Muscle group(s):Abdominals, shoulders, arms
Phase/modality:Strength, stabilisation
Equipment:Stability ball
Purpose
❑ To integrate isometric abdominal strength into upper and lower extremity
movements.
❑ To improve multi-planar lumbar stability.
Prerequisites
❑ Adequate rotator cuff strength.
❑ Instruction in diaphragmatic breathing. ❑ Good level of core strength.
Starting position
Client assumes a kneeling position in front of the ball and places clasped hands at the centre of the ball, ensuring neutral spine alignment and bracing abdominals.
Correct performance
❑ Client begins to roll forwards slowly, keeping the spine in good alignment. The forward movement comes from the simultaneous action of knee extension and shoulder flexion. The hips should remain the same distance away from the ball at all times.
❑ The therapist should observe for arching in the low back, which may indicate a lack of stability. In this instance, a tighter brace may be the solution. If the problem persists, instruct the client to perform a shorter movement.
151 Corrective exercise for the trunk
Figure 11.19.Iso-abdominals: side-lying – (a) before,
(b) after (b) (a)
Progressions
Increase the distance moved.
Supine lateral ball roll
Muscle group(s):Abdominals, total body
Phase/modality:Strength, stabilisation, balance, coordination
Equipment:Stability ball
Purpose
❑ To strengthen the abdominals and low back in all three planes of motion. ❑ To improve static stabilisation of the
muscles of the trunk.
Prerequisites
This is an advanced exercise and the client must possess good flexibility and strength in the lumbo-pelvic-hip complex.
Starting position
From a seated position on the ball, client rolls down into a bridge position, allowing the head and shoulders to rest on the ball. Arms are straight and out to the sides and a wooden dowel is held across the chest. The abdominals are braced.
Correct performance
❑ Client slowly rolls the whole body along the ball to the right, until the right shoulder begins to come off the ball, ensuring that the hips and shoulders are level throughout the movement. This position is held for 2–3 seconds, before rolling over to the other side and repeating. Perform 3–4 repetitions each side, before resting.
152 Corrective Exercise: A Practical Approach
(a)
Figure 11.20.Forward ball roll – (a) before, (b) after
❑ It is important that the abdominals are braced throughout the movement and that the whole body rolls as one unit. ❑ The therapist can observe the wooden
dowel to ensure it remains horizontal throughout and that the spine is not twisting in any way.
Progressions
❑ Increase the holding time to up to 8 seconds.
❑ Increase the distance moved. This will place increasing stresses on the trunk musculature to stabilise the entire body.
Note:This is an advanced exercise that should be placed towards the end of the functional phase. It is designed to train a number of skills, including strength,
endurance, agility, balance, coordination and flexibility – with this in mind, careful
attention should be paid to technique and execution.
Squat
Muscle group(s):Abdominals, low back, legs
Phase/modality:Strength, stabilisation
Equipment:None
Purpose
❑ To improve lumbar stabilisation during functional movements.
❑ To enhance the body’s ability to transfer force along the kinetic chain, during extension and flexion. Particularly useful for activities and sports where force is generated from the ground up.
Prerequisites
❑ Pain-free range of motion in shoulder flexion.
153 Corrective exercise for the trunk
(a) (b)
❑ If a lower- or upper-crossed posture is noted, a proper stretching programme must be completed before attempting this exercise, to ensure ideal lumbar
alignment and stability.
❑ Good flexibility in the calf muscles. ❑ The client must exhibit good core
strength and stabilisation.
Starting position
In a standing position, client places the feet shoulder-width apart, places arms across chest and assumes good postural alignment. The spine should remain in neutral
alignment throughout the movement. The abdominals should be lightly braced.
Correct performance
❑ Client performs triple flexion of the hip, knee and ankle, and squats down to a position where the thighs are parallel with the floor. In this position, the knees should not overshoot the toes and should be tracking over the second toe of each foot (not bowing inwards or outwards). The spine is still in neutral alignment and the hips are pushed backwards to
maintain balance over the feet. 154 Corrective Exercise: A Practical Approach
Figure 11.22.Squat – (a) before, (b) after
❑ From this position, client braces the abdominals further and contracts the glutes, while performing triple extension of the ankle, knee and hip, to return to the start position. Perform 10–12 repetitions.
❑ It is important to contract the glutes at the beginning of the upward push, as this will allow the pelvis to initiate the movement, prior to the spine.
❑ The therapist should observe spinal alignment, knee position and the
coordination of triple extension/flexion. There should be particular emphasis on the sequencing of abdominal and glute contraction at the start of the upward phase.
❑ If there is muscle weakness in the legs, the squat can be modified into a half- or quarter-squat, where the client only completes the range of motion available to them. Tightness in the calves may prevent full range of motion and these muscles should be stretched prior to attempting this exercise.
Progressions
❑ Slower tempo.
❑ Use of a weighted barbell. This progression involves holding a barbell across the upper back and requires adequate strength in shoulder abduction, along with good scapula control.