Before You Start

Before you start on these stretching and strengthening exercises, please read Before You Start. If you would like to view movies of all the exercises on these pages, then please look at:- Exercise eBook for Windows Media Player Movies (AVI) Exercise CD/ROM for QuickTime 6.5 movies Some of the exercises require you to use a piece of Thera-Band for muscle strengthening. If required you can buy it from Physio Med. I would suggest red for the upper limb exercises, and green for the lower limb exercises. Depending on your physical capabilities, you may need to go higher or lower in the range. Modern Lifestyle - as we increasingly spend more time seated in the car, on the sofa, and at the desk at the office, we spend more time with out hips and knee bent at 90 degrees. In women the situation is compounded further by high heels (short calf muscles). Spending long periods in the seated position quite quickly leads to shortening of the hip flexors (iliopsoas), knee flexors (rectus femoris and the other quadriceps muscles), calf muscles (soleus and gastrocnemius), and the buttock muscle piriformis. The seated posture also causes the abdominal muscles to become weak. It is therefore very important that all these muscles are regularly stretched and strengthened to help prevent low back pain and sciatica in later life. Neural Tension Theory - Many people with nerve root sciatica either have tight hamstring muscles already OR develop tight hamstring muscles quite quickly after the sciatica starts, because of reduced activity levels. The sciatic nerve runs in the middle of the hamstrings and calf muscles, as well as being quite close to piriformis. It can be already shortened OR become shortened during an attack of sciatica. Bending forwards (lumbar flexion) involves stretching the muscles and nerves in the buttock, leg and calf. If theses structures are already under excessive tension, the blood supply to the sciatic nerve becomes cut off, producing severe pain in the leg. Therefore stretching the muscles of the buttock, back of the thigh, and calf has the effect of progressively stretching the sciatic nerve, and can be beneficial in the management of sciatica whatever the cause. In my experience it may take many months to sufficiently stretch the sciatic nerve to the point where you can touch your toes. Warning / none of these stretches is to be performed in the presence of severe sciatica with pronounced leg weakness. If there is pronounced leg weakness then an MRI scan and a surgical opinion is indicated quickly. For lesser degrees of sciatic pain and weakness, a series of Epidural Injections may help to speed up the recovery phase.

Gluteal Muscles

Basic Gluteal Stretch People with severe hip disease may find this stretch provokes pain in the groin - if this is the case try doing the Iliopsoas, Quadriceps and Adductor stretches first, coming back to this one later. Lie on your back with both legs straight out in front of you. Bring your left leg up, bent at the knee, and clasp both hands in front of it, fingers interlaced. Use your arms to bring the knee further towards you, until you feel a barrier point in the buttock. Gently move your knee in and out of the barrier point for a few minutes, feeling the muscle stretch progressively, breathing out on the stretch phase. Try no.1 to no.4 for the right leg. Stronger Gluteal Stretch Do not do this stretch if you have hip problems, including a hip joint replacement, as it may cause hip dislocation. Lie on your back with both legs straight out in front of you. Bring up your right leg bent at the knee, with your foot flat on the floor. Bend your left knee and hip to place the side of your left foot on top of the lower part of the right thigh (half cross legged). Bring your right leg up further with the left foot still resting on the thigh, and thread your arms through the gap, so that your hands are clasped in front of your right knee. Use your arms to bring the right leg up further until you reach a barrier point in the right buttock. Rock your leg in and out of the barrier for a few minutes, feeling that the buttock muscles are progressively stretching. Try no.1 to no.6 with your left leg. Gluteus Maximus Exercise This exercise also strengthens your lower back at the same time. Lie on the floor face down with your forwards and palms down for support Extend your right leg behind you as high as you can. Make sure that your leg is straight at the knee and that you are pointing your toes (this helps to keep you knee straight). You can either hold the leg for 5 seconds then release and repeat, or do it as a continuous exercise. Repeat 1 - 3 for your left leg. Gluteus Maximus Theraband Exercise (Standing) Stand behind a dining chair and hold on with both hands. Loop a 50 cm piece of Theraband around the back left chair leg and your ankle. Swing your left leg behind you straight at the knee feeling the tension build in the band. Repeat 5 - 10 times and repeat for your right leg. Gluteus Medius Stretch Lie on your left side. Shuffle back wards towards the edge of the bed, being careful not to fall on the floor !! Bring your left leg up with the knee and hip bent at 90 degrees. While breathing out, drop your right leg back wards over the edge of the bed, keeping it straight at the knee. Relax and let the leg drop as far as it can feeling the tightness in the upper buttock and outside of the hip and leg. To increase the power of this stretch, hook your left foot over the right leg and push the leg downwards (as shown in the diagram above).  Gluteus Medius Exercise Lie on your left side with your left hip and knee flexed to 90 degrees. With your right leg straight at the hip and knee, and your body straight, extend the leg upwards, being careful not to let it move out in front of you. Look down your body, your right leg should be in line with your trunk during the whole exercise. You can either hold the leg in the air for a count of 5 seconds and then release and repeat, or do it as a continuous exercise. Repeat 1 - 4 for your left leg. Gluteus Medius Theraband Exercise (Sitting) Sit on a dining chair with a loop of Theraband around your lower thighs. Gently separate your knees until you feel the tension build in the band. Repeat 5 - 10 times Gluteus Medius Theraband Exercise (Standing) Stand sideways behind a dining chair holding on to the chair back with your right hand. Loop a 50 cm piece of Theraband around the left back leg of the chair and your left ankle. Swing your left leg out to the side feeling the tension build in the band. Repeat 5 - 10 times and repeat for your right leg.

