Half Kneeling Chops and Lifts

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, Hip EXT Firing Pattern, Scapular Stabilization, Shoulder Abduction, Supine Heel slide, Supine Hip ABD and ER, Supine Shoulder Flexion

Half Kneeling Chops and Lifts

The patient starts in half kneeling with the left knee down and right knee up, with their right knee bent to a right angle so that their right knee is position over the right ankle.
The patient grasps a dowel in both hands with the palm of the right hand facing upwards (supinated) and the palm of the left hand facing down (pronated).
The patient is instructed to raise the dowel upwards to the right (lift). Then bring the dowel downwards towards the left (chop) so that they always lift towards the upside knee and always chop toward the downside knee.
Ask the patient to keep their head and eyes facing forward as they raise (lift) and lower (chop) the dowel in front of their body, keeping their trunk tall.
The trunk should remain still and the patient should try to maintain a neutral lumbar spine during the movement
Instruct the patient to repeat the movements 6-8 times then reverse their leg and hand positions to repeat the chop and lift to the left side.
The patient can begin this exercise with their knees initially separated for a more stable base and then bring the knees close together to increase the level of difficulty.

Tall Kneeling Chops and Lifts

Chopping is the downward movement across the body from a high position to a low position and lifting is the upward movement from a low position to a high position.
The patient starts in kneeling with a dowel in both hands with the palm of the top hand facing upwards (supinated) and the palm of the lower hand facing down (pronated).
Ask the patient to keep their eyes and head facing forward as they raise and lower the dowel in front of their body with 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 chop and lifting motions 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 close together to increase the level of difficulty.

Supine Quadratus Lumborum Self Stretch

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Supine Quadratus Lumborum Self Stretch

To Stretch the Left Quadratus Lumborum

The patient is lying supine and crosses the right leg over the left.
Instruct the patient to drop both legs to the right.
Have the patient push their knees together for 5 to 7 seconds and then relax. Upon relaxation the right leg pulls the left leg further over to the right to increase the stretch.
Repeat 3-4 times progressively.
Goal – try to touch the inside of the left knee to the floor without raising the left shoulder off the floor.
Repeat on the opposite side.

Chin Nodding in Supine

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Cervical Flexion Stability/Motor Control, Retraining

Chin Nodding in Supine

The patient is lying on their back and places one hand under the upper part of the neck, at the base of the skull.
Ask the patient to attempt to nod the chin down slightly, increasing the pressure against the hand under the upper neck. Instruct the patient to avoid pushing their head back toward the table.
There should not be any palpable tension in the superficial muscles in the front of the neck as they perform the exercise.
The patient is instructed to hold for 10 seconds and repeat 3-5 times, gradually working up to 10 repetitions.

Chin Nodding Against a Fist

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Cervical Flexion Stability/Motor Control, Retraining

Chin Nodding Against a Fist

Chin Nodding against a Fist

The patient is sitting erect and instructed to make a fist and place it directly beneath the chin.
Then instruct the patient in using the deep neck flexors by nodding their chin down firmly against their fist.
Emphasize tucking the chin toward the chest rather than bending the head forward.
The patient may feel a slight stretch at the base of their head.
They hold for 10 seconds and repeat 3-5 times gradually increasing to 10 repetitions.

Chin Nodding in Sitting

in 3 Movement Tests Upper Quarter, All Upper Quarter, Cervical Flexion Stability/Motor Control

Chin Nodding in Sitting

In sitting, instruct the patient to palpate the muscles in the front of the neck.
Then instruct the patient in using the deep neck flexors by nodding their chin down slightly towards their chest. Explain to the patient to try to avoid activating the superficial muscles that their are feeling in the front of the neck.
Emphasize tucking the chin toward the chest rather than bending the head forward. Little actual movement of the head should occur if done correctly.
The patient may feel a slight stretch at the base of their head.
They hold for 10 seconds and repeat 3-5 times.

Pectoralis Minor Hypertonicity

in 3 Movement Tests Upper Quarter, All Upper Quarter, Shoulder Abduction, Supine Shoulder Flexion

Pectoralis Minor Hypertonicity

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.

Eccentric Retraining Deep Neck Flexors

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Eccentric Retraining Deep Neck Flexors

The patient is lying on their back with their hands clasped behind the head.
Instruct the patient to only use their arms to lift their head up so that the chin is drawn toward the chest and a stretch is felt through the back of the neck.
Once the head is brought up fully the patient is told to hold this position for 5-10 seconds, then slowly lower the head back to the table segmentally from below up, using the deep neck flexors eccentrically to lower the head back down to the table and assisting the movement with their hands as needed.
The hands only support the head as needed and an emphasis is placed upon keeping the chin down as the head is returned back to the table.
They repeat 3-5 times.
Eventually as the deep neck flexors become stronger, the hands should no longer be needed to assist in slowly returning the head back to the table.
The goal with this exercise is for the patient to be able to segmentally flex the neck and return back down to the table segmentally without using the hands to assist with the chin staying down throughout the entire movement.

Retraining Deep Neck Flexors

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Cervical Flexion Stability/Motor Control, Retraining

Retraining Deep Neck Flexors

Treatment Considerations:

Note: make sure that you can passively flex the patient’s cervical spine in supine lying through its full ROM without feeling any resistance before initiating retraining of the deep neck flexors.

Retraining for this dysfunctional movement test focuses on improving the patient’s sensory awareness and ability to activate the deep neck flexors once the inhibiting factors for recruitment of these muscles has been removed. Therefore the exercises selected will depend upon the ability of the patient to “find” these muscles and recruit them appropriately.

Before attempting to retrain the deep neck flexors the sources of abnormal afferent input need to be addressed first. To review these sources and the recommended treatments see Module 6.

Upper Trapezius and SCM Stretch

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Upper Trapezius and SCM Stretch

These muscles extend the upper cervical spine, side bend toward the ipsilateral side and rotate the head to the opposite side
When tight these muscles may serve as long restrictors for mobility at C0-C1

To stretch the right upper trapezius and sternocleidomastoid:

Instruct the patient to position their head in flexion, side bending to the left and rotation to the right.
Their left hand is placed on top and around their head for support. Instruct the patient not to pull on the head with the left hand.
The right hand grasps the chair or bench behind the right hip.
The stretch is introduced by asking the patient to slowly lean forward and away and not by pulling on the head. They should feel a stretch over the top of the right shoulder and behind the ear.
Then instruct the patient to tuck the chin down (nod the chin) to add to the stretch which should be felt at the attachment behind the right ear.
Ask the patient to pull their right shoulder blade down and back to further increase the stretch.
They hold for 20 seconds and repeat 2-3 times. Have the patient alternate sides and stretch to symmetry as much as possible.

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