Balance and Coordination Training

Part 1.  Basic activities to improve balance and coordination.

When kids start to walk they do more advance activities.

Basic balance and coordination training.

Sometimes when physical therapist is thinking of more complex activities, the important basic things are forgotten.

I hope you press the orange task tab above before you proceed to part 2.

Part 2: Sports related injury that can cause uncoordinated movement.

  1. Common concussion injury,
  2. Incidence according to age.
  3. Post-concussion evaluation.
  4. Neck pain in concussion.
  5. Neurological Examination.
  6. Coordination.
  7. Balance.
  8. Vestibular and Oculomotor test.
  9. Vestibular Intervention.
  10. Dizziness Intervention.
  11. Gait Assesment.
  12. Physical Therapy Evaluation.
  13. Recovery Stage.

1. CONCUSSION INJURY: Before we discuss concussion injury. Let me test you. What is the most common causes of the concussion ?
2. CONCUSSION INCIDENCE WITH DIFFERENT AGE: What age do you thinks kids has more concussion Incidence. According to MCH trauma data base 2011. Guess what age children has more concussion.
3. POST-CONCUSSION EVALUATION: Emotional symptoms are irritability, sadness, nervousness, and more emotional. They recover around 2-3 weeks, 10 to 20 percent recovers slowly. Slow recovery impact on social activities, extra-curricular activities, physical activities, and academic activities. Severity of injury does not always slow down recovery. We have to ask the right questions to the patient. How many, circumstances, symptoms, duration of symptoms, equipment worn, and force. Now who do you think involve in team evaluation.
4. NECK PAIN IN CONCUSSION: Over 48 percent of triathletes has neck pain. When you do neurological screening it should include: cranial nerves, reflexes/tone, range of motion, and general strength. Question: When should we perform detailed neck assessment?
5. NEUROLOGICAL EXAMINATION: PT should be aware how to test: cranial nerve, reflexes, range of motion, and general strength. What is the reason we are doing these.
6. COORDINATION EVALUATION: Coordination test can be finger to nose, itsy bitsy spider finger movement, jumping jack, walking on straight line, standing on one leg, and finger tapping on the table. Question, how should we do the balancing test for coordination.
7. BALANCE EXAMINATION: SCAT 3 test for balance are: Modified Bess, and tandem gait. There are also norm-referenced assessments available in pediatrics. Sample test are standing with feet together arms crossed, and one leg standing with eyes open and eyes closed. Challenges that we can add are the following;
8. VESTIBULAR AND OCULOMOTOR TEST: Children usually complain of dizzinezz, nausea, blurred vision, balance problem, and increase symptoms while walking. Oculomotor sreening includes: 1. cranial nerves III, IV,VI, VIII, 2. Pursuit. 3. Saccades. 4. Convergence. 5. Optokinetic Nystagmus. 6. VOR cancellation. Eye test should be quick but if test is abnormal, what about vestibular assessment?
9. VESTIBULAR INTERVENTION: Three vestibular rehabilitation: 1. Adaptation 2. Substitution. 3. Habituation. Adaptation training of vestibular system by standing with small base of support and other challenges possible. Substitution training to replace lost functions by using eye-head movement between 2 target or imaginary target. Habituation is finding movement such as head movement, trunk flexion, walk and stop, walk on threadmill while looking right/left/up/down, and walking in mall when well. Daily home exercise program: a.) Habituation 1-2x/day. b.) Balance training: 1-2x/day. c.) Adaptation for gaze stability: 2-5x/day. d.) Substitution for gaze stability: 2-5x/day. How can we progress in exercise program?
10. DIZZINESS INTERVENTION: In habituation intervention, find the movement that:
11. GAIT ASSESSMENT: What are the common gait assessment.
12. PHYSICAL THERAPY EVALUATION: It has to include the following: 1. History 2. Post-concussion scale. 3. Neck screening. 4. Neurological exam. 5. Coordination. 6. Balance. 7. Vestibular assessment. 8. Gait and Function. Question, what test can you use for coordination or balance.
13. RECOVERY STAGE: Children should return to school gradually after few days of rest. They have to return school then to physical activities. PT should work in interdisciplinary team. They have to have clearance from the clinic and PT should provide individualized activity program. Weekly follow up should be done. What are the rehabilitation stages to return to sport and activity?

Part 3: Balance and coordination from birth to advance level.

From birth children improve their balance and coordination in a very fast pace. There are different functional level that the PT can easily figure out the goals.

