Scapular Stabilization

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Muscle Energy Technique for ERS Dysfunctions of the Upper Thoracic Spine

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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

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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.

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.

Kettle Bell Shoulder Integration – Supine

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

Kettle Bell Shoulder Integration – Supine

To promote stability of the R shoulder:

  • The patient is lying on their R side and they grasp a kettle bell with both hands with the R hand inside the loop of the bell and the L hand on top.
  • Instruct the patient to keep the bell close to their body as they roll onto their back.
  • Once on their back have the patient straighten their L leg and secure the kettle bell with their R hand only. Then have the patient exhale as they press the kettle bell up towards the ceiling keeping their wrist in a neutral position.
  • Once the elbow is fully extended instruct the patient to find the sweet spot for stabilization of their shoulder by drawing the humeral head back down into the glenoid fossa to “pack” the shoulder.
  • While holding this position have the patient turn their head slowly to the R and L and internally and externally rotate their arm 3-5 times each way without losing the packing of the shoulder.
  • The patient should keep their neck relaxed and avoid holding their breath.
  • Once they have completed the exercise have them bring the kettle bell back down to the chest, grasp the bell with both hands and keeping the bell close to their body they roll back onto their R side and place the kettle bell down.
  • Have them repeat the exercise on the other side for the L shoulder.

Seated Bilateral UE D2 Flexion Diagonals

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

Seated Bilateral UE D2 Flexion Diagonals

  • The patient is sitting in a chair with their feet supported on the ground or small stool.
  • Instruct the patient to cross their arms, bend their elbows, pronate the forearms, flex the wrists and make a fist with both hands.
  • Ask the patient to slump and look down towards the floor.
  • Instruct the patient to inhale and bring both shoulder blades towards their opposite back pocket while they raise their arms up and diagonally across the body to end with their arms externally rotated, elbows extended forearms supinated and wrist and fingers extended. The head and upper trunk extend as they look up to the ceiling at the end of the movement.
  • Then the patient exhales and slowly returns their arms back to the starting position.
  • They repeat 6-8 times.

Seated UE D1 Flexion/Extension Diagonals

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

Seated UE D1 Flexion/Extension Diagonals

  • The patient is sitting in a chair with their feet supported on the ground or small stool.
  • The patient starts with the right hand down toward the floor next to their right upper thigh with their elbow extended and their arm internally rotated. Their palm should be facing away from them with their eyes directed down towards their right hand.
  • Ask the patient to inhale as they lift their right arm up and diagonally across their body to end with their elbow flexed, their arm externally rotated and their fist closed and facing inward. Instruct the patient to follow their R hand with their eyes throughout this exercise.
  • Have them exhale and slowly return their R hand back to the starting position by extending the elbow, internally rotating the arm and extending the wrist and fingers.
  • They perform 6-8 repetitions and then repeat on the other side.
  • Once they are able to perform this pattern correctly, you can add resistive bands held in the hands to increase the level of difficulty of this exercise.

Seated UE D2 Flexion Diagonals

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

Seated UE D2 Flexion Diagonals

  • The patient is sitting in chair with their feet supported on the ground or small stool.
  • Instruct them to reach their R hand across the body, making a fist so the palm of their hand faces the outside of the left upper thigh and they are looking down at their right hand.
  • Ask the patient to inhale and bring their right shoulder blade towards their L back pocket while they raise the R arm up and diagonally across their body ending up with the elbow and wrist extended, the palm open and the thumb facing backward. Instruct the patient to follow their R arm with their eyes throughout the exercise.
  • The patient exhales as they slowly lower their arm back to the starting position.
  • Have the patient repeat this sequence 6-8 times then switch sides.
  • Once they are able to perform this pattern correctly, you can add resistive bands that are held in the hands to increase the difficulty of this exercise.
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