All About Gait

(Walking)

This eBook will detail common issues that many deal with after a stroke with regards to gait- and exercises to help

INTRODUCTION

Gait (walking) may be the single most important and common issue that physical therapists help to recover after a stroke. Here are tips and exercises from a stroke survivor and physical therapist herself.

Key Subjects

Main gait related issues seen after one suffers a stroke:

"Up with the good, down with bad"
Using an assistive device (cane)
Circumduction
Trendelenburg Gait
Foot Drop
Weak Glutes
Gravity elimination
Quads

I hope some of my tips help you. For years I have been told that the blog I started writing (www.mycerebellarstrokerecovery.com) after I got sick has helped people with specific problems so I decided to condense information into several Ebooks. Having a stroke is devastating. You're not alone. I'm here to help.

In each different part, there are exercises that would help with the condition that I write about. Some of them may overlap. I have pictures of both exercises that you can do at home and more advanced exercises that you may need to do at a gym.

These lists of exercises are in no way exhaustive. There are many, many more. Also, specific to repetitions/ sets/ weights - My recommendations are pretty similar for each exercise. You'll have to figure out what you can do on your own. You can always make an exercise harder by adding weight/theraband or reps.

Thank you SO, SO much to physitrack.com for allowing me to use their pictures of exercises in my eBook!!!!!!!

Amy Elder, PT, DPT, Cert.MDT

The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read in this eBook. Never rely on information in this eBook in place of seeking professional medical advice.

Cover Page
Introduction
Part1: "Up with the Good, Down with the Bad"
Part 1a: continued
Part1b : Exercises to strengthen your legs for stairs
Part 2: Canes
Part 2a: Using canes correctly
Part 2b: Using canes on steps
Part 3: Foot Drop
Part 3a: Foot Drop explained
Part 3b: Exercises to help Foot Drop
Part 4: Circumduction
Part 4a: Circumduction explained
Part 4b: Hip exercises for Circumduction
Part 4b: Hamstring/Knee exercises for Circumduction
Part 5: Trendelenburg Gait
Part 5a: Trendelenburg explained
Part 5b: Exercises to help with Trendelenburg
Part 6 - Glutes
Part 6a : Glute exercises you can do at home
Part 6b: Advanced Glute exercises
Part 7: Gravity
Part 8: Quads
Part 8b: Exercises for the quadriceps
About The Author
Disclaimer

part 1 "Up With the Good, Down with the Bad"

Press this button for a YouTube video demonstrating proper gait on stairs when one leg is weaker and needs protection

Sometimes, looking at the search terms that were used of how people ended up on my blog is a great way to give me an idea for a new post. This exact wording was put into Google (or maybe a lesser-known search engine)….”Why do you go up with the good and down with the bad?”

I’ll explain this using the example of a sprained ankle. Think of an orthopedic injury that requires you to put less weight through one foot when walking or it will hurt very badly. When it comes to the weird gait patterns after a stroke, sometimes this won’t apply.

At first, in some cases, this advice may not apply to you due to your specific symptoms. It did not apply to me for the first couple of years after my stroke. Because of the tremor and ataxia in my right leg, I had to do the opposite of this gait pattern for quite some time when negotiating stairs. Going down with the bad didn’t work for me because my “bad” leg had a mind of its own for a while and I had zero control over it. I wasn’t able to direct it and tell it where to go.

Some time later, when I had more control of my right leg, I was able to use this piece of advice.

Ok, back to the question. Pretend your right ankle is messed up. So the right leg is the “bad” leg. When going up stairs, the entire weight of the whole body must be lifted up to the next stair. You wouldn’t want to put all that weight through your messed up ankle. So, when you go up stairs, you “lead” with your left leg, using that leg to do all of the work lifting your body, and bring your right leg up to same step to meet it. That way, when climbing a step, all the weight being lifted is on the “good” leg. You wouldn’t want all that weight put on your messed up ankle.

Going down a flight of stairs is the exact opposite. Again, you don’t want all that weight on your “bad” leg, so you would put your “bad” leg down onto the next, lower step first, which will transfer all the body weight to the left “good” leg and it can then do the job of lowering your body down without using your right leg at all.

Try it. Go down a step, put your right leg first on the step below. You should feel your left side tense up a little as it prepares to perform the act of lowering the body to the next step down.

On the next few pages, there are some exercises pictured with instructions that a physical therapist (PT) will give patients to help with stair negotiation. On many of the exercises, you'll see the instruction, "Make sure you are holding onto something when attempting this exercise." This instruction always stands for safety, but try to put as little weight through your arms as you feel comfortable doing. The weight should be on the leg that you are attempting to make stronger.

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1. Step toe taps

10 Sets / 10 Reps

Stand up straight facing a step with your feet hip width apart.
Lift one foot up, and tap your toes on the step.
Do not place any weight on this foot.
Ensure you stand tall on your stance leg whilst you do this.
Return your tapping leg to the floor, and repeat with your other leg.

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2. Step up

5 Sets / 20 Reps

Stand in front of a stair or step.
Place weaker foot up onto the step and when you are stable bring up the other foot.
Reverse the movement and return to the starting position by lowering your stronger foot behind you to the floor, following with your weak leg.
Repeat.

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3. Step up and over

5 Sets / 20 Reps

Stand up straight facing a step with your feet hip width apart.
Stand close to the step.
Place your affected leg on the center of the step.
Step up and over, bringing your unaffected leg from one side of the step, to the ground on the other side.
Step your affected leg down from the step, so that both of your feet are back on the floor.

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4. Step down

5 Sets / 20 Reps

Stand upright on a step, facing down.
Slowly step your unaffected leg down off the step.
You should complete the movement slowly, so that your affected leg is controlling the movement.
Ensure your knee on the affected leg is going straight over your toes.
Push yourself back up onto the step and repeat the movement.

Make sure you are holding to something when attempting this exercise.

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5. Stepping backwards

5 Sets / 20 Reps

Stand on a stair or step with your affected leg.
Carefully bend your leg so you can tap the floor with your other foot.
Return to the starting position by stretching out your affected leg.

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6. Lateral step ups

5 Sets / 20 Reps

Stand with your affected side closest to the step.
Step up, bringing your other foot up to join the affected leg, then lower this foot back down.
Make sure the knee on the affected leg travels forwards, and not inwards, when bending and straightening it.
Make sure you're holding onto something if attempting this exercise.

Part 2 - Canes

Using an assistive device

This chapter will help to explain how to properly use a cane when walking and how it can help you

Press this button to watch a YouTube video for using a cane on stairs

Here’s how to use a cane correctly when walking on level ground.……

You hold the cane on the OPPOSITE side of the weaker side. In my case, my right side is all goofy so I held my cane with my LEFT hand. The purpose of a cane is to increase your base of support which improves your balance so that you don’t fall. So, at the same time that you take a step forward with the BAD leg, the cane, held with the opposite hand, should be advanced forward simultaneously. When I walked with a cane, I would move the cane forward with my left hand AT THE SAME TIME as when I took a step forward with my right, weaker leg.

