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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:

  1. Restore range of motion
  2. Improve strength
The body regions material covers assessment and correction of range of motion. This section covers implementation of strength exercises.
Before we get into details you have to realize that 99% of providers are violating the order of operations principle. Most patients have a “weakness” identified and strength training begins right away. This is tragic. Placing unhealthy load on unhealthy tissues is not treatment.


Strength Assessment
Whenever possible we want to assess strength with testing. The primary strength tests in the ID system are:
1. Lunge
2. Lockout
3. Push Up
These are tests that ask the basic question: Can you move your body efficiently through space with load?
When do we perform these tests?
Strength tests should be performed during the initial examination. This establishes baseline function. After the initial exam strength tests are reexamined when when ranges have improved to 80% function or better. This starts to give you an assessment of actual weakness rather than weakness secondary to pain and limited range.
If symptoms are acute and severe or capacity is very low then do not test strength at the initial exam.
When are strength exercises implemented?
Strength exercises are implemented, ideally, when:
  1. Range is 80% function or better
    Exercising (loading) tissue without good function just injures it further. You must restore good function first.
  2. 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.
  3. 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.  

When the lunge test is positive (and other criteria have been met) implement the hip lift. 

Strength Exercise: Hip Lift

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.

Strength Exercise: Good Morning

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.

Eccentric Hamstring Exercise