Anterior Elevation and Posterior Depression O Fig 64 ac

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The therapist stands behind the patient, facing up toward the patient's head.

Grip. Place one hand on the anterior aspect of the glenohumeral joint and the acromion with your fingers cupped. The other hand covers and supports the first. Contact is with the fingers and not the palm of the hand.

D Fig. 6.3a,b. The direction of the resistance is an arc (posterior depression of the scapula)

Anterior Elevation Scapula Pettern

□ Table 6.1. Scapula movements

Movement

Muscles: principal components

Anterior elevation

Levator scapulae, rhomboids, serratus anterior

Posterior depression

Serratus anterior (lower), rhomboids, latissimus dorsi

Posterior elevation

Trapezius, levator scapulae

Anterior depression

Rhomboids, serratus anterior, pectoralis minor and major

Elongated Position (O Fig. 6.5 a). Pull the entire scapula down and back toward the lower thoracic spine (posterior depression) with the angulus inferior rotated toward the spine. Be sure that the glenohumeral complex is positioned posterior to the central anteroposterior line of the body (mid-frontal plane). You should see and feel that the anterior muscles of the neck are taut. Do not pull so far that you lift the patient's head up. Continued pressure on the scapula should not cause the patient to roll back or rotate the spine around one segment.

Body Mechanics. Keep your arms relaxed and let your body give the resistance by shifting your weight from the back to the front leg.

Resistance. The line of resistance is an arc following the curve of the patient's body. To resist the rotation component, the therapist resists the angulus inferior in the direction of the spine. Start with your elbows low and your forearms parallel to the patient's back. At the end of the pattern your elbows are extending and you are lifting upward.

Command. "Shrug your shoulder up toward your nose." "Pull".

Movement. The scapula moves up and forward in a line aimed approximately at the patient's nose. The inferior angle moves away from the spine.

End Position (O Fig. 6.5 b). The scapula is up and forward with the acromion close to the patient's nose. The angulus inferior is moved away from the spine. In the end position, the muscular activity moves the scapula in this direction. The scapular retractor and depressor muscles are taut.

Scapula Pattern Elevation Anterior
Fig. 6.5a,b. Resistance to scapular anterior elevation

Functional Activities. This scapula pattern facilitates rolling forward, reaching in front of the body, and gait-related phases. The terminal stance on the ipsilateral side and the swing phase on the contralateral side are related to this pattern.

Posterior Depression (O Fig. 6.4 c, 6.6) Grip. Place the heels of your hands along the vertebral border of the scapula with one hand just above (cranial to) the other. Your fingers lie on the scapula pointing toward the acromion. Try to keep all pressure below (caudal to) the spine of the scapula.

Elongated Position (O Fig. 6.6 a). Push the scapula up and forward (Anterior elevation) with the angulus inferior moved away from the spine until you feel and see that the posterior muscles below the spine of the scapula are tight. Continued pressure should not cause the patient to roll forward or rotate the spine around one segment.

Command. "Push your shoulder blade down to me." "Push".

Movement. The scapula moves down (caudal) and back (adduction), toward the lower thoracic spine, with the inferior angle rotated toward the spine.

Body Mechanics. Flex your elbows to keep your forearms parallel to the line of resistance. Shift your weight to your back foot and allow your elbows to drop as the patient's scapula moves down and back (O Fig. 6.6 b).

Resistance. The line of resistance is an arc following the curve of the patient's body. To resist the rotation component, the therapist resists the inferior angle in the direction away from the spine. Start by lifting the scapula down toward the patient's nose. As the scapula moves toward the anteroposterior mid-line, the resistance is forward and almost parallel to the supporting table. By the end of the motion the resistance is forward and upward toward the ceiling with a rotational resistance away from the spine.

End Position (O Fig. 6.6 b). The scapula is depressed and retracted with the glenohumer-al complex posterior to the central anteroposteri-

Scapular Depression

Fig. 6.6a,b. Resistance to scapular posterior depression

Fig. 6.6a,b. Resistance to scapular posterior depression or line of the trunk. The vertebral border should lie flat and not wing out.

Functional Activities. This scapula pattern activates trunk extension, rolling backward, using crutches while walking, and pushing up with a straight trunk. When a patient moves from a wheelchair to a bed he/she may use anterior depression of the scapula.

Anterior Depression and Posterior Elevation (O Fig. 6.7 a-c)

The therapist stands behind the patient's head facing towards the patient's bottom (right) hip.

Anterior Depression (O Fig. 6.7 b, O Fig. 6.8) Grip. Place one hand posteriorly with the fingers holding the lateral (axillary) border of the scapula. The other hand holds anteriorly on the axillary border of the pectoralis major muscle and on the coracoid process. The fingers of both hands point toward the opposite ilium, and your arms are lined up in the same direction.