Functional Level

  1. Bed Level
  2. Sitting and Crawling Level.
  3. Cruising Level.
  4. Standing and Walking Level.
  5. Challenged Standing and Walking Level.

Goals for children at bed level.

  • They will bring their hand to their mouth while supported in side-lying
  • They will look at a toy when supported in side-lying
  • They will touches a toy when supported side-lying
  • They will stay in side-lying position without support
  • They will look at you and focus on your face while back-lying
  • They will bring their hand to their mouth or chest while back-lying
  • They will touch the toys on their chest while back-lying
  • They will turn the head to center and hold it there while propped back-lying
  • They will touch the suspended rattle while propped back-lying
  • The will turn the head to the center and hold it there back-lying without propped
  • They will touch the suspended rattle while back-lying without proppedThey
  • They will maintain their legs together and kicks them in back-lying
  • They will hold their clothes in back-lying
  • They will reach 2 inches above their chest in back-lying
  • They will reach wit elbow straight in back-lying
  • They will kick their legs up with feet above their hips in back-lying
  • They will hold their feet in back-lying
  • They will touch their knees in back-lying
  • They will play with their feet in back-lying

Goals for children for sitting and crawling level.

  • They will hold their head up for 3min. in supported propped on elbows
  • They will hold their head up for 2min. in supported propped on elbows
  • They will hold their head up for 1min. in supported propped on elbows
  • They will hold their head up for 10-20 sec. in supported propped on elbows
  • They will maintain supported sitting for 2-3 minutes
  • They will maintain supported sitting for 30 seconds
  • They will maintain supported sitting for 10 seconds
  • They will lift their head up and props on their elbows for 30 seconds in stomach lying
  • They will lift their head up and props on their elbows for 5 minutes in stomach-lying
  • They will prop on their hands for 5 seconds in stomach-lying
  • They will prop on their hands for 20 seconds in stomach-lying
  • They will reach forward while propped on their hands stomach-lying
  • They will reach upward while  propped on their hands stomach-lying
  • They will holds their head up for 20sec., upper trunk supported sitting
  • They will holds their head up for 2min.,upper trunk supported sitting
  • They will holds their head up for 5min.,upper trunk supported sitting
  • They will holds their head up for 2min.mid trunk supported sitting
  • They will holds their head up for 5min. mid trunk supported sitting
  • They will lift their head in pull to sitting with arms
  • They will roll accidentally to back-lying from stomach-lying
  • They will roll consistently to back-lying from stomach-lying
  • They will roll with assistance from side-lying to stomach-lying
  • They will roll with half assistance form side to stomach
  • They will roll from side-lying to stomach
  • They will roll from back to stomach
  • They will pivot to the side while sitting
  • The will pivot one time while sitting
  • They will pivot 180 degrees
  • They will pivot 360 degrees
  • They will hold wall in waist supported sitting
  • They will hold thumbs in waist supported sitting
  • They will reach for toys in waist supported sitting
  • They will stay in high chair waist supported sitting
  • They will reach toys in waist supported sitting
  • They will hold wall in hip supported sitting
  • They will hold thumbs in hip supported sitting
  • They will sit on couch with hip supported sitting
  • They will aligned body in challenged hip supported sitting
  • They will sit for 10 seconds with hands on thigh
  • They will sit for 2 minutes with hands on thigh
  • They will sit for 5 minute without support
  • They will transition to sitting
  • They will hold trunk for 20 seconds in supported quadruped position
  • They will hold trunk for 20 second without support quadruped position
  • They will hold knees together in supported kneeling
  • They will hold on in supported kneeling
  • They will move up and down in supported kneeling
  • They will attempt to transition from kneeling to sitting
  • They will crawl on their belly 2 pulls forward
  • They will crawl on their belly 5 ft.
  • They will crawl on their belly 10 ft.
  • They will transition to quadruped
  • They will creep 2 steps
  • They will creep 5 feet
  • They will creep 10 feet
  • They will scoot 5 feet
  • They will climb cushion less sofa without cushion as a step stool
  • They will remove cushion and climb the sofa
  • They will get down the sofa
  • They will creep back down the stairs with support
  • They will creep back down the stairs independently
  • They will transition from hands and knees to sitting
  • They will transition from stomach-lying to sitting
  • They will transition from sitting to stomach-lying
  • They will transition from sitting to quadruped
  • They will transition from sitting to kneeling
  • They will pull to kneel from sitting holding with low surface edge
  • They will pull to kneel from sitting holding with high surface edge
  • They will pull to kneel from quadruped with low surface edge
  • They will pull to kneel from quadruped with high surface edge

Goals for children at cruising level.

