Supine Shoulder Flexion

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Mobilization of the Thoracic Spine in the Lat Dorsi Stretch Position

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

Mobilization of the Thoracic Spine in the Lat Dorsi Stretch Position

  • In kneeling, have the patient place their elbows on top of a bench or chair and walk their knees back until their hips are flexed to approximately 90º.
  • Their hands and forearms should be together with the head resting on their upper arms.
  • Ask the patient to press the inner border of their arms together to separate the shoulder blades in back.
  • The patient is instructed 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.
  • The therapist can then apply a posterior to anterior mobilization glide on the spinous process or transverse processes of any segment that appears to be restricted for extension while the patient maintains the stretch or the therapist can perform a myofascial stretch using the fists to draw the soft tissues towards the midline.
  • The goal is to increase extension in the mid to lower thoracic spine before instructing the patient in self-stretching of the latissimus dorsi.

  • Remember that the lower trapezius not only contributes to mobility of the shoulder, but is also a thoracic spinal extensor. Consequently studies have found that both mobilization and manipulation techniques to increase extension in the thoracic spine result in an increase in lower trapezius muscle strength, at least in the short term (Liebler et al., 2001 and Cleland et al., 2004).

Muscle Energy Technique for FRS Dysfunctions T6-10

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Muscle Energy, Scapular Depression, Shoulder Abduction, Shoulder Circle, Supine Shoulder Flexion

Muscle Energy Technique for FRS Dysfunctions T6-10

For an FRS R from T6-10:

  • The patient places their R hand on their L shoulder and the therapist reaches under the patient’s R arm and grasps the patient’s L shoulder.
  • The therapist palpates the L side of the interspinous space monitoring the superior aspect of the inferior spinous process, ie., FRS R T8,9 the therapist monitors the superior aspect of the spinous process of T9 on the L side.
  • Initially the patient is sitting with their spine flexed and the therapist asks the patient to slowly sit up by pushing the belly forward to introduce extension from below up to the palpated interspinous space.
  • The therapist introduces slight L rotation down to the palpating finger.
  • The therapist then translates the patient from L to R to introduce L side bending without closing down and pinching at the interspinous space.
  • The patient attempts to R SB for 5-7 seconds which the therapist blocks.
  • When the patient relaxes the therapist repositions the patient to the new motion barrier by first standing up to decompress the segment, then rotating the patient to the L and finally translating the patient from L to R to the new L side bending barrier.
  • No pinching should be felt at the palpated segment by the therapist or the patient.
  • This entire sequence is repeated 3 to 4 times then mobility is reassessed.

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.

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.

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