Core Exercise & Stretches

Welcome to the Poise Health Exercise Rehabilitation Programme

These exercises are those prescribed by your Poise Health Practitioner.  Only attempt the ones that you have been advised to do so.  The exercises prescribed here are designed to improve your joint and muscle function after an episode of pain.  Each exercise builds on the next.  It is important to ‘listen’ to your body and not over do it. If you experience pain or discomfort, check with your practitioner before proceeding.  A routine of around 20 minutes per day is adequate.  Unless otherwise stated by your practitioner, do no more than 10 repetitions of each exercise prescribed to you.

When lying on your back, if necessary, place a pillow under your head to support your head, neck and shoulder girdle.

Exercise 1 – Knees to Chest with gentle rocking to mobilise the spine.

Rocking to gently mobilise the lower backLie on your back and bring your knees to your chest.  Gently pull your knees towards you and away from you to rock the knees back and forth.  If necessary, place a pillow under your head if you feel that your head does not easily reach the floor.  You can place your hands on top of your knees if that is more comfortable.  Rock forward and back 10 times.  If you wish, you can also attempt to rock side to side with your knees draw in towards the chest.

Exercise 2 – one knee to chest to mobilise the hip joint and lengthen the hip flexors on the straight leg side.

Exercise 2 - one knee to chest 2Keep one knee bent and gently bring towards the chest.  Lengthen the other leg so that it straightens.

If possible, encourage the back of the knee to flatten towards the floor.

Hold for 3 breaths.  Place the foot of the bent leg on the floor then swap to the other side.  Repeat 3 times each leg.

Exercise 3 – Pelvic tilts to gently mobilise the lower spine and train your inner core muscles.

pelvic tiltsLying on your back, gently tilt your pelvis in a scoop action so that your pubic bone is moving upwards. At the same time gently contract your lower stomach muscles.

pelvic tilt stage 1

You may feel your lower back (lumbar spine) move towards the floor as you gently draw in your stomach muscles towards your spine.

pelvic tilt stage 2Hold the position for one relaxed breathe and then release the pelvis and the stomach contraction.

Repeat 10 times.

This is a good exercise to perform at the start of each exercise session.

Exercise 4 – Bridge Curl to gently mobilise the lower spine, open up the front of the hip joint and activate the buttock muscles.

bridge

Lie on your back with knees bent and feet hip width apart.  Slowly and gently lift the spine off the floor one vertebrae at a time.  Slowly lower the spine back to the floor, again one vertebrae at a time.  If the core muscles are weak, the movement can feel ‘jerky’.  Over time, the movement will become more smooth.  Repeat the movement 5 times.  Remember to breathe.

Exercise 5 – Bridge Curl with theraband to increase the strength of the gluteus medius muscle.  (progression from the Bridge Curl)

bridge with therabandSet up is the same as the Bridge Curl (exercise 4) then, whilst the buttocks are lifted, abduct the legs (in and out) with a theraband around the knees.  Ensure both legs are working equally.  Control the movement in and out.  Ensure the pelvis remains lifted.

Repeat 10 times then gently lower the spine one vertebrae at a time.

Exercise 6 – Pelvic tilt with leg slides to train the core muscles to maintain a contraction whilst limbs (legs) move.

Whilst maintaining your pelvic tilt (as in exercise 3 above) to activate your core.

core with one leg slide 2core with one leg slide

Gentle slide one leg along the floor until the leg is straight.  Reactivate the core muscles by re-tilting the pelvis then gently draw the leg back into the start position.

Change to the other leg.  Each stage of the way re-tilt the pelvis to ensure the core muscles are contracting.

Repeat 10 times on each leg. Remember to breathe.

Exercise 7 – Cat-Camel stretch to gently mobilise the spine in extension and flexion.

table topStart in the ‘table top’ position so that you are on your hands and knees.

Make sure that hands and knees are both hip width apart.  Ensure that your shoulders feel strong and that you are not allowing your spine to ‘sag’ between your shoulder blades.

cat camel stage 1Gently draw in the stomach muscles to activate the core muscles.

cat camel stage 2

To start, gently allow the head to lower and start to raise the spine upwards.

