Supine Shoulder Flexion

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

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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

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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.

Self-Stretch of the Pectorals

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Self-Stretch of the Pectorals

To stretch the right pectorals:

Initially the patient stands facing the wall and places their outstretched right hand on the wall at shoulder height.
Ask them to turn their trunk to the left so that their feet are parallel to the wall.
Have them bend their right elbow as they bring the right shoulder blade down and back.
Instruct the patient to place their left hand on the wall to help turn the trunk further to the left.
Make sure they hold the right shoulder down and back so that the right shoulder is no higher than the left.
Instruct the patient to lean into the wall to increase the stretch.
They should feel a stretch through the front of the chest and right shoulder.
Have them hold for 30 seconds and repeat 2-3 times.
Then have them repeat on the opposite side.

Egyptian Self-Mobs

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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.

Quadratus Lumborum Self Stretch

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Quadratus Lumborum Self Stretch

To stretch the left quadratus lumborum:

The patient is supine with hips and knees flexed and feet flat on the floor.
Instruct the patient to cross the right leg over the left and drop both legs to the right.
Ask the patient to push the legs 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 then repeat on the R side.
Goal – for the patient to try to touch the inside of the left knee to the floor while keeping the left shoulder on the floor.

AP Mobilization to the L Sternochondral Joints to Increase Thoracic Rotation to the Left

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AP Mobilization to the L Sternochondral Joints to Increase Thoracic Rotation to the Left

The patient is right side lying with the hips and knees flexed to about 45 degrees and places their left hand behind the head.
Instruct the patient to rotate back to the left without separating the knees.
The therapist places the pad of their right thumb on the superior border of the L sternochondral joint and applies an AP glide to promote external rotation (torsion) at each rib.
The therapist assesses rib mobility from T1-T7 and identifies the most significant restriction needing mobilization.
The anterior ribs can be very tender/painful so the therapist is looking for the most hypomobile rib, not the most tender.
Posterior capsule tightness resolves most commonly after AP mobilization of the hypomobile 4th and 5th sternochondral joints on the opposite side.
Pectoralis minor tightness often resolves after AP mobilization of the ipsilateral sternochondral joints from T3-5.

Latissimus Dorsi Self Stretch

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Latissimus Dorsi Self Stretch

The patient is kneeling with their elbows on top of a bench or chair and their hips and knees flexed to approximately 90º.
Instruct the patient to place their hands and forearms together and rest their head on their upper arms.
Ask the patient to press the inner borders of their arms together to separate the shoulder blades in back.
Ask the patient to drop their chest toward the floor as much as possible, then perform a posterior tilt (12:00) of the pelvis without lifting up the chest. They should feel a good stretch along the sides, around their shoulder blades.
Have the patient hold the stretch for 30 seconds, then relax and sag the chest further toward the floor. They repeat the stretch 2-3 times.

Segmental Cat Backs – Self-Mobilization for Thoracic Extension

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Segmental Cat Backs – Self-Mobilization for Thoracic Extension

The patient is in the hands and knees position with the hands directly beneath the shoulders and knees directly under the hips.
The patient is instructed to drop the head down and segmentally lift their spine towards the ceiling progressing segmentally from the neck then thorax and finally the lumbar spine, finishing by tucking the pelvis under with a posterior tilt.
From this fully flexed position the patient has the option to reverse their spine from the bottom up or from the top down.
If reversing from the bottom up the patient is instructed to anteriorly tilt the pelvis and drop the lumbar spine into lordosis, segmentally progressing up into the thoracic spine with the shoulder blades approximating as the chest drops forward and the neck and head are extended. The therapist observes the motion to make sure that the patient does not skip over a portion of the spine, but moves segmentally as much as possible.
If reversing from above down from the fully flexed position the patient is instructed to lift up their head, extend the neck and drop their chest towards the table with the scapula approximating as the mid-thoracic spine extends. As the motion approaches the lumbar spine the patient drops their belly and anteriorly rotates the pelvis, lifting the tailbone up.
The therapist evaluates in which direction that the patient appears to have better control, from the bottom up or from the top down, and instructs the patient to always initially start the exercise moving in the direction that they have the best control.
The patient repeats the movements 5 to 6 times alternating the initiation of movement from the head and from the tailbone.

Manual Stretch of the Latissimus Dorsi

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Manual Stretching, Scapular Depression, Supine Shoulder Flexion

Manual Stretch of the Latissimus Dorsi

To Stretch the Left Latissimus Dorsi:

The patient is supine with the arms brought up overhead to the shoulder flexion barrier without pinching or producing pain in the shoulders.
The patient’s arms are supported with a gentle longitudinal traction applied by an assistant.
The therapist flexes the patient’s knees to chest to reduce the lumbar lordosis and to initiate the stretch from below up.
With the knees held to the patient’s chest the therapist reaches around and grasps the left side of the patient’s pelvis with his R hand.
The therapist then pulls the patient’s pelvis to the right to side bend the trunk to the right and stretch the L latissimus dorsi.
The therapist holds the stretch momentarily and repeats the stretch 4 to 5 times before repeating on the opposite side.

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