eAddendum
Olivetti L, Schurr K, Sherrington C, Wallbank G, Pamphlett P, Kwan M M-S, Herbert RD
(2007) A novel weight-bearing strengthening program during rehabilitation of older people is
feasible and improves standing up more than a non-weight-bearing strengthening program:
a randomised trial.
Australian Journal of Physiotherapy 53: 147–153
Copyright © 2007 Australian Journal of Physiotherapy
INCLUSION CRITERIA CHECKLIST
1. Are they over the age of 60?
Yes
No
2. Are they unable to stand up from a 35 cm chair without using their
hands?
Yes
No
3. Are they likely to be an inpatient for 2 weeks?
Yes
No
4. Are they able to speak and understand English, and if not can an
interpreter be organised?
Yes
No
5. Are they (or their legal guardian) willing to provide informed consent? Yes
No
6. Have they had a recent AMI?
Yes
No
7. Are they unable to bear weight on one or both lower limb/s?
Yes
No
8. Have they had bone/joint surgery on their lower limbs in the last three
weeks?
Yes
No
9. Do they have extreme stiffness in one or both limbs?
Yes
No
10. Do they have severe arthritis in one or both of their lower limbs?
Yes
No
11. Is the cause of their lower limb weakness progressive in nature (eg,
Multiple Sclerosis or Motor Neuron Disease)?
Yes
No
12. Are there any other reasons that may preclude them from participating
in wither of the exercise protocols? (eg, fragile skin)
Yes
No
If the answer was YES to questions 1-5 and NO to 6-12, the person is
eligible for inclusion in the weight-bearing vs non-weight-bearing
strengthening trial.
Please contact Lyn who will organise an initial assessment with you or the
research assistant
1
PROTOCOL FOR MEASUREMENT OF PERFORMANCE
EQUIPMENT
Bathroom scales
Tape measure (check on wall – for height)
54 cm chair
Dynamometer, standard padding, board and padded donut
Stopwatch
Plinth in gym
Block to raise floor height
Tape measure and ruler for chair height
45 cm chair with arms
6 metre walking track
15 cm step adjacent to a hand rail
Pens for heels and tape
1. Maximal Voluntary Contraction (MVC)
• Use Safe Operating Procedure for use of the dynamometer
• Start with patient sitting in a 54 cm chair with hips and knees at 90 degrees flexion
• Use the attachment with the groove for the tibial measurements and padding on
the attachment.
• This should be placed in line with the subject’s ankle joint.
• Measurer prepares themselves to match the force of the subject but without
pushing against them (“Make Test”)
• Measurer to stabilise themselves by holding the chair
• Subject is instructed to push as hard as they can. Instructions may include
repetitions of “Push”or “keep going”.
• Allow the subject one practice contraction
• Record the best of three attempts
(1) Quadriceps - align the interface in the middle of the anterior shank close to the
ankle.
(2) Hamstrings - align the interface with the middle of the posterior shank close to the
ankle.
2. Lowest Possible Chair Height
• Have the patient sitting on the raised adjustable plinth with the feet hip width
apart, thighs parallel, toes under knees and arms folded.
• Place a floor marker at the position of the feet
• Explain the procedure using the following words: “I want to find out the lowest
height you can stand-up from without using your hands. The bed you are sitting
on can go up and down. Fold your arms across your chest. When you stand-up
keep your arms against your chest. Make sure that the backs of your legs do not
push against the bed as you stand. Have three practice runs to make sure that you
understand.”
• After the practice runs give the person positive feed back about their attempt if it
is correct and advice about what to change if their attempt was incorrect. Manual
guidance may be used. Only provide the subject with sufficient information to
2
•
•
•
•
•
•
•
•
enable them to be successful. If the subject is unsuccessful after three attempts
then cease the testing procedure.
Use these trial attempts to gauge how easy/hard the initial height is. If the
subject’s observed exertion level is: very hard - lower the bed by 1 cm, hard lower the bed by 5 cm, easy - lower the bed by 10 cm.
