Three-Dimensional Scapular Mobilization (Side Lying)

in 3 Movement Tests Upper Quarter, 4 Manual Therapy Strategies, 5 Home Exercise Strategy, All Home Exercises, All Manual Therapy, All Upper Quarter, Mobilization, Retraining

Three-Dimensional Scapular Mobilization (Side Lying)

To Stretch the Right Rhomboids:

Patient is lying on their L side and the therapist is standing behind.
The therapist reaches underneath the patient’s R arm and places their hand on top of the patient’s R scapula.
The therapist’s L fingers reach under the superior medial border of the scapula.
Using both hands the therapist draws the scapula inferiorly while upwardly rotating and abducting the scapula to stretch the rhomboids.
The therapist maintains the stretch for 30 seconds and repeats 2 to 3 times.

Self-Stretching of the Upper Trapezius and Sternocleidomastoid

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Self-Stretching of the Upper Trapezius and Sternocleidomastoid

Upper Trapezius and SCM Stretch

These muscles extend the upper cervical spine, side bend toward the ipsilateral side and rotate the head to the opposite side
When tight these muscles may serve as long restrictors for mobility at C0-C1

To stretch the right upper trapezius and sternocleidomastoid:

Instruct the patient to position their head in flexion, side bending to the left and rotation to the right.
Their left hand is placed on top and around their head for support. Instruct the patient not to pull on the head with the left hand.
The right hand grasps the chair or bench behind the right hip.
The stretch is introduced by asking the patient to slowly lean forward and away and not by pulling on the head. They should feel a stretch over the top of the right shoulder and behind the ear.
Then instruct the patient to tuck the chin down (nod the chin) to add to the stretch which should be felt at the attachment behind the right ear.
Ask the patient to pull their right shoulder blade down and back to further increase the stretch.
They hold for 20 seconds and repeat 2-3 times. Have the patient alternate sides and stretch to symmetry as much as possible.

Levator Scapulae Self Stretch

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Levator Scapulae Self Stretch

To stretch the right levator scapulae:

The patient is instructed to sit with the head positioned in flexion, left side bending and left rotation, as though looking down towards the left hip.
Their left hand is placed on top and around their head for support. Instruct the patient not to pull on their head with the left hand.
The right hand is placed behind the right hip and grasps the chair/bench.
Ask the patient to slowly lean forward and to the left to feel a stretch along the right side of their neck.
To facilitate a balance between the levator scapulae and ipsilateral lower trapezius, instruct the patient to pull their right shoulder down and back using the lower trapezius muscle. If done properly they should feel an additional stretch in the levator scapulae muscle.
They hold for 20 seconds and repeat 2-3 times on each side.

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.

Shoulder Circles

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Shoulder Circles

How to Perform

The patient is side lying with the hips and knees flexed to approximately 60 degrees and the arms straight out in front.
The top arm is taken around in a circle overhead keeping the elbow straight and the hand in contact with the floor.
The patient is instructed to keep the knees together, but is encouraged to rotate through the thoracic spine and rib cage.

Interpretation and the most common dysfunctional patterns seen
Normally the patient should be able to keep the hand in contact with the floor with the elbow straight as they circle the hand around a full 360 degrees.

Notice in the patient above, the restriction for the left versus the right shoulder circle. This restriction is indicative of a loss of thoracic and rib cage mobility for left rotation and limits ER of the left shoulder.

Note: This patient presents with a loss of IR of the R shoulder and ER of the left shoulder secondary to a loss of left rotation of the thoracic spine and rib cage!

Rolling Through the Legs

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, Active Trunk Rotation, All Home Exercises, All Lower Quarter, All Upper Quarter, Functional Integration, Hip EXT Firing Pattern

Rolling Through the Legs

Patient is lying supine with the arms separated overhead and legs apart, at the 10 and 2 and 8 and 4 o’clock positions.
Ask the patient to roll over to the prone position starting and moving by using the right leg only.
The patient should lead with right hip flexion followed by adduction of the extended leg.
The upper body should not contribute to the roll, but follow segmentally the movement of the right leg and pelvis. Watch for any breath holding or substitution by pushing off the left foot.
If the patient has difficulty you can use verbal cues and manual contacts thru the pelvis to assist. Asking the patient to elongate along the axis of movement can be helpful. In the illustrated example above the patient would attempt to elongate thru the right arm and/or left leg as they roll to the left.
You can also provide compression through the bottom of the left foot or through the right arm to encourage elongation through the axis of movement.
Once prone you instruct the patient to roll back to supine initiating the movement through the right leg by extending the hip, adducting the hip and segmentally extending back through the spine without substituting by pushing off with either hand or the left foot. The same manual contacts can be applied to the left foot and/or right arm to assist the patient as needed.
Ask the patient to repeat the movement 5 to 6 times as tolerated to both sides.

Tripod Stance

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Functional Integration, Hip ABD Firing Pattern, Hip EXT Firing Pattern, Supine Hip ABD and ER

Tripod Stance

The patient starts in kneeling with the right foot forward and the left foot back. The patient comes up on the toes of their left foot and positions the right knee over the right foot and ankle.
Ask the patient to hold the arms out in front of them as if pushing against a wall and draw the abdomen in to stabilize the lumbar spine and pelvis.
Instruct the patient to come straight up off the floor a couple of inches while trying to maintain the right knee positioned over the right foot.
Ideally the patient moves straight up and down without the right knee advancing forward over the toes and without losing a neutral lumbar spine.
Have the patient hold this position for 10 seconds and repeat 3 to 5 times initially, adding repetitions as their strength improves.
They then reverse the leg positions to repeat on the opposite side.

Half Kneeling Chops with Resistance

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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

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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

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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.

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