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Wall Press Self-Mobilizing Exercise

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Cervical Flexion Mobility, Scapular Stabilization, Self-mobilization, Shoulder Abduction

Wall Press Self-Mobilizing Exercise

To Self-Mobilize ERS Dysfunctions in the Upper TS:

  • The patient is standing approximately three feet from a wall and places their hands on the wall at shoulder height.
  • Instruct the patient to drop their head down and push their arms against the wall fully extending their elbows and rounding their upper back. They should feel a stretch in their upper back.
  • Make sure that the apex of spinal flexion occurs in the upper and not the middle or lower back when they extend their arms.
  • Instruct the patient to rotate their head to the R to stretch L sided ERS dysfunctions or rotate their head to the L to stretch R sided ERS dysfunctions as they extend their arms fully.
  • Ask the patient to hold for 5-10 seconds.
  • Then have the patient stand up straight and lean into the wall maintaining a neutral low back. Ask the patient to try to touch the wall with their forehead.
  • The shoulder blades should draw close together as they drop into the wall.
  • Instruct the patient to hold this position for 5-10 seconds and repeat the entire exercise 3-5 times.

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.

Dysfunctional Cervical Flexion Test

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

Dysfunctional Cervical Flexion Test

Barry Wyke, 1981 reported that when experiencing pain in the neck and/or low back there is facilitation of the spinal extensors and inhibition of the spinal flexors. In describing muscle imbalances found in his Upper Crossed Syndrome Janda (1994)) observed that the neck extensors are tight (SCM and suboccipitals) and the deep neck flexors are inhibited and weak.

Jull (1994 and 1997) studied the recruitment of the deep upper cervical flexors in patients with neck pain using a biofeedback cuff placed under the upper cervical spine that they used to measure the amount of pressure a patient can produce when asked to perform upper cervical flexion without recruiting the superficial neck flexors. Patients with neck pain were found to display a deficit in their ability to activate and maintain contraction of the deep neck flexors.

If the cervical flexion test is dysfunctional you first need to determine if there is also a restriction for passive cervical flexion. Restricted passive cervical spine flexion indicates a mobility problem that needs to be addressed first before attempting to retrain the deep neck flexors. Restricted passive neck flexion can be due to the presence of ERS dysfunctions in the upper thoracic and lower cervical spine, hypertonicity of the levator scapula and splenius cervicis muscles or as a consequence of adverse neural tension. Once passive supine cervical flexion mobility is free then retraining as presented in Module #7 can begin.

Anatomy and Biomechanical Considerations:

Cervical flexion requires that the cervical and upper thoracic facet joints can bilaterally open and slide superiorly freely. The cervical flexion test if done sequentially from above down requires that the chin approaches the chest and remains there through the full range of neck flexion. Remember that the SCM muscles when activated bilaterally, participate in flexion of the typical cervical spine, but extension of the upper cervical spine. It is because of this dual action of the SCMs that with inhibition of the deep neck flexors we see patients extend the upper cervical spine during the cervical flexion test leading with their chin up.

Sternocleidomastoid:

  • Two divisions: sternal and clavicular attach into the mastoid process of the temporal bone
  • Function: bilateral activation – flexion of the typical CS and extension of OA, unilateral – side bends to the same side and rotates to opposite side
  • Innervation – spinal accessory n., cranial XI

Levator Scapulae and Splenius Cervicis:

The levator scapulae attaches from C1-C4 and with the scapula fixed, extends, side bends and rotates the cervical spine to the ipsilateral side

When hypertonic these muscles not only restrict passive neck flexion, but also they can act as long restrictors at multiple levels of the cervical spine for passive translation to the contralateral side when the spine is tested in flexion

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.

Related

Supine to Prone Leading with Lower Body

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

Supine to Prone Leading with Lower Body

How to Perform

  • Patient is lying supine with arms separated overhead and legs apart, 10 and 2 and 8 and 4 positions.
  • Ask the patient to roll to the prone position starting with the right leg only.
  • The patient should lead with right hip flexion followed by adduction of the extended leg.
  • The upper body should not contribute to the roll.
  • Evaluate for the quality, ease of movement, respiration, synergy and ability to complete the roll without substitution.
  • Repeat with the left leg to assess for symmetry and quality of the movement

Shoulder Circles

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

Shoulder Circles

How to Perform

  • The patient is side lying with the hips and knees flexed to approximately 60 degrees and the arms straight out in front.
  • The top arm is taken around in a circle overhead keeping the elbow straight and the hand in contact with the floor.
  • The patient is instructed to keep the knees together, but is encouraged to rotate through the thoracic spine and rib cage.

Interpretation and the most common dysfunctional patterns seen
Normally the patient should be able to keep the hand in contact with the floor with the elbow straight as they circle the hand around a full 360 degrees.

Notice in the patient above, the restriction for the left versus the right shoulder circle. This restriction is indicative of a loss of thoracic and rib cage mobility for left rotation and limits ER of the left shoulder.

Note: This patient presents with a loss of IR of the R shoulder and ER of the left shoulder secondary to a loss of left rotation of the thoracic spine and rib cage!

Posterior Capsule Tightness: Restricted IR Right vs Left Side

in 3 Movement Tests Upper Quarter, All Upper Quarter, Pectoralis Minor/Posterior Capsule

Posterior Capsule Tightness: Restricted IR Right vs Left Side

  • Patient is side lying with the scapula stabilized underneath.
  • The shoulder is abducted to 90º then internally rotated to its limit without the shoulder rising off the table. Normally the fingertips should be able to touch the table (approximately 70º of internal rotation).
  • Note the loss of IR of the R shoulder versus the L in the patient above.
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