The definition of balance is keeping your center of mass (COM) over your base of support (BOS). If your center of mass goes outside the base of support, you fall. Manipulating the COM/BOS is how therapists move people around. In standing, a woman’s center of mass is around her belly button and a man's is around his chest.

When you’re standing, your feet are your base. Stand up and imagine a circle around your feet – that’s your base of support. Stand with your feet wider apart. It’s easier to balance, right? That’s because you just made your base of support bigger. When balancing on one leg, you have a wee little base of support. This makes it harder. That’s why therapists tell people to use canes and walkers. To increase their base of support. When you’re using a cane, your BOS is no longer just your feet, but the point of that cane is included in the circle around your feet (opposite of the bad leg) so the BOS is bigger. If you held your cane on the same side as the bad leg, your base of support wouldn't be increased by much.

The above picture is an incorrect example of use of a cane. A cane should never be advanced forward on the same side of a leg. The cane should always mimic what the opposite, weaker leg is doing.

This is the correct use of a cane (assuming her left leg is the injured one). The cane is advanced forward along with the opposite, weaker leg.

Photo by Elle Hughes

I wrote about how to safely go up and down stairs with a bad leg. Now it's time to write about how to use a cane on steps. A previous chapter mentions the phrase “Up with the Good, Down with the Bad.” Consider your cane a part of the BAD. Whatever you do with the weaker leg, the cane held by the opposite hand, does the same or similar thing.

So to go up stairs, you would first take a step up leading with the GOOD leg. Next, bring up the cane held in the opposite hand, followed by the "bad' leg and the cane to the meet the 'good' leg on the higher stair. You always want the cane to do the same thing (or same thing just prior) as the bad leg, because the bad leg needs that support. This is for safety. Getting the bad leg stronger and back to normal function is an entirely different story.

To go down stairs, again remember, “up with the good, down with the bad.” So, to go down stairs, put the cane below you first (held with the opposite hand), then take a step down with the 'BAD' leg . The cane will already be there for support.

The cane side always does the same thing that the bad side is doing, or does the same thing just prior to advancing the bad leg. Next, step down to the same stair with the GOOD leg. It’s the opposite of what you do when going up stairs.

You’ll do the opposite of this in physical therapy to get that leg stronger. I’ve said the word 'opposite' 3 times in this chapter, I hope you’re not confused.

The image below would be incorrect assuming the woman's left leg is the weaker one. Assuming this, she is holding the cane appropriately opposite the weak leg. But the problem is, the left (weak) leg should descend before the right leg.

The image below demonstrates the correct way to use a cane going down stairs. The cane is held opposite to the weaker leg (assuming the right leg is the weaker one) and is on the same level as the weaker leg, giving more support.

part 3 Foot Drop

Press this button to watch an example of a drop foot gait, the foot drop is on his right side when he walks

Foot drop is a very common condition caused by stroke. You may have heard foot drop or drop foot or foot slap. Foot slap is a little different but they all involve weakness of the same muscle. This muscle is called the tibialis anterior.

Lift your foot up and keep your heel on the ground. Feel on the front of your lower leg the part that gets hard and pops out. That’s your tibialis anterior muscle. This muscle is responsible for an action called dorsiflexion.

Dorsiflexion is lifting the foot, bringing the toes closer to the shin. When this muscle isn’t working right, that action doesn’t happen and your foot drags. Your toes don't clear the ground and can trip you when you walk. The foot isn’t being lifted up properly. Strokes frequently cause this.

This is the reason someone will get an AFO (ankle foot orthotic). An AFO is something you wear on your lower leg keeping the foot lifted at all times. This makes it easier to walk.

A tip – a PT will say you need an AFO and think they’ve fixed the problem. Now you can walk – success! Not so much to a stroke survivor. Whenever you’re wearing that AFO, it’s doing the work for you. You should wear it to walk outside for safety’s sake and less embarrassment but as soon as you get home, take it off and try to do everything yourself.

Some exercises to help this condition are on the next few pages.

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1. AROM ankle dorsiflexion

5 Sets / 20 Reps

Start in a seated position with your legs out straight.
Pull your toes up towards your head, keeping the leg straight.
The knee stays flat on the table as your move the foot up and down.

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2. Alphabet exercise

5 Set / 5 Reps

Sit down with your legs extended or hanging off the table.
Draw the capital letters of the alphabet with your ankle, accentuating all of the ranges of motion.

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3. AROM ankle circumduction

5 Set / 5 Reps

Lie down on your back with your legs straight out in front of you.
Make clockwise circles with your ankles, then change direction to make
anticlockwise circles.

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4. Ankle dorsiflexion stretch with towel

1 Set / 5 Reps / 10 s hold

Place the towel or strap underneath the ball of your foot.
Keeping your heel on the ground, pull the ball of your foot up towards you, flexing the ankle.
You should feel a stretch in your calf, Achilles and ankle.

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5. Great toe extension stretch with strap

5 Sets / 5 Reps / 10 s hold

Sit in a chair and place a belt around your toe.
Pull up on the belt until you feel a stretch through the bottom of the big toe.

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6. Tibialis anterior toe raises

1 Set / 20 Reps / 2 s hold

Stand up straight holding onto a supportive surface.
With your legs hips width apart and your knees straight, lift your toes and the balls of your feet up.
Hold this position, and then control the movement as you lower your feet back down to the floor.
Begin this exercise from a seated position, keeping your heels on the floor as you lift your foot, as you get stronger, try it standing up.

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7. Isometric ankle dorsiflexion

10 Sets / 10 Reps / 10 s hold

Sit up straight in a chair.
Place your good foot on top of your affected foot.
Try to lift the ball of your affected foot upwards, resisting the movement with your good foot.
Hold this position.

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8. Resisted ankle dorsiflexion

5 Sets / 20 Reps

Start in a seated position with your legs extended.
Take the band and place it around your feet.
Next, bend your knee on the affected side so that your heel is resting on your shin.
Pull the toes of the affected side up towards your head as you maintain tension in the band.
The unaffected foot acts as an anchor to allow more tension to be created in the band.
Relax to the starting position and repeat.

If you have someone else to help you, he/she else could also stand in front of you,
wrap the theraband around your foot as resistance as you pull your toes towards
your nose.

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9. Resisted inversion/eversion

15 Sets / 20 Reps / 2 s hold

Sit with your legs straight out in front.
Tie a resistance band around both feet and slightly bend your affected leg, creating tension in the band.
Pull the foot of your affected leg towards you against the resistance of the band.
Holding this position, turn your foot inwards and outwards, keeping your knee pointing straight up to the ceiling.

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10. Isometric inversion in long sit against ball

5 Sets / 5 Reps / 10 s hold

Sit with your legs straight out in front of you, for example on a mat.
Your legs should be close to a wall with the foot to be exercised furthest from the wall.
Place a ball between the inside of your foot and the wall.
Bend your other leg so that is out the way.
Move sideways until you have your leg parallel to the wall.
Press the inside of your foot into the ball, keeping your knee straight.
Hold this position.
Relax, and repeat.

