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.

Pelvic See Saw: Combining lumbar extension with hip flexion and lumbar flexion with hip extension

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Functional Integration, Hip EXT Firing Pattern, Pelvic Clocks, Supine Curl Up, Supine Heel slide

Pelvic See Saw: Combining lumbar extension with hip flexion and lumbar flexion with hip extension

  • The patient is lying on their back with the knees bent and feet flat on the table.
  • Ask the patient to roll the pelvis toward 6:00 extending through the lumbar spine up into the thoracic spine and increasing flexion of the hips. (Top)
  • Then instruct the patient to relax the erector spinae and slowly reverse the position by touching the spine down to the table, rolling the pelvis up toward 12:00 and adding extension through the hips by bridging and lifting the hips up off the table. (Bottom)
  • From the bridge position ask the patient to slowly touch the spine down to the table working from above down segmentally, i.e., T11, T12, L1, L2, etc. until the sacrum touches the table. They then reverse directions by rolling the pelvis towards 6:00 and extending the spine segmentally from below up.
  • The patient is instructed to repeat this movement 4-5 times.

Hands and Knees Diagonals

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Hip ABD Firing Pattern, Pelvic Clocks, Retraining

Hands and Knees Diagonals

To eccentrically work the right gluteus medius:

  • From the hands and knees position the patient is instructed to sit back diagonally toward their right hip as far as they can without holding on with the hands.
  • Make sure the patient elongates/lengthens the right side of the spine as they sit back.
  • Instruct the patient to hold for 10 seconds and repeat 3-5 times or they can alternate from one side to the other.
  • The patient should report that they feel their gluteal/buttocks muscles contract with this movement.
  • To increase ROM and gluteal recruitment instruct the patient to do the hands and knees quadratus lumborum/lat dorsi self stretch before this exercise.

The Clam Exercise

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Hip ABD Firing Pattern, Pelvic Clocks, Retraining, Self-mobilization

The Clam Exercise

To Strengthen the Left Gluteus Medius:

  • The patient is lying on their R side with their shoulders, hips and feet touching against a wall. The shoulders and hips are perpendicular to the table or floor and the hips and knees are flexed to 45-60 degrees.
  • Instruct the patient to draw in the abdomen using the transversus abdominis without holding their breath.
  • Ask the patient to lift the left knee toward the ceiling, keeping the feet in contact.
  • The instruction to the patient is to attempt to lift the leg up to touch the wall and then hold for 10 seconds.
  • The patient repeats the movement 3-5 times initially, then increases the number of repetitions as their strength improves.

Feldenkrais Thoracic Spine Rotation

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Pelvic Clocks, Retraining

Feldenkrais Thoracic Spine Rotation

  • The patient is lying on their back with both knees bent up and the feet flat on the floor with their arms straight out in front and with palms together.
  • Instruct the patient to take their arms to the right and turn their head to the right as far as they can comfortably, then repeat to the left side to determine which side is easier to do.
  • Then if they found it was easier to turn to the right side, have them take their arms to the right while they turn their head to the left as far as they can comfortably and without straining, then have them bring the head and arms back to the midline starting position and repeat 5 times, rotating their head and arms in opposite directions.
  • Then ask them to recheck their ability to turn to the right while looking to the right and see if it’s even easier than before.
  • Then repeat these movements going the opposite way with their arms going to the left as they turn the head to the right, repeat 5 times, then they stop and recheck their ability to bring their arms to the left as they look to the left.
  • They patient is instructed to finish by bringing their arms to the right as they look to the right and arms to the left as they look to the left, back and forth 5 times each way.
  • Then have the patient recheck their ability to rotate the pelvis towards 3 and 9 o’clock to see if it’s easier to perform.

