Bilateral Knees to Chest

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Bilateral Knees to Chest

Bilateral Knees to Chest

To stretch an ERS and/or tight erector spinae to increase lumbar flexion:

Have the patient lying on their back and ask them to bring both knees up to the chest with their hands.
Instruct them to hold the stretch for 5 to 10 seconds and repeat 10 times to mobilize the lumbar spine into further flexion.

Prayer Stretch

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

Prayer Stretch

Prayer Stretch

To increase lumbar flexion:

Starting in hands and knees have the patient sit back on their heels to stretch the low back.
To increase the stretch have the patient reach forward with their hands as far as possible.
They hold the stretch position for 30 to 60 seconds.
Have them repeat the stretch 2 to 3 times.

Muscle Energy Technique: ERS Dysfunction in the Lower Thoracic Spine

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Muscle Energy Technique: ERS Dysfunction in the Lower Thoracic Spine

The therapist places their L index and middle fingers on the L side of the spinous processes and translates the spine towards him looking for any restriction in L to R translation (L side bending). If the restriction is worse in flexion and improves in extension the diagnosis is an ERS R.
To treat the ERS R the therapist has the patient sit up tall initially, then introduces flexion from above down and below up creating an apex for flexion at the palpated segment. L side bending is then introduced by translating the patient’s shoulders from L to R to the feather edge of the L side bending barrier.
The patient is instructed to gently side bend to the R for 5-7 seconds and then relax.
The therapist takes up the slack by further translating the shoulders to the R. This is repeated 3-4 times.

Dysfunctional Supine Curl Up Functional Movement Test

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Dysfunctional Supine Curl Up Functional Movement Test

This dysfunctional movement test can be best addressed by first mobilizing any ERS spinal dysfunctions that are found in the lower thoracic spine and thoracolumbar junction that restrict spinal flexion followed by stretching the erector spinae muscles. These inhibitory influences should be addressed before attempting to retrain this dysfunctional test.

It is also sometimes helpful to stretch the hip flexors as covered in #3b and c.

Anatomy and Biomechanical Considerations:

The erector spinae muscles consist of the longissimus thoracis and iliocostalis thoracis and iliocostalis lumborum muscles. These muscles working unilaterally rotate the spine to the ipsilateral side and when working bilaterally they extend the spine. The longissimus thoracis muscle becomes hypertonic when there is a non-neutral dysfunction in the thoracic spine. This hypertonicity, which is often seen unilaterally, results in inhibition of the abdominals and interferes with the ability to perform a curl up and/or reverse the lumbar lordosis during forward flexion.