Lower the bed gradually until they are unable to stand-up.
Once this height is reached then increase the height incrementally until they are
successful again without compensating.
A successful attempt is one where the patient’s arms remain folded, against their
chest and their legs do not push against the bed.
Allow 1 to 2 minutes rest between attempts at the lowest height if the subject is
having physical difficulty such as increased shortness of breath.
If the subject is able to stand-up from the lowest bed height then place a 10 or 15
cm block underneath their feet and raise the bed height by an appropriate amount
until the height at which they can no longer stand-up is reached.
Measure the height in millimeters
Allow uneven weight-bearing but no other compensations
3. MVC (Cont.)
The subject needs to move to a plinth and get into supine.
(3) Hip extensors - place a board under the subject’s leg so the dynamometer is on a
hard surface. Place the dynamometer under the subject’s heel with the piece of
padding in between. Instruct the subject to keep their knee straight and press down
through their heel. The dynamometer may need to be stabilised to prevent it from
slipping on the board. Do not allow external rotation of the hip.
(4) Hip abductors - The subject’s heel should be placed on the donut ring to allow it to
slide along the board. Place the dynamometer on the lateral side of the ankle adjacent
to the line of the joint. Instruct the subject to keep their knee straight and push their
leg against the device near the ankle. Stabilise the non-tested leg while testing. Check
the leg does not externally rotate or flex at the hip.
4. Physical Performance & Mobility Examination (PPME)
FUNCTIONAL STATUS SCREENING
• Ask the patient if they feel they have any restrictions they might have which might
prevent them from doing any of the tasks involved and record these
• Participants should be encouraged to perform each test if possible but also
instructed not to perform if they feel they will be unsafe.
INSTRUCTIONS TO PARTICIPANTS
• Examiner needs to consider the patients understanding and provide appropriate
level of instruction.
• Describe each test according to guidelines and do not provide additional
encouragement beyond these instructions.
• Demonstrate the test for the participant where indicated in these instructions.
RESTS
Participants are able to rest briefly in between tasks for the sake of enabling
completion.
3
SCORING
Score accordingly if the person stops, refuses or unable to complete (fail = 0)
High pass = 2
Low pass = 1
Fail = 0
TASKS
BED MOBILITY (SUPINE TO SITTING)
• Bed at lowest height (ie, approximately 45 cm)
• Start with participant supine
• Start timing when you say begin and stop timing when the feet are over the side of
the bed, participant sits upright and movement has stopped.
• Initial Instruction: “When I say begin, I want you to put your feet over the side of
the bed and then sit up on the side of the bed. You may push off from the bed.”
• Verbal cues (to be provided after 20 sec if unable to perform - step by step after
each part of movement)
Roll to your side
Put your legs over the side of the bed
Push yourself up with your arms
Scoring:
2 High Pass = Completes without assistance < 10 sec
1 Low Pass = completes without assistance more than or equal to 10 sec, in 2 tries or needs
verbal assistance
0 Fail = unable to complete without physical assistance
STANDING UP FROM BED AND MOVE TO CHAIR (TRANSFER TO
CHAIR)
• 45 cm chair with arms placed next to the bed. Bed should be at its lowest possible
height (47 cm).
• Initial instruction: “Stand up from the bed, move to the chair and sit down. When
the backs of your legs are touching the chair you may sit down”
• Examiner may provide assistance as necessary
• Ensure participants legs are free of the bed
Scoring:
2 High Pass = completes without assistance
1 Low Pass = completes with assistance
0 Fail = unable to complete
STANDING UP FROM A 45 CM CHAIR x 5
Instructions:
• “Try and stand up without using your hands to push up on the arms of the chair”
• “Now when I say begin, stand up five times as quickly as you can without stopping
in between.”
• “I’ll be timing you so do this as rapidly as you can comfortably do it.”