  • They will pull up to standing
  • They will lower halfway to sitting
  • They will lower to sitting
  • They will move to half kneel from kneeling
  • They will pull to standing using hard surface
  • They will pull to standing using soft surface
  • They will pull to standing using any surface
  • They will stand holding quickly on with both elbow on surface
  • They will stand quickly with hands holds on surface
  • They will bounce in hand held standing
  • They will stand with one hand hold on the surface
  • They will stand for 3 minutes, both hands hold on edge surface
  • They will stand for 3 minutes one hand hold on edge surface
  • They will stand with one hand holding other hand playing
  • They will stand for 3 minutes with back against furniture
  • They will stand for 3 minutes, hands on top of surface
  • They will stand for 3 minutes with one hand on top of surface
  • They will stand with one hand on top of surface other hand playing
  • They will stand without support for 2 seconds
  • They will stand for 10 seconds
  • They will stand for 20 seconds
  • They will cruise 2 steps
  • They will cruise 3 steps
  • They will cruise from end to end of sofa
  • They will cruise around corner of table
  • They will cruise from one furniture to other
  • They will cruise with hands lightly touching
  • They will move to plantigrade from creeping
  • They will bear walk around
  • They will bear walk to plantigrade
  • They will stand quickly from plantigrade
  • They will stand with one hand held from plantigrade

Goals for children standing and walking level.

  • They will stand without support from plantigrade
  • They will walk on the mattress with one hand held
  • They will walk on the mattress independently
  • They will walk on the sand 10 feet with one hand held
  • They will walk on the sidewalk with crack 10 feet with one hand held
  • They will walk on the chips 10 feet with one hand held
  • They will walk on the rocks 10 feet with one hand held
  • They will walk on the sand 100 feet with one hand held
  • They will walk on the sidewalk with crack 100 feet with one hand held
  • They will walk on the chips 100 feet with one hand held
  • They will walk on the rocks 100 feet with one hand held
  • They will walk on the sand 10 feet without support
  • They will walk on the sand 10 feet without support
  • They will walk on the sidewalk with crack 10 feet without support
  • They will walk on the chips 10 feet without support
  • They will walk on the rocks 10 feet without support
  • They will walk on the sand 100 feet without support
  • They will walk on the sidewalk with crack 100 feet without support

Goals for children to challenged standing and walking level.

