This is a follow up to registered physiotherapist Clyde Smith’s blog post titled “Why Your Misalignment Issues Persist, Pt. 1: Understanding the Cause”. Here, Clyde talks about alignment correction drills and post-correction exercises that he uses with his clients. For clients of Clyde’s this is a good refresher on how to execute them!

Alignment exercises are meant to bring your center of gravity (S2) back into a neutral position. In this position, your body can move more efficiently, with less stress on individual muscles.

Common popular treatment strategies that are often used, but fail:

A. Tight individual muscles or tissues (ITB, quadrates, hip flexors)

B. Muscle imbalance (hamstrings, VM)

C. Core weakness

None of these alone or in combination will solve an alignment problem. The symptoms are reduced but they return quickly. Once balance is restored then a participation in active strategies such and yoga, Pilates or other exercise programs will be successful.

FIRST STEP: Alignment drills and education. This may include leg length, feet and footwear assessment, and education (able to return to most activities immediately). (Shown below!)

SECOND STEP: Activation of all hip and pelvic control, muscle groups. (Shown below!)

THIRD STEP: Addressing other contributing anatomical and habitual factors (posture, sleep position, leg length, feet).

FOURTH STEP: Integration back to your life with understanding of contributing factors.

FIRST STEP: ALIGNMENT DRILLS & EDUCATION

Before and after alignment drills. Figure on left: the hockey stick is not level, demonstrating a malalignment. Figure on right: the hockey stick is level. 

Pelvic malalignment is a function of habits and repetition of movement patterns. Right hand dominance in sports and daily life activities lead to most people developing a predictable pattern of movement dysfunction. Other contributing factors include, posture, leg length, arch formations, and trauma. All can lead to chronic pain patterns (syndromes).

Because you are twisted you do an offset number of exercise or opposite movement patterns.

Remember these are not strength or stretch exercises, they are correction drills. Go easy!

• Lumbar Correction:

Figure on left: twist the upper spine to right and cross the leg over and twist the lower spine to left.

Figure right: lift the leg to high position, lower and lift 3-5 times. Same on the other side and repeat the start side.

• Lie on the left side (may put a small pillow under lumbar spine) and twist upper body to the right, cross right leg over the left. Slide the lower leg (left one) back.
• Lift the right leg 3-5 times. This additionally works the hip abductors.
• Repeat this 3-5 times, increasing the lumbar twist a little more each time.
• Then go to the next drill: Pelvic Correction.

• Pelvic Correction

• Right: Push knee away into hand (very gentle push), move knee up toward outside of shoulder, push again, move up again. 1, 2, 3 positions, light and easy.
• On the left side (not shown) it is the opposite, push into hand 5-8 seconds, toward hip, then relax. Do this three times. Do not advance the knee!

• Standing Correction

Figure on left: right leg up twist right on exhale, (you want the trunk twisting and not just the shoulders) and repeat 2-3 times.

Figure on right: hang down. Right only or right, left, right.

• Right leg up, twist right on exhale. Repeat 2-3 times.
• Hang down. Hands to feet (belly button to floor) do not over flex upper back. Lazy hang.
• Right only or right, left, right.

NOTE: THIS IS VERY IMPORTANT, DO YOUR CORRECTION EXERCISE BEFORE AND AFTER ANY ACTIVE EXERCISE PROGRAM AND/OR A COUPLE TIMES A DAY. 

SECOND STEP: AFTER CORRECTION EXERCISE

Get an old road bike tire tube (or long resistance band tied in a loop) and a toy ball (about the size of a soccer ball).

How to prep your bike tire tube: 

• Cut the valve stem off the tube and tie it so it is approximately 20 inches in diameter.
• Then double the tube and place knees inside, so one loop is above knee and one below knee.
• Then cross under the knees forming a sling so the ball will not fall!

• Exercise 1: Butt down

Figure above: Exercise 1: butt down. Exercise 2: butt up (bridge position) 2-4 inches up.

• Squeeze the ball 10-15 times in a pulsing motion, light and to a 4 count. Then push out against the tube (ball will not fall) using the same pulsing 4 count, 10-15 times. Repeat 3-5 sets.

• Exercise 2: Butt up (bridge position)

• Lift the butt off the floor 2-4 inches. Do not over arch your back. Perform the same movements, reps and sets as in Exercise 1.
• A progression of this exercise is to move the heels a few inches away from the butt. This will bring in more hamstring work.

• Exercise 3. Hip Flexion (flex in diagonal plane to outside of shoulder)

Figure above: Exercise 3

• Hook tube around foot of the down straight leg and the top of the thigh of the flexed hip. Flex the hip up (moving toward the outside of the shoulder).
• Stay within comfort. 2-5 sets of 10-20 reps.

• Exercise 4: Rotation of Hip

Figure above: Exercise 4

• Hip at about 70 degrees
• Externally rotate hip (foot in) and internally rotate (foot out). 2-5 sets 5-30 reps. 
• You shouldn’t feel any pain, but it’s okay to feel tired. 

DON’T FORGET: 

THIRD STEP: Addressing other contributing anatomical and habitual factors (posture, sleep position, leg length, feet).

FOURTH STEP: Integration back to your life with understanding of contributing factors.

Clyde is a registered physiotherapist and founding principal of Allan McGavin Sports Medicine Centre. Clyde’s specialty lies in chronic injury as they relate to pelvic and back alignment. When Clyde is not in the clinic, you can find him on multi-day cycling trips, gardening, and spending time with his family! You can contact Clyde at bookaphysio@hotmail.com for more details about this blog.