Progressing exercises are a systematic and organized approach that should be individualized to each person depending on their health, fitness level, and specific goals. The great part about exercise is that everyone is able to start somewhere! No matter what that starting point is for you, the only direction from there is UP. In this article, we will discuss a linear progression of how to progress lower extremity injuries in the clinic. It is imperative to master the fundamentals before working on highly skilled movements. This progression is inspired by the ‘Powers Program’, which is an evidence-based lower body exercise progression developed by Dr. Chris Powers, DPT, Ph.D. from the University of Southern California (USC). This program will begin with non-weight bearing isometric holds, don’t let these exercises fool you – they are extremely challenging! We then progress to static double-leg weight-bearing exercises, followed by single-leg exercises, and finish the exercise progression with dynamic strengthening movements. Follow along in this article to learn how to progress lower body exercises!

 

Start With Isometrics

Why isometrics? Iso’s help with increasing both corticomotor excitability (mind-muscle connection) in addition to increasing the representational area in the primary motor cortex! This is just a fancy word for the area of the brain that is responsible for activating muscles. Inherently, the real estate in the motor cortex that is responsible for the glute is poorly represented- demonstrated via Transcranial Magnetic Stimulation (TMS). In addition, if someone is in a more irritable state when first starting to exercise, isometrics allow one to still work on muscle activation while benefitting from the analgesic effect (pain-reducing effect) isometrics can have!

Clams, Sidelying Hip Abduction, Fire Hydrant

Begin this lower body exercise progression with 3 non-weight-bearing exercises to improve glute excitability. Simply hold the desired position with all 3 of these exercises. I recommend starting this exercise with some type of resistance; however, feel free to begin this exercise without any resistance initially. Here I am using a Hip & Core system by Crossover Symmetry.

  • Clams: Focus on bringing the knee out and back. Avoid rotating the trunk, I bias the chest towards the floor to avoid cheating here. I push into the bottom arm to activate my core and stabilize my pelvis, which helps with isolating this motion to my hip, which allows for more optimal recruitment of the gluteal muscles.

 

  • Side-lying Hip Abduction: I keep my bottom leg slightly hip flexed so I can bias my hip extensors in addition to hip abductors. This will target the glutes over the tensor fascia latae (TFL). Focus on bringing the top leg both up and back.

 

  • Fire Hydrant: Drive your knee out to the side and back. Avoid rotating at the trunk or bending your elbows. Focus on pulling with the glute muscles.

 

With all of the exercises, hold the positions for 2×30 seconds on each side, and eventually, work towards progressing yourself to 2×60 second holds. You will feel the burn! This is a great way to start someone on a Lower Extremity Strengthening program prior to having someone work in a more demanding, closed-chain position.

 

Looking To Learn How To Progress Lower Body Exercises On Your Own?

lower extremity performance program progress lower body exercises prehab guys

How about the character coach Herb Brooks of the USA Men’s Miracle Hockey Olympic team created?!? In training, he once stated, “the legs feed the wolf.” That’s what this program is all about! Landing mechanics from jumping are focused on first along with power via medicine ball slam exercises. If training power, strength is also a must. You dive into our favorite lunge, squat, thrust, and deadlift variations. Lastly, to “fully feed the wolf” cardio and mobility are needed, and don’t worry, it is included!

Full Plank With Alternating Leg Lifts

Sample [P]rehab Lower Extremity Performance Program Exercise

The goal of the plank is to work on your core stability. Adding in the alternating leg lifts further challenges your core stability.  The intent of this exercise is to move the limbs as the core is engaged. Although the legs are moving, this exercise is still under isometrics because the emphasis here is on the isometric contraction of the core musculature.

 

Sidelying Hip Adductor Isometrics

For this exercise begin on your side. Squeeze your thigh and straighten your knee first, in particular, the inner portion of your thigh. While maintaining the squeeze, slowly lift up your leg. You should feel the muscles on the inside part of your thigh working. Do not let your hips/core move. Keep them tight the entire time!

 

Concepts For Glute Exercise Progressions

 

Double Leg Static Lower Body Exercises

Once you master the non-weight bearing isometrics, you have the option of performing these exercises in an isotonic manner; however, I like to get people weight-bearing as quickly as possible. This phase of the lower body exercise progressions will load the entire system more and will begin to activate the quadriceps in addition to the hip muscles. We still want to focus on getting great gluteal activation with a ratio of glutes to quads activation of ~ 2:1. If you are still having difficulty finding this ratio, you may need to prime your glutes with isometrics prior to performing these exercises. Often times in these earlier stages, I will implement a blood flow restriction cuff, allowing me to augment my results. Below are a few exercises to help improve your muscle function in this double-leg static phase.

LISTEN: TALKING GLUTES WITH BRET CONTRERAS

glute activation bret contreras progress lower body exercises

 

Chair Squat Isometrics

This exercise will help to strengthen your leg muscles, and back muscles, and promote trunk stability.

Get set-up on the edge of a chair or surface that you feel comfortable standing up from without having to use your arms for assistance. Lean forward and lift your butt off the surface, you should now be in a low squat position. Hold this position for 3-5s followed by slowly shifting your weight back towards the starting position and have a seat on the surface. This should feel like a leg workout! Your butt and thigh muscles should be working hard to maintain the chair squat hold position. Your back and stomach muscles will also be working to maintain an optimal trunk position. Follow the video for other cues and tips.