  • They will walk on the chips 100 feet without support
  • They will walk on the rocks 100 feet without support
  • They will walk from sidewalk to grass with hand support
  • They will walk from grass to sidewalk with hand support
  • They will walk from grass to gravel with hand support
  • They will walk from gravel to grass with hand support
  • They will walk from sidewalk to grass without hand support
  • They will walk from grass to sidewalk without hand support
  • They will walk from grass to gravel without hand support
  • They will walk from gravel to grass without hand support
  • They will kick the ball on even surface with both hand held
  • They will kick the ball on the grass with both hand held
  • They will kick the ball on even surface with one hand held
  • They will kick the ball on the grass with one hand held
  • They will kick the ball run to it repeatedly, one hand support
  • They will kick the ball on even surface independently
  • They will kick the ball on the grass independently
  • They will kick the ball run to it repeatedly and independently
  • They will kick the ball 20 feet knee straight
  • They will kick the ball for 30 feet knee straight
  • They will walk up the small inclines with two-hand support
  • They will walk down the small inclines with two-hand support
  • They will walk up the small inclines with one-hand support
  • They will walk down the small inclines with one-hand support
  • They will walk up the small inclines without support
  • They will walk down the small inclines without support
  • They will walk up the medium inclines with two-hand support
  • They will walk down the medium inclines with two-hand support
  • They will walk up the medium inclines with one-hand support
  • They will walk down the medium inclines with one-hand support
  • They will walk up the medium inclines without support
  • They will walk down the medium inclines without support
  • They will walk up the large inclines with two-hand support
  • They will walk down the large inclines with two-hand support
  • They will walk up the large inclines with one-hand support
  • They will walk down the large inclines with one-hand support
  • They will walk up the large inclines without support
  • They will walk down the large inclines without support
  • They will walk up 1 inches curb with support
  • They will walk up 1 inches curb without support
  • They will walk down 1 inches curb with support
  • They will walk down 1 inches curb without support
  • They will walk up 2 inches curb with support
  • They will walk up 2 inches curb without support
  • They will walk down 2 inches curb with support
  • They will walk down 2 inches curb without support
  • They will walk up 3 inches curb with support
  • They will walk up 3 inches curb without support
  • They will walk down 3 inches curb with support
  • They will walk down 3 inches curb without support
  • They will walk up 4 inches curb with support
  • They will walk up 4 inches curb without support
  • They will walk down 4 inches curb with support
  • They will walk down 4 inches curb without support
  • They will walk up 5 inches curb with support
  • They will walk up 5 inches curb without support
  • They will walk down 5 inches curb with support
  • They will walk down 5 inches curb without support
  • They will walk up 6 inches curb with support
  • They will walk up 6 inches curb without support
  • They will walk down 6 inches curb with support
  • They will walk down 6 inches curb without support
  • They will walk up 7 inches curb with support
  • They will walk up 7 inches curb without support
  • They will walk down 7 inches curb with support
  • They will walk down 7 inches curb without support
  • They will walk up 8 inches curb with support
  • They will walk up 8 inches curb without support
  • They will walk down 8 inches curb with support
  • They will walk down 8 inches curb without support
  • They will walk up stairs, marking time, two-hand support
  • They will walk down stairs, marking time, two-hand support
  • They will walk up stairs, marking time, a hand held and other on railing
  • They will walk down stairs, marking time, a hand held and other on railing
  • They will walk up stairs, marking time, two-hand on railing
  • They will walk down stairs, marking time, two-hand on railing
  • They will walk up stairs, marking time steps, one-hand on railing
  • They will walk down stairs, marking time steps, one-hand on railing
  • They will walk up stairs, alternate steps, one-hand on railing
  • They will walk down stairs, alternate steps, one-hand on railing
  • They will walk fast 25 feet two-hand support
  • They will walk fast 100 feet two-hand support
  • They will walk fast a medium incline with hand support
  • They will walk fast a medium incline without support
  • They will walk fast for 50 feet, one-hand held
  • They will walk fast for 100 feet, one-hand held
  • They will walk fast for 100 feet, one-hand held
  • They will walk fast 100 feet in 25 seconds
  • They will walk fast 100 feet in 15 seconds
  • They will walk across a 10″ wide balance beam with one hand held
  • They will walk across a 10″ wide balance beam without support
  • They will walk across a 7″ wide balance beam with one hand held
  • They will walk across a 7″ wide balance beam without support
  • They will walk across a 6″ wide balance beam with one hand held
  • They will walk across a 6″ wide balance beam without support
  • They will walk across a 4″ wide balance beam with one hand held
  • They will walk across a 4″ wide balance beam without support
  • They will bounce the springy surface 5 times with two-hand support
  • They will bounce the springy surface 10 times with two-hand support
  • They will jump forward springy surface 10 times with two-hand support
  • They will bounce tiptoes springy surface 5 times with two-hand support
  • They will bounce tiptoes  springy surface 10 times with two-hand support
  • They will jump on springy object occasionally with two-hand support
  • They will jump on springy object consistently with two-hand support
  • They will jump on floor occasionally with two-hand support
  • They will jump on floor consistently with two-hand support
  • They will jump on floor independently
  • They will jump forward 6 inches over a line without support
  • They will jump off 2 inches step without support
  • They will jump off 4 inches step without support
  • They will jump off 8 inches step without support
  • They will climb on toy with support
  • They will climb on toy without support
  • They will climb off toy with support
  • They will climb off toy without support
  • They will scoot back the riding toy 10 feet
  • They will scoot forward the riding toy 15 feet
  • They will steer and scoot forward the riding toy 15 feet
  • They will ride while push on tricycle
  • They will ride down incline on the tricycle intermittent support
  • They will ride down incline on the tricycle pedaling
  • They will ride down incline on the tricycle pedaling and steering
  • They will ride tricycle on level surface for 5 feet
  • They will ride tricycle on level surface for 15 feet

Exercises Stages in Developing Children

How do we start with kids to develop movement. 

14. When there is no movement yet

Developmental Mileage

Although babies develop differently, majority of the babies develops just like the following.