Breathe.

cat camel stage 3

Continue the movement until you feel a stretch along the length of the spine.

Breathe.

Then reverse the posture by gently lifting the head upwards  and at the same time allow the spine to lower.

Only move as much as your joints allow.  Avoid forcing any movement.  With practice, the movement will increase.

Avoid the feeling of ‘pinching’ at the base of the spine or at the back of the neck.  Avoid over stretching in either direction.

Breathe in and out with the movement.  Repeat 10 times.

Exercise 8 – Table Top postion with arm lifts to train the core muscles with limbs (arms) moving.

table top with arm liftStart in the ‘table top’ position.  Gently draw in your lower stomach muscles to activate your core muscles.  It is good to imagine that you are keeping a tray on your back with glass of water that you wish to balance.  Gently lift one arm whilst maintaining your balance.  If that feels easy, then repeat this with eyes closed.  Alternate arm lifts.  Check that your lower stomach muscle contraction is maintained. Repeat 10 times.

Exercise 9 – Table Top postion with leg slides to train the core muscles with limbs (leg) moving.

core with leg liftStart in the ‘table top’ position.  Draw in your lower stomach muscles to activate your core muscles.  Gently allow one leg to slide backwards to a straight leg position.  If you are comfortable in this position, then allow the leg to raise a few inches off the ground. If this also seems easy, then repeat the movement with eyes closed.  Alternate leg slides.  Check that your lower stomach muscle contraction is maintained.  Repeat 10 times.

Exercise 10 – Deadbug exercise stage 1 to help train the core muscles to contract when limbs (arms) move.

Deadbug preparationLying on your back, place the legs at 90 degrees at the hip and 90 degrees at the knees with the arms up to the ceiling.  If necessary, place a folded towel or small pillow under the head to keep your spine in a neutral position.  Draw the stomach muscles back towards the spine to prepare.

core with armThen allow one arm to lower towards the ground beside the ear.  Return the arm to the start position and repeat on the other side.

Alternate arms.

Repeat 10 times

Exercise 11 – Deadbug exercise stage 2 to help train the core muscles to contract when limbs (legs) move.

deadbug with leg slideSet up for Deadbug exercise stage 1.  Initially, place the hands on the lower abdominal muscles to ensure you are contracting the lower abdominal muscles.

deadbug with leg slides

Then allow one leg to slide away until the leg is straight.  Return the leg to the start position.

If you are sure that the lower abdominal muscles are contracting, then bring the arms up so that they are positioned towards the ceiling.  Then allow one leg to slide away until the leg is straight.  Return the leg to the start position.

The lower stomach muscles must contract throughout the movement.  If you feel you are unable to maintain the contraction.  Do not proceed with this exercise and return to stage 1 above until the core muscles have strengthened.

Exercise 12 – Deadbug exercise stage 3 to help train the core muscles to contract when limbs (legs and arms) move.

deadbug with arms and legsPrepare as in Deadbug exercise stage 1.  Ensure that the lower stomach muscles are contracting to protect your spine.  Then allow the opposite arm and leg to move away from each other;  the arm beside the ear and the leg straightening away from you.  Bring the arms and legs back to the start position.  Repeat on the other arm and leg.  Repeat 10 times.  Remember to breathe.

Exercise 13 – Back extension with arms supporting – an exercise to train the extensor muscles of the spine.

preparation for back extensionLying face down.  Bring the arms to a bent arm position so that the forearms rest on the floor as shown in the photo.  Gently pull the stomach muscles in to protect the spine.  Gently raise the body off the ground whilst gently resting on the forearms.

back extAvoid using your arms to lift you up, instead lightly rest on the forearms and use your back muscles to lift you.  Avoid hyper-extending the spine to avoid ‘pinching’ the lower back.  Hold the position for 10 seconds and then return to the resting position.  Repeat 10 times.  Remember to breathe.

Exercise 14 – Back extension without arms supporting – an exercise to train the extensor muscles of the spine.

preparation for back extension with arms by sideLying face down, place the arms by the side of the body.

Gently pull in the lower stomach muscles to activate the core muscles and protect the spine.

back extension with arms by sideRaise the upper body off the floor.  Keep breathing throughout the exercise.