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11. Resisted ankle inversion

5 Sets / 20 Reps

Place a band around the end of each foot.
Cross the affected leg over the other leg, then pull against the resistance of the band to turn the affected foot away (away from your other foot).
The unaffected foot acts as a stabilizer and allows you to create more tension in the band.
Return to the starting position.

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12. Isometric eversion in long sit against ball

5 Sets / 5 Reps / 10 s hold

Sit with your legs straight out in front of you, for example on a mat.
Your legs should be close to a wall with the foot to be exercised closest to the wall.
Place a ball between the outside of your foot and the wall.
Move sideways until you have your leg parallel to the wall.
Press the outside of your foot into the ball, keeping your knee straight.
Hold this position.
Relax, and repeat.

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13. Resisted ankle eversion

5 Sets / 21 Reps

Place a resistance band around the ends of each foot.
Make sure your feet are spread apart, so there is tension on the band.
Use the unaffected foot as an anchor as you turn the affected foot outwards, away from the body.
Control the return back to the starting position.

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14. Hold and relax, heel raises

5 Sets / 20 Reps / 2 s hold

Sit upright on a chair with your feet flat on the floor.
Slowly raise your heels up keeping your toes in contact with the floor.
Continue on for the required duration.

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15. SAQ (short-arc quad) in long sitting

5 Sets / 20 Reps

Lie on your back with a roam roller or rolled towel under your knees and let your legs hang over in a comfortable position.
Straighten your affected knee by tensing the thigh muscles, so that your heel comes off the table and the knee straightens.
Hold this position, then control the movement back down to the start position and repeat.

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16. Knee extension in sitting

5 Sets / 20 Reps / 2 s hold

Sit on a chair.
Stretch one leg out and keep it in that position for the required duration.
Return your leg to the starting position and then repeat with your other leg.

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17. Standing weight transference side to side

10 Sets / 20 Reps / 5 s hold

Stand in front of a mirror, with your feet hip-width apart.
Then using your core muscles, gently move side to side, shifting your body weight from one side to the other.
Make sure your hips don’t drop down or push out to the sides and keep your shoulders level.

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18. Single leg balance

10 Sets / 10 Reps / 10 s hold

Stand with your legs straight at shoulder width apart.
Now lean slightly to the side and at the same time bend your opposite knee.
You can make this more difficult by bending further but only within the limits of your mobility.

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19. SLSq semi-supported

3 Sets / 10 Reps

Stand near a wall or table to hold on for support.
Stand on your affected leg, resting the toes of your other leg on the floor for a little bit of balance.
Squat down on your affected leg, pushing your hips backwards and leaning your chest forwards whilst maintaining a straight back.
Ensure your knee travels directly forwards over your toes.
Stand back up straight, driving your movement through your thigh and buttock muscles.

part 4 Circumduction

Press this button to watch a YouTubeb video of a person with a Circumduction gait

I was walking behind someone in a coffee shop today who displayed a telltale sign that he had either a stroke or another neurological injury affecting the legs. Or just one leg. When this guy advanced forward with his right leg (took a step forward), his leg swung out to the side instead of following the normal gait pattern of flexing the hip, bending the knee, and lifting the foot. The right leg just stayed straight and swung out to the side. When the body does this, it’s called circumduction of the leg.

It did this for clearance of the foot so that he wouldn’t trip. The body automatically compensated with other muscles to make up for the muscles that were not being properly used. The foot couldn’t lift and the knee couldn’t bend which – if the leg was able to go straight forward - would cause the man to trip. The leg automatically swung out to the side in order to clear the foot from the ground and prevent tripping.

There are several things going on here. Starting at the top of the leg, the hip flexor muscle is not working properly. I’m assuming this is because of signals from his brain not communicating correctly to his leg muscles, but of course I could be wrong not knowing this man.

Sit down with your knees bent. Raise your right knee. Can you do that? Your hip flexor was responsible for that movement. When you’re walking, your hip flexor must activate in order to raise the leg and move it forward a little.

Next, your knee has to bend which also helps with clearance of the ground. If you can do that, the hip flexors may or may not be as much of an issue. You'll also want to strengthen the hip adductors as well. These are the muscles on the inside of the hip that pull your leg inward closer to the body. They'll be all stretched out and weak from the hip always abducting (taking away from the body) the leg in this gait.

Lastly, perhaps the most common issue with circumduction is at the ankle. Are you able to lift your foot? Not just lift it, but bend it at the ankle, bringing your toes up towards the shin? A lot of times, an AFO (ankle-foot-orthosis) will be issued in this case which is a hard, non-bendable orthotic placed on the back of your calf that lengthens to underneath the foot to keep it in proper positioning. It is solid in a neutral position so that tripping is minimized. This is great to use in the short term but the goal is to get those dorsiflexor muscles (muscles on the front of the lower leg responsible for flexing the foot upwards) working properly again.

If this sounds like your gait, then your hip flexors, knee flexors and especially the dorsiflexors need to be focused on for strengthening.

All dorsiflexion/ankle exercises here would be the same as for Foot Drop a few pages up. Exercises for the hip and knee are on the next few pages.

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1. AROM hip flexion supine

5 sets/ 20 reps

Lie on your back with your legs straight.
Slide your affected foot in towards your bottom, bending your hip and knee.
Keep your knee pointing to the ceiling and then slowly lower back to the start position.
Relax and repeat.

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2. Isometric hip flexion (supine)

10 Sets / 10 Reps / 10 s hold

Lie on your back.
Bend your affected leg, bringing your foot off the floor.
Place your hand on your thigh, just above your knee.
Try to bring your knee in towards your chest, resisting the movement with your hand.
Hold this position.

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3. Sitting active hip flexion

5 Sets / 20 Reps / 2 s hold

Start in a seated position in a chair.
Place your hands on the sides of the chair for support and slowly raise one knee off the chair.
Hold as directed and return to the starting position.
Repeat with the opposite hip.

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4. SLR

5 Sets / 20 Reps / 2 s hold

Lie on your back with your legs bent and feet flat on the floor.
Straighten your affected leg out so that it is flat.
Tighten your abdominal and thigh muscles, and lift this leg directly up, keeping the knee completely straight.
Ensure your stationary leg stays still with the knee pointing to the ceiling.
Control the movement as you lower the leg back down onto the floor.

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5. Straight leg raise long sit

5 Sets / 20 Reps / 2 s hold

Start in a seated position on a bench with your legs stretched out in front of you.
Bend your toes in towards you and push your knee down into the bench.
Raise one leg slightly.
Hold, and then return to the starting position.

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6. AROM hip abduction side lying

5 Sets / 20 Reps / 2 s hold

Lie on your side with your affected leg on top.
Bend your bottom leg for stability but keep your top leg straight and in line with your body.
Lift the top leg up, making sure you do not roll your body forwards or backwards.
Control the movement as you lower it back down to the starting position and repeat.

