The goal of this study was to create a progressive resistance training program to strengthen hip muscles in order to improve walking. This protocol provides a solution to address hip weakness which is a primary impairment that affects the quality of life of people with neurodegenerative diseases. The main advantage of this technique is that the program uses resistance bands in a systematic way that is accessible, inexpensive, and can be used in a group setting for people with variable levels of disability.
We emphasize isolated muscle strengthening and proper alignment for how the muscle is used in walking. This progressive resistance training program can be individualized to accommodate asymmetric weakness, profound weakness or mild weakness. Demonstrating the procedure with me will Zipporah Thompson, a research coordinator from our laboratory.
Begin by explaining the procedure to the participant. Assess baseline strength status for the hip flexor, hip extensor, and hip abductor muscles by using a handheld dynamometer during a break test. During the break test, obtain measures from each side of the body and repeat to obtain two consistent measures for each side within 45 newtons of eachother.
Ask the participant to hold each position for four to five seconds at maximal effort and encourage the participant as they complete the test. Record each measure and average the two measures for each side. Begin the break test by measuring hip flexion.
Instruct the participant to lie supine on a mat, legs extended, body relaxed, and head resting on a pillow. Have them bend one knee and hip and hold the hip at 90 degrees. Next, place the dynamometer on the distal femur.
Instruct the participant to pull their knee toward their nose and to hold as strongly as possible. Then slowly and evenly pull the dynamometer in the direction of the particpant's toes. For the hip extension, instruct the participant to lie prone on a plinth with their legs extended and body relaxed.
Ask them to bend one knee to 90 degrees flexion and hold. Then place the dynamometer on the distal femur. Instruct the participant to use their buttocks to lift their knee off the mat.
Then hold and do not twist. Push the dynamometer down in the direction of the mat. Finally, for hip abduction, instruct the participant to lie on their side with their shoulders back and hips resting against a wall.
Provide the participant with the option to rest their head on the bottom arm or hand. Ask the participant to bend their bottom leg knee and extend the top leg with the heel touching the wall and toes pointing slightly upward. Then instruct them to keep the top leg straight with their heel against the wall, lift the leg up to 45 degrees and hold.
Place the dynamometer on the participant's distal femur and push down in the direction of the mat. Prior to each exercise, instruct the participant to look at their exercise log to determine which resistance level to use and to fill in the log after each exercise is complete. Begin with the hip flexion exercise by instructing the participant to lie supine with both hips straight.
Ask them to slowly lift one knee towards the chest to end range of hip flexion, all the while keeping the knee close to the midline. Then instruct them to lower the leg with control to the starting position. For weaker participants, provide the option of performing this exercise side-lying with the top leg supported on a low bench placed in front of the participant.
Next for hip abduction, instruct the participant to lie side-lying with their bottom leg slightly bent and the top leg straight. Instruct them to lift their top leg toward the ceiling, keeping the leg inline with the trunk and the knee facing straight ahead or slightly turned up toward the ceiling. Then ask them to lower their leg to the starting position.
To perform hip extension instruct the participant to lie face-lying with one leg straight and one leg bent. Instruct them to raise the bent thigh off the support surface while keeping the knee bent. For knee flexion, instruct the participant to lie face-lying with both legs straight.
Ask the participant to bend their knee as far as possible, keeping the pelvis and thigh still and keeping the hips on the support surface. Next, for hip external rotation, instruct the participant to start in a seated position. Then have them rotate the knee or thigh outward.
Instruct stronger participants to perform hip external rotation while standing with their knee resting on a chair and hip maintained in extension. To perform knee extension, instruct the participant to lie supine with their exercise leg straight and resting leg bent. Then instruct them to raise the leg from the hip, keeping the knee straight and stopping at the height of the resting leg knee.
Finally, provide each participant an individualized home exercise program for each weekend. Remind each participant to fill out the exercise log immediately following each exercise. In this study, individuals with varying levels of disability for multiple sclerosis participated in lower extremity resistance training in which statistically significant improvements were made in hip strength over the course of 12 weeks.
Here, data from an individual with asymmetrical hip strength at baseline is shown. Following strength training, this individual gained hip flexion strength on their weaker left side. Additionally, hip abductor and extensor muscles were more symmetric and stronger post-intervention.
These results demonstrate that significant strength improvements occur within eight weeks of training. In designing clinical trials that test pharmacologic or rehabilitative interventions, seeing change in eight weeks allows for expedient results. As with other intervention studies, participant compliance both with frequency and quality of performance is a potential issue.
Providing specific feedback to the individual as well as maintaining a motivating group setting is essential for the success of the program. After watching this video, you should have a good understanding at how to quantitatively evaluate progress from a resistance training program. Don't forget that the reliability of the tester in the use of the dynamometer as well as properly instructing and encouraging the participant on giving their best performance is necessary.
Resistance exercise is a common intervention used by therapists and has tremendous potential. However, it is necessary to provide appropriate supervision to ensure that proper alignment and safety is maintained throughout the program. Future application of this protocol in the home will provide greater opportunity for more individuals to benefit from this program.
