3 Movement Tests Upper Quarter

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Muscle Energy Technique for ERS Dysfunctions of the Upper Thoracic Spine

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Muscle Energy, Scapular Stabilization

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.

Manual Therapy to Address Pectoralis Minor Hypertonicity

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Manual Stretching, Scapular Stabilization

Manual Therapy to Address Pectoralis Minor Hypertonicity

Note that applying AP glides to the Sternochondral Joints in side lying from T3-5, which helps to diminish tone in the pectoralis minor, should precede manual stretching of this muscle.

Manual Stretching of the Pectoralis Minor:

The therapist’s left hand is placed over the 3-5th ribs to stabilize the origin of the pec minor.

  • The patient’s right arm is taken into horizontal abduction with varying amounts of flexion depending on the direction of greatest restriction.
  • The stretch is applied by tractioning the patient’s R arm longitudinally as the arm is taken into further horizontal abduction.
  • The stretch is held for 30 seconds and repeated 2-3 times.

Muscle Energy Technique for ERS Dysfunctions of the Upper Thoracic Spine

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Muscle Energy, Pectoralis Minor/Posterior Capsule

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.

Quadratus Lumborum Hands and Knees Self Stretch

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Self Stretch, Shoulder Abduction

Quadratus Lumborum Hands and Knees Self Stretch

To Stretch the Right Quadratus Lumborum:

  • Have the patient reach forward with the right hand and grasp a solid object. From this position instruct the patient to sit back diagonally towards the right hip, elongating (stretching) the right side of the back.
  • The right arm may be internally rotated (thumb down) or externally rotated (thumb up). Since the latissimus dorsi is an internal rotator of the shoulder internal rotation of the arm places more stretch selectively on the quadratus muscle.
  • Have the patient hold the stretch position for 30 seconds and repeat 2-3 times alternating sides.

Muscle Energy Technique for a FRS Right in R Side Lying

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Muscle Energy, Shoulder Abduction

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

Levator Scapulae Self Stretch

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Cervical Flexion Mobility, Self Stretch

Levator Scapulae Self Stretch

To stretch the right levator scapulae:

  • The patient is instructed to sit with the head positioned in flexion, left side bending and left rotation, as though looking down towards the left hip.
  • Their left hand is placed on top and around their head for support. Instruct the patient not to pull on their head with the left hand.
  • The right hand is placed behind the right hip and grasps the chair/bench.
  • Ask the patient to slowly lean forward and to the left to feel a stretch along the right side of their neck.
  • To facilitate a balance between the levator scapulae and ipsilateral lower trapezius, instruct the patient to pull their right shoulder down and back using the lower trapezius muscle. If done properly they should feel an additional stretch in the levator scapulae muscle.
  • They hold for 20 seconds and repeat 2-3 times on each side.

Shoulder Abduction with Hip Hiking

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

Shoulder Abduction with Hip Hiking

Elongation exercise in sitting:

  • This exercise helps to normalize shoulder abduction by asking the patient to hike up/lift the opposite hip to actively recruit the contralateral quadratus lumborum muscle.
  • The patient is sitting on a firm surface with the feet on the floor and is instructed to lift one arm out to side and up toward the ceiling.
  • At the same time as they are lifting the arm ask them to lift the opposite hip off the table/chair so that they lengthen the spine on the same side as the arm that is being raised. All of their weight should shift to the side of the pelvis that is directly underneath the raised arm.
  • Then they slowly lower their arm and repeat to the opposite side, alternating sides for 6-8 repetitions.
  • Tell the patient to try to coordinate raising the arm with lifting the opposite hip so that they occur simultaneously.

Robbery with or without Resistance Bands

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

Robbery with or without Resistance Bands

  • The patient is standing with their hips and knees slightly bent, elbows straight and hands holding onto resistive bands.
  • Instruct the patient to keep their elbows close to their body as they straighten the knees and hips and move their arms so that their elbows and shoulder blades are pulled down and back towards the opposite back pockets with the palms ultimately facing forward.
  • Their neck should be relaxed and they should not hold their breath during this movement.
  • Ask them to repeat the exercise 3-5 times initially then increase the number of repetitions as their strength improves.

Lawnmower with or without a Resistance Band

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Functional Integration, Scapular Depression, Scapular Stabilization, Shoulder Abduction

Lawnmower with or without a Resistance Band

  • The patient is standing bent forward and rotated to the left to grasp a resistance band with their R hand as if they were going to start a lawnmower.
  • Instruct the patient to stand up and pull their R elbow back and to the right, aiming their elbow toward their L back pocket. Emphasis is placed on having the patient pull their shoulder blade down and back with R rotation of their upper body to finish the movement.
  • Have them hold for 5-10 seconds then relax & slowly return to the starting position and repeat 3-5 times to start, gradually increasing to 10 repetitions.

Kettle Bell Shoulder Integration – Sidelying

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, All Upper Quarter, Functional Integration, Scapular Depression, Scapular Stabilization, Shoulder Abduction

Kettle Bell Shoulder Integration – Sidelying

To promote stability of the R shoulder:

  • Have the patient lie on their L side with their R arm abducted to 90 degrees, their R leg is bent and their L leg is straight.
  • Place a kettle bell into the patient’s R hand and instruct the patient to hold their wrist in a neutral position.
  • Instruct the patient to find the sweet spot for stabilization of their R shoulder by drawing the humeral head back down into the glenoid fossa to “pack” the shoulder.
  • With the shoulder packed have the patient perform the following movements for 3-5 reps each:
    Turn their head to the R and L
    Internally and externally rotate the R arm
    Bend and straighten the R leg
    Rotate the R hip/pelvis forward and backward
  • They should keep their neck relaxed and avoid holding their breath during the exercise.
  • Once they have completed this exercise for the R shoulder you remove the kettle bell from the patient’s hand and have them roll onto their R side to repeat the exercise with the L shoulder.
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