Record time taken to complete 5 stands
4
Scoring:
2 High Pass = completes 5 stands without using arms
1 Low pass = completes 5 stands using arms or moves all way to edge of chair
0 Fail = unable to complete even using arms
STANDING BALANCE
• Tests are performed with eyes opened
• Positions must be maintained for 10 seconds; without the use of aids, initially may
be supported by examiner
• Positions:
• Position 1: Standing with feet apart (shoulder width apart)
• Position 2: Feet side by side within 2.5 cm apart
• Position 3: Semi-tandem stand (whichever foot most comfortable in front).
Feet within 2.5 cm apart.
• Position 4: Tandem stand (whichever foot most comfortable in front). Feet
within 2.5 cm apart.
• Progress from position 1 to 4 based on performance of easier positions, with
subjects preferred foot in front
• Start timing from release of participant’s arm
• Stop timer if foot moves or person requires support and record time taken if less
than 10 sec
• For positions 1 & 2
• Instructions: “You may use your legs for balance but do not use your arms.
Try to hold this position until I say stop. It helps to keep your balance by
looking up and straight ahead.”
• For position 3
• Instructions: “Try to stand with the side of the heel of one foot touching the big
toe of the other foot – like this”
• For position 4
• Instructions: “Try to stand with the heel of one foot in front and touching the
toes for the other foot”
Scoring:
2 High Pass = Able to maintain all manoeuvres for 10 sec
1 Low Pass = able to maintain feet apart, feet together and semi-tandem for 10 sec,
able to maintain tandem for less than 10 sec
0 Fail = unable to maintain feet together, feet apart or semi-tandem for 10 sec
STEP UPS
• Move over to stairs and position 15 cm platform adjacent to rail.
• Determine ability to step up once and down once without using handrail or use
handrail but without support from another person. A PUF or stick may be used for
additional hand support where required.
• Instructions:
• “Step forward up onto the step without using the rail”(If unable after 3 tries
patient may use the rail.)
• “Step forwards and down without using the handrail”(If unable or looking
unsafe patient may use the handrail.)
5
Scoring:
2 High Pass = Completes without using handrail
1 Low Pass = Completes using handrail or requiring physical assistance
0 Fail = Unable to complete even with physical assistance
AMBULATION 6 M
• In order to collect step length data pens should be taped to subject’s heels with
patient seated 1 metre prior to the start of a 6 m walkway. Attach pens to patient’s
heels using wide micropore. Check the tips are in contact with the floor in
standing and that pens are firmly secured.
• Time in seconds taken to walk 6 m at fast pace. A walking aid may be used if
required. Assistance may be provided if necessary.
• Instructions:
• “When I say begin I’m going to time you walking as well and as fast as you
can. Continue walking (to … point at approx. 8 metres/chair placed at 8 m
mark).”
• Start with the subject 1 metre before the 0 m mark. The patient should continue
walking for 1 metre beyond the 6 metre line (8 m total). Start and stop timer &
stride analyser when heel crosses the 0 & 6 m lines respectively.
• Collect step length/BOS data from floor and remove marks afterwards using
mediwipes. Base of support is measured as per the stance foot’s dot. Eg, the left
base of support is the perpendicular distance of the left foot’s dot from the
trajectory of the right foot dots (ascertained from the previous dot and the
following dot, both made by the right foot)
Scoring:
2 High Pass = Time for 6m < 13 sec
1 Low Pass = Time for 6m > 13 sec
0 Fail = Unable to complete:
6
DATA COLLECTION FORM
INITIAL MEASUREMENT
DATE: __ / __ / __
SUBJECT’S NAME: ____________________
SUBJECT IDENTIFICATION NO.: __ __ __
(ensure each space is filled with zeros to the left of the subjects number)
PRIMARY DIAGNOSIS:__________________
Sided weakness: (L = left / R = right / B = both sides ) _____________
Hospital admission date:
_____________
Rehabilitation admission date:
_____________
DEMOGRAPHICS:
Date of Birth: _____________
Sex: (F = Female , M = male) : ______
COGNITIVE STATUS : If problems have been identified, document MSQ score
obtained during screening _____
HEALTH:
List of medications: __________________________________________________
__________________________________________________________________
Other conditions:
Ever (1 = yes, 2 = No)
Stroke
__________
Fracture of lower limb
__________
Heart problems
__________
Diabetes
__________
Cancer
__________
OA/RA
__________
Parkinsons Disease
__________
Respiratory Problems
__________
Other (specify)
__________
Do you currently have pain in either your back or either of your lower limbs?
