The pain endured living many years with osteoarthritis will likely lead to muscle imbalances and postural deviations. The following postural deviations or changes are common among many participants. With each limitation, consider the appropriate exercise recommendations to promote muscle balance. Not all exercises are appropriate for all classes. Be sure to select appropriate exercises for the SilverSneakers class format you teach.
1) Tight hip flexors and weak hip extensors that pull the torso forward into a hunched position.
» Try this:
Position
Stretch
Strengthen
Seated
- Sitting to the edge of the chair, move outside leg back with knee toward the floor; squeeze glutes; add same side arm raise
- Gluteal contractions
Standing
- Alternate tap leg back with double arm overhead raise
- Modified baby back bend
- Standing or seated: Modified dead lift or hip hinge
- Single leg rear extension; add alternate arm raise or tubing
Supine
- Supported bridge position
- Gluteal bridge
2) Uneven pelvis: This can occur if there is a leg length discrepancy following THR and can result from muscular imbalances, especially of the Illiotibial band (ITB). The ITB coordinates muscle function and stabilization between the hip and knee joint.
» Try this:
Position
Stretch
Strengthen
Seated
- Adapted foam roller - roll the ball up and down along the outside of the hip
- Sit to stand squat; progress to kickstand or split stance
- Alternating hip lift. “Hip walk” forward and backward in chair
Standing
- Lateral side bend with feet neutral or together; progress to one foot crossed behind
- Neutral squat; progress to kickstand squat or modified single leg squat
- Step touch; progress to walking 4 steps right and 4 steps left or stand on a resistance tube
- Neutral squat; progress to kickstand squat or pistol squat
- Rear lunge, progress to “curtsy” lunge
- “Hip hike”-shift weight into right hip/shift weight into left hip
- “Hip hike jog” - lift the opposite heel when shifting weight
Side lying
- Legs stacked, knees bent, top leg moves back, hold, then forward, hold
- Leg lift with downward pointed toe
- Clam shell
3) External rotation of the hips or foot: Can be the result of pain, weakness, or joint deterioration prior to surgery or from the surgical procedure itself.
» Try this:
Position
Stretch
Strengthen
Seated
- Internal/external rotation-ball under foot, roll knee outward and inward
- Clam shell
Standing
- Internal/external rotation-shift weight to one leg, other leg
- Rotational squat
4) Flat back is a decreased anterior lumbar curve often caused from tight hamstrings leading to overstretched or weak back muscles. Stretch the hamstrings; strengthen the iliopsoas and abdominal core muscles.
» Try this:
Position
Stretch
Strengthen
Seated
- Hamstring stretch
- Alternating knee lift; progress to leg extension or add weight on top of thigh
- Abdominal curl
- Knee lift with upper body opposite shoulder rotation; progress to hands across chest or behind head
Standing
- Hamstring stretch with leg forward
- Forward fold
- Alternating knee lifts; progress to upper body rotation
Supine
- Straight leg lifted towards ceiling, flex foot
- Modified ab curl, hands cross at chest
- Bridge
- Alternating bent knee toe taps
- Straight leg extension
Prone
- Spinal extension-arms by sides, palms down or arms bent, palms under shoulder-lift shoulders up off floor
- Hands and Knees: Cat/Cow
- Swimming-extend arms in front of shoulders-lift opposite arm and opposite leg
- Hands and Knees: Bird Dog
5) Rounded shoulders or protracted shoulder blades from using canes, walkers or crutches.
» Try this:
Position
Stretch
Strengthen
Seated or Standing
- Roll shoulders up, back and down
- Pectoral muscles: “chest stretch” arms open wide laterally, palms up, thumbs pointing back
- Scapular retraction- squeeze shoulder blades together with arms long at sides, external rotation; progress to weights or tubing
- Rowing exercises; progress to weights or tubing
6) Chin/head jutting forward from watching where they are walking for balance and/or a lot of sitting and poor posture.
» Try this:
Position
Stretch
Strengthen
Seated or Standing
- Nose to shoulder/release
- Chin to chest/release
- Ear to shoulder/release hands behind low back
- Rotate neck side to side
- Extend chin forward, draw chin back in
- Place palm at forehead/behind head/sides of head, press in/release; add ball
Standing
- Same as above
- Walking drills: Slowly walk forward; progress to tight rope or heel to toe; cue for tall posture, looking forward
- Walk with variation-cover one eye with palm of hand or look right/left
- Painters tape line drills
7) As hip mobility decreases, lumbar mobility decreases.
» Try this:
Position
Mobility
Seated or standing
- Pelvic tilts
- Hip circles right/left
- Cat/Cow