5 Home Exercise Strategy

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Shoulder Circles

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, All Upper Quarter, Rolling, Self-mobilization, Shoulder Circle

Shoulder Circles

To restore thoracic rotation to the left:

The patient is lying on their right side with their hips flexed between 45-60º and their hands out in front of them.

  • Instruct the patient to take their left arm and sweep their hand up over the head with the hand remaining in contact with the floor and the elbow straight.
  • The patient is encouraged to rotate their trunk and rib cage back as they circle around, but keep the knees together. They only circle around as far as they can while keeping the hand touching the floor.
  • Instruct the patient to follow their hand with their eyes as they circle around with an emphasis on opening the chest.
  • If the hand comes off the floor the patient is instructed to reverse directions and circle around the opposite way.
  • Have the patient repeat the exercise 5-6 times in a clockwise and counterclockwise direction on each side.

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.

Side Lying Reach and Roll

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, Rolling, Self Stretch, Self-mobilization, Shoulder Circle

Side Lying Reach and Roll

To restore thoracic rotation to the left:

  • The patient is lying on their right side with both hands out in front of them at arms length.
  • Ask the patient to reach forward with their left hand past their right hand and turn the thumb down to internally rotate the arm.
  • Instruct the patient to initiate the movement from the shoulder then shoulder blade, upper ribs, segmentally down to the lower ribs and finally move the left hip and knee forward.
  • To reverse this movement ask the patient to rotate back from below up so that the hip and knee move back first, then they bring the lower ribs back segmentally to the upper ribs and finally the shoulder blade and arm until the left elbow touches the floor behind them.
  • The goal is for the patient to be able to extend their elbow and lie the back of their hand on the floor with the palm of the hand facing the ceiling. If the patient is unable to fully extend their elbow initially they can just touch the elbow to the floor then reverse direction.
  • Instruct the patient to repeat the whole sequence 5-6 times then switch and repeat lying on their L side.

Side Lying Rib Cage 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, Rolling, Self-mobilization, Shoulder Abduction, Shoulder Circle

Side Lying Rib Cage Self-Mobs

Self mobs to restore thoracic rotation to the left:

  • The patient is lying on their right side with the hips flexed to between 45-60º with their left hand placed underneath the lower right side of the rib cage.
  • Instruct the patient to roll back to the left and with your left hand pull the right lower rib cage into left rotation. They repeat 3-4 times moving their hand slightly superior with each rotation.
  • Moving up to the xiphoid process have the patient place the fingertips of their left hand on the left side of the rib cage, just off the sternum and lateral to the xiphoid process.
  • Instruct the patient to rotate back to the left and use their left hand to pull the ribs back towards the floor.
  • After the patient returns to the midline they move their fingers up to the next rib and they repeat the rotation drawing the next rib back to the floor.
  • The patient should always start from below, approximately the 7th or 8th rib, and work their way up until they reach the collarbone.
  • The patient is instructed to rotate back approximately 7 times moving their hand up approximately 1 inch each time to draw back a new rib. To enhance the stretch, the patient takes a deep breath in, then exhales as they draw the rib back further.

Side Lying Thoracic Rotation

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, Rolling, Self Stretch, Self-mobilization, Shoulder Circle

Side Lying Thoracic Rotation

To increase thoracic spinal rotation to the left:

  • The patient is side lying on their right side with both hips flexed below 90º.
  • Have the patient place their left hand behind the head with their right arm straight out in front of them.
  • Instruct the patient to rotate back to the left as far as they can then return to midline and repeat again 5 times.
  • Then have them flex both hips to 90º and rotate back again 5 times.
  • Finally, have the patient flex both hips above 90º and rotate back 5 times.
  • As they flex their hips higher they move the focus of the rotation higher up their spine.
  • They repeat the exercise 5 times in each position to the opposite side, with the hips flexed below, at and above 90º.

Quadratus Lumborum Self Stretch

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Self Stretch, Shoulder Abduction, Supine Shoulder Flexion

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.

Mobilization of the Rib Cage to Restore Thoracic Spine Rotation to the Left

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

Mobilization of the Rib Cage to Restore Thoracic Spine Rotation to the Left

  • Top – To restore thoracic rotation to the left, mobilize the left rib cage in an anterior to posterior direction
  • Bottom – Mobilize the right side of the rib cage in a posterior to anterior direction

Latissimus Dorsi Self Stretch

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Scapular Depression, Self Stretch, Supine Shoulder Flexion

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

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Self-mobilization, Supine Shoulder Flexion

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.
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