(Y = yes, N = No) __________
Provisional diagnosis for pain (if known) ____________________________
ANTHROPOMETRIC DATA:
height ________ cm (transfer this data onto the final measurement sheet now)
weight ________kg (transfer this data onto the final measurement sheet now)
shank length _______ cm (with shank perpendicular to floor - from floor to tib-fem
joint line)
Followed by measures of performance as per final assessment below.
7
DATA COLLECTION FORM
FINAL MEASUREMENT
DATE: __ / __ / __
SUBJECT IDENTIFICATION NO.: __ __ __
(ensure each space is filled with zeros to the left of the subjects number)
Discharge date from hospital if this occurred within the 2 week period ___/___/___
FOOTWEAR
Examination to be performed with same footwear situation as for initial assessment.
Footwear on initial assessment (0 = none, 1 = slippers, 2 = low heeled shoes, 3 = high
heeled shoes) _____
Reason for examination in footwear if required in initial assessment:
__________________________________________
Footwear on final assessment (0 = none, 1 = slippers, 2 = low heeled shoes, 3 = high
heeled shoes) _____
Reason if not the same as for initial assessment:
__________________________________________
MEASURES OF PERFORMANCE
Sitting in a 54 cm chair: (best of 3)
1. MVC
Left
Quadriceps
_______N
Hamstrings
_______N
Right
________N
________N
Move to adjustable plinth:
2. Lowest possible chair height (measure from perpendicular distance of top of
plinth to floor)
________mm
3. Supine (MVC cont) Left
Hip extensors
_______N
Hip abductors
_______N
Right
________N
________N
8
Start in supine:
4. PPME
supine to sitting- sit up from supine (stop timing when trunk upright)
Time taken
________(sec)
Able to complete(Y/N) ________
Physical assistance needed
(Y/N) ________
Score ________
transfer to chair (45 cm chair with arms 1 metre away from bed)
Able to complete(Y/N) ________
Physical assistance
________
or aid needed (Y/N)
Score ________
sit to stand x5 (same 45 cm chair – 1/2 thigh support with knees sl > 90F)
Time taken
________(sec)
Able to complete(Y/N) ________
Arms needed (Y/N)
________
Score ________
standing balance (10 sec, eyes open, no physical assistance. Time how long if under
10sec)
feet apart
(Y/N) ______ If N, record time in sec____
feet together (Y/N) ______ If N, record time in sec____
semitandem (Y/N) ______ If N, record time in sec____
tandem
(Y/N) ______ If N, record time in sec____
Score _________
step ups (15 cm block. Next to rail)
Able to complete up and down(no help)
(Y/N) ________
No of hand supports
(1 or 2)________
Physical assistance required (Y/N) ________
Score _________
walking 6m
(attach stride analyser and pens on heels)
(walking at fastest possible speed)
(Time from 0 m mark with 1 m lead up. Start and stop timer when heel
crosses line)
able to walk 6 metres (Y/N) ________
Time to walk 6m
________sec
velocity_______m/sec
steps taken (count from floor markers)
________steps
9
Walking (cont)
step lengths
L
______
______
______
______
______
Step length (cm)
Total
______
Average
______
R
Base of support
______
______
______
______
______
______
______
L
_____
_____
_____
_____
_____
R
_____
_____
_____
_____
_____
Base of support (cm)
Total
_____
Average
_____
_____
_____
walking aid used (Y/N) _______
If so, which aid (0 = none, 1 = stick, 2 = 2sticks, 3 = PUF, 4 = rollator frame)
________________
Score _________
Final Score __________
PROTOCOL DEVIATIONS:
