The Integrative Diagnosis system always follows true fundamental concepts. Regarding strength exercises the fundamental concept is order of operations. Simply put, there is an objectively correct order to treatment. And it is:
- Restore range of motion
- Improve strength
- Range is 80% function or better
Exercising (loading) tissue without good function just injures it further. You must restore good function first.
- Strength assessment demonstrates weakness
There needs to be a weakness identified to benefit from strength exercise. As with any treatment there must be a diagnosis. Here the diagnosis is weakness and the treatment is strength exercise.
- They can safely handle the increased load from exercise
Exercise increases load to strengthen muscle but it also loads discs, cartilage, joints etc. We need to load the muscle enough to strengthen while minimizing load on other vulnerable tissue.
That’s in a perfect world. It’s important to understand the concepts… then know that implementation is imperfect. We are often implementing exercises when two of the three criteria are met.
Use the Good Morning exercise to strengthen the erectors and posterior chain. Use this after the hip lift can be done for 2×15 and/or the lunge test is passed. There is no separate strength test for the erectors. If you have improved function of QLF use the Good Morning as a test. See if they can perform it with good form. Then add weight. 2×15 with around 15 lbs is adequate for most patients.
Eccentric Hamstring Exercise: For proximal hamstring tendinosis
When SLR is cleared or plateaued and proximal hamstring symptoms persist that are consistent with tendinosis this exercise can be prescribed.