If you feel any tension in the lower back return to the start position and rest for a few breaths.

back extension with arms at side and lifted

This will allow the muscles to relax before you perform a second lift.

A slightly more challenging option is to then raise the arms off the floor.  This will increase the effort of the extensor muscles of the spine.

Hold the position for 10 seconds.

Repeat 10 times.

Exercise 15 – plank with knees bent to strengthen the core muscles.

plank with knees bentThe plank is a ‘strong’ exercise.  A good way to start is with knees bent.  Bend the arms and place the forearms on the floor.  With knees bent, keep the trunk of the body off the ground.  Hold for 10 seconds and then rest.  Over time increase the time in the position to 20 seconds, 30 seconds and eventually 60 seconds.  If you start to shake, take a rest.

Remember to breathe.  Repeat 2 or 3 times.

Exercise 16 – Plank with mid back mobilisation to strengthen the muscles that support the scapular (shoulder blade).

plank with thoracic spine exerciseplank with thoracic stretchOnce you have mastered the plank position, you can use the plank to strengthen the shoulder girdle and also mobilise the thoracic spine (mid back).

As always, remember to gently pull in the lower stomach muscles to activate the core muscles.

Lower the spine between the shoulders towards the ground.

Then encourage the spine to lift up towards the ceiling.

Repeat this 5 times.

Remember to breathe.

Exercise 17 – Spinal stretch with side stretch to mobilise the spine and rib joints.

child pose with support for headStart by kneeling and allow the buttocks to move towards the feet.  If necessary place a pillow on the calf muscles to reduce the pressure on the knees.

Reach forward with the arms and place the forehead on the floor.  If the distance to the floor is too great, place a towel under the head .

child pose with twist and head supportThen reach the arms around to one side and breathe in and out in the slightly ‘off to one side’ position.

Encourage the finger tips to stretch forward.

Breathe in and out a few times in this position.

child pose from above with twistThen bring the arms back to the start position.

When you are ready, move the arms to the other side.  Again stretch the finger tips forward to increase the stretch.

Keep the buttock area close to the heels of the feet.

Repeat two or three times each way.  Finish in the start position for two to three breaths.

Exercise 18 – Gluteal (buttock) muscle and hamstring stretch

glut stretch 1Whilst sitting with legs out in front of you, bend one leg.

Using your hands to guide the leg, place the lower part of the bent leg on to the thigh of the straight leg.  Avoid stressing the ankle joint in this position.

glut stretch 2Sit up tall.

You may find that this is already an intense stretch so to start with you may wish to stay at this level.

If you are able to increase the stretch, raise the arms out in front of you and then gently reach forward to increase the stretch.

glut stretch 3glut stretch 4Remember to breathe.

Repeat on the other side.

Hold the position for 20 – 30 seconds.

Exercise 19 – Seated twist to mobilise the spine and stretch the gluteal muscles

seated twist preparationWhilst seated start with the legs out in front. Using the hands guide one leg so that the leg bends at the knee and hip and then position the leg over the straight leg.

Place the foot of the bent leg next to the knee of the straight leg.

seated twist to the left

Then take the opposite arm across the body to hug the bent knee.

Use the knee to allow the body to be rotated toward the bent leg side.

Gently encourage the spine to rotate from the base of the spine to the upper part of the spine.

seated twist to the right

Place the free hand on the floor to help guide the stretch.

Return to the start position.

Then repeat on the other side and rotate in the other direction.

Remember to breathe.

Hold each position for two or three breaths.

Remember to encourage the movement and not to force anything.

Exercise 20 – Seated Hamstring stretch and calf stretch

seated hamstring stretchWhen seated, place the legs out in front of you.

Take a dressing gown cord (or similar) and place the cord around the balls of the feet.

Allow the toes to come towards you as this will increase the stretch in the calf muscles too.

hamstring stretch 2Gently draw the chest forward.

Keep the chest lifted to ensure the stretch works on the hamstring muscles and does not over stretch the lower back.

Remember to breathe.

Hold for 20 – 30 seconds.

Rest and repeat 2 or 3 times.