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7. AROM hip flexion and extension in crook lying

5 sets/ 20 reps

Lie on your back with one knee bent and your foot flat on the floor
The leg you wish to exercise should be lying out straight in front of you.
Tighten your abdominal muscles.
Using the muscles at the front of your hip, bend your straight leg, bringing you knee in towards your chest.
Maintain a steady speed, ensuring that your knee does not drift out to one side.
Straighten your leg back down in a controlled motion until you return back to the starting position.

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8. Eccentric leg raise

5 sets/ 20 reps

Lie on your back with your legs straight and your abdominals tight.
Bend your knee and bring it in towards your chest.
Straighten out your leg and return to the starting position.

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9. Hip adduction level 1

5 Sets / 20 Reps

Lie on your affected side with your top leg resting up on a chair.
Keeping the bottom leg straight, lift it up towards the top leg.
Control the movement back to the start position.

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10. Prone hip extensions long lever

5 Sets / 20 Reps / 2 s hold

Lie on your stomach with your arms at your sides.
Keeping the knee straight throughout the exercise, lift your symptomatic leg up using your buttock muscles.
Imagine your heel is being pulled towards the ceiling.
Make sure you keep your hips flat throughout the exercise.

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11. Standing hip flexion

5 Sets / 20 Reps

Stand straight holding a chair or table.
Bend your affected leg, bringing your knee up in front of you.
Control the movement as you lower back down.
Repeat the movement, making sure you do not lean your body, or hitch your pelvis up as you lift your leg.

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12. Resisted hip flexion (kicking)

5 Sets / 20 Reps

Stand up straight with a resistance band around your affected ankle.
Tie the other end to a solid surface behind you.
Keeping your leg straight, kick your leg forwards against the resistance band.
Tighten the band to increase the resistance as required.

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13. Resisted hip flexion (standing)

5 Sets / 20 Reps

Stand up straight and hold onto a supportive surface.
Place a resistance band around the ankle on your affected leg.
Stand firmly on the other end of the resistance band.
Lift your leg up in front of you, bending your knee.
You should feel the effort at the front of the hip against the resistance band.
Slowly lower your leg back down.

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14. Mini squats from a frame

5 Sets / 20 Reps

Stand up straight with both hands on the frame and a chair behind you.
Keep your posture upright, and let go of the frame.
Bend your knees, lean forwards and push your hips back behind you as though you are about to sit down.
Half way down, tighten your buttock muscles and stand back up again.
You should not actually sit on the chair.
Keep your gaze directly ahead throughout this movement.

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1. Hamstring stretch in sit

3 Sets / 3 Reps / 10 s hold

Sit in a chair.
Place your affected leg out in front of you.
Straighten your knee, keeping your foot on the floor.
Keeping your back straight, lean forwards from your hips until you feel a stretch down the back of the thigh.
Hold and then relax.

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2. Prone hamstring curl

5 Sets / 20 Reps

Lie on your front with your legs straight.
Bend your affected knee in towards your buttocks as far as you can.
Control the movement as you slowly lower the leg back down to the floor.

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3. Eccentric hamstrings in prone

5 Sets / 20 Reps

Lie on your front.
Hook the ankle of your good leg under your affected leg.
Bend your knees, bringing your heels up towards your buttocks, using your good leg to assist in the effort.
Take away the support of your good leg and then lower your affected leg back down steadily on its own.
Relax and repeat.

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4. Resisted prone hamstring curl

5 Sets / 20 Reps

Lie on your front with a resistance band tied around both ankles.
Keeping your good leg straight, bend your affected knee, moving your heel towards your buttocks.
Control the pull of the resistance band as you lower the leg back down.

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5. Isometric hamstring in sitting

5 Sets / 10 Reps / 10 s hold

Sit in a chair with your legs bent.
Place your good leg behind the calf of your affected leg.
Try to bend your affected leg, whilst resisting the movement with your other leg.

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6. Flexion of the knee in standing

5 Sets / 20 Reps

Start in a standing position holding on to a chair.
Stand on one leg and keep your thighs pressed together.
Then bring your heel up towards your bottom.
Hold briefly and then return to the starting position.

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7. Resisted hamstrings in standing

5 Sets / 20 Reps

Stand up straight with a resistance band tied around your ankles and under the foot of your unaffected leg.
Hold on to a supportive surface for balance.
Pull against the resistance of the band, bending your affected knee and bringing your heel towards you buttocks.
Control the movement as you slowly lower the leg back down.
Ensure you keep your body upright and your knees together throughout the movement.

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8. Resisted knee flexion seated

5 Sets / 20 Reps

Start in a seated position and place a band around your ankles.
One leg acts as the anchor, whilst the symptomatic leg is going to do the work.
Pull the heel of the symptomatic leg back towards you, bending the knee against the resistance of the band.
Control the movement as you return to the start position.

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9. Bridge

5 Sets / 20 Reps / 2 s hold

Lie on your back.
Bend both knees and place your feet flat on the bed.
Lift your buttocks from the bed.
Place your buttocks back on the bed.
Repeat this exercise and remember to continue to breathe properly.

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10. Bridge on step

5 Sets / 20 Reps / 2 s hold

Lie on your back, with your legs bent and feet on a step.
Ensure your legs are hips width apart.
Tighten your buttock and abdominal muscles, and press your heels into the step.
Lift your hips up, so that your weight is on your shoulders.
There should be a straight line from your shoulders to your knees.
Control the movement back to the start position.
Notice how your hips stay level throughout this movement.

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11. Seated hamstring curl - machine

5 Sets / 20 Reps / 4lbs weight

Set up the weights and the leg supports.
Starting position is with your legs extended and the supports on your upper thigh and resting on your lower calves.
Gently curl your legs in towards your buttocks.
Pause briefly at the top of the movement and then release the weight in a slow and controlled manner.

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12. Stiff leg deadlift - with dumbbells

5 Sets / 10 Reps / 2lbs weight

Stand with your knees slightly bent, holding a pair of dumbbells with an overhand grip.
Hinge forward at the waist, keeping your back straight and lower the dumbbells towards your shin.
Contract your gluteus and hamstrings and return to a standing position.

part 5 Trendelenburg Gait

Press this button to watch a YouTube video of a Trendelenburg gait

Trendelenburg gait is also called lurch gait. This gait pattern I bet is really, really common in stroke survivors. Trendelenburg gait happens when one side of the body has really weak hip abductor muscles. This is what happens when you’re walking…let’s use the right leg. I’m going to describe what you’ll see with the on the right side.

When you’re walking and it’s time for the right leg to leave the ground and advance forward, you need muscles to kick in so that your right foot can clear the ground. A lot of times after a stroke, your leg will have trouble clearing the ground because of weak shin muscles leading to foot drop. This means you must strengthen your tibialis anterior muscle. In this case, it’s weak hip muscles.

Stand on both feet. Now lift up your right leg. Do your hips stay level and unmoving? Or when you lifted your right leg off the ground, did your right hip drop? The correct answer is that your hips stayed level.