Elongated Position (O Fig. 6.8 a). Lift the entire scapula up and back toward the middle of the back of the head (posterior elevation). Be sure that the glenohumeral complex is positioned posterior to the central anteroposterior line of the body (mid-frontal plane). You should see and feel that the abdominal area is taut from the ipsilateral ribs to the contralateral pelvis. Continued pressure on the scapula should not cause the patient to roll back or rotate the spine around one segment.

Command. "Pull your shoulder blade down toward your navel." "Pull."

Movement. The scapula moves down and forward, in a line aimed at the opposite anterior iliac crest. The scapula moves forward with the inferior angle in the direction of the spine.

Body Mechanics. Let the resistance come from your body weight as you shift from the back to the front leg.

Resistance. The resistance follows the curve of the patient's body. At the end of the pattern you are lifting in a line parallel to the front of the patient's thorax.

End Position (O Fig. 6.8 b). The scapula is rotated forward, depressed, and abducted. The gleno-humeral complex is anterior to the central anteroposterior line of the body.

Functional Activities. Rolling forward, reaching forward, throwing a ball in sport activities, reaching down to the feet to take off socks and shoes.

Scapular Protraction With Resistance
evation
Anterior Depression

Posterior Elevation (O Fig. 6.7 c, O Fig. 6.9) Grip. Place your hands posterior on the upper tra-pezius muscle, staying above (superior to) the spine of the scapula. Overlap your hands as necessary to stay distal to the junction of the spine and first rib.

Elongated Position (O Fig. 6.9 a). Round the scapula down and forward toward the opposite ilium (anterior depression) with the angulus inferior moving toward the spine until you feel that the upper trapezius muscle is taut. Do not push so far that you lift the patient's head up. Continued pressure should not cause the patient to roll forward or rotate the spine around one segment.

Command. "Shrug your shoulder up." "Push".

Movement. The scapula shrugs up (cranially) and back (adduction) in a line aimed at the middle of the top of the patient's head with the angulus inferior rotating away from the spine. The glenohumeral complex moves posteriorly and rotates upward.

Resistance. The resistance follows the curve of the patient's body. At the end of the pattern you are lifting around the thorax and away from top of the patient's head.

End Position (O Fig. 6.9 b). The scapula is elevated and adducted, the glenohumeral complex is posterior to the central anteroposterior line of the body.

Functional Activities. Moving backward, reaching out before throwing something, and putting on a shirt are activities that show these movements of the scapula.

Points to Remember

When doing pure scapular patterns the trunk does not roll or rotate. The glenohumeral complex is part of the scapular pattern. The humerus must be free to move along.

Body Mechanics. Shift your weight from the front to the back foot as the scapula moves. Your forearms stay parallel to the line of resistance.

Scapular Region The Body

6.4.2 Specific Uses for Scapular Patterns

— Exercise the scapula for motion and stability

— Exercise trunk muscles

- Using timing for emphasis, prevent scapular motion at the beginning of the range until you feel and see the trunk muscles contract. When this occurs, change the resistance at the scapula so that both the scapula and the trunk motion are resisted.

- At the end of the scapular range of motion, "lock in" the scapula with a stabilizing contraction and exercise the trunk with repeated contractions.

- Use Reversal of Antagonist techniques to train coordination and prevent or reduce fatigue of the scapular and trunk muscles.

— Exercise functional activities such as rolling.

- When the trunk muscles are contracting you can extend their action into such functional activities as rolling forward or backward (7 Sect. 11.5.1). Give a movement command such as "roll forward" and resist the functional activity using the stabilized scapula as the handle.

- Repeated Contractions of the functional activity will reinforce both learning the activity and the physical ability to do it.

— Facilitate cervical motion and stability (by resisting scapular motion and stabilization, since the scapula and neck reinforce each other)

- Resist the moving or stabilizing contraction at the scapula and head simultaneously to exercise the muscles that go from the cervical spine to the scapula.

- To stretch these muscles for increased range of motion, stabilize the cervical spine and resist the appropriate scapular motion.

— Facilitate arm motion and stability (by resisting scapular motion and stabilization, since the scapula and arm muscles reinforce each other). (O Fig. 6.10)

- Scapular elevation patterns work with arm flexion patterns.

- Scapular depression patterns work with arm extension patterns.

— Treat the lower trunk indirectly through irradiation. Give sustained maximal resistance to a b

Resisted Protraction Scapula

O Fig. 6.10. Patient with right hemiplegia. a Combination of scapula (posterior depression) with arm motion. b Combination of scapula (anterior elevation) with arm motion stabilizing or isometric scapula patterns until you see and feel contraction of the desired lower trunk muscles.

Points to Remember

The scapular patterns work directly on the spine as well.

When using scapular patterns for rolling, the scapula is the handle and the rolling is exercised.

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Responses

  • Flavia
    Which pattern of scapula use in puting out shirt?
    4 years ago
  • folco took-brandybuck
    Which came first: scapular elevation or depression?
    6 months ago

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