Hamstrings

Gentle Basic Stretch Sit on the floor with your left leg stretched straight out in front of you (knee straight), and the right leg bent at the hip and knee so that the sole of the right foot is resting against the side of the right knee. Gently stretch both arms out to grab your shin, and find the barrier point where the stretch starts in your back, buttock or leg. Gently move forwards and backwards in and out of this barrier point for a few minutes, breathing out as you stretch forwards. You can use the weight of your trunk to progressively help stretch the hamstrings, allowing your fingers to go further down the shin bone. Try no.1 to no.3 again with the right leg. Eventually over several weeks and months you will be able to reach the laces of your training shoes. Try walking up your laces with your fingertips one at a time until you can reach your toes. Grab them with your hand, and at this point you can combine the hamstring stretch with the calf stretch by pulling your toes up towards your body. Stronger Stretch While in the standing position, extend your right leg out in front of you, foot flat to the floor. Bend forwards with your trunk resting both your hands on the front of your right thigh, while bending your left knee. Increase the degree of trunk and left knee flexion until the stretch can be felt behind the right thigh (keep your right leg straight at the knee). Hold for 10 - 15 seconds. For increased stretch in the right calf, try bending your right ankle so that your toes come up, leaving your right heel on the ground. Repeat no.1 to no.4 with the left leg. MET Stretch Lie on your back with your right knee and hip flexed, foot flat on the floor. Bring your left leg up straight at the knee, until you can grasp your ankle with both hands. Find the barrier point in the thigh or buttock. Take a breath in and hold it, using 25% of maximum effort, push away from you with your left leg, while your hands resist, to produce an isometric contraction over the next FIVE seconds. Let your breath go quickly, relaxing your leg muscles but not your arms. During the next THREE seconds pull the left leg closer to you to find the new barrier point. Do no.3 to no.4 several times until you are able to get your left knee closer to your face. You may not be able to keep your left knee totally straight, but try your best. Repeat no.1 to no.5 for the right leg. If you do this stretch with your foot and ankle relaxed it will not be too difficult. However, if you want to add a little extra, try bending your ankle so that your toes are pointing towards your face. You will feel an extra pull in the thigh and calf indicating that the sciatic nerve is being stretched a little more. Partner Stretch If you have a capable partner, ask them to sit or kneel facing you, so that you can rest the back of your right ankle on one of their shoulders. They bring their arms around your right leg so that they can keep your knee straight. This exercise can be done as an ordinary or MET stretch. For the ordinary stretch, your partner takes your right leg further up in the air until you can feel the pull behind the rightn thigh and knee. For the MET stretch, you can push against their shoulder for FIVE seconds, relax your leg, and then have your partner shuffle closer to you, steadily increasing the degree of hip flexion. Try both of these for your left leg. Good communication between partners is essential to avoid over-zealous stretching. Hamstring Thera-Band Exercise (Sitting) Sit on a dining chair with another in front with its back to you. Loop a 50 cm piece of Thera-Band around the front left leg of the chair in front, and your left ankle. Start with your left knee as straight as possible. Hold on to the chair in front with both hands to steady it. Bend your knee to past a right angle, feeling the tension build in the band. Release the tension slowly back to the starting point. Repeat 5 - 10 times. Repeat on the other side.