When you lift up your right leg, the hip abductor muscles on the OPPOSITE side of the body turn on to prevent your hip from dropping. Since your left leg is stationary, the only way to ABDUCT (move away from midline of the body) the left leg is to raise the right hip. If the hip abductor muscles on the left side are weak, the right hip will drop when the right leg is lifted off of the ground. So if you see a hip drop on the right side, it means that the left hip muscles are weak.

This drop of the hip is called the Trendelenburg sign. Sometimes, the body has compensated in order to find a way to clear the foot when walking. This compensation is by the upper body leaning to the left(in the case of right hip drop) in order to pull the right leg up and allow the foot to clear the ground. So the body will lean to the affected side during advancement of the opposite leg. If you’re affected on the left, the upper body will lean to the left when advancing your right foot forward during the gait cycle. If you’re right side affected, the upper body will lean to the right when advancing the left leg forward. So if this happens to you, you’ll want to exhaustively strengthen the hip abductor muscles.

Some exercises that address this specific issue are on the next few pages.

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1. Hamstring stretch in sit

3 Sets / 3 Reps / 10 s hold

Sit in a chair.
Place your affected leg out in front of you.
Straighten your knee, keeping your foot on the floor.
Keeping your back straight, lean forwards from your hips until you feel a stretch down the back of the thigh.
Hold and then relax.

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2. AROM hip abduction supine

5 sets/ 20 reps

Lie on your back with your legs straight and your toes pointing upwards.
Move your affected leg out to the side as far as you comfortably can and then bring it slowly back in to the start position.
Do not allow this leg to cross the center line and keep your toes pointing upwards.
Relax and repeat.

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3. AROM hip abduction side lying

5 Sets / 10 Reps / 10 s hold

Lie on your side with your affected leg on top.
Bend your bottom leg for stability but keep your top leg straight and in line with your body.
Lift the top leg up, making sure you do not roll your body forwards or backwards.
Control the movement as you lower it back down to the starting position andrepeat.

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4. Isometric hip abduction

5 Sets / 10 Reps / 10 s hold

Sit in a chair and place your hands on the outsides of your knees.
Push your knees together with your hands, resisting the movement with your hips.
Hold this position and relax.

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5. Resisted hip abduction in sitting

5 Sets / 20 Reps

Sit with a resistance band tied around your knees.
Keeping your good leg still, turn the thigh of your affected leg out as far as you can without twisting the body and then steadily return to the start position.
You will feel this down the side of your hip.
Relax and repeat.

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6. Clam shells

5 Sets / 20 Reps

Lie on your side with your feet, ankles and knees together.
Bend the legs a little and tighten your core stability muscles.
Keeping the feet together, lift the top knee up.
Make sure you don't roll your body back with the movement.
Control the movement as you bring the knee back down to the starting position.

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7. Resisted clam shell

5 Sets / 20 Reps

Lie on your side and place a band above your knees, approximately an inch or two above the knee joint.
Bend your legs a little, keeping the feet in line with your back.
Use your core stability muscles to keep the body stable.
Keeping your feet together, lift the top knee up against the resistance of the band.
Ensure you stay on your side and do not roll your hips and your body back with the movement.
Lower the knee back down, controlling the resistance.

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8. Pilates clam

5 Sets / 20 Reps

Lie on your side and bend your legs so your hips are bent at a 45 degree angle and the knees are at a 90 degree angle.
Stretch out your bottom arm and rest your head on it.
Bend the top arm with your hand on the mat in front of your body for stability.
Lift your both feet away of the mat, keeping your knees together and down.
EXHALE: rotate in your hip and lift your knee upwards, keeping your feet together.
INHALE: rotate in your hip and close your knee together, keeping your feet in the air.
Keep your pelvis stable and perpendicular to the floor while rotating in your hip joint.
Maintain your feet together and at the same height off the mat.
Engage your deep abdominal muscles to keep this alignment stable.

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9. Hip abduction side kick

5 Sets / 20 Reps

Lie on your good side with your legs straight.
Keeping it straight, lift the top leg up, then move it forwards in front of you keeping it horizontal.
Control the movement back to the start position, and repeat.

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10. Standing hip abduction

5 Sets / 20 Reps

Stand straight, holding a chair or table for balance.
Keeping your affected leg straight, slowly move it out to the side.
Control the leg as you bring it back in to the starting position, and then repeat the movement.
Make sure you do not lean your body or hitch your hip up as you move your leg.

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11. Resisted hip abduction (standing with post)

5 Sets / 20 Reps / 2 s hold

Stand up straight with a looped resistance band tied to a solid object at one side.
Step the leg furthest away from the band into the loop. This will be the leg you exercise.
Stand with your legs hips width apart and some slight tension in the band.
Keeping your back straight and your hips level, lift your leg with the band attached out to one side.
Ensure you do not lean your body or hitch your hip.
Your leg should remain straight and move directly out to the side.
Control the movement as you bring your leg back in to the starting position.

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12. Hip hikes

5 Sets / 20 Reps

Stand up on a step and allow your affected leg to hang off the step.
Hike your hip of the leg hanging off of the step up towards your shoulder, and then let it come down towards the floor.
The knee of the standing leg on the step should remain straight. (shown differently in this video)
Make sure you're holding onto something when attempting this exercise

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13. Kneeling hip abduction - 90 degrees

5 Sets / 20 Reps

Start on your hands and knees, with your hands under your shoulders, and knees under your hips.
Tighten your abdominal muscles, keeping your back straight and your gaze between your hands.
With your knee and hip bent to 90 degrees, lift your leg out to your side.
Control the leg back to the starting position and continue.
Ensure you keep your elbows straight and your abdominal muscles strong.
Minimize how much your pelvis rotates with the movement.

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14. Bridging with resisted hip abduction

5 Sets / 20 Reps

Tie a resistance band around both thighs, just above your knees.
Lie on your back with your knees bent and legs hips width apart. There should be tension in the band.
Raise your hips up into a bridge, keeping the knees hips width apart.
Control the movement back down to the start position, maintaining constant tension on the band.

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15. Side stepping along a support

5 Sets / 20 Reps

Stand up straight in front of something sturdy, such as a wall or work surface.
Step one leg to the side, taking your weight onto it, then step the other leg in to join it.
Continue this sequence so that you effectively walk sideways.
Ensure your posture remains upright and your gaze is ahead and not at the floor.

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16. Lateral step ups

5 Sets / 20 Reps

Stand with your affected side closest to the step.
Step up, bringing your other foot up to join the affected leg, then lower this foot back down.
Make sure the knee on the affected leg travels forwards, and not inwards, when ending and straightening it.
Make sure you're holding onto something if attempting this exercise.

part 6 Glutes

The glutes. They're the butt muscles. The butt muscles straighten the leg, move it behind you and move the leg out to the side depending on what’s contracted. So they’re very important in standing up and are very involved in walking. In every aspect of walking, every aspect, they are important and why I'm including a chapter on the glutes. In everything I've discussed previously, strengthening the glutes will help. In every glute exercise, take advantage of the mind-muscle connection and really focus on squeezing your glutes!!!