Did you exercise every week day? (Y/N)_____
If not, what were the reasons? __________________________________
___________________________________
___________________________________
Did pain stop you from exercising at any time?(Y/N)_________
5. SUBJECTIVE OUTCOME:
1. Have the exercises helped you?
A great
A moderate
amount
amount
A small
amount
2. Do you feel stronger as a result of the exercises?
A great
A moderate
A small
amount
amount
amount
Not at all
Not at all
3. Has your ability to stand up from a chair improved as a result of the exercises?
A great
A moderate
A small
Not at all
amount
amount
amount
4. Has your walking improved as a result of the exercises ?
A great
A moderate
A small
amount
amount
amount
Not at all
5. How difficult were the exercises ?
A great
A moderate
amount
amount
Not at all
A small
amount
10
6. Do you plan to continue with the exercises you have been doing?
A great
A moderate
A small
Not at all
amount
amount
amount
11
GUIDELINES FOR EXERCISES AND PROGRESSION
FOR BOTH GROUPS:
• Training should be performed for the affected side primarily; however for both
where there are bilateral impairments.
• Each exercise to be performed at either:
• 10–15 RM (approximately – this can extend up to 15RM) 1 set daily
• 2–3 sets with the 1st set as a warm up, 2nd slightly increased intensity 3rd set
at 10–15 RM per day, with 1–2 minutes rest between sets (not essential for
physical benefits).
• “10 RM”: it is not vital to get the “10 RM”the first time. The patient may do
closer to 15–20 RM the first time, and adjustments made for subsequent sets. This
is beneficial for the purposes of conditioning and avoiding Delayed Onset Muscle
Soreness (DOMS).
• Aim for 10–15RM in the pain-free range for those with painful knees.
• Instruct the patient to “do as many as you can at this level” to avoid “early”
fatigue.
• “Warm up” with a few repetitions of the task at a lower intensity (this will assist
in determining the intensity for the first set and allow the opportunity for the
patient to get the right idea).
• Explain the task to the subject using demonstration or guidance if required
• Patients should be encouraged to try their best each day
• “Comments” to include at the bottom of the exercise sheet, may include variations
made to the training environment, pain, medical issues of that day etc.
• “Other practice” includes other training activities the patient is involved in, eg.
walking
• Record the intensity and repetitions of each set in the session on the training sheet
• Frequency: Aim to do training every day, although if this is not possible simply
record the reasons on the practice record sheet. Exercises are required to be
performed a least 3 times weekly. It is therefore not necessary to do each exercise
every day where there are time constraints.
• Alternation of exercises may be necessary if patients experience soreness. Record
the order exercises were performed in on the practice record sheet in the little box
in the right hand side of the column
• Alternation of exercises may be required if patients are not be able to do all of the
exercises.
• Patients are permitted to do additional practice at a lower intensity of the tasks
they are practicing (eg, sit to stand from a higher height or knee extension without
weights).
12
NON-WEIGHT-BEARING STRENGTHENING EXERCISE GROUP
•
•
A lower intensity may be prescribed in the event of muscle soreness.
Where individuals are unable to perform exercises on the front of the practice
sheet (stepping up onto blocks), they should attempt the less difficult exercises
included on the reverse side (pushing on to a set of scales in sitting and in supine
with leg over the side of the bed)
Sitting to standing
• Measure height of seat using the ruler and tape-measure device to determine the
perpendicular distance from the top of the plinth to the floor.
• Foot placement to be beneath the knees.
• Bottom / thigh base of support: leave to the subject to determine, although cues
may be used later.
1. Use the protocol for determining the lowest possible chair height to determine
starting height. Where this is to be lower than the lowest plinth height, place the
subject’s feet on a block (eg, 10-15 cm high platform).