Piriformis

Basic Stretch People with severe hip disease may find this stretch provokes pain in the groin - if this is the case try doing the Iliopsoas, Quadriceps and Adductor stretches first, coming back to this one later. Lie on your back with both legs straight out in front of you. Bend your right leg at the hip and knee, and place your right heel on your left thigh just above the left kneecap. Use your left hand to grab your right knee. Gently pull your right knee towards your left shoulder to find the barrier point in your right buttock (if your head is north on the compass then the direction of the pull is north east). Gently move in and out of the barrier point using your left arm to control the movements for a few minutes. Feel the right buttock muscles progressively stretch. Try no.1 to no.6 with your left leg (the direction of pull will be now north west). To make this stretch slightly tougher, try sliding the foot over the side of the other knee, rather than resting it on top of the other knee. Eventually you may be able to get your foot flat on the floor. MET Stretch Do no.1 to no.4 with your right leg as above to find the barrier point in your right buttock. Take a deep breath in and hold it. Push your right knee away from you, but stop it from moving by holding your right knee with your left hand. Hold this for FIVE seconds. Breath out quickly and relax your leg muscles, but not your left arm. In the next THREE seconds use your left arm to pull your right knee closer to your left shoulder (north east) to find the new barrier point. Do no.2 to no.3 again several times until your right buttock no longer feels tight. Do no.1 to no.4 for your left leg. To make this stretch slightly tougher, try sliding the foot over the side of the other knee, rather than resting it on top of the other knee. Eventually you may be able to get your foot flat on the floor.