Tip - There is a glute-heel connection and the more weight that you put on your heels for these exercises, the more the glutes will work. Sometimes, when I personally perform a bridge exercise, I will actually lift up my toes in order to put more weight through my heels so that my glutes contract more.

The next few pages have illustrations and instruction on some glute exercises that you can do at home or at the gym.

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1. Isometric glutes in supine

10 Sets / 10 Reps / 10 s hold

Lie on your back with your legs straight.
Clench your buttocks together and hold this position.
Relax and then repeat.

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2. Bridge

5 Sets / 20 Reps / 2 s hold

Lie on your back.
Bend both knees and place your feet flat on the bed.
Lift your buttocks from the bed.
Place your buttocks back on the bed.
Repeat this exercise and remember to continue to breathe properly.

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3. Bridge with toes off the floor

5 Sets / 20 Reps / 2 s hold

Lie on your back and bend your knees at 90 degrees.
Pull your toes in towards you and rest your weight on your heels.
Now tuck in your navel and lift your pelvis off the floor.
Tighten your buttocks and your abdominal muscles and keep breathing normally.
Make sure your back is in line with your thighs, so you can draw an imaginary line from your shoulders through your back, pelvis and knees.
Make sure you keep your pelvis level during this exercise, hold for the required time and then lower back down in a controlled manner.

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4. Single leg bridging

5 sets/ 20 reps

Lie on your back.
Bend one leg upwards, placing the foot on the floor.
Draw your other leg up to the same position, maintaining a hips width between your legs.
Lift one foot slightly off the floor.
Using the effort of your remaining foot, lift your hips up into a bridge until you have a straight line from your shoulders to your knees.
Lower back down and repeat.
Keep your pelvis level throughout this exercise.

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5. Bridge while lifting one leg and extending knee

5 sets/ 10 reps

Lie on your back with your knees bent and your feet flat on the floor.
Tighten your buttock muscles and lift your hips up into the bridge position.
Lift one foot off the floor then straighten your knee until it is aligned with your other thigh.
Hold this position for 2 seconds.
Make sure you keep your hips up and level throughout the movement.

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6. Prone hip extensions long lever

5 Set / 20 Rep / 2 s hold

Lie on your stomach with your arms at your sides.
Keeping the knee straight throughout the exercise, lift your symptomatic leg up using your buttock muscles.
Imagine your heel is being pulled towards the ceiling.
Make sure you keep your hips flat throughout the exercise.

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7. Resisted hip extension and ER

5 Sets / 20 Reps / 2 s hold

Lie on your front with your legs straight.
Tie a resistance band around your knees.
Rotate your leg outwards.
Raise your leg by using your leg muscles and gluteal muscles.
Prevent arching of your lower back by putting light tension on your abdominals.

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8. Prone hip extension - leg bent

5 Set / 20 Rep / 2 s hold

Lie on your tummy with your hands folded under your chin.
Bend the knee of your affected leg to a 90 degree angle, with your toes pulled up.
Push the heel towards the ceiling, squeezing your buttock muscles at all times.
Keep your hips flat on the floor.
Lower your leg back to the starting position and repeat.

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9. 4 point kneeling - hip extension to abduction

5 Sets / 20 Reps

Start on your hands and knees with your hands under your shoulders and knees under your hips.
Leading with your heel, lift one leg up behind you, keeping your knee at 90 degrees.
Think about pushing the sole of your elevated foot up towards the ceiling.
Extend as far as able ensuring you do not arch your back or twist your hips as you do this.
Next, bring your knee to the outside, ensuring your foot stays aligned with your hip.
Hold this position.
Control the movement as you bring your knee back down towards the floor, then repeat.

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10. AROM hip extension

5 Sets / 20 Reps

Hold on to a table or work surface and stand straight.
Keep your affected leg straight as you lift it out behind you, then slowly return it to the start position.
Make sure you keep your body upright throughout this exercise.

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11. Resisted hip extension standing

5 Sets / 20 Reps

Stand up straight with a resistance band secured in front of you.
Attach the other end of the band around the ankle of the leg you would like to exercise.
There should be some tension in the band.
Keeping your posture upright move this leg directly backwards.
Drive the movement from your buttock muscles ensuring you keep your body completely still.
Think about pushing your foot back behind you.
Control the movement as you bring the leg back to the starting position to repeat.

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12. Mini squats from a frame

5 Sets / 20 Reps

Stand up straight with both hands on the frame and a chair behind you.
Keep your posture upright, and let go of the frame.
Bend your knees, lean forwards and push your hips back behind you as though you are about to sit down.
Half way down, tighten your buttock muscles and stand back up again.
You should not actually sit on the chair.
Keep your gaze directly ahead throughout this movement.

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13. Squat with resisted abduction

5 Sets / 20 Reps

Start in a standing position.
Tie a resistance band just above the knees.
Move into a squat position and put tension on the band.

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14. Wall squat with ER resistance

5 Sets / 20 Reps

Lean against a wall, with your feet away from the wall and shoulder width apart.
Tie a tensioned resistance band around your thighs, just above your knees.
Your back and buttocks should remain in contact with the wall throughout.
Slide down the wall, aiming to reach horizontal with your thighs.
Your knees should be at 90 degrees at this point.
Push yourself back up the wall, driving the movement with your buttock muscles.

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15. Box squat with chair

5 Sets / 20 Reps

Put the chair behind you and take a very wide step.
Push your hips back behind you, as you try and sit down into the chair.
Counterbalance this by leaning your chest forwards, keeping your back straight.
Stand up, trying to maintain straight shins the whole time.

Try to keep the shins in one vertical position not much beyond the toes the whole time. Don't let your shins move too much, the point is to use only your posterior chain of muscles.

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1. Pilates swimming level 1

Lie in the prone position with your forehead resting on your hands and your legs lifted just off the mat, with your feet Plantar flexed (pointed).
INHALE: alternate lifting your right and left legs for 5 changes
EXHALE: alternate lifting your left and right legs for 5 changes
Alternate your legs and keep your upper body absolute stable.
Gradually increase the pace of your leg movements as you progress through the exercise.

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2. Gluteal abd strength with ball against wall and hip flex/ext
5 Sets / 20 Reps

Stand side onto the wall with the ball between your thigh and the wall.
Press the ball up against the wall using your thigh and hip muscles and then lift your leg off the floor with your knee bent and gently push the ball against the wall with this thigh.
In this position, cross your arms and move the leg that is holding the ball forward and as far backward as possible by moving through the hip.
Keep your hips square and your pelvis and lower back stable.
As you move the ball backwards, be sure not to change the position of your lower back.
Repeat and then swap legs.

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3. Static gluteal activity against ball
10 Sets / 10 Reps / 10 s hold

Lie on your back with a stability ball against a wall.
Place the sole of the foot on your affected leg against the ball with your knee around 90 degrees.
Your other foot should be flat on the floor with your knee bent.
Activate your core stability muscles and push your heel into the ball, tightening the buttock muscles on this side.
Try to keep the back of your thigh as relaxed as possible.
It helps to think about trying to push the ball away by straightening from your hip rather than your knee.
Remember to keep your upper body relaxed.

