Welcome to the Otago Strength and Balance programme. The exercise programme that you will undertake has been designed specifically for you. The benefits of exercise are plentiful. By maintaining your programme, you can improve:

• Balance
• Muscle strength
• General fitness
• General well-being

You need to do the prescribed exercises three times a week. You can divide the exercises up. They do not all have to be done at the same time.

Walking

• Walking is an excellent way to enhance your general fitness
• Try going for a walk on the days between your exercises
• Try to increase the distance you walk and the time you spend walking
• Take advantage of fine weather to go walking

Tips for Walking

• Wear comfortable shoes and clothing for walking
• Start with a warm-up marching on the spot for 2 minutes

When you walk

You should make sure:

• Your shoulders are relaxed and the arms gently swing
• You look ahead not down
• With each step the heel lands first, then you push off on the toes
• Finish with a warm-down i.e. marching on the spot for 2 minutes
• Enjoy yourself!

Safety

Never exercise holding on to an object which may move, for example a chair. Always use the side of something stable like a bench or solid table unless otherwise instructed. If illness stops you from maintaining the exercise programme contact your instructor before starting again.
Contact your doctor if while exercising you experience:

• Dizziness
• Chest pain
• Shortness of breath (you are unable to speak because you are short
  of breath)

These exercises are designed to grade the ease with which you can carry them out. They need to be a bit of a challenge without risk of further falls. There is an option to do most of these exercises with varying levels of support depending on your balance and confidence.

Level 1 Holding on with 2 hands
Level 2 Holding on with 1 hand
Level 3 No hands/no support

Start by holding on with 2 hands and as you progress, reduce the support to holding on with 1 hand, finger tips or no hands. Your physiotherapist will be able to advise you about the level of support you should try and achieve during the programme.

Head Movements

• Stand up tall and look ahead
• Slowly turn your head as far as you can to the right
• Slowly turn your head as far as you can to the left
• Repeat 5 times to each side

Neck Movements

• Stand up tall and look ahead
• Place one hand on your chin
• Guide your head straight back
• Repeat 5 times

Back Extension

• Stand up tall with your feet shoulder-width apart
• Place your hands on the small of your back
• Gently arch your back
• Repeat 5 times

Trunks Movements

• Stand up tall and place your hands on your hips
• Do not move your hips
• Turn as far as you can to the right, comfortably
• Turn as far as you can to the left, comfortably
• Repeat 5 times to each side

Ankle Movements

• Either sit or stand
• Point the foot down then pull the foot back towards you
• Repeat 10 times for each foot

Getting stronger by using weights

Strengthening your muscles is essential for maintaining healthy bones and muscles necessary for walking and being independent in your daily activities.

You should aim to do the strengthening exercises three times a week with a rest day in between.

Lift the weight slowly through the entire range of movement.
Never hold your breath while lifting. Inhale before lifting, exhale while lifting and inhale again while lowering the weight.

You may feel a bit stiff after you first start to exercise. This is quite normal. It is because you are using muscles which may not be accustomed to the exercise. It is important that you keep exercising. The stiffness will leave as your body becomes more familiar with the exercise.

Front knee strengthening exercise

• You could do this while you watch TV
• Strap the weight onto your ankle
• Sit on a chair with your back well supported
• Straighten your leg out
• Lower your leg
• Repeat
• Strap the weight onto your other ankle
• Repeat this exercise

Back knee strengthening exercise

• Strap the weight onto your ankle
• Stand up tall facing the bench with both hands on the bench
• Bend your knee, bringing your foot towards your bottom
• Return to the starting position
• Repeat
• Strap the weight onto your other ankle
• Repeat this exercise

Side hip strengthening exercise

• Strap the weight onto your ankle
• Stand up tall beside the bench
• Hold onto the bench
• Keep the exercising leg straight and the foot straight forward
• Lift the leg out to the side and return
• Repeat
• Strap the weight onto your other ankle
• Turn around
• Repeat this exercise

Calf raises – hold support

• Stand up tall facing the bench
• Hold on and look ahead
• Your feet should be shoulder-width apart
• Come up onto your toes
• Lower your heels to the ground
• Repeat this exercise 20 times

Toe raises – hold support

• Stand up tall beside the bench
• Hold on and look ahead
• Your feet should be shoulder-width apart
• Come back onto your heels, raising the front foot off the floor
• Lower your feet to the ground
• Repeat this exercise 20 times

Backwards walking – hold support

• Stand up tall and hold onto the bench
• Walk backwards 10 steps
• Turn around and hold on with the other hand
• Walk backwards 10 steps to the beginning
• Repeat this exercise

Walking and turning round

• Walk at your regular pace
• Turn in a clockwise position
• Turn in an anti-clockwise position
• The exercise is a figure of eight movement
• Repeat this movement

The gluteal tendons transfer the force produced by your gluteal muscles to the thigh. The deep gluteal muscles lift your leg out to the side (Figure 1) and stop your pelvis dropping when walking and running (Figure 2). They also play a major role in activities such as squatting, climbing stairs and getting out of a chair.

Figure 1	Figure 2

Gluteal Tendinopathy is a term that describes any problem with the Gluteal Tendons.

In this condition the tendons are not normally inflamed. This explains why the typical approach of rest and anti-inflammatory medication fails to resolve the issue in many cases. Most experts accept that the problem is degenerative, which sounds scary, however for most people it is a rectifiable issue.

Put simply, the body is constantly being strained (causing wear) with activity and repaired during rest. If the rate of wear becomes faster than the rate of repair, then healthy tendons can start to become weaker, until the point they become painful.  

Many issues affect this wear and repair process such as exercise loads, fitness levels, body fat, hormonal changes, stress, postures and limb alignment, and previous injuries. Therefore gradual re-introduction of activity alone does not always work and more specific rehabilitation is needed. This rehabilitation will look to identify the factors contributing to the problem and build a specific exercise programme to strengthen the gluteal muscles and tendon, to improve their tolerance to activity.
The rehabilitation process often takes months as tendons do not have a rich blood supply, meaning adaptation to exercise can be slow. In the majority of cases however, if you are compliant with the exercise programme and patient, this approach is successful and leads to long-term successful outcomes.  

Symptoms

When suffering with Gluteal tendinopathy you may experience different symptoms, but the most common are pain in the outside of your hip, sometimes spreading down the outside of your thigh. Symptoms are often felt following a long period of rest, when lying on the painful side, during activities that require deep squatting, stair climbing or during and after impact exercise.

Symptom relief

Postures which compress the sensitive tendon into the bone it attaches to, can be painful. Avoidance of these postures in the early stages of your recovery can provide some relief and ensure your recovery is smoother:

• Avoiding or decreasing the activities which cause your pain.
• Strengthening the muscles which support the hip.
• Spreading your weight evenly across both feet and not leaning on just one leg.
• Avoiding low chairs.
• Avoid sitting with your legs crossed.
• Losing weight if you are overweight.
• Using a handrail when going up or down stairs.
• Avoid sleeping on the painful side. Try lying on your back with a pillow under your knees or lie on your good side with a pillow between your legs to keep them in line with your hip joints.

Avoid the following positions

Try the following positions

Tips

More information

Contact the Physiotherapy Department on 0121 728 9442