6
Chapter
The basic exercises
General introduction: basic exercises General introduction: basic exercises
General introduction: basic exercises General introduction: basic exercises
presented here. Once you have learned and under-
stood some of these exercises you may wish to create
variations or design your own exercises according to
your patients’ diagnosis and needs.
Most exercises are illustrated with photographs.
Some of the fine movements cannot be seen very
easily on the pictures, but can be followed from the
description.
Frequently used positions and
movements
In the exercise instructions we prefer to refer to
individual measures like the patient’s foot length or
hand width, as body measurements are individual.
Knees hip width apart is particularly used for
parallel alignment of the thighs: this corresponds to
the knees one fist width apart.
For the position of the feet we sometimes use dor-
siflexion and plantar flexion (exercise 10.3, Figure
6.194). Dorsiflexion is the movement at the ankle
towards the superior surface of the foot. When
wearing flat shoes the foot is mainly in dorsiflexion.
Plantar flexion is the movement at the ankle towards
the sole of the foot: the higher the heels, the more
the foot is in plantar flexion. In dorsiflexion the foot
has more stability, whereas in plantar flexion it its
more vulnerable. Inversion is the movement of the
foot inwards (exercise 10.3, Figure 6.195), while
eversion is an outwards movement (Figure 6.196),
both without rotation at the hip or knee joints
(Kingston 2001).
Supination and pronation in the elbow joint are
the rotation of the radius on the ulna. Supination
is the rotation of the forearm so that the palm is
facing forwards, with the thumb outwards, whereas
pronation is the rotation of the forearm so that the
palm is facing backwards, with the thumb inwards.
The joint surfaces of the carpal bones also allow
some complex supination and pronation movements
(Kingston 2001).
The neutral position is a fundamental position for
many exercises. “Lumbar neutral position is midway
between full flexion and full extension as brought
about by posterior and anterior tilting of the pelvis
... the neutral position places minimal stress on the
body tissues. Also, because postural alignment is
optimal, the neutral position is generally the most
effective position from which trunk muscles can
work” (Norris 2000, p. 10). In this neutral position
the joints and their soft tissues are least stressed.
The neutral position must be distinguished from
the concept of neutral zone. This is “the zone in
which movement occurs at the beginning of the
range of motion before any effective resistance is
offered from either the muscular system or the
spinal column” (Norris 2000, p. 9 ). The less stable
a spinal segment is, the larger the neutral zone.
The concept of the neutral position can be applied
to the whole musculoskeletal system. For the neu-
tral lumbopelvic position the neutral zone between
the sacrum and the fifth lumbar vertebra is relevant.
Feel your way towards it by tilting the pelvis for-
wards and backwards within the comfortable range.
Make the movements smaller and smaller, until you
reach the midrange position. When you are lying on
your back, this is often the most relaxed position for
the abdomen and the lumbar area. Sitting and stand-
ing, the neutral position is the basis for the upright
position with the minimum stress. In neutral position
the spine is stable during all movements, including
movements of the legs and arms. It is a good founda-
tion for lifting and lengthening the spine to support
the nutrition of the discs and create enough space for
the nerve roots. The neutral position will be applied
in many of our exercises and āsanas. Depending on
the context it is described in different ways, for
example tilting or stabilizing the pelvis, lifting from
the lower abdomen, or adjusting the costal arches.
Supine means lying on your back. To achieve the
optimum neutral, relaxed position you may need
support. To support from the bottom, place a rolled
blanket or bolster underneath the knees or a chair
under the lower legs. To support from the top, put a
pillow underneath the neck and head (see Śavāsana,
Chapter 7). There are various methods to sup-
port lying supine (Lasater 1995). You may need to
experiment to find the best for individual patients.
To come up from the supine position, stretch your
right arm over your head and turn on your right
side, with the right arm supporting the head. Bend
both knees, keeping your left hand on the floor in
front. Stay lying comfortably on this side for a few
breaths in a neutral lumbopelvic position. To push