 

Split Stance Lunge Isometrics

Sample [P]rehab Lower Extremity Performance Program Exercise

  • HOW: Begin in a split stance by placing the non-affected leg backward with the heel off the ground. Be sure to place 70-80% of your weight in your front leg and 20-30% in your back leg. Slowly lower yourself down, and then hold this position

 

  • FEEL: You should feel all of the thigh muscles and butt muscles working, primarily in the forward leg.

 

  • COMPENSATION: Avoiding having an over-arched or rounded back – keep a neutral spine with core engaged. Don’t let the knee cave in or bow out. Keep equal weight distribution in the entire foot of the forward leg.

 

Supine Bridge With Adduction

Place a firm object like a ball between your legs and squeeze. Maintain this contraction the entire time while performing a bridge. You should feel the muscles on the insides of your thighs and glutes working. Do not arch the back. Use your hips to lift you up, not your back.

READ: GROIN PAIN REHAB

how to progress lower body exercises groin pain the prehab guys

 

Single-Leg Static

Once double leg static activation and strengthening have been mastered, it is time to progress into single leg static activation. This will essentially double the load on your lower extremity and may add a challenge to your balance system! The progression is not as black and white as I am showcasing in this article. You can perform the exercises in the previous phase isotonically while you transition into the single-leg static phase. Below are a few lower body exercises you can perform in this phase.

Captain Morgan

With your knee closest to the wall elevate and push your knee into the wall so that your hip is not touching the wall. Avoid leaning over towards your stance limb, this is tricky because at the same time you want to avoid allowing your shoulder to touch the wall. Basically, allow your trunk to remain in the neutral position you would be in if you were to stand. The further you walk out your stance leg the more difficult this exercise will get. Although you are strengthening the leg that is pushing up against the wall, the stance limb is the one that should fatigue first! Go ahead and try this out, it is much more difficult than it looks!

 

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Bilateral Load & Dynamic Single Leg!

The previous phases can take anywhere from 3-6 weeks to master for most of my patients and clients. After we have mastered the double to single leg activation phase it is time to focus on strength!

How do we get strong? By using heavy loads!

There is no other way to get these neural adaptations. Avoid rushing into this phase, if you don’t build a solid foundation with the previous phases you are doing yourself a disservice. If you strengthen your poor movement patterns, you are only strengthening your dysfunctions! Below are examples of exercises to help improve double leg dynamic strength. These exercises depend on what activity or sport you are looking to get back to.

Romanian Barbell Deadlift

Sample [P]rehab Lower Extremity Performance Program Exercise

Find your “power stance”, or the stance you would set up in if you were told to jump as high as you can. This is your starting position. Drive your feet into the ground and “spread the ground”. Pull the slack out of the bar and then lift the barbell using your legs.

 

Toe Tap – 3 Way

This exercise is now beginning to transition into single-leg dynamic strengthening. This will be where part two of this article will begin, stay tuned! Place a band around your knees above your knee cap. Bend your knees slightly and hinge forward at the hips performing a small squat. From this position, shift your weight to one side. With the other leg, reach out and tap your toe in a diagonal direction in front of you, then back, then straight out to the side, then back, and in a backward diagonal motion. Return back to the starting position in between each rep. Looking for more single leg strengthening exercises? Look no further than the foolproof single leg strengthening exercises!

 

Closing Thoughts

This article showcased lower body exercise progressions taking you from non-weight bearing isometric holds -> double leg static hold -> single leg static hold-> double leg strengthening! For some individuals, this is where the progression of exercises end, and we continue to improve double leg strengthening. However, for many of the clients and patients that are looking to get back to higher-level activities or sports, this is only the beginning.

 

Looking To Learn How To Progress Lower Body Exercises On Your Own?

lower extremity performance program progress lower body exercises prehab guys

How about the character coach Herb Brooks of the USA Men’s Miracle Hockey Olympic team created?!? In training, he once stated, “the legs feed the wolf.” That’s what this program is all about! Landing mechanics from jumping are focused on first along with power via medicine ball slam exercises. If training power, strength is also a must. You dive into our favorite lunge, squat, thrust, and deadlift variations. Lastly, to “fully feed the wolf” cardio and mobility are needed, and don’t worry, it is included!

 

About The Author

Arash Maghsoodi, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Marketing Officer

Arash Maghsoodi received his Doctorate in Physical Therapy from the University of Southern California. For his undergraduate studies, he attended San Diego State University and studied Kinesiology. After sustaining a career-ending ankle sprain while playing collegiate soccer, he realized how disabling and life-altering injuries can be. Arash currently resides in beautiful Santa Monica, California. His clinical experience is primarily in the orthopedic and sports setting. He has treated a wide variety of conditions ranging from the post-operative individual to the professional athlete. Arash is keeping the family legacy of becoming a physical therapist, as his mother is a practicing clinician of 30 years in the Orange County area.

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

About the author : Arash Maghsoodi PT, DPT, CSCS

2 Comments

  1. Sean Mc August 13, 2019 at 7:03 pm

    I’d love to see more about single leg, Plyo, and agility. I’m a fencer and martial artist. Had IT band and patella femoral problems a few years ago that flared up again last summer when doing some heavier than usual training. Physical therapy helped But I Want to get my confidence back in my explosive lunges and jump kicks. Lots of torque of my knees.

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