on the gym ball with the ball at waist height and your legs spread wide touching a wall for stability.
Raise the upper half of your body up so it is straight in line with your legs. Only use the muscles on the side of your waist. Hold for 10 seconds.
Lower back down so your side muscle relaxes and repeat 10 times, “10 for 10”

Shoulder Rehab

Scapular setting

Choose a light weight and the adjust pulley height so that it is near the top setting or use a theraband attached to the top of a door.
Stand in a slight lunge position with back leg on same side as pulley and engage pulley so cable/band is tight and light weight is engaged allowing your shoulder to be pulled up and forward.Using your shoulder only and keeping your elbow straight set the shoulder blade by depressing your shoulder ‘back and down’.
Allow your shoulder to return to the start position.
Perform the same movement again but this time follow through with lat dorsi pull down (see fig.3). Repeat 20 times once a day.All of the exercises detailed here are for specific problems or injuries. It is always recommended to consult your practitioner before attempting any exercises.

Theraband/cable exercises

Below are some theraband/cable exercises which must be performed with your shoulder blade set in the position as shown in Fig 1 above, “back and down”.
Do not swing your body into the movements as this will be ‘cheating’ and not working the correct muscles we are aiming for. Low to medium weight (or theraband) for 20 reps once a day. Do not use too much weight.

Hip Strengthening Routine 1

X-walk

Using a theraband (stretchy elastic) hold each end, stand on the middle region of the band legs at shoulder width and with your hips turned inwards (i.e heels out, toes in)
Pull the band up at each end and cross the ends over so the opposite hands are holding each end of the band forming a cross in front of you.
Side step whilst holding the band, 2 steps to each side, do this 10 times to the right and 10 to the left. Therefore performing 20 side steps to each side and making 40 in all.

Remember to keep everything above your waist as upright as vertical as possible so that you do not use your lower back to cheat. Also engage your core by holding a 10% of maximum contraction tummy tuck.

Monster Walk

Again using a theraband in the same manner as before, this time with your toes pointing straight ahead and heels in a normal position.
Walk forwards taking your leg in to out as you walk, go forward ten steps.
Then walk backward in the same manner, in to outwards, take ten steps.

Hip Strengthening Routine 2

X-walk

Using a theraband (stretchy elastic) hold each end, stand on the middle region of the band legs at shoulder width and with your hips turned inwards (i.e heels out, toes in)
Pull the band up at each end and cross the ends over so the opposite hands are holding each end of the band forming a cross in front of you.
Side step whilst holding the band, 2 steps to each side, do this 10 times to the right and 10 to the left. Therefore performing 20 side steps to each side and making 40 in all.

Monster Walk

Again using a theraband in the same manner as before, this time with your toes pointing straight ahead and heels in a normal position.
Walk forwards taking your leg in to out as you walk, go forward ten steps.
Then walk backward in the same manner, in to outwards, take ten steps.

Clam shell routine for hips

Lay on side, knees bent to 90 degrees, keep hips square and do not allow them to move when the legs are moving. Engage abs 25% of maximum (ensure hips and abs are set like this for all the exercises). Open legs as if opening a clam shell. Repeat 15 times, progress by using a theraband as resistance.
While in the same position, lift foot toward ceiling as if turning you hip in, repeat 15 times and progress by using a theraband as resistance.
(For the same leg) turn on to opposite side and flex bottom hip to 90 degrees, keep the other leg straight and prop up on a pillow. push the thigh down in to the ground as you raise your foot to the ceiling, repeat 15 times and progress by using an ankle weight as resistance.

Hip Strengthening Routine 3

X-walk

Using a theraband (stretchy elastic) hold each end, stand on the middle region of the band legs at shoulder width and with your hips turned inwards (i.e heels out, toes in)
Pull the band up at each end and cross the ends over so the opposite hands are holding each end of the band forming a cross in front of you.
Side step whilst holding the band, 2 steps to each side, do this 10 times to the right and 10 to the left. Therefore performing 20 side steps to each side and making 40 in all.

Monster Walk

Again using a theraband in the same manner as before, this time with your toes pointing straight ahead and heels in a normal position.
Walk forwards taking your leg in to out as you walk, go forward ten steps.
Then walk backward in the same manner, in to outwards, take ten steps.

Squat with ball

Stand with your back to a wall and place a football between your knees
Squeeze the ball between your knees and squat so that your knees and hips are bent to 90 degrees.
Hold for 10 seconds and repeat 10 times.

