Sample Exercises

Pilates for Hip and Knee Syndromes and Arthroplasties

Introduction

This section will display several of the Pilates mat movements from the book. You will find the exercise, it’s description, pictures and how the movement changes overtime from the very modified to ideal. The goal is that you can see variations of the movement with regressions or progressions to meet the needs of the individual depending on their available range of motion, flexibility and stability whether for a hip or knee syndrome or post-operative arthroplasty.

To accommodate the needs of a client with a hip or knee syndrome, one would chose a variation as shown below that meets the needs of the individual based upon their range of motion and ability to stabilize and maintain alignment.

Sample exercise
The sample exercise below (Single Leg Circle) is pictured with variations and modifications demonstrating the multiple ways that the exercise can be performed based upon the individual needs of the client.

Disclaimer:
All exercises should be performed under the guidance of a qualified Pilates instructor and with referral from the operative physician. The client’s needs, restrictions, and ROM recommendations should be specified by the physician and followed accordingly. These guidelines may vary from the protocols noted in “Pilates for Hip and Knee Syndromes and Arthroplasties”. The protocols should be modified based on the individual’s needs and the surgeon’s preferences.

Single Leg Circle

Timeline: 6 weeks to 3 months post-op Appropriate for: knee and hip Location: a raised mat, hip height	Instructions Lie supine on the mat with a pad under the head as needed with a small barrel, pillows, rolled-up towels, or mats under the knees to create a bent-knee position. Place an exercise band around the bottom pad of the right foot. Make sure the exercise band is open and flat against the foot.Extend the right leg to the ceiling to a maximum of 90° of flexion with (a) or without (b) a bend in the knee. Keep a light but secure grasp on the exercise band. Hold the band together with both hands, with elbows on the mat and hands held stable on the core. Draw the abdominals in and up. Knee: Inhale to prepare. Exhale and circle the right leg across the midline toward the left hip and down and around to the width of the right shoulder and back to the starting position. Stop at the top. Make small circles that are the size of a basketball. Hip: Inhale to prepare. Exhale and circle the right leg to the midline only and down and around to the width of the right shoulder and stop at the top. Make small circles that are the size of a basketball. Circle 3 to 5 times and then reverse direction and circle 3 to 5 times. Change legs and repeat. Keep the hips planted on the mat with minimal movement. The goal is to maintain a stable torso throughout the movement.
Option 1 Setup Option 2 Setup
Timeline: 3 to 6 months post-op Appropriate for: knee and hip Location: a floor mat or a raised mat as needed; a raised mat for a bilateral knee or hip replacement as needed	Instructions Lie supine on the mat with the head resting on a small pad as needed. Extend the left leg out onto the mat and hug the leg toward the midline of the body with a rolled-up towel under the knee as needed. Extend the right leg to 90° of flexion without  or with  a slight bend in the knee. Keep the leg parallel, point the toes toward the ceiling, and keep the arms long by the sides of the body. Draw the abdominals in and up, stabilizing the core. Knee: Inhale to prepare. Exhale and circle the right leg across the midline toward the left hip and down and around to the width of the right shoulder; stop at the top. Slightly bend your right knee as needed. Make small circles the size of a basketball. A cue for the movement is deep cross, shallow out, stop at the top. Hip: Inhale to prepare. Exhale and circle the right leg across the midline, moving no more than 20° across the midline, and around to the width of the right shoulder; stop at the top. Make small circles the size of a basketball. Circle 5 times and then reverse the direction and circle 5 times. Change legs and repeat. Keep the hips planted on the mat with the movement.
Option 1 Setup Option 2 Setup
Timeline: 6 months and beyond post-op Appropriate for: knee and hip Location: a floor mat or a raised mat as needed	Instructions Lie supine on the mat with the left leg extended out onto the mat and hugging toward the midline of the body; bend the knee as needed. Extend the right leg to 90° of flexion. The arms are long by the sides of the body. Keep the leg perpendicular to the floor and toes pointed. Draw the abdominals in and up to stabilize the torso. Knee and hip: Inhale to prepare. Exhale and circle the right leg across the midline toward the width of the left hip and down and around to the width of the right shoul- der. Stop at the top. The size of the circle depends on keeping the hips stable and the abdominals engaged. The flow is deep cross, shallow out, stop at the top. Circle 5 to 8 times in each direction and then change legs. Keep the hips planted on the mat. Bend knees of both legs as needed.

Look for (Encourage):

• Working leg engaged hip to toe
• Shoulders gliding toward the hips as if suspenders were hooked to the bottom tips of the shoulder blades and attached to the hips
• A secure hold maintained on the exercise band
• Stable core and torso and leg working with precision and control
• Open collarbones as if taffy were strung across the shoulders
• Elbows lengthening on the mat toward the feet when using the exercise band
• Arms long by the sides of the body when not using the exercise band
• Disassociation of the head of the femur from the acetablum (stable pelvis with a flowing movement of the working leg

Be aware of (Prevent):

• Lower lumbar spine arching away from the mat and loss of the neutral spine
• Movement of the pelvis and lack of disassociation of the hip from the pelvis

Primary Muscles Activated:

The primary muscles activated depend on the chosen option. Abdominals, rectus femoris, vastus medialis, vastus intermedius, vastus lateralis, sartorius, pectineus, iliopsoas, gluteus maximus, gluteus medius, gluteus minimus, biceps femoris, semitendinosus, semimembra- nosus, tensor fasciae latae, adductor magnus, adductor longus, adductor brevis, gracilis, sartorius, popliteus, gastrocnemius, plantaris