4 Point Kneeling Exercise - For Trunk Stability

In a previous post we discussed some basic exercises for training trunk stability in patients with lower back pain. Today we will go through our progressions for one of those, the 4 point kneeling exercise (bird dog). This is another staple beginner exercise in low back pain rehab, but everyone can benefit from it, as trunk stability is crucial in all walks of life.

Here’s how to do it:

1) Start off hands under shoulders, knees under hips. Shoulders set down in neutral. 2) Tilt your pelvis into anterior and posterior tilt then find where NEUTRAL is (should be a slight curvature in your lower back). 3) Draw in lower abdomen to engage your CORE. 4) Lift up one arm and slowly extend it out in front then control it back to its starting position. Cycle through each upper and lower limb. Keep your spine in neutral the whole time. Progressions:

🔸 As described above, works on your ability to keep a neutral spine during dynamic isolation of each limb. Develops low level rotational, anterior and posterior chain control. 🔸 Lift up your diagonal arm and leg then extend them out, lengthening out your body. This increases the emphasis on rotational stability and targets your posterior oblique sling. 🔸 Same as above except bringing your opposite elbow to your knee, meeting in the middle. This forces you to move in and out of neutral spine in a dynamic manner.

Bonus Exercises:

🔸🔸 Narrow starting position (reduces base of support).

🔸🔸 Use unstable surface (further challenges stability, you can use bosu balls, folded yoga mats, or in a standing position with your hand on a swiss ball). Tips:

1) If having trouble maintaining neutral, place a water bottle or foam roller on your lower back and perform the exercises without letting it roll off. Don’t become too reliant on this though as you need be to able to maintain neutral spine on your own.⠀ 2) Keep your spine in line with an imaginary centre line to prevent shifting your hips to either side.⠀ 3) Try and stretch out to wall in front or behind you, rather than lifting towards the ceiling.


If you need help, reach out to our caring and friendly Infinite Health Physio Team at our Chatswood or North Sydney Physiotherapy Clinic. You’ll be glad you did!

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