resisted during weight shifting. During walking the pelvic motions are larger and the steps are higher. Resistance to the large motions helps the patient gain the strength and skill needed to stand and walk functionally.

Your hands should stay on the crest of the ilium and not slip down to the ASIS. The stretch should move the pelvis down and back. Do not rotate the patient's body around the stance foot.

12.5.1 Approximation and Stretch

Approximation facilitates contraction of the extensor muscles of the legs and promotes trunk stability. Correct timing of approximation during the stance phase is important. The first approximation comes at or just after heel strike to promote weight acceptance. The approximation may be repeated at any time during stance to maintain proper weight-bearing.

To approximate, place the heel (carpal ridge) of each hand on the anterior crest of the ilium, above the anterior superior iliac spine (ASIS). Your fingers point down and back in the direction of the force. Keep the patient's pelvis in a slight posterior tilt. The direction of the approximation force should go through the ischial tuberosities towards the patient's heels. Apply the approximation sharply and maintain it while adding resistance. Precautions for the approximation

— Your wrists should be extended only a few degrees past neutral to avoid wrist injury.

— To avoid fatigue and shoulder pain, use your body weight to give the approximation force. Keep your elbows in a near-extended position so the body weight can come down through your arms (O Fig. 12.6a).

— Your hands should stay on the crest of the ilium to prevent pain and bruising of the tissues of the abdomen and ASIS.

The stretch response facilitates contraction of the abdominal muscles and the flexor muscles of the swing leg. Correct timing of the stretch is when all the weight is off the foot (toe off).

To apply the stretch reflex at the pelvis, use the same grip as used for approximation. When the patient's foot is unweighted, stretch the pelvis down and back. The direction of the stretch is the same as for the pattern of anterior elevation of the pelvis. Precautions for the stretch:

O Fig. 12.6. a Approximation at the pelvis; b approximation at the scapula

O Fig. 12.6. a Approximation at the pelvis; b approximation at the scapula a b

12.5.2 Using Approximation and Stretch Reflex


Use approximation to facilitate balance and weight-bearing. Give resistance immediately to the resulting muscle contractions. The direction of the resistance determines which muscles are emphasized:

— Resistance directed diagonally backward facilitates and strengthens the anterior trunk and limb muscles.

— Resistance directed diagonally forward facilitates and strengthens the posterior trunk and limb muscles.

— Rotational resistance facilitates and strengthens all the trunk and limb muscles with an emphasis on their rotational component.

Approximation with resistance through the shoulder girdle places more demand on the upper trunk muscles. Put your hands on the top of the shoulder girdle to give the approximation. Be sure that the patient's spine is properly aligned before giving any downward pressure (O Fig. 12.6 b).


The walking descriptions below apply to walking forward with the therapist in front of the patient. The same principles hold true when the patient walks backward or sideways. When the patient walks backward, stand behind the patient and direct your pressure down and forward. For sideways balancing and walking stand to the side of the patient and direct your pressure down and laterally.

Swing Leg

Stretch and resistance to the upward and forward motion of the pelvis promotes both the pelvic motion and the hip flexion needed for swing. You can further facilitate hip flexion with timing for emphasis. Do this by blocking the pelvic motion until the hip begins to flex and the leg to swing forward. In normal gait the pelvic tilt during the first part of swing is minimal, but there has to be enough muscle tone in the trunk and abdominals to control a normal leg swing.

Stance Leg

Approximation combined with resistance to the forward motion of the pelvis facilitates and strengthens the extensor musculature. Give approximation in a downward and backward direction to the stance leg at or just after heel strike to promote weight acceptance. Approximate again at any time during the stance phase to maintain proper weight bearing.

Was this article helpful?

0 0
Fire Up Your Core

Fire Up Your Core

If you weaken the center of any freestanding structure it becomes unstable. Eventually, everyday wear-and-tear takes its toll, causing the structure to buckle under pressure. This is exactly what happens when the core muscles are weak – it compromises your body’s ability to support the frame properly. In recent years, there has been a lot of buzz about the importance of a strong core – and there is a valid reason for this. The core is where all of the powerful movements in the body originate – so it can essentially be thought of as your “center of power.”

Get My Free Ebook

Post a comment