Iliopsoas

Hurdler Stretch Kneel on a sofa scatter cushion with your right knee (this helps to take the pressure off your kneecap). Bend your left leg up in front of you, bent at the hip and knee at 90 degrees each, with your left foot flat on the floor, and with your back vertical. You may want to do this along side the arm of the sofa or the bed if you feel unsteady. Keep your legs parallel to each other - don't let them splay out sideways - imagine they're on railway lines. Place your hands on your hips, look into the distance (not at your feet), and gently move forwards with your trunk, leaving your right knee behind on the cushion. Find the barrier point in the front of your right thigh / groin. Bend at the hip joint, try not to arch your back excessively. Move gently backwards and forwards in and out of the barrier point for a few minutes, until the stretch in the thigh has gone. Straighten up again, and move your right foot forward a few inches, and try no.2 to no3 again. Repeatedly move forwards with your left foot until you can extend your right leg well behind you, and the stretch in the thigh has gone. Remember to keep your trunk vertical, and keep looking into the distance, not at your feet. Try no.1 to no.5 with your left leg. MET Stretch This stretch helps tight iliopsoas and quadriceps muscles at the same time. Lie on your left side, bringing your left hip and knee up to 90 degrees. Hang on to your left knee with your left hand. Bring your right foot towards your buttock, and grab your foot with your right hand. Make sure that your legs are straight,  and not splayed out sideways. Making sure that your left hand does not allow your left knee to move (this protects your back by preventing it arching backwards), use your right hand to pull your right heel towards your right buttock. Stop at the barrier point in the right groin and thigh. Take a deep breath in and hold it. At 25% maximum effort, try to bring your right knee forward, but counter balance it by pulling with your right hand. Hold this for FIVE seconds. Breath out quickly, letting your right leg relax, but not your right arm. In the next THREE seconds, pull your right foot further towards your buttock to find the new barrier point in the right groin and thigh. Repeat no.4 to no.5 several times. The aim is to be able to extend your right thigh backwards beyond the line of your trunk. If you look down your body and your right knee is still protruding forwards, then you haven't gone far enough. Remember,  hold on to your left knee always to protect your back, and don't let your legs splay sideways. Try no.1 to no.6 with your left leg. Partner Stretch This stretch may not work if you have a low bed. Try sitting on two pillows to give you extra height. If you have a capable partner, lie on the edge of your bed with your trunk and bottom on the mattress, and with your legs hanging over the edge, with your feet dangling. Don't have the edge of the mattress under your thighs, it has to be under your sacral area. Be careful not to fall while getting into this position !! Flex your left hip and knee to 90 degrees. Have your partner stand facing you, standing just below your left buttock. Have your partner place their right hand on the front of your left shin just below the kneecap, and their left hand on the front of your right thigh just above the knee cap. Your partner gently pushes forwards with their right hand, and down with their left hand, until you feel the barrier point in your right groin and thigh. Take a big breath in and hold it for FIVE seconds, while trying to pull your right thigh upwards. This is resisted by your partner pushing down with their left hand, and forwards with their right hand on your left upper shin. Breath out quickly relaxing your right leg, but with your partner maintaining their hold. During the next THREE seconds, have your partner gently push down on your right thigh with their left hand, until you feel the new barrier point in your right thigh. Repeat no.5 to no.6 several times. Repeat no.1 to no.7 with your other leg. Good communication between partners is essential to avoid over-zealous stretching. Iliopsoas Thera-Band Exercise (Sitting) Sit on a dining chair comfortably. Place a 50 cm loop of Thera-Band so that it sits over your left thigh just above the knee, and with the other end secured under your right heel. Bend your left hip as far as you can get it, feeling the tension build in the band. Release the tension slowly back to the starting point. Repeat 5 - 10 times. Repeat on the other side.

Quadriceps

Basic Stretch This stretch can be done either standing or lying face down. Bring your left foot up to your left buttock, grabbing your foot with your left hand. Make sure that your knees are together and not splayed side ways. Try not to arch your back. If you can't reach your foot, then place a towel around the front of your left shin, holding the two ends in your left hand. Find the barrier point in the front of your left thigh. Gently move in and out of the barrier point for a few minutes, until the stretch feeling in the thigh has gone. Pull your left foot further towards your buttock, and repeat no.2 again. The aim is to be able to get your left heel all the way to your left buttock. If you want to do a little more In the standing position, try taking your left knee further backwards than your right (try not to arch your back), In the face down position, try lifting your left knee off the floor without lifting your hip bone up. Try no.1 to no.6 with your right leg MET Stretch See Iliopsoas MET stretch above. Quadriceps Thera-Band Exercise ( Sitting) Sit on a dining chair comfortably. Loop a 50 cm piece of Thera-Band around the back left chair leg, and around your lower leg just above the ankle. Starting with your knee bent at 90 degrees, straighten out your left knee until you feel the tension builing in the band. Make sure that you keep your left foot locked back towards you at all times in order to recruit Vastus Medialis Obliquus (important in maintaining correct patellar tracking on the femur). Release the tension slowly back to the starting point. Repeat 5 - 10 times. Repeat on the other side.

Tensor Fascia Lata

Basic Stretch Lie on your left side. Shuffle back wards towards the edge of the bed, being careful not to fall on the floor !! Bend your left leg 90 degrees at the hip and knee. While breathing out, drop your right leg back wards over the edge of the bed, keeping it straight at the knee. Relax and let the leg drop as far as it can feeling the tightness in the upper buttock and outside of the hip and leg. To increase the power of this stretch, hook your left foot over the upper leg and push the leg downwards (as shown in the diagram above).

