Egyptian Self-Mobs

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, All Upper Quarter, Pectoralis Minor/Posterior Capsule, Scapular Stabilization, Self-mobilization, Shoulder Circle, Supine Shoulder Flexion

Egyptian Self-Mobs

The patient is lying on their back with their legs straight and their arms straight out to the sides with their elbows bent to a right angle.
Instruct the patient to bring the palm of one hand towards the floor while the back of the other hand reaches back to touch the floor. As the arms are rotating tell the patient to turn their head to face the palm that is facing up toward the ceiling.
Instruct the patient to reverse directions with their arms and head rotation so that their eyes always look towards the palm that is turned up facing the ceiling.
The patient repeats this alternating rotation of their arms and head 8 to 10 times.
Tell the patient not to force their neck to turn any further than is comfortable, but that they can push further rotation thru their arms to increase the rotation of the neck.
Make sure that the patient maintains 90 degrees of shoulder abduction and 90 degrees of elbow flexion throughout the exercise.

PA Mobilization to the Rib Angles to Increase Thoracic Rotation to the Left

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Lower Quarter, All Manual Therapy, All Upper Quarter, Mobilization, Pectoralis Minor/Posterior Capsule, Scapular Depression, Scapular Stabilization, Shoulder Circle

PA Mobilization to the Rib Angles to Increase Thoracic Rotation to the Left

The patient is lying on their left side with their right arm resting on top of the left
The therapist places a reinforced thumb on the rib angle of each rib and assesses mobility for anterior glide and IR of the rib

Dysfunctional Scapular Stabilization Test

in 3 Movement Tests Upper Quarter, All Upper Quarter, Scapular Stabilization

Dysfunctional Scapular Stabilization Test

The scapular stabilization tests are designed to assess the ability of the serratus anterior to hold the medial border of the scapula firmly against the thorax when loading is applied through the arms. If the therapist observes winging of the scapula with either one of these tests then the assumption is that the serratus anterior is weak/inhibited. Often when this occurs you’ll notice that the normal thoracic kyphosis is reduced with straightening of the upper thoracic spine. In extreme cases the upper thoracic spine appears lordotic. Multiple ERS dysfunctions from T3-5 are often found when this has occurred and they need to be addressed first before attempting to retrain and strengthen the serratus.

Anatomy and Biomechanical Considerations:

Serratus Anterior

Attaches from along the medial border of the scapula and especially to the inferior angle, to ribs 1-8 or 9
Functions: upwardly rotates, posteriorly tilts and externally rotates the scapula; protracts the shoulder or posteriorly translates the thorax resulting in flexion of the thoracic spine
Innervation: long thoracic n., C5, 6, 7
Inhibited by ERS dysfunctions from T3-5

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.

Scapular Stabilization Test: A test of serratus anterior and lower trapezius strength

in 3 Movement Tests Upper Quarter, All Upper Quarter, Scapular Stabilization

Scapular Stabilization Test: A test of serratus anterior and lower trapezius strength

How to Perform

The patient is standing facing a wall with the feet parallel and hip width apart and approximately 2 feet away from the wall. The patient is instructed to perform a wall push-up, slowly lowering the trunk and chest towards the wall while keeping the spine straight.
An alternative test can be done in hands and knees. The patient bends the elbows so that the shoulders are the same height as the hips and the head is held level with the spine.

Interpretation and the most common dysfunctional pattern seen

During the wall push up the examiner observes for any scapular winging during the movement indicating inhibition/weakness of the scapular stabilizers, i.e., the lower trapezius, serratus anterior, and rhomboids.

During the hands and knees stability test the examiner observes for any winging of the scapula. The patient is then asked to raise one hand off the table to further challenge the scapular stabilizers. The therapist looks for any weakness/winging of the scapula on the support arm side.

Cools et al., 2005 reported finding a decrease in strength of the scapular protractors (serratus anterior) in overhead athletes with impingement syndrome compared to a group of overhead athletes without a history of shoulder pain further supporting the importance of focusing on scapular stabilizing exercises in patients complaining of shoulder pain.

We further believe that recruitment and the force output of the major scapular stabilizing muscles, the middle and lower trapezius and serratus anterior are greatly influenced and inhibited by thoracic non-neutral spinal dysfunctions. We have consistently observed that ERS dysfunctions from T3-6 inhibit the serratus anterior. These patients often present with a straight, and sometimes, even lordotic upper thoracic spine with visible scapular winging at rest.

Half Kneeling Chops with Resistance

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

Half Kneeling Chops with Resistance

Chopping is the downward oblique movement across the body from a high position to a low position.
The patient starts in half kneeling with the left knee down and right knee flexed to 90 degrees and with the R knee centered over the right foot. Both arms are raised up over the right shoulder holding onto handles that are attached to resistance bands.
Ask the patient to find a neutral lumbar spine then draw the belly in to maintain it throughout the exercise.
Instruct the patient to keep their eyes and head facing forward as they pull obliquely down and across their body towards the left knee extending 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 chopping motion in the opposite direction.
The patient can begin this exercise with their legs initially separated for a more stable base and then bring the legs closer together to increase the level of difficulty.

Kneeling Chops with Resistance

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 Stabilization, Shoulder Abduction, Supine Shoulder Flexion

Kneeling Chops with Resistance

Chopping is the downward oblique movement across the body from a high position to a low position.
The patient starts in kneeling with both arms raised up over the right shoulder holding onto handles that are attached to resistance bands.
Ask the patient to find a neutral lumbar spine then draw the belly in to maintain it throughout the exercise.
Instruct the patient to keep their eyes and head facing forward as they pull obliquely down and across their body towards the left knee extending 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 chopping motion 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 closer together to increase the level of difficulty.

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

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

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.

Scapular Stabilization