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4. Bridge with bilateral hamstring curls on ball
5 Sets / 20 Reps

Lie on your back with the ball placed underneath your heels.
Lift your hips up off the floor keeping the legs straight.
Holding this position, bend your knees and roll the ball in towards you, applying constant pressure on the ball with your heels.
Your hips remain level, they do not tilt.
Roll the ball back out, straightening your legs but keeping your hips up, and repeat.

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5. TRX glute bridge
5 Sets / 20 Reps

Lie on your back underneath the lengthened TRX straps and place your feet into the handles.
Your knees should be bent.
Lie your arms by your side and tighten your abdominal and buttock muscles.
Lift your hips up into the bridge position until you have a straight line from your shoulders to your knees.
Control the movement as you lower your hips back down to the floor.
To make this harder, cross your arms over your chest.

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6. Unilateral hip extension
5 Sets / 20 Reps

Lie on your back with your good leg on the ball.
Bend the other leg with the foot on the floor.
Lift your hips up off the floor until you achieve a straight line from your shoulders to your knee, driving the movement with your buttock muscles.
Control the movement back to the start position, keeping your core tight and hips level throughout the movements.

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7. Alternate leg extension prone over a gym ball
5 Sets / 10 Reps / 10 s hold

Kneel on the floor with a stability ball in front of you.
Roll forwards over the ball until you are lying on it with the ball under your hips.
Make sure your hands are on the floor under your shoulders.
Keep your feet on the ground.
Slowly lift one leg out straight behind you so that your leg is in a straight line with your back.
Do not arch your back.
Lower your leg back down and repeat with the other leg.

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5 sets/ 20 reps

8. Bridge reverse on stability ball

Sit on a stability ball and walk your feet forwards until the ball is under your
shoulder blades.
Lift your hips up high, driving the movement with your buttock muscles.
Control the movement lowering the hips down, and repeat.

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9. Back extension on ball with hands behind head
5 Sets / 20 Reps

Lie down with your upper thighs and pelvis over a fitness ball.
If needed use a partner to hold your feet on the floor.
Place your hands behind your head and move down slowly bending from your trunk, and then return back upright until your shoulders, hips, knees and ankles are aligned.

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10. Bridge on step
5 Sets / 20 Reps / 2 s hold

Lie on your back, with your legs bent and feet on a step.
Ensure your legs are hips width apart.
Tighten your buttock and abdominal muscles, and press your heels into the step.
Lift your hips up, so that your weight is on your shoulders.
There should be a straight line from your shoulders to your knees.
Control the movement back to the start position.
Notice how your hips stay level throughout this movement.

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11. Bridge single leg on step

5 Sets / 20 Reps

Lie flat on your back, with your heels elevated on a step.
Keep your affected heel on the step, lift the other leg up.
Press your heel into the box and lift your hips up, so that your weight is on your shoulders.
Control the movement back to the start position.
Notice how your hips stay level throughout this movement.

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12. Cable hip extension
5 Sets / 20 Reps / 2lbs weight

With the cable attached at the lower position, attach the cuff to your ankle.
Take the strain of the weight and stand facing the machine.
Have a slight bend in both knees.
Begin to kick your leg backwards until you feel a strain in your glutes.
Slowly, under control, allow your leg to return back to the starting position.
Repeat for the required number of repetitions and then perform with the other leg.

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13. Cable hip abduction
5 Sets / 20 Reps / 2lbs weight

With the cable attached at the lower position, attach the cuff to your outer ankle.
Take the strain of the weight and stand sideways to the machine, your legs should be slightly crossed.
Move your outer leg outwards to about 45 degrees and then slowly, under control, return it back to the starting position.
You can hold on to the machine for balance if required.
Repeat for the required number of repetitions and then perform with the other leg.

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14. Resisted hip external rotation in prone
5 Sets / 20 Reps

Lie on your front with a resistance band tied around the ankle on your affected side.
Secure the band around a sturdy object.
Bend the knee on your affected side to 90 degrees and allow the lower leg to rotate outwards with the pull of the band.
Keep your thighs close together and rotate the lower leg inwards, pulling against the band.
Ensure your knee stays at 90 degrees.
Control the movement as you rotate the lower leg back outwards.

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15. Squat - with dumbbells
3 Sets / 10 Reps / 2lbs weight

Stand with your feet shoulder-width apart, holding a dumbbell in each hand.
Initiate the movement by flexing at the hips, knees and ankles until your thighs are parallel to the ground.
Your back must remain straight and upright throughout the movement with the head up and your gaze forward.
Keep your knees inline with your toes and do not allow your heels to rise off the ground.
Stand by pushing through your hips and returning to standing position

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16. Goblet squat

Hold on to the dumbbell, keeping it close to your chest. Step your feet wide apart and turn the toes out slightly.
Drop down into a deep squat position, dropping your hips straight down past 90 degrees, keeping your feet on the floor.
Control the movement back to the start position.

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17. Rear foot elevated spilt squat - with dumbbells
3 Sets / 5 Reps / 2lbs weight

Place your back foot on a box or bench and step the front foot forward into a staggered stance, holding a dumbbell in each hand.
Initiate the movement by flexing at the hips, knees and ankles until your front thigh is parallel to the ground.
Your back must remain straight and upright throughout the movement with the head up and your gaze forward.
Keep your knee in line with your toe and do not allow your heel to rise off the ground.
Stand by pushing through your hip and returning to standing position.

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18. Stiff leg deadlift - with dumbbells

5 Sets / 10 Reps / 2lbs weight

Stand with your knees slightly bent, holding a pair of dumbbells with an overhand grip.
Hinge forward at the waist, keeping your back straight and lower the dumbbells towards your shin. Contract your gluteus and hamstrings and return to a standing position.

Part 7: gravity

If you are unable to perform any of the exercises, here's a tip....

When someone has trouble performing an exercise, making that exercise gravity-eliminated is often helpful. So what does that mean? That means that if someone is not strong enough yet to perform an exercise, like for instance shoulder abduction (raising your arm out to the side), figure out a way to eliminate gravity from the equation.

When someone is sitting or standing and asked to raise their arm out to the side, they’re not only lifting the resistance of the weight of their arm, but lifting against the resistance of gravity as well. Doing this exercise gravity-eliminated would mean doing it lying down on their back and bringing your arm to your ear. That takes away the resistance of gravity.

And to make it even easier, I would sometimes put a sliding board under their arm to also eliminate friction. A sliding board is something that’s really slippery that is usually used as something you sit on to help you ‘scoot.’

But easy is not at all what you want. This is a trick I would use to help get the movement back. But as soon as possible, gravity should be added back in. Then as you gain strength, add resistance.

Part 8: Quads....

You may be wondering why I haven't specifically discussed the quadriceps muscles. Most of the exercises in this eBook will hit the quads. They are worked with most exercises to improve gait.

