All Lower Quarter

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Side Lying Rib Cage Self-Mobs

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, All Upper Quarter, Pectoralis Minor/Posterior Capsule, Rolling, Self-mobilization, Shoulder Abduction, Shoulder Circle

Side Lying Rib Cage Self-Mobs

Self mobs to restore thoracic rotation to the left:

  • The patient is lying on their right side with the hips flexed to between 45-60º with their left hand placed underneath the lower right side of the rib cage.
  • Instruct the patient to roll back to the left and with your left hand pull the right lower rib cage into left rotation. They repeat 3-4 times moving their hand slightly superior with each rotation.
  • Moving up to the xiphoid process have the patient place the fingertips of their left hand on the left side of the rib cage, just off the sternum and lateral to the xiphoid process.
  • Instruct the patient to rotate back to the left and use their left hand to pull the ribs back towards the floor.
  • After the patient returns to the midline they move their fingers up to the next rib and they repeat the rotation drawing the next rib back to the floor.
  • The patient should always start from below, approximately the 7th or 8th rib, and work their way up until they reach the collarbone.
  • The patient is instructed to rotate back approximately 7 times moving their hand up approximately 1 inch each time to draw back a new rib. To enhance the stretch, the patient takes a deep breath in, then exhales as they draw the rib back further.

Side Lying Thoracic Rotation

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, All Upper Quarter, Pectoralis Minor/Posterior Capsule, Rolling, Self Stretch, Self-mobilization, Shoulder Circle

Side Lying Thoracic Rotation

To increase thoracic spinal rotation to the left:

  • The patient is side lying on their right side with both hips flexed below 90º.
  • Have the patient place their left hand behind the head with their right arm straight out in front of them.
  • Instruct the patient to rotate back to the left as far as they can then return to midline and repeat again 5 times.
  • Then have them flex both hips to 90º and rotate back again 5 times.
  • Finally, have the patient flex both hips above 90º and rotate back 5 times.
  • As they flex their hips higher they move the focus of the rotation higher up their spine.
  • They repeat the exercise 5 times in each position to the opposite side, with the hips flexed below, at and above 90º.

PA Mobilization to the Rib Angles to Increase Thoracic Rotation to the Left

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Lower Quarter, All Manual Therapy, All Upper Quarter, Mobilization, Pectoralis Minor/Posterior Capsule, Scapular Depression, Scapular Stabilization, Shoulder Circle

PA Mobilization to the Rib Angles to Increase Thoracic Rotation to the Left

  • The patient is lying on their left side with their right arm resting on top of the left
  • The therapist places a reinforced thumb on the rib angle of each rib and assesses mobility for anterior glide and IR of the rib

Muscle Energy Technique for ERS Dysfunctions of the Upper Thoracic Spine

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Lower Quarter, All Manual Therapy, All Upper Quarter, Cervical Flexion Mobility, Manual Stretching, Muscle Energy, Pelvic Clocks, Shoulder Abduction, Shoulder Circle

Muscle Energy Technique for ERS Dysfunctions of the Upper Thoracic Spine

For an ERS R from C7 to T5:

  • Patient places their R arm on your R leg with their whole arm resting and supported on your R thigh.
  • Place your R hand gently on top of their head and your L thumb on the L side of the interspinous space of the dysfunctional segment to monitor the motion barriers.
  • The patient is initially sitting in a slumped position, but with their head up. Ask the patient to sit up tall from below up by pushing their belly forward until you feel motion at your palpating L thumb.
  • Then with your R hand move the patient’s head from an extended position into flexion introducing flexion from above down to your palpating L thumb so that you create an apex for flexion at the dysfunctional segment.
  • L side bending is then introduced by translating your R leg to the R to create an apex for L side bending at your palpating L thumb.
  • The therapist then adds L rotation thru the head from above down to the dysfunctional segment making sure to go to just the feather edge and not beyond the motion barrier.
  • The patient is instructed to gently side bend their head to the R or pull their R arm down on your leg for 5-7 seconds.
  • When the patient relaxes you introduce additional L side bending to the new motion barrier by translating your R leg further to the R.
  • You repeat 3 to 4 times then reassess.

Rolling Through the Arms

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, All Lower Quarter, All Upper Quarter, Hip EXT Firing Pattern

Rolling Through the Arms

  • Patient is lying supine with the arms separated overhead and legs apart, at the 10 and 2 and 8 and 4 o’clock positions.
  • Ask the patient to roll onto her stomach by reaching obliquely across the trunk to roll onto her stomach using only her right arm.
  • Instruct the patient to lift up her head and look under her left axilla to facilitate the movement. A common dysfunctional pattern is that the patient will extend the head and neck rather than lead with head and neck flexion making this movement more difficult to perform.
  • The lower body should not contribute to the roll, but follow the rotation of the spine and pelvis. Watch to insure that the patient doesn’t push off through the right foot to assist this movement.
  • Once prone ask the patient to roll over onto her back using the right arm only.
  • The head and neck should extend and rotate to the right as the arm is brought back.
  • The lower body/legs should not contribute to the roll. A common substitution pattern is for the patient to push off with the right foot or left hand to assist this movement.
  • Ask the patient to repeat the movement 5 to 6 times as tolerated to both sides.