10 Great Pool Low Back Exercises!

Low Back Hydrotherapy Protocol

Exercise		Time (mins)
1	Walking on spot	3
2	Walking lengths	3
3	Marching on spot	3
4	Marching lengths	3
5	Standing rotation with woggle	3
6	Push pull with hands	3
7	Side steps straight leg (to left and right)	3
8	Side steps over ball (to left and right)	3
9	Standing: hip forward and back far/av_cell]3
10	Squats (sets of 10 and small rest)	3
11	Step up’s	3
12	Lunges	3
13	Flipper legs	3
14	Woggle push down’s	3
15	Woggle cycling	3
16	Light & free swim (NO frogleg!)	10-15

Lower Body Stretches

Calf Stretch

Stand with feet shoulder width apart, feet facing forward. Take one foot back, pushing heel into floor. Keep front leg slightly bent.

Quadriceps Stretch

Standing one leg bring, take your other leg behind you with your hand holding around your ankle. Keep your knees together, titling your hips forward for a deeper stretch.

Hamstring Stretch

Sitting on the floor, bend one leg into your opposite thigh, then slowly lean forward towards your ankle, to a point where you can feel a stretch.
Stand shoulder width apart, lean back on your back leg slightly bending it, keeping the front leg straight, and pushing your bottom in the air until you can feel the stretch.

Adductors Stretch

Sitting on your bottom, bring the soles of your feet together, slowly pushing your knees slowly to the floor until you can feel a stretch.
Standing slightly wider than shoulder width apart, keeping one leg straight, lean to one side whilst you slightly bending your knee until you feel a stretch in your straight leg.

Hip Flexor Stretch

In a lunge position on the floor (bent leg in front, back leg on floor behind) slowly lean forward till you feel a stretch.

Glute Stretch

In a lunge position on the floor (bent leg in front, back leg on floor behind) slowly lean forward till you feel a stretch.

Isometric Neck Strength Exercises

Isometric Neutral Extension

Lay on your back on the floor or bed
Place your tongue in the roof of your mouth (this promotes proper cervical muscle activation)
Perform a chin tuck by pulling your chin straight back in to your neck (This activates the deep neck flexors)
Chin tuck backwards into resistance such as a stiff pillow or the floor and hold
Try to repeat 15-20 times, 10 second holds at a time and try not to rest for longer than 10 seconds between each attempt.

Once you begin to find this easy, let your practitioner know.

Isometric Neutral Flexion

Lay face down on the floor or bed
Again place your tongue in the roof of your mouth, perform a chin tuck.
Push your head forwards in to the floor or a stiff pillow.
Try to repeat 15-20 times, 10 second holds at a time and try not to rest for longer than 10 seconds between each attempt.

Once you begin to find this easy, let your practitioner know.

Isometric Lateral Flexion

Lay on your side with your head and shoulders perpendicular to the floor. Use a stiff pillow or soft football to support your head so that it stays parallel to the floor and straight with the rest of the spine.
Place your tongue in the roof of your mouth and perform the chin tuck.
Push sideways in to the resistance.
Try to repeat 15-20 times, 10 second holds at a time and try not to rest for longer than 10 seconds between each attempt.

Again, Once you begin to find this easy, let your practitioner know.

I will monitor these exercises and once you are comfortable with them we can progress them.

Hip Strengthening Excerises

Neck Stretches

Upper Trap Stretch

With the hand and arm on the same side as the side to be stretched, reach straight down behind your body.
With the opposite hand reach over your head and pull the head away from the side you are stretching.
Hold a nice stretch for 20 seconds, stop if painful.

Levator Scapulae Stretch

Similar to the previous stretch however this time rotate your head away from the side to be stretched
Now pull your head forwards and away also from side you want to stretch by using the opposite side’s hand
Reach straight down your back with the hand and arm on the same side as the stretch.
Hold a nice stretch for 20 seconds, stop if painful.

Rhomboid Stretch

With both arms, straighten them out and make a fist with each
Put your fists together and push your fists forwards as if you were pushing someone away in front of you
Tuck your head down feel a stretch across the top of your back and hold a nice stretch for 20 seconds, stop if painful.

Hip & Knee Hydrotherapy Protocol

Exercise		Time (mins)
1	Walking on spot	3
2	Walking lengths	3
3	Marching on spot	3
4	Marching lengths	3
5	Standing side leg lift (left and right)	3
6	Side steps straight leg (to left and right)	3
7	Side steps over ball (to left and right)	3
8	Little & quick steps… Forward 10, back 10!	3
9	Squats (sets of 10 and small rest)	3
10	Step up’s	3
11	Lunges	3
12	Flipper legs	3
13	Woggle push down’s	3
14	Woggle cycling	3
15	Length runs (jogs………sprints)	10
16	Light & free swim (NO frogleg!)	10-15

Strengthening Exercises

All of the exercises detailed here are for specific problems or injuries. It is always recommended to consult your practitioner before attempting any exercises.

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