Hip Abduction Sidelying

I try side lying in the middle of the floor only with my most reliable clients or with the ones who are too heavy to move. I may also try this side lying in the middle of the floor with a client if I plan to let the child abduct with knee flexion to decrease the lever arm. Most of the time, I put my client side lying with his back to the wall to encourage a straight plane of movement into abduction. (Unfortunately that was too tricky to photograph.) Often a client who is trying to abduct their leg will substitute by flexing his knee, externally rotating, or with hip flexion. A wall makes these substitutions more apparent. I am a stickler about making sure the child keeps his hips and back flat against the wall. I frequently have to verbally cue the child to think about leading with his heel in abduction. Frequently the child will turn his leg into external rotation and go toe first. "Heel first" is a useful cue. I often will put my hand up on the wall above the child’s foot as a target for him to hit as he raises his leg into abduction. Obviously the higher I request the child abduct, the harder this activity is. I may put a weight on the child’s lower thigh to resist the movement or I may assist the child with abduction. This activity lends itself easily to abduction for repetition or for the duration that the child maintains the leg abducted. Sometimes I tell the child to abduct his leg, and I get a 5 or a 10 count to try to push the abducted leg down to meet the leg on the ground to emphasize eccentric muscle contractions. I push as hard as I can still allowing the child to win.