Unilateral Bridging

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Pelvic Clocks, Retraining

Unilateral Bridging

Unilateral bridging on the left side to re-educate 9 o’clock control:

  • The patient is lying flat on their back with their left knee bent and the left foot flat on the floor with their arms resting on the floor at the sides.
  • Instruct the patient to imagine that there is a string attached to their left knee that is pulling the knee forward over their left big toe as they slowly lift their left hip, then pelvis and finally the spine off the floor shifting their weight onto the right buttocks.
  • The patient should not lift any further than is comfortable while keeping their shoulders flat on the floor.
  • Then instruct the patient to slowly lower back to the floor initiating the movement from above down, first touching the middle back, then the lower back, then the pelvis and finally the hip to the floor.
  • Have them repeat this exercise slowly 6-8 times trying to get them to feel that their hip, pelvis and spine can move independently from each other rather than as a block.
  • Have them repeat the exercise on the right side to re-educate 3 o’clock control. Instruct the patient to always start with the easiest side first

Retraining Exercise to Restore Symmetrical 12 to 6 o’clock

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Pelvic Clocks, Retraining

Retraining Exercise to Restore Symmetrical 12 to 6 o’clock

Patient is positioned supine with hips and knees flexed and feet hip width apart.

The patient palpates the ASISs with their fingers or thumbs to assess for symmetry of the ASISs in the frontal plane before they initiate movement. The therapist observes the ASISs and gives the patient verbal cues if needed to level the ASISs before movement is initiated. The most common initial instruction to the patient is to bring the R ASIS up superiorly in order for the ASISs to start from a position of symmetry before movement begins.

The patient is then instructed to inhale as they roll the pelvis down towards 6 o’clock attempting to keep the ASISs level by continuing to monitor with their fingers. If during the initial movement assessment it was found that the R ASIS moved farther inferiorly than the L ASIS the therapist instructs the patient to focus on pushing the L ASIS a little further inferiorly to keep the ASISs level in the frontal plane.

The patient is then instructed to exhale and roll the pelvis up towards 12 o’clock while still maintaining contact at the ASISs. If during the initial movement assessment it was found that the L ASIS moved farther superiorly than the R ASIS, the therapist instructs the patient to focus on drawing the R ASIS up further superiorly in order to keep the ASISs level. The patient repeats the movements toward 6 and 12 o’clock 6 to 8 times trying to maintain symmetry by continuing to monitor at the ASISs and making any adjustments as needed.

The goal is for the patient to be able to roll the pelvis towards 6 and 12 o’clock with symmetry of the ASISs maintained throughout the full range of motion and eventually without the patient having “to think” about maintaining this symmetry.

Muscle Energy Technique for a FRS Right in R Side Lying

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, Active Trunk Rotation, All Lower Quarter, All Manual Therapy, Hip ABD Firing Pattern, Hip EXT Firing Pattern, Muscle Energy, Pelvic Clocks, Rolling

Muscle Energy Technique for a FRS Right in R Side Lying

  • Extension is introduced from above down and from below up to the barrier
  • Rotation is then introduced from above down to the feather edge of the barrier
  • The segment to be treated must remain perpendicular to the table
  • Using the R forearm the therapist introduces L side bending thru the pelvis by pushing up in an anterior and superior direction
  • Patient is instructed to push the pelvis caudally to activate the R side benders
  • Upon relaxation the therapist takes up the slack thru the pelvis
  • Repeat 3 to 4 times
  • To finish the patient is asked to extend the top leg (L) back while the therapist maintains the correction

Forward Bending in Right Step Standing

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Pelvic Clocks, Self-mobilization, Supine Curl Up

Forward Bending in Right Step Standing

Forward Bending in Right Step Standing

For an ERS Left and or high tone in the Left Erector Spinae:

  • The patient starts in standing and places their right foot up on a chair.
  • Instruct the patient to place their hands around each side of their right knee and slide their hands down the leg towards the ankle attempting to bring the chest down towards the right knee.
  • They hold the stretch for 5 to 10 seconds then return to upright standing.
  • Have the patient repeat this sequence 8 to 10 times.
  • For an ERS Right they place the left foot up on a chair.