Ehlers-Danlos Syndromes/Hypermobility Spectrum Disorders Advance Rehabilitation Programme
Sacroiliac Joint and Lumbar Spine Exercise
Level Two Mat Exercises
1. Bridges With Ball Squeezes
POSITION:
-Lie on your back with knees and hips bent and a ball between your thighs (ball should be the circumference of a soccer ball). Squeeze your buttocks and then lift your buttocks off the mat into a bridge position, keeping the ball between your thighs. While up in the bridge position, squeeze the ball five times repeatedly in between your thighs. Then lower your hips down and rest for one second. Repeat this process for one and a half minutes.
PROGRESSION:
Begin this exercise at one and a half minutes and add ten seconds each day until you reach three minutes. Once you reach three minutes for this exercise, you are ready for Level Three Mat exercises
2. Supine Kick Out
POSITION:
-Lie on your back with your knees bent and hip-width apart and perform pelvic neutral with abdominal bracing. Slowly kick your leg out by straightening your knee. (Do not hyperextend your knee; keep it slightly bent). Hold your leg out for five seconds, then return the leg to the bent knee position and then switch legs. Repeat this process for one and a half minutes, keeping stomach tight the entire time, even through the transition from the right to the left leg.
PROGRESSION:
-Begin this exercise at one and a half minutes and add ten seconds each day until you reach three minutes. Once you reach three minutes for this exercise, you are ready for Level Three Mat exercises.
2a. ALTERNATE POSITION FOR SUPINE KICKOUTS/ SUPINE HEEL TOUCHES
POSITION:
-This exercise will be performed if patient has increased pain in their back or hips when performing supine kickouts. Have the patient lie on their back with feet hip-width apart. Have the patient perform pelvic neutral with abdominal bracing. Then have them kick their leg out straight and touch their heel to the mat.
3. Prone Swimmer
POSITION:
-Lie on your stomach with a pillow underneath your hips and a towel roll under your forehead. Bring shoulders out to the side to about eighty degrees of shoulder abduction (elbows even with your chest) and elbows bent to ninety degrees (keeping elbows below shoulder height), like a field goal post in football. Lift your bent arm up toward the ceiling and, at the same time, lift the opposite leg up until you feel your scapula (shoulder blade) and opposite buttock squeeze. Hold this position for a count of five seconds and then lower arm and leg down and then repeat this process on the opposite side. Head should be resting on a towel roll, face down to avoid neck pain.
PROGRESSION:
-Begin this exercise at one and a half minutes and add ten seconds each day until you reach three minutes. Once you reach three minutes for this exercise, continue this exercise for three minutes in Level Three Mat, because there is no progression for this exercise.
3a. Alternate Position Prone Swimmer Leaning Over Ball
POSITION:
Place a physioball on a couch and lean over the ball, hugging it (their hands can touch the couch if they need more support to balance on the ball). Bring their shoulders to about eighty degrees of shoulder abduction and elbows bent to ninety degrees (keeping elbows below shoulder height), like a field goal post in football. Lift their arm up toward the ceiling and opposite leg up until they feel their buttocks and scapula (shoulder blade) squeeze. Hold this position for a count of five seconds and then lower their arm and leg down and then repeat this process on the opposite side. Repeat this process for one and a half minutes.
PROGRESSION:
-Begin this exercise at one and a half minutes and add ten seconds each day until you reach three minutes. Once you reach three minutes for this exercise, continue at this level because there is no level three for this exercise.
4. Sit On Ball With Feet and Knees Together
POSITION:
-Sit on physioball with your knees and feet hip-width apart and hands on thighs. Do not arch your back. Hold this position for three to five minutes. This exercise works on your balance on the physioball before adding Level One Ball exercises in two to three days. Perform this exercise in a hallway so you can hold onto the walls if you lose your balance. Do not continue this exercise once Level One Ball exercises are added. Your physical therapist needs to determine if you are safe to perform this exercise at home.
5. Clam With Green Tubing
POSITION:
This exercise is the same as clam performed in Level One Mat, with the exception of now using green tubing instead of yellow. Begin this exercise at a minute and a half until you reach three minutes. Once you reach three minutes, you are ready to progress to Level Three Mat exercises. The tubing should be nine to ten inches in length once tied, for consistency.
6. Ball Squeezes
-This exercise is the same as ball squeezes in Level One Mat. Patients should perform this exercise for three minutes every day.
Level One Ball Exercises
1. Seated Alternating Heel Ups
POSITION:
-Sit on the ball while performing pelvic neutral with abdominal bracing. Hands should be on your thighs and knees and feet should be hip-width apart. Raise one heel off the ground, lower it down and then switch to the other heel. Do not hold your heel up. Instead, just raise the heel up and down slowly, alternating left and right heels. Holding your heel up can increase pain in your ankle.
PROGRESSION:
-Begin this exercise at one and a half minutes and add ten seconds each day until you reach three minutes. Once you reach three minutes for this exercise, you are ready for Level Two Ball exercises.
1a. Alternate Position Seated Alternating Toe Ups:
If a patient is unable to raise heels up due to increased ankle pain, then the patient can lift the toes up instead. This will decrease stress on the talocrural joint. Maintain abdominal bracing while performing this exercise. Have the patient contract the oblique opposite to the leg that is performing the heel/toe up in order to stabilize their body on the ball. Instruct patient to perform all ball exercises in a hallway at home, so they will be able to hold onto a wall in case they lose their balance. Do not allow the patient to excessively arch the low back because this will lock out the facet joints and not allow the lumbar paraspinal muscles to be activated.
2. Bridging With Legs On Ball
POSITION:
-Lie on your back with calves on the physioball and both hands by your side on the mat. Squeeze your buttocks and lift your hips up off the mat in a bridge position and hold that position for five seconds. Then return to the mat and rest for one second. If you sway to the right or left while on the ball, tighten your stomach to stabilize your body on the ball. Repeat this process for one and a half minutes.
3. Ball Multifidus
POSITION:
-Kneel on the mat, leaning over the physioball, hugging it. Then lift your knee straight up off the mat about once inch while keeping the foot on the mat at all times. Hold the knee up for five seconds, then switch legs. -Repeat this process for one and a half minutes.
PROGRESSION:
-Begin this exercise at one and a half minutes and add ten seconds each day until you reach three minutes. Once you reach three minutes for this exercise, you are ready for Level Two Ball exercises.
3a. Alternate Position For Ball Multifidus With Hands On Mat
-If the patient cannot avoid twisting their back, have them place their hands on the bed or mat to stabilize their body. Perform this position for one and a half minutes. Add ten seconds per day until they reach three minutes. Then, perform Ball Multifidus exercise without touching the mat (original position), beginning at one and a half minutes and progressing to three minutes in that position. Only once the patient has completed the Ball Multifidus exercise without touching the mat (original position) can they progress to Level Two Ball exercises. Make sure the patient does not twist their back when lifting their knee off the bed or mat. If this occurs, it means the patient is lifting their knee too high, or they are not contracting their stomach muscles needed to stabilize their body.