0 to1 month: Head aligned when held vertically. Rotates head and move legs while lying on stomach. When the head rotates to the right, the right arms and legs extend. Rolls to back when placed in side lying position. Arms and legs move while lying on their back.
 2 to 3 months: Head aligned and stiffens legs when bounced three times.  Raised head and chest then bear weight on arms while lying on stomach. Bear weight on legs for three seconds and show stepping reflex when placed in standing position. When pulled up to sitting the head maintain its alignment. Kick legs simultaneously while lying on their back.
4 to 5 months: Head and body aligned when supported around the waist. Reach toys up on eye level while lying on stomach. Bear weight on legs when supported three seconds. While lying on back, grabs the feet, and pull self to sitting when assisted. From lying on back, they roll to the side.
6 to 7 months: Maintain sitting while playing toy for about a minute. Bear weight on hands and crawl about three feet while lying on stomach. Rolls from back to stomach. 4. Pull self to sitting with better head control when assisted. From lying on back they can reach toys from the side.
8 to 9 months: Maintain sitting while pivoting the body and leans forward when falling backward. Move around while sitting and crawls about five feet. Bounce while assisted to standing and rolls using counter rotation on hips and shoulder. Pull self to sitting by holding on stable furniture.  Maintain hands and knees stationary position while reaching forward.
10 to 11 months: Get up to sitting and reach forward for toys. Creeps forward with hands and knees. Walk sideways while holding on stable furniture and lowers body slowly. Raises to standing while holding onto stable furniture. 5. Balance in standing for three seconds and walk with one hand supported.
12 to 14 months: Maintain kneeling position. Creeps over parent’s legs and creeps up two steps stairs. Creeps forward with hands and feet. Pick up toys, walk about 5 steps, and turns half circle while standing. Roll the dodge ball and fling the tennis ball.
15 to 17 months: Creep backward down stairs about three steps. Walk forward, sideward and backward about 10 feet. Walk on stairs while holding on railings with dominant leg leading. Attempt to kick the ball slowly. Stand in straightforward line.
18 to 23 months: Stand up without holding on furniture or support. Walk on balance beam with one foot off the balance beam. Jump up two inches, down the 4 inches, and forward with one foot leading and jump forward. Kick the dodge ball forward. Pick up tennis ball and throw it while standing. Run about 10 feet. Walk on stairs about four steps with same foot leading while holding on railings.
24 to 29 months: Walk up stairs with alternate stepping but still walks down with same foot leading. Jump down the 16 inches chair or curb. Stand on one foot for a second. Walk on balance beam about three steps. Walk in different directions. Throw tennis or dodge ball about 7 feet forward.
30-35 months: Stand up with less effort. Walk up and down the stairs with alternate stepping. Catch, throw, and kick the ball. Jump down 18 inches chair, over 3 inches obstacle, and forward 24 inches. Stand and hops on one foot.
36 to 41 months: Pedals tricycle about 10 feet. Walk on stairs with alternate stepping independently. Jump forward 26 inches and down the 24 inches chair. Catch ball with hands while elbow bent. Stand on one foot for 5 seconds and hops 5 times.
42 to 47 months: Overhead throw tennis or dodge ball aiming at object. Catch tennis ball. Jump over 6 inches obstacle. Stand on tiptoes with hands on head and on one foot for 10 seconds. Hops on one foot 10 times.

9 Exercises for Neck and Shoulder Pain

  1. If you wanted to start the exercises you have to put your two fingers on the top of your forehead resist bending head forward then hold it for couple of seconds.
  2. Resist movement by using light pressure with fingertips into the temple on the sides of the forehead area. Keep the resistance by pushing the head to the side.
  3. Apply side resistance by using the light pressure with fingertips, press into the side of the head about the ear. You can resist by bending head sideways.
  4. Apply light pressure with fingertips at the back of the head. Resist backward bending of head. Hold it for a couple of seconds.
  5. Full head straight by keeping jaw and I level bed shrug shoulder up, down, forward and backward.
  6. Gently pull on elbow with opposite hand, until stretch is found in the shoulder. You can gently pull an elbow with opposite hand until I stretch is felt in shoulder.
  7. In the next exercise you need a towel. Pull involved arm behind the back by pulling towel.
  8. Assume an all fours position. While positioned comfortably on hands and knees gently lean forward, smoothly and without pain. Stay in this position for a couple of minutes.
  9. Scratch your opposite shoulder blade by by lift hand up behind you head, low behind your back, up in front of your chest, and low in front of your chest

Compensatory Movement

Gross motor training is the most scientifically proven concept in the field of physical therapy. Most of the functional activities can be master by good gross motor training. There are two functional movement one is fine motor where the OT concentrates on and there is gross motor which falls in the field of PT. When there is an impairment the easiest way to compensate with it is to use the rest of you body that is not impaired. For example if your back is injured and you can’t bend forward to lower your body, you can use your knees to lower your body. If you injured the right arm, you can use the left arm. These are the example that is easy to figure out. In some cases it is hard to figure out how to move with compensatory movement, for example if you have pain on neck while lying down how can you find the compensatory position?
It is a lot easier if you do the movement or positioning very slowly at the beginning to figure out how to learn the compensatory movement. The main thing to remember is you have to move while preventing the pain. When you find that movement, you have to master that movement. After you master the movement offer some challenges later on. Your body should be able to brace the injured area while doing some activities. Compensatory movement must be coordinated to minimize stress to injured area.

