Here is a basic progression we’ve developed to correct low scores on the Active Straight Leg Raise. The general idea is to progress from isolation exercises to integration exercises to functional exercises.
Of course, the first step to improving poor performance on the Active Straight Leg Raise is releasing any scar tissue in the hamstrings and hip flexors with Active Release (Dr. Glenn is standing by). Then add in the following therapeutic exercises.
In reality, a corrective exercise program is tailored to you, based on your personal condition and your score on the Functional Movement Screen, from which the ASLR was extracted.
Single Leg Contract-Relax Stretch (isolation). Start on your back. Your right leg is the one doing the stretching, so with a slight bend at the knee, bring it up until you feel a bit of a stretch in the hamstring. Grab a hold of the leg as shown and push the leg into your hands for about as long as it takes you to take 3 slow deep breaths (this is the contract part). When you exhale that third breath, relax the hamstring and slowly stretch further by bringing your leg closer to chest. This takes advantage of 2 types of reflexes, the relaxation that comes with a deep exhale and the relaxation that comes after a prolonged contraction. Together, these two activities help your nervous system learn a new resting length for the hamstring. Repeat 3-5 times on each side.
Single leg stretch with opposite terminal extension (isolation/integration). While we would normally use an isolated leg stretch for a few days, for our purposes here we’ll move right into an integration exercise. Here, we’re basically combining a the contract-relax hamstring stretch above with active hip extension on the other side. So start with your left leg flattened out leg onto the ground while gently pulling the other one into the stretch. As you start to feel the right leg reach a stretch, actively push the left leg into the ground. Pay attention to what each leg is doing and hold the extension during the stretch on that third exhale. Do 3 reps on each side. Same picture as above.
Combining hip extension with hip flexion on the opposite side is a pattern that’s fundamental to many sports. This rehab activity helps restore and reinforce the fundamental pattern. It’s a stepping stone to the more complicated activities below.
Quadruped hip extension with opposite flexion (integration). Taking the idea of combining opposing hip flexion and extension farther, we have this excellent little move. Get down on all 4’s. Extend your right leg straight behind you making sure you fully engage the right glute.
While maintaining the extension of the right hip, drop your left hip further into flexion- moving your whole body toward the floor. You must keep that right glute contracted and that right leg straight. Watch what happens with my left (bent) leg below. It’s tougher than it looks.
This exercise lets you improve your neuromuscular control and directly improves or maintains your Active Straight Leg Raise score and helps protect your back, your hips, and your knees. Remember to work both sides, 3-5 reps.
Stiff-Leg Deadlift with stick (functional pattern). After a couple of weeks of training in the above rehab exercises, it’s time to up the complexity. Now you’ll combine the opposing hip flexion and extension with a whole body balance challenge. Hold a stick in your right hand to help with balance (if needed). First, you’ll tilt slightly forward, arch your back slightly and kick your right leg back into full extension.
Continue moving forward toward the floor by flexing forward at the hip joint. The end range is when your body is almost parallel to the ground.
It’s once again important to maintain hip extension in that right hip. And of course, switch legs. Do 3 sets of 5 reps.
As you can see, we’ve progressed the basic pattern of opposing hip extension and hip flexion and created a greater demand on both legs. This is the essence of the progressive rehab that we’ve added to our treatment plans at Denver Chiropractic Center. Once again, we’ve moved beyond simply treating symptoms, like pain.
We’re looking to correct the underlying dysfunctional patterns that are the underlying cause of pain. This is what keeps problems from coming back over and over. If something’s been hurting you, or if you just feel like certain movements feel restricted or “wrong,” give us a call and come on in. 303.300.0424. Or simply reply to this email.
(BTW-Why am I holding a crutch? Well, it’s Meredith’s after her recent major knee surgery, but that’s a topic for a future email.)