Basic Procedures

Fig. 6.1. Diagonal motion of the scapula and pelvis

the curve of the patient's torso. When the scapula or pelvis is moved within the diagonal, the patient will not roll forward or back or rotate around one spinal segment.

Picture a patient lying on the leftside (□ Fig. 6.1). Now imagine a clock with the 12 o'clock position toward the patient's head, the 6 o'clock position toward the feet, the 3 o'clock position anterior and the 9 o'clock position posterior. When working with the right scapula or pelvis, anterior elevation is toward 1 o'clock and posterior depression toward 7 o'clock. Posterior elevation is toward 11 o'clock and anterior depression toward 5 o'clock (□ Fig. 6.1).

Now imagine that the patient is lying on the right side. The 12 o'clock position is still toward the patient's head but the 3 o'clock position is posterior and the 9 o'clock position anterior. Working with the left scapula or pelvis, anterior elevation is toward 11 o'clock and posterior depression toward 5 o'clock; posterior - elevation is toward 1 o'clock and anterior depression toward 7 o'clock. In this chapter we show all patterns being done on the patient's left scapula or pelvis. All references are to motion of the left scapula or the left side of the pelvis.

Patient Position

We illustrate the basic scapula and pelvic patterns with the patient side lying on a treatment table. The use of these patterns in other positions is illustrated in later chapters.

The procedures start with the patient in a stable side lying position, the hips and knees flexed as much as the activity needs to get an optimal result. The patient should be positioned so that his or her back is close to the edge of the treatment table. The patient's spine is maintained in a normal alignment and the head and neck in as neutral a position as possible, neither flexed nor extended. The patient's head is supported in line with the spine, avoiding lateral bend.

Before beginning a scapula or pelvis pattern, place the scapula or pelvis in a mid-position where the line of the two diagonals cross. The scapula should not be rotated, and the glenohumeral complex should lie in the anteroposterior midline. The pelvis should be in the middle, between anterior and posterior tilt. You can use a pillow between the knees when the pelvis is rotated. From this midline position, the scapula or pelvis can then be moved into the elongated range of the pattern.

Therapist Position

The therapist stands behind the patient, facing the line of the scapular or pelvic diagonal and with arms and hand aligned with the motion. All the grips described in this chapter assume that the therapist is in this position.

In an alternative position the patient lies facing the edge of the treatment table. The therapist stands in front of the patient in the line of the chosen diag-

□ Fig. 6.2. Alternative position: the therapist is in front of the patient (anterior elevation of the pelvis)

onal. The hand placement on the patient's body remains the same but the grips use different areas of the therapist's hands (O Fig. 6.2).

The scapular and pelvic patterns can also be done with the patient lying on the mats. In this position, the therapist must kneel on the mats either in front of or behind the patient. Weight shifting is done by moving from the position of sitting on the heels (kneeling down) to partial or fully upright kneeling (kneeling up).

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

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