Adductors

Sitting Stretch Sit up straight on the floor with your knees drawn up and apart, and your feet sole to sole resting on the floor. Your feet should be about 30 cm away from your bottom. Place your elbows on the inside of each knee. Gently push your knees apart with your elbows to find the barrier point in the inner thigh. Move in and out of the barrier point for a few minutes until the inner thigh stretch has gone. Move your feet closer to your bottom a little, and repeat no.2 to no.3 several times. The end point is when you have moved your feet as far as they will go towards your bottom, and your knees as far apart as comfortable. MET Stretch Do no.1 and no.2 as above to find the barrier point. Take a big breath in and hold it for FIVE seconds, while using your elbows to push your knees apart, counter-balancing this by pulling inwards with your knees. Quickly breath out, relaxing your leg muscles but not your arms. In the next THREE seconds find the new barrier point by letting your elbows push your knees further apart. Repeat no.2 to no.3 until your knees are as far apart as feels comfortable. Repeat no.1 to no.4 after bringing your feet closer to your bottom. Try to move your feet as close to your bottom as they will go. Against The Wall Stretch Stand with the palms of your palms against the wall just more than shoulders width apart. Have your legs apart the same distance too. Make sure that your feet are pointing towards the wall and are not turned outwards. Bend your right knee and move your trunk to the right keeping it upright. Leave your left foot where it started and feel the stretch in the left inner thigh. Hold for 10 - 15 seconds, and come back up to the upright position. Repeat no.2 to no.3 for the right inner thigh. Adductors Thera-Band Exercise (Sitting) Sit comfortably on a dining chair, having another chair to the left side of you. Loop a 50 cm piece of Thera-Band around your lower thigh just above the knee, and around the front left leg of the chair to the left of you. Start with your legs apart. Move your left leg towards your right, feeling the tension build in the band. Release the tension slowly back to the starting point. Repeat 5 - 10 times. Repeat on the other side. Adductors Thera-Band Exercise (Standing) Stand with a dining chair back to your right side. Loop a 50 cm piece of Thera-Band around the back left leg of the chair and around your right ankle. Hold on to the back of the chair with your right hand for support. Move your right leg away from the chair and in front of the left feeling the tension build in the band. Release the tension slowly back to the starting point. Repeat 5 - 10 times. Repeat on the other side.

Calf Muscles

Against The Wall Find a free wall. Stand about 1 metre away facing it, toes pointing forwards.  Place both hands against the wall about 1 metre apart, keeping your trunk, hips and knees straight so that you make a right-angled triangle with the wall when looking from the side. Bring your right leg forward half way between the wall and your left foot, and place it flat on the floor, toes pointing towards the wall. Shift your weight on to your left leg, making sure that your left foot is not turned outwards, and that your knee is straight. Move your trunk towards the wall by bending your elbows until you feel the stretch in your left calf (a bit like doing press ups against the wall). Hold this stretch for a few minutes. Straighten up, with your feet side by side again. Move away from the wall a little further with your feet and repeat no.2 to no.5 until the left calf stretch feeling has gone. Try this on the other leg. On The Stairs Don't try this wearing slippers or smooth soled shoes, and don't use the top step of the stairs in case you fall !! Wearing a pair of training shoes with a good tread, stand upright on the bottom step of your stairs with your feet together pointing forwards, and all of your foot on the step. If possible hang on to the banister with one hand for support. Move your left foot backwards so that the ball of your foot is on the edge of the step. Slightly bend your right knee, and shift your weight on to your left foot, dropping your heel down over the edge of the step, until you feel a stretch in your left calf. Keep your left knee straight. Hold this stretch for a few minutes. You can increase the stretch in the left calf by shifting more of your body weight on to your left leg. If you have good balance, and can hang onto a banister for support, try lifting your right foot off the step and behind you, so that all of your body weight goes through your left leg. Try no.1 to no.6 with your right leg. Calf Thera-Band Exercise (Sitting) Sit comfortably on a dining chair. Loop a 50 cm piece of Thera-Band around your left foot near to the toes, and hold on to the other end with both hands. Extend your leg keeping it straight at the knee. Point your toes away from you, feeling the tension build in the band. You can also adjust the tension by pulling harder with your hands. Release the tension slowly back to the starting point. Repeat 5 - 10 times. Repeat on the other side.