But, the following pages show a few exercises specifically for the quadriceps muscles that may or may not have been included in previous sets of exercises.

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1. Isometric quads supine

10 Sets / 10 Reps / 10 s hold

Lie on the bed.
Stretch out your leg and press the back of your knee downwards until you feel your thigh muscles tighten.

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2. Extension strength knee

5 Sets / 20 Reps / 2 s hold

Start in a seated position with your legs stretched out.
Stretch out your affected knee as far as possible.
Hold, and then return to the starting position.

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3. VMO quads extension in sit

5 Sets / 20 Reps / 2 s hold

Sit in a chair and turn the foot of the affected leg slightly outwards.
Straighten your knee, keeping the foot turned outwards as you lift it off the floor.

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4. Eccentric knee extension in sitting

5 Sets / 20 Reps

Sit up straight in a chair with your legs bent and feet flat on the floor.
Place the foot of your unaffected leg behind the ankle of your affected foot.
Lift your affected foot forwards and up, using the effort of your unaffected leg to assist.
When your leg is straightened out in front of you, take away the support of your unaffected leg behind your ankle.
Control the movement as you slowly lower your foot back to the floor.
Repeat, ensuring you use the effort of your unaffected leg each time to lift your other foot up.

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5. SAQ in long sitting

5 Sets / 20 Reps

Lie on your back with a roam roller or rolled towel under your knees and let your legs hang over in a comfortable position.
Straighten your affected knee by tensing the thigh muscles, so that your heel comes off the table and the knee straightens.
Hold this position, then control the movement back down to the start position and repeat.

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6. Gentle squat

5 Sets / 10 Reps

Stand behind a chair.
Reach your hands forward onto the back rest.
Bend both knees into a squatting position, allowing your hand to slide over the back rest.
Push through your legs and return to standing.
Repeat.

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7. Bodyweight squat

5 Sets / 5 Reps / 2 s hold

Start position is standing straight with the arms out in front and bent at the elbows, the fists should be clenched and the palms facing inwards.
Move downwards into a squat position so that the knees are aligned over the toes and the heels are in contact with the floor, make sure the back is straight.
Keep the head and chest upright and the gaze horizontal.
Hold for 2 seconds and return to the start position.

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8. Eccentric squats - stability ball

5 Sets / 20 Reps / 2 s hold

Stand up straight facing away from a wall.
Position a large stability ball against the wall and rest it against your calves just above your ankles.
Tighten your thigh and buttock muscles, pushing your knees back into the ball to lock your legs straight.
Next, bend your knees, moving your hips and body backwards.
Continue until your thighs are close to horizontal. It should look as though you are sitting up straight in a chair.
Ensure your knees have not traveled forwards at all.
Steadily return to the upright position and repeat.

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9. Resisted (TKE )terminal knee extension in stand

5 Sets / 20 Reps

Stand with your feet flat on the floor at hip width apart.
Tie a resistance band into a loop around a secure object.
Place your affected leg in the loop, with the band behind your knee.
Step back so you have some tension in the band.
Keeping your body straight, bend both knees a little.
As you straighten your knee back up you will pull against the resistance of the band, working the thigh muscle.
Relax and then repeat.

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10. Knee extension - machine

5 Sets / 20 Reps / 2lbs weight

Set up the seat length, the height and leg supports to suit.
With the lower pads on your lower shins gently extend and straighten your legs.
Pause briefly at the top of the movement and then lower the legs back down in a slow and controlled manner.

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11. Knee extension single leg - machine

5 Sets / 20 Reps / 2lbs weight

Set up the seat length, the height and leg support to suit.
With the lower pad on your lower shin gently extend and straighten your affected leg, keep the other leg relaxed and to one side.
Pause briefly at the top of the movement and then lower the leg back down in a slow and controlled manner.

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12. Leg press

5 Sets / 20 Reps / 2lbs weight

Adjust the seat to a comfortable start position for your knees and hips.
Position your feet comfortably on the foot plates with your toes pointing slightly
outwards.
Push into the foot plate until your legs are fully extended.
Return to the start position.

ABOUT THE AUTHOR

When I started my blog, www.mycerebellarstrokerecovery.com, in 2012 I thought my life was over and I said in the ‘About Me’ section that “I used to be a physical therapist.” Now, I’m back to work as a physical therapist with an ENTIRELY different perspective and treatment methods.

I had a massive stroke at the age of 30. It’s a lot more common for a young person to have a stroke than anyone thinks. I could’ve taken a continuing education course about strokes but I decided to have one instead. I’m getting a much better education this way.

I have a Doctorate of Physical Therapy and a few certifications on top of that. But more importantly, I am a stroke survivor.

All of that education is all well and good but it is the experience of having a stroke myself that made me think that I had a ton of knowledge to share.

Since my stroke and losing the ability to function as a practicing physical therapist, I have learned that I love writing. I hope these eBooks will help someone.

Amy Elder, PT, DPT, Cert. MDT

Ebook medical Disclaimer

This eBook is for informational purposes only. The information contained in this eBook should in no way replace evaluation by a licensed medical practitioner. Attempt the exercises within at your own risk.

This book details the author’s personal experiences with and opinions about stroke recovery and knowledge of specific exercises from having an education as a physical therapist.

The information about health provided in this eBook is not intended to
diagnose, treat, cure or prevent disease. Products, services, information and
other content provided by the Service, including information linking to third-
party websites are provided for informational purposes only.

Information offered by this eBook is not comprehensive and does not cover all
diseases, ailments, physical conditions or their treatment.

Individuals are different and may react differently to different products.
Comments made on the eBook by other users are strictly their own personal views made in their own personal capacity and are not claims made by the author nor do they represent the position or view of the author.

The author makes no guarantee or warranty with respect to any products or
services sold. The author is not responsible for any damages for information
or services provided even if the author has been advised of the possibility
of damages.

Before you begin any healthcare program, or change your lifestyle in any way, you will consult your physician or another licensed healthcare practitioner to ensure that you are in good health and that the examples contained in this book will not harm you.

This book provides content related to physical health issues. As such, use of this book
implies your acceptance of this disclaimer.

​

All About Gait​

(Walking)​

Key Subjects

Table of Contents

part 1 ​

"Up With the Good,​ Down with the Bad"

Using an assistive device​

part 3​

Foot Drop​

part 4​

Circumduction​

All dorsiflexion/ankle exercises here would be the same as for Foot Drop a few pages up.​ Exercises for the hip and knee are on the next few pages.

part 5 ​

Trendelenburg Gait​

part 6​

Glutes​

Part 7: gravity​

Part 8: Quads....​

ABOUT THE AUTHOR

Ebook medical Disclaimer

All About Gait

(Walking)

part 1

"Up With the Good, Down with the Bad"

Using an assistive device

part 3

Foot Drop

part 4

Circumduction

All dorsiflexion/ankle exercises here would be the same as for Foot Drop a few pages up. Exercises for the hip and knee are on the next few pages.

part 5

Trendelenburg Gait

part 6

Glutes

Part 7: gravity

Part 8: Quads....