Rolling Through the Legs

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, Active Trunk Rotation, All Home Exercises, All Lower Quarter, All Upper Quarter, Functional Integration, Hip EXT Firing Pattern

Rolling Through the Legs

  • Patient is lying supine with the arms separated overhead and legs apart, at the 10 and 2 and 8 and 4 o’clock positions.
  • Ask the patient to roll over to the prone position starting and moving by using the right leg only.
  • The patient should lead with right hip flexion followed by adduction of the extended leg.
  • The upper body should not contribute to the roll, but follow segmentally the movement of the right leg and pelvis. Watch for any breath holding or substitution by pushing off the left foot.
  • If the patient has difficulty you can use verbal cues and manual contacts thru the pelvis to assist. Asking the patient to elongate along the axis of movement can be helpful. In the illustrated example above the patient would attempt to elongate thru the right arm and/or left leg as they roll to the left.
  • You can also provide compression through the bottom of the left foot or through the right arm to encourage elongation through the axis of movement.
  • Once prone you instruct the patient to roll back to supine initiating the movement through the right leg by extending the hip, adducting the hip and segmentally extending back through the spine without substituting by pushing off with either hand or the left foot. The same manual contacts can be applied to the left foot and/or right arm to assist the patient as needed.
  • Ask the patient to repeat the movement 5 to 6 times as tolerated to both sides.

Tripod Stance

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Functional Integration, Hip ABD Firing Pattern, Hip EXT Firing Pattern, Supine Hip ABD and ER

Tripod Stance

  • The patient starts in kneeling with the right foot forward and the left foot back. The patient comes up on the toes of their left foot and positions the right knee over the right foot and ankle.
  • Ask the patient to hold the arms out in front of them as if pushing against a wall and draw the abdomen in to stabilize the lumbar spine and pelvis.
  • Instruct the patient to come straight up off the floor a couple of inches while trying to maintain the right knee positioned over the right foot.
  • Ideally the patient moves straight up and down without the right knee advancing forward over the toes and without losing a neutral lumbar spine.
  • Have the patient hold this position for 10 seconds and repeat 3 to 5 times initially, adding repetitions as their strength improves.
  • They then reverse the leg positions to repeat on the opposite side.

Half Kneeling Lifts with Resistance

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, All Lower Quarter, All Upper Quarter, Hip EXT Firing Pattern

Half Kneeling Lifts with Resistance

  • Lifting is an upward oblique movement from a low position to a high position.
  • The patient starts in half kneeling with the left knee down and right knee flexed to 90 degrees and with the R knee centered over the right foot.
    Both arms are lowered off to the left side holding onto handles that are attached to resistance bands.
  • Ask the patient to find a neutral lumbar spine then draw the belly in to maintain it throughout the exercise.
  • Instruct the patient to keep their eyes and head facing forward as they pull obliquely up and across their body above their right shoulder extending both arms.
  • Their trunk should remain still and their spine in neutral as they perform 6-8 repetitions.
  • Then have them switch their hand positions and repeat the lifting motion in the opposite direction.
  • The patient can begin this exercise with their legs initially separated for a more stable base and then bring the legs closer together to increase the level of difficulty.

Kneeling Lifts with Resistance

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, All Lower Quarter, All Upper Quarter, Hip EXT Firing Pattern

Kneeling Lifts with Resistance

  • Lifting is an upward oblique movement from a low position to a high position.
  • The patient starts in kneeling with both arms lowered off to the left side holding onto handles that are attached to resistance bands.
  • Ask the patient to find a neutral lumbar spine then draw the belly in to maintain it throughout the exercise.
  • Instruct the patient to keep their eyes and head facing forward as they pull obliquely up and across their body above their right shoulder extending both arms.
  • Their trunk should remain still and their spine in neutral as they perform 6-8 repetitions.
  • Then have them switch their hand positions and repeat the lifting motion in the opposite direction.
  • The patient can begin this exercise with their knees initially separated for a more stable base and then bring the knees closer together to increase the level of difficulty.

Half Kneeling Chops with Resistance

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Functional Integration, Hip EXT Firing Pattern, Scapular Stabilization, Shoulder Abduction, Supine Shoulder Flexion

Half Kneeling Chops with Resistance

  • Chopping is the downward oblique movement across the body from a high position to a low position.
  • The patient starts in half kneeling with the left knee down and right knee flexed to 90 degrees and with the R knee centered over the right foot. Both arms are raised up over the right shoulder holding onto handles that are attached to resistance bands.
  • Ask the patient to find a neutral lumbar spine then draw the belly in to maintain it throughout the exercise.
  • Instruct the patient to keep their eyes and head facing forward as they pull obliquely down and across their body towards the left knee extending both arms.
  • Their trunk should remain still and their spine in neutral as they perform 6-8 repetitions.
  • Then have them switch their hand positions and repeat the chopping motion in the opposite direction.
  • The patient can begin this exercise with their legs initially separated for a more stable base and then bring the legs closer together to increase the level of difficulty.
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