Shoulder Circles

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, All Upper Quarter, Rolling, Self-mobilization, Shoulder Circle

Shoulder Circles

To restore thoracic rotation to the left:

The patient is lying on their right side with their hips flexed between 45-60º and their hands out in front of them.

Instruct the patient to take their left arm and sweep their hand up over the head with the hand remaining in contact with the floor and the elbow straight.
The patient is encouraged to rotate their trunk and rib cage back as they circle around, but keep the knees together. They only circle around as far as they can while keeping the hand touching the floor.
Instruct the patient to follow their hand with their eyes as they circle around with an emphasis on opening the chest.
If the hand comes off the floor the patient is instructed to reverse directions and circle around the opposite way.
Have the patient repeat the exercise 5-6 times in a clockwise and counterclockwise direction on each side.

Egyptian Self-Mobs

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Egyptian Self-Mobs

The patient is lying on their back with their legs straight and their arms straight out to the sides with their elbows bent to a right angle.
Instruct the patient to bring the palm of one hand towards the floor while the back of the other hand reaches back to touch the floor. As the arms are rotating tell the patient to turn their head to face the palm that is facing up toward the ceiling.
Instruct the patient to reverse directions with their arms and head rotation so that their eyes always look towards the palm that is turned up facing the ceiling.
The patient repeats this alternating rotation of their arms and head 8 to 10 times.
Tell the patient not to force their neck to turn any further than is comfortable, but that they can push further rotation thru their arms to increase the rotation of the neck.
Make sure that the patient maintains 90 degrees of shoulder abduction and 90 degrees of elbow flexion throughout the exercise.

Side Lying Reach and Roll

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Side Lying Reach and Roll

To restore thoracic rotation to the left:

The patient is lying on their right side with both hands out in front of them at arms length.
Ask the patient to reach forward with their left hand past their right hand and turn the thumb down to internally rotate the arm.
Instruct the patient to initiate the movement from the shoulder then shoulder blade, upper ribs, segmentally down to the lower ribs and finally move the left hip and knee forward.
To reverse this movement ask the patient to rotate back from below up so that the hip and knee move back first, then they bring the lower ribs back segmentally to the upper ribs and finally the shoulder blade and arm until the left elbow touches the floor behind them.
The goal is for the patient to be able to extend their elbow and lie the back of their hand on the floor with the palm of the hand facing the ceiling. If the patient is unable to fully extend their elbow initially they can just touch the elbow to the floor then reverse direction.
Instruct the patient to repeat the whole sequence 5-6 times then switch and repeat lying on their L side.

Side Lying Rib Cage Self-Mobs

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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

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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

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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

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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.

Prone to Supine Leading with the Upper Body

in 3 Movement Tests Upper Quarter, All Upper Quarter, Rolling

Prone to Supine Leading with the Upper Body

How to Perform

Patient is lying prone with arms and legs straight and slightly abducted and head is in neutral.
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.
Evaluate for quality, ease of movement, respiration, synergy and ability to complete the roll without substitution by pushing off with the feet.
Repeat to the opposite side initiating the movement from the left arm and compare the two sides.

Supine to Prone Leading with Lower Body

in 3 Movement Tests Upper Quarter, All Upper Quarter, Rolling

Supine to Prone Leading with Lower Body

Patient is prone with arms and legs slightly abducted and head in neutral.
Ask patient to roll over onto her back using her right leg only.
The patient should keep the right leg straight if possible.
The upper body should not contribute to the roll.
Evaluate for quality, ease of movement, respiration, synergy and ability to complete the roll.
Repeat to the opposite side leading with the left leg

Supine to Prone Leading with the Upper Body

in 3 Movement Tests Upper Quarter, All Upper Quarter, Rolling

Supine to Prone Leading with the Upper Body

How to Perform

Patient is lying supine with legs extended and slightly abducted and arms flexed overhead and slightly abducted.
Head starts in the neutral position.
Ask patient to roll onto her stomach by reaching obliquely across with her right arm.
The patient’s head should flex and turn towards the left axilla.
The lower body should not contribute to the roll, watch for assistance by the legs pushing off.
Evaluate for the quality, ease of movement, respiration, synergy and ability to complete the roll using only the right upper body.
Repeat by rolling to the right using only the left upper body and compare the two sides.