Exercise 21 – Hamstring stretch whilst lying down

hamstring stretch lying 1Lie on your back with knees bent.  Straighten one of the legs and place a dressing cord (or similar) around the ball of the foot of the straight leg.

Allow the arms to straighten to prevent the arms tiring.

If possible keep the lifted leg at around 90 degrees.

hamstring stretch lying 2

If this is a strong enough stretch stay at this position.

Alternatively, encourage the bent leg to straighten along the floor which will allow the front of the hip joint to open and lengthen.

Hold the stretch for 20 to 30 seconds.  Remember to breathe.  Repeat two or three times on each side.

Exercise 22 – Quadriceps muscle (front of thigh) stretch

quad stretch 1Lying face down, rest the forehead on to one of the forearms.   Bend one knee and place a dressing gown cord (or similar) around the ankle of the bent leg side.  Gently encourage the heel towards the buttock.  When you feel a stretch in the front of your thigh, gently encourage the pubic bone towards the floor to increase the stretch still further.  Hold the stretch for 20 to 30 seconds.  Repeat on the other side.  Stretch both sides two or three times.

Exercise 23 – clam exercise to strengthen the gluteal muscles

clam stage 1Whilst lying on your side, place an arm under your head and a towel if required to support the head and neck.

Bend the knees slightly.  Raise the top knee whilst keeping the feet together.

clam stage 2Keep the back perpendicular to the floor to ensure that the movement comes from the hip rather than a full twist of the body.

Repeat 10 times on each leg.

Remember to breathe.

Exercise 24 – side lying twist for the spine and shoulder girdle

prep for side lying twistStart by lying on your side with your hands out in front of you and place one on top of the other.  You may wish to place a towel under your head for support.

side lying twist page 1

Straighten the leg closest to the floor.  Then bend the knee of the upper leg so that it is at 90 degrees to the hip and the lower part of the leg is also bent to 90 degrees.

Slowly raise the upper most arm arm towards the ceiling

side lying twist full twist

Continue the movement of the arm in the same plane.

There will come a point of resistance when you feel you  cannot allow the arm to continue towards the floor.

Close your eyes and breath in and out allowing the weight of the arm to gradually allow the arm to drop towards the floor.

You may not get there immediately.  With practice, your arm will gradually become closer to the ground and may, in time, comfortably rest on the ground.

Return to the start position and change to the other side.  You may wish to use the arm that does not move in this exercise to hold the knee of the bent leg towards the floor.

This is a ‘strong’ exercise and you must ‘encourage’ the movement and not ‘force’ the movement.  Hold the position for two to three breaths.

Exercise 25 – Buttock Stretch one side and Hip Opener on the other side

inverted VThis is another ‘strong’ exercise and should only be performed if you do not have any suspected knee problems or on-going symptoms.

To start, position yourself in an ‘inverted V’ position with feet and hands hip width apart.

prep for pelvic two side stretch

In this position, encourage your heels towards the floor.  Take a few breaths.  Encourage a stretch in the calf muscles at the back of the lower leg.

Move your weight forward so that you are in a position to easily lift one of your legs off the floor as you transfer your weight forwards.

stretch for hip & buttock

Then raise one leg and bring the lifted leg underneath you as in the photograph:-

Gently allow your weight to come forward so that you lie over the bent leg which is now underneath you.

pelvic stretch

This will increase the stretch in the buttock area of the folded leg side.

If you are comfortable here, you may wish to relax over the bent leg for a few breaths.

groin stretch

Then lift your upper body up with weight back in your arms.  Allow your pelvis to drop down towards the heel of the bent leg. This will open up the front of the hip on the straight leg side.

Again, take a few breaths in this position before returning to the ‘inverted V’ position and changing to the other side.

Please remember to ‘listen’ to your body.  These exercises are designed to encourage core strength, flexibility and improved function following a symptomatic period of pain. Whilst it is acceptable to feel a little discomfort it is important not to over do any of the stretches in terms of forcing the movement or simply doing too many of the exercises.  In these situations, often ‘less is more’.  If you are unsure, talk to your practitioner before proceeding.

Wishing you a speedy and long-lasting recovery.

The Poise Health Team of Professionals.