__Progressive_Exercise_Therapy_in_Rehabilitation_and_Physical_Education

96 PROGRESSIVE EXERCISE THERAPY 4. Pelvis and Lumbar Spine on Upper Trunk Hip updrawing from such starting positions as heave grasp lying and reach grasp standing. The pelvis is tilted sideways by the combined action of the lateral flexors of the thoracolumbar spine ofthe side of the raised hip, and the hip abductors of the opposite side. Example: Reach grasp standing (wall bars); Hip updrawing (Fig. 121). This group of exercises includes lateral pelvic tilting from side to side; the usual starting positions for these movements are reach grasp kneel sitting and reach grasp standing. Example: Reach grasp kneel sitting (wall bars); Pelvis tilting from side to side. Fig. 119. ~;:::>. ,, ~.-.--- ~ ~w:~l .<:~:.\\l Fig. 120. Fig. 121. Fig. 122. 5. Simultaneous Movement of Trunk and One Leg Lateral flexion of the spine combined with either Hip updrawing or single Leg carrying sideways of the side to which the trunk is moved. The movements are performed in lying. Examples: (i) Lying; Trunk bending sideways with Hip updrawing of the same side. (ii) Lying; Trunk bending sideways with single Leg carrying to the same side. 6. Pelvis Lowering and Raising from Side Falling Position Pelvis lowering and raising from side falling by combined movements of lateral flexion of the thoracolumbar spine and hip abduction and adduction. The lateral flexors of the thoracolumbar spine on the underneath side of the trunk act with the hip abductors of the underneath leg and the hip adductors of the uppermost leg. Example: Side falling (one leg slightly in front of other); Pelvis lowering to touch supporting surface, raising as high as possible, and return to starting position (Fig. 122).

TRUNK EXERCISES 97 Strengthening Exercises Elementary GRADE 1 1. Stride lying; Trunk bending sideways. 2. Heave grasp lying (mattress) or lying (hands grasping sides of mattress); Hip updrawing. (See Fig. 121.) 3. Stride sitting; Trunk bending sideways. GRADE 2 1. Lying; Trunk bending sideways with single Leg carrying to the same side. la. Lying; Trunk bending sideways with Hip updrawing of the same side. 2. Reach grasp standing (wall bars); Hip updrawing. (See Fig. 121.) 3. Neck rest stride sitting; Trunk bending sideways. 4. Neck rest stride standing; Trunk bending sideways. Intermediate GRADE I I and la. No progressions. 2. Reach grasp high half standing (wall bars and stool); Hip sinking, updrawing, and lowering to starting position. 3. Stretch ride sitting (chair: thighs gripping chair back); Trunk bending sideways. 4. Stretch stride standing; Trunk bending sideways. GRADE 2. 1-4. No progressions. 5. Side falling (one leg slightly in front of other); Pelvis lowering to touch supponing surface, raising as high as possible, and return to staning position. (See Fig. 122, p. 96.) Advanced GRADE 1 1-5. No progressions. 6. Fixed side-lying (one leg slightly in front of other); Trunk bending sideways. (See Fig. 118, p. 95.) 7. Reverse hanging (wall bars); Leg lowering sideways (Fig. 123, p. 99.)* * Leg lowering sideways from reverse hanging is easier for the working muscles than leg raising sideways from hanging. The reverse hanging position, however, is a difficult one for the average patient to maintain; for this reason leg raising sideways from hanging is often used before the other exercise.

98 PROGRESSIVE EXERCISE THERAPY GRADE 2 1-5. No progressions. 6. Half neck rest fixed side lying (one leg slightly in front of other); Trunk bending sideways. 7. Hanging (wall bars); Leg raising sideways. (See Fig. 119, p. 96.)* Mobilizing Exercises Elementary GRADE 1 1. Stride lying; Trunk bending from side to side. GRADE 2 1. Stride standing; Trunk bending from side to side. 2. Ride sitting (chair: thighs gripping chair back); Trunk bending from side to side, (See Fig. 116, p. 95.) 3. Reach grasp kneel sitting (wall bars); Pelvis tilting from side to side. Intermediate GRADE 1 1. Neck rest stride standing; Trunk bending from side to side. la. Stride standing; Trunk bending from side to side with rhythmical pressing to 3 counts in position. 2. Neck rest ride sitting (chair: thighs gripping chair back); Trunk bending from side to side. 2a. Ride sitting (chair: thighs gripping chair back); Trunk bending from side to side with rhythmical pressing to 3 counts in position. 3. No progression. 4. Stride standing; Trunk bending sideways with single Arm (of opposite side) swinging forwards-downwards-sideways-upwards, the Trunk being bent to the side during the sideways-upwards swing of the arm. 5. Half neck rest foot support side toward standing (wall bars); Trunk bending sideways towards the bars with rhythmical pressing to a given count. (See Fig. 117, p. 95.) 6. Half neck rest leg sideways stretch half kneeling; Trunk bending sideways with rhythmical pressing to a given count (Fig. 124). GRADE 2 1. Head rest stride standing; Trunk bending from side to side. la-4. No progressions. * Leg lowering sideways from reverse hanging is easier for the working muscles than leg raising sideways from hanging. The reverse hanging position, however, is a difficult one for the average patient to maintain; for this reason leg raising sideways from hanging is often used before the other exercise.