PNF techniques

[qwiz] [i]

 

This quiz will be fill in the blanks. Use hint when you have difficulty. You can not progress to the next question if you have incorrect answer.

[q]

[hangman]

is passive diagonal movement through the range, PNF technique.

[c] Rythmic Initiation

 

[f] Correct!

 

[q]

 

[hangman]is a passive movement through ROM with alternating/multidirectional direction.

 

 

[c] Rythmic Rotation

 

[f] Good!

 

[q]

[hangman]is a combination of the patient participation and PT assistance though the ROM.

 

[c] Active Assisted

 

[f] Correct!

 

[q]

[hangman]is the isometric contraction of agonist and antagonist muscles.

 

[c] Alternate Isometric

 

[f] Good!

 

[q]

[hangman]is the isometric contraction of multidirectional force.

 

[c] Rytmic Stabilization

 

[f] Correct!

 

[q]

[hangman]is the repeated dynamic movement at one point of range

 

[c] hStabilization

 

[f] Great!

 

[/qwiz]

 

 

 

 

6 Simple Lower Back Exercises

  1. While lying on back flatten back tightening stomach muscles and buttocks. Repeat as much as you can.
  2. While lying on back, bring one knee to the chest. Repeat as much as you can.
  3. While lying on back, bend both knees together. Slowly rock knees side to side in a small pain free range. Allow back to rotate slightly.
  4. While lying on stomach, tighten buttocks while pressing pelvis to the floor.
  5. While lying on stomach, rise on elbows as high as possible, keeping hips on floor.
  6. While leaning back to the wall, keep head, shoulder and back against the wall with feet out in front and slightly wide then shoulder width. Slowly lower buttocks while sliding down wall, until thigh are parallel to floor. Keep back flat.

6 Simple Leg Exercises in Sitting

  1. Place the front ankle to the back of the opposite ankle. Push it together then straighten it.
  2. Straighten the knee alternately.
  3. Bend the hips alternately.
  4. Move leg widely apart, then together again.
  5. Place a foot on smooth surface. Slowly slide foot back as far as possible.
  6. Raise heels, then rock back on heels and then raise toes.

6 Simple Standing Training

  1. While sitting on the armchair, push hands on the arms of chair and push body up out of chair.
  2. While standing holding on the top of back chair or other furniture, slowly bend knees. Keep both feet on the floor.
  3. While standing close to  side of table. Hold the table then bend knee as far as possible.
  4. While standing holding on furniture, raise the leg out to side. Keep the toes pointing forward.
  5. While holding on furniture, raise the leg out backward with knees straight.
  6. Stand on one leg for few seconds. Stay close to wall or furniture to hold on when you fall.

6 Simple Leg Strengthening Exercises

  1. While lying on back. With one leg bent slightly, push heel into bed without bending knee further.
  2. While lying on back tighten muscles on front of thigh, then lift leg as much as you can from surface, keeping knee locked.
  3. While lying on stomach bend knee, bringing heel towards buttocks.
  4. While lying on stomach tighten muscle on front of one thigh then lift the opposite leg.
  5. While lying on side with top leg stabilizing the position, tighten muscle on front of lower leg thigh, then lift leg several inches from the surface, keeping knee locked.

6 Simple Core exercises

1. While lying on stomach with pillows supporting abdomen and forehead, bend knees and gently squeeze heels together. Estimate the time you hold it. It suppose to be painless but with stress.

2.While lying on back with knees bent, tighten stomach by presenting elbows int floor.

3. While lying on back tighten stomach muscles to keep trunk rigid and slowly raise one leg three to four inches from floor, then slowly lower it, while raising the other leg.

4. While lying on back, tighten stomach muscles and slowly lower one arm over/head until you feel your back begin to arch.

5. While lying on back tighten stomach muscles and slowly raise one leg and lower opposite arm over head.

6. While lying on back slowly rise buttocks from floor, keeping stomach tight.