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8 Quadruped Exercises by a Pediatric Physical Therapist

Jan 04th, 2023 | by Karleigh Page, PT, DPT

Karleigh Page, PT, DPT

January 04th, 2023

Quadruped (or hands and knees/crawling position) is one of my favorite positions to use during physical therapy sessions. This position elicits the recruitment of various muscle groups, and it requires dissociation of the trunk from the pelvis. It can be easily modified and tailored to meet the individuals’ therapeutic needs and is a great position to practice at home! In this blog, I share 8 of my favorite quadruped exercises.

8 Quadruped Exercises to Try at Home


1. Quadruped Spinal Flexion/Extension:

Bring out the yoga mat and practice some cat cows!  This exercise is great for promoting spinal and pelvic mobility in the sagittal plane (forwards and backwards).  I oftentimes use this with individuals who seem “stuck” in a position with their lumbar spine in extension and their pelvis tilted forwards. Transitioning in between flexion and extension can help get the pelvis and the vertebrae moving more freely to work towards increased range of motion and achieving more neutral alignment.  

2. Quadruped Spinal Rotation:

You may also know this one as “thread the needle”. Beginning in quadruped, the individual will reach one arm towards the sky then twist the opposite direction to slide the hand under their chest and then alternate sides. This exercise targets movement of the spine in the transverse (or rotational) plane which is oftentimes limited. I like to use different variations of this exercise with individuals who tend to move only in the sagittal plane (forwards/backwards) and lack the rotational mobility that is required for functional movements and transitions!  


3. Static Hold:

Sometimes simple is best! Simply maintaining quadruped position requires upper extremity, cervical, core and pelvic girdle strength and stability. Therefore, just holding the position is a great therapeutic exercise to practice at home.  

4. Quadruped Upper Extremity Reaching:

In this exercise, the individual will maintain quadruped while reaching alternating arms up to grab toys, give high fives etc. This exercise is awesome for targeting posterior core strength (muscles along the back of the body) and shoulder strength.  

5. Quadruped Lower Extremity Kicks:

In this exercise the individual will maintain quadruped and kick 1 leg straight back (into hip extension) or out to the side with the knee bent (into hip abduction). This targets core musculature and works the muscles surrounding the hips and pelvis.  

Coordination/Dual Task:

6. Bird Dogs:

This exercise is the combination of the prior two exercises. The goal is to hold quadruped position and reach the right arm forwards while the left leg kicks backwards into extension simultaneously then slowly alternate between sides with control. This is a great strength, balance and coordination challenge!  

7. Cone Taps:

In this exercise, the individual maintains quadruped while reaching for specific, colored cones placed in front of them. I like to call out colors at random, or for an added challenge call out a sequence of colors to add a cognitive component to the exercise.  


Heel Sit to Quadruped Rocking: 

Many individuals that I work with have a difficult time dissociating their trunk from their pelvis and have extensor tone that makes it challenging to achieve and maintain quadruped. This exercise is great to break up that extensor tone and work on the dissociation that is required for many functional, motor skills. The individual begins in a heel sit position (hands on mat and bottom resting on their feet). Then I work on passively, slowly weight shifting them forwards (towards a true quadruped position) and backwards to heel sit to see if they can maintain the position with their arms and legs.  

Modifications and Progressions:  

For any of these activities, there are modifications that can be made to make the exercise more accessible for differing functional levels.  

I like to utilize arm immobilizers if an individual is having a hard time keeping their arms extended in quadruped. I frequently place a bolster or a peanut ball underneath the trunk to provide external support as needed. Lastly, many of these movements can be performed with hands on assistance to assure that the individual is able to get the maximum benefit from the exercise.  

In order to make any of these exercises more challenging, I place the hands or knees on a dynamic/unstable surface or increase the time spent in the position/the number of repetitions performed. 

Find Additional Resources and Exercises in the NAPA Blog:

About the Author

NAPA Denver therapist Karleigh enjoys play-based pediatric therapy as it gives her the opportunity to be creative with her treatment techniques and create a positive, exciting experience for the children that she works with. Karleigh loves helping individuals recreate alongside their peers and has enjoyed volunteering for adaptive golf, swimming, and wheelchair/bike racing programs. In her time outside of the clinic, Karleigh can be found hiking, biking, running or exploring national parks (as she hopes to one day visit all 62)! 

TAGS: Blogs, PT
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