Position patient in supine, with arms crossed at chest. Determine whether bilateral or unilateral strengthening is needed, as below:



1) If patient can perform hip extension (lifting buttock off bed/mat) unilaterally, then work on unilateral strengthening. If not, perform bilateral strengthening.



2) Using leg-pac device, instruct patient to perform unilateral or bilateral hip extension, encouraging full hip extension (to 180 degrees) X 10 reps. Relax, repeat. Repeat with opposite leg. Remind patient to keep arms folded across chest.



3) If using bilateral hip extensor strengthening, progress to unilateral, when pt. is able to perform full bilateral hip extension for 10 reps.


4) Unilateral hip extension should be performed with opposite lower extremity either fully extended, or crossed over the thigh of working leg. (Do not allow patient to assist with opposite lower extremity.)



5) As hip extension improves, demonstrated by ability to lift buttock to full (neutral) extension, add 5 lb. Weight (sandbag) across pelvis, to increase resistance. Increase weight by approximately 2# daily, as tolerated. Continue 2 sets of 10 repetitions each leg.


6) Provide rest periods as needed throughout exercise session.



7) Encourage counting/breathing throughout, to avoid holding breath. Monitor for signs of respiratory or cardiac stress. Report pain to physical therapist and nurse for further evaluation and administration of pain medication by nurse, as needed.





 These exercises should be performed only under the direction of a physician/physical therapist