2. Repeat this at least 6 times and see if they can continue.
3. If they are able to do more than 15 repetitions, add weights to the weight belt.
Tilt table Weight-Bearing Exercise
• Where the non-sliding tilt table is used, place 2 sliding sheets placed on to of one
another underneath the patient to reduce friction between the patient and the bed
• Establish 10–15 RM by starting at the “too hard” end and making progressively
easier.
1. Place a bed sheet or sliding sheets on the tilt table.
2. Strap the patient at their chest and hips (not too firmly), place foam on the tilt
table at the level of the exercising knee to prevent hyper extension, and adjust
shoulder pads as necessary.
3. Place the exercising foot on the phone book(s). Use between 1 and 4 phone books
(ie,, 5-20 cm).
4. For the non-exercising leg, ensure that it does not assist. If the subject
compensates (ie, unable to keep the non-exercising foot dorsiflexed throughout
the movement), then tie, use a sling, or hold this leg. An AFO could be used to
restrain PF.
5. The angle of the tilt table is measured by the inclinometer on the side of the bed
near the controls, or by using a goniometer.
6. Ensure the subject’s body remains in the midline as they push, by ensuring their
head is over the top of the exercising foot.
7. Manual guidance may be necessary, but try not to assist with extension of the
exercising leg.
8. Progress this exercise by increasing the angle of tilt on the table before adding
more phone books. Weights may be added to the tilt table in order to approximate
the 10-15 RM.
13
Standing Weight-bearing Exercise
1. Place tables or chairs on 1 or both sides of the patient for safety. To reduce upper
limb support, position the person next to a wall with a table on the other side. Note
which side as this needs to remain consistent.
2. The exercising foot is placed on the phone book(s) while standing on the other
foot.
3. The subject keeps the non-exercising foot dorsiflexed as they extend their
exercising leg on the phone books. An AFO could be used to restrain PF.
4. Preferably, the hands will not be used for support on the tables. Record whether
they were used on the training sheet. Practising adjacent to a wall on the
exercising side may assist in guiding the patient’s alignment.
5. Progress the task by eliminating the use of hands before adding more phone
books.
6. Add weights to weight belt to approximate 10–15 RM
Stepping up and forwards to a block
1. Place tables or chairs on one or both sides of the subject for safety. To reduce
upper limb support, position the person next to a wall with a table on the other
side. Note which side as this needs to remain consistent.
2. Place a block (using phone books) on the floor in front of the stepping leg.
3. The subject begins by standing behind the block(s), places the exercising foot on
the block and steps forwards and up onto it and back down to the starting position.
Record the height of the block in cm.
4. Check that the patient does not push up with the other foot to achieve the step-up.
5. Preferably the hands will not be used for support on the tables. Record this on the
training sheet. Practicing adjacent to a wall on the exercising side may assist in
guiding the patient’s alignment.
6. The exercise is progressed by increasing the step height or adding weights to the
weight belt once no hands are required to achieve 10–15 RM.
Home exercise suggestions:
• Standing up and sitting down
• Weight-bearing extension exercise with phone book/s and table if required
For subjects who are unable to perform step exercises in standing:
A. Hip extension pushing onto scales in supine
1. Start with the patient supine on a plinth and the exercising closer to the edge of the
bed.
2. Place the exercising leg over the side of the bed on a set of scales, so that the hip
is in a neutral position and the knee at 90 degrees. Adjustments may be made with
placing blocks under the scales, changing the height of the plinth to achieve the
starting position. The degree of hip extension may be decreased slightly if the
subject is unable to generate tension in the hips extensors in neutral or is unable to
achieve this degree of passive hip extension.
3. Place a chair next to the edge of the bed if the patient requires reassurance, but do
not allow them to hold onto it.
4. Instruct the patient to “push down hard through the heel of your foot to lift your
bottom off the bed as hard as you can”
14
5. Record the maximum force in kg. The patient should attempt to reproduce this 6
times for each set.
