Manual Stretching

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Manual Therapy to Address Pectoralis Minor Hypertonicity

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Manual Stretching, Scapular Stabilization

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.

Rectus Femoris/ Femoral Nerve Mobilization : On/Off Flossing

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, All Lower Quarter, All Manual Therapy, Hip EXT Firing Pattern, Manual Stretching, Mobilization, Supine Heel slide

Rectus Femoris/ Femoral Nerve Mobilization : On/Off Flossing

Rectus Femoris/ Femoral Nerve Mobilization : On/off flossing

  • Therapist stabilizes the right ischial tuberosity
  • Therapist passively flexes and extends the  knee on/off 10 times to the motion barrier
  • Therapist gradually increases the amount of knee flexion as resistance diminishes
  • Goal – heel to buttocks
 

Stretch the Left Iliopsoas

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, 5 Home Exercise Strategy, Active Trunk Rotation, All Home Exercises, All Manual Therapy, Manual Stretching, Self Stretch, Supine Heel slide

Stretch the Left Iliopsoas

To Stretch the Left Iliopsoas:

  • The patient starts in half kneeling with the left knee placed on a towel or pillow on the floor with the hip internally rotated and the right hip and knee flexed to 90º. Their right hand may be placed on a chair or against the wall for support.
  • Have them place their left hand on their left buttocks. They are instructed to tighten the left buttocks muscle and tuck the hips under (12:00). They draw the belly button in and keep the shoulders centered over the hips so that they don’t arch the back.
  • Instruct the patient to use their right leg to pull the pelvis forward leading with the front of the left hip. They should feel a stretch in the front of the left leg/thigh. Further stretch can be obtained by maintaining this stretch position and side bending the trunk away (toward the right).
  • They are instructed to hold the stretch for 30 seconds 2-3 times or perform a series of isometric contractions attempting to pull the left hip forward for 5-7 seconds then relaxing and stretching further.
  • Then have the patient switch sides and repeat with the right leg.

Mobilization of Adverse Neural Tension on the R side of the Cervical Spine

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Cervical Flexion Mobility, Manual Stretching, Mobilization, Shoulder Abduction

Mobilization of Adverse Neural Tension on the R side of the Cervical Spine

  • The therapist introduces translation from right to left with his/her contact on the dysfunctional articular pillar.
  • The patient is instructed to slowly abduct their R arm along the table as far as they can while the therapist maintains the right to left translated position of the cervical spine and prevents the dysfunctional segment from translating back to the right.
  • This is repeated several times. Each time the patient lowers their arm to their side the therapist takes up any additional slack for right to left translation.
  • Goals for treatment: translation from right to left at the previously noted dysfunctional segment is now free and the patient should be able to fully and comfortably abduct the right shoulder overhead without the therapist feeling the cervical spine translate to the right at any segmental level.

Manual Therapy to Address Pectoralis Minor Hypertonicity

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Manual Stretching, Pectoralis Minor/Posterior Capsule, Shoulder Circle

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.

To Evaluate for Pectoralis Minor Tightness on the R Side

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Manual Stretching, Shoulder Abduction

To Evaluate for Pectoralis Minor Tightness on the R Side

  • The therapist places their L thenar eminence on the superior border of the patient’s R 3rd thru 5th ribs.
  • The therapist’s R arm passively raises and supports the patient’s R arm overhead.
  • The therapist applies an inferior and medial glide to the ribs and pectoral fascia from ribs #3-5 to assess for hypertonicity in the pectoralis minor.
  • No restriction was detected in this patient who presented with a protracted R shoulder.

Significance of Posterior Capsule Tightness:

  • Tightness of the posterior capsule correlates to a loss of internal rotation and increased anterior humeral head translation (Tyler et al, 1999; Tyler et al., 2000)
  • Tightness of the posterior capsule is linked to increased superior migration of the humeral head (Harryman et al., 1990))
  • A positive Tyler posterior shoulder tightness test has been found in patients with subacromial impingement (Tyler et al, 2000)

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.

Muscle Energy Technique for the Levator Scapulae

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, All Manual Therapy, All Upper Quarter, Cervical Flexion Mobility, Manual Stretching, Muscle Energy

Muscle Energy Technique for the Levator Scapulae

To stretch the right levator scapulae:

  • The patient is left side lying with the head positioned in flexion, left side bending and left rotation.
  • The operator’s right hand is placed on the lateral aspect of the neck from C1 through C4 to stabilize the cervical spine. The operator’s left hand is placed over the patient’s right shoulder in front of the clavicle so that the shoulder can be brought into posterior tilt with depression of the medial border of the scapula. The patient’s right hand should be placed upon and remain on top of the right hip.
  • The patient is instructed to raise the right shoulder towards their ear which is resisted by the therapist for five to seven seconds.
  • Upon relaxation further posterior tilt and depression of the scapula are introduced by the therapist.
  • This procedure is repeated 3-4 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.

Advancement of Supine Heel Slide Exercise

in 4 Manual Therapy Strategies, 5 Home Exercise Strategy, All Manual Therapy, Manual Stretching, Retraining

Advancement of Supine Heel Slide Exercise

  • The patient is lying supine with their hips and knees flexed and the feet flat on the table.
  • Instruct the patient to find a neutral lumbar spine position, midway between 12:00 and 6:00, monitoring the ASISs with their thumbs.
  • Have the patient draw their belly in without flattening the low back (the ASISs should not move when they draw the belly in).
  • Instruct the patient to slowly extend their right leg keeping the foot off the table while monitoring the ASISs. The patient tries to touch their heel to the table only after the leg is extended. They then bring the leg back up with the foot remaining off the table. The right ASIS should remain stable as the right leg is extended. If the ASIS moves inferiorly, the patient should stop, and bring the leg back up to the starting position.
  • Goal – the patient should be able to fully straighten either leg without the ASISs moving and touch their heel to the table while maintaining a neutral lumbar spine.
  • They repeat the exercise 3-5 times initially and increase repetitions as their performance improves.
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