6. Check the patient does not move their foot or rotate their trunk while pushing
B. Hip extension pushing onto scales in sitting
1. Start with the patient sitting on a “high” chair with a set of scales under the
exercising foot. A tale should be placed in front to standardise the degree of
forward shoulder movement. Establish the height of the chair so as to optimise the
extent of force generated with the exercising limb safely.
2. Instruct the patient to “bend forwards to rest their arms on the table in front and
push hard through the heel of your left/right foot as hard as you can”
3. Record the maximum force in kg. The patient should attempt to reproduce this 10
times for each set.
Home exercise suggestion:
• Pushing down through the foot onto bathroom scales in sitting
15
WEIGHT-BEARING STRENGTHENING EXERCISE GROUP
These subjects are not permitted to do repetitions of sit to stand practice, but may do
whole walking practice.
If subjects are only able to achieve grade 2 knee extension or flexion, those exercises
are performed with the foot resting on a skateboard, and intensity recorded as “0 kg”.
Attempt to keep the weight rack balanced either side with weights, so the full rack is
lifted with each repetition.
Knee Flexion
Plan to perform this exercise when the gym is less busy as 2 beds are needed.
1. Sit the subject on a chair (that allows knee flexion of > 90 degrees) facing the
pulleys with their back supported, feet off the ground, and arms folded.
2. Attach the pulley cuff in a figure 8 around the exercising ankle and foot and align
the pulley rope to be perpendicular to the shank when the knee is 90 degrees.
3. Explain the task to the subject, and practice with no resistance.
4. Ensure the subject’s back remains in contact with the chair support.
5. Train between 30–130 degrees knee flexion.
6. Record the weight and the number of repetitions.
Knee Extension
1. Sit the subject on a chair (that allows > 90 degrees knee flexion) with their back
supported and facing away from the pulleys, feet off the ground, and arms folded.
2. Attach the pulley cuff in a figure 8 around the exercising ankle and foot and align
the pulley rope to be perpendicular to the shank when the knee is 90 degrees.
3. Explain the task to the subject, and practice with no resistance.
4. Ensure the subject’s back remains in contact with the chair support.
5. Train between 0–130 degrees knee flexion.
6. Record the weight and the number of repetitions.
Hip Abduction
1. Begin with the subject supine on a plinth placed alongside the pulleys with the
exercising leg furthermost, and arms folded. A skateboard or sheet of plastic may
be placed under the person’s heel to reduce the friction on the bed. Record this.
2. Rest the non-exercising leg on a stool so the hip and knee are flexed.
3. Attach the pulley cuff around the exercising ankle and align the pulley rope to be
perpendicular to the leg in supine. A Zimmer splint may be required to help keep
the knee extended.
4. Explain the task to the subject, and practice with no resistance.
5. Ensure the subject holds their trunk in the starting position throughout.
6. Train between 0 and 20–30 cm of hip abduction away from the midline.
7. Record the weight and number of repetitions.
Hip Extension
This procedure exercises the lowermost leg in sidelying.
1. Begin with the subject sidelying on a plinth with a Zimmer splint around the
exercising leg. The exercising leg being lowermost, face the pulleys, and have
arms resting on thigh or shoulder.
2. Place pillows under the flexed upper leg to maintain hips and spine in a neutral
position.
16
3. Attach the pulley cuff around the exercising ankle and align the pulley rope to be
perpendicular to the leg.
4. Explain the task to the subject, and practice with no resistance.
5. Ensure the subject holds their trunk in the starting position throughout.
6. Train through 0 - 40 degrees of hip extension from some degree of flexion.
7. Record the weight and the number of repetitions.
Suggestions for home exercises:
• Knee extension with weight approximating 6–1 5 RM
• Hip abduction
• Isometric resisted exercises: 10 seconds hold, 10 repetitions, 2 sets
17
WEIGHT-BEARING STRENGTHENING EXERCISES
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19
NON-WEIGHT-BEARING STRENGTHENING EXERCISES
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