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Elongated Position

The patient's left arm is in flexion-adduction-external rotation. The right hand grips the left wrist with the right arm in modified flexion-abduction-external rotation. The patient looks at the left hand, putting the neck in modified extension to the right (O Fig. 10.1 a).

Stretch

Traction the left arm and scapula until you feel the trunk muscles elongate. Continue the traction to give stretch to the arms and the trunk.

Command

"Push your arms down to me and lift your head. Now keep your arms down here and push some more." "Reach for your left knee."

Movement

The patient's left arm moves through the pattern of extension-abduction-internal rotation with the right arm following into extension-adduction-internal rotation. The patient's head and neck come into flexion to the left. At the same time, the patient's upper trunk begins to move into flexion with rotation and lateral flexion to the left.

Resistance

The major resistance is to the arm motion and through the arms in the direction of the opposite shoulder to facilitate the trunk. The resistance to the head is light and serves mainly to guide the head and neck motion.

Use resistance to hold back on the beginning arm motion until you feel and see the abdominal muscles begin to contract. Then allow the arms and head to complete their motion against enough resistance to keep the trunk flexor muscles contracting. As the trunk begins to flex, add approximation through the arms in the direction of the opposite shoulder.

End Position

The left arm is extended by the patient's side and the patient's neck is in flexion to the left. The upper trunk is flexed to the left as far as the patient can go.

Normal Timing

The abdominal muscles begin to contract as soon as the arms and head begin their motion. By the time the arms and head have finished their movement, the upper trunk is flexed with left rotation and left lateral flexion.

Reversal of Chopping

This is different from the lifting pattern in that there is no stopping to change grips. It is useful when you desire to use a reversal technique such as going from rolling forward to rolling backward. In this way no stopping or relaxation occurs between the movements (O Fig. 10.3).

Timing for Emphasis

Lock in the arms at their end range using approximation and rotational resistance. Using the stable arms as a handle, exercise the trunk flexion.

In the end position the arms and head are the handle and do not move. Only the trunk moves as you exercise it.

You can use timing for emphasis with various techniques such as combination of isotonics and reversal of antagonists. When working on the mats use chopping and reversal of chopping to help the patient roll forward and backward. Shift the angle of resistance slightly to get the patient to roll.

Use chopping to help the patient go from supine to sitting. The rotational resistance and approximation through the arms promote and resist the patient's movement to sitting.

Alternative Position

Sitting

Your goal can be flexion of the trunk with gravity assistance or flexion of the hips with irradiation from the arms and trunk. Use this position to train the trunk and hip flexor muscles in eccentric work.

Points to Remember

At the end of the pattern only the trunk moves, the arms are the handle The proximal hand can resist the contralateral scapular motion of anterior-depression

10.2.2 Lifting

Bilateral asymmetrical upper extremity flexion with neck extension is used for trunk extension, as shown here. Other uses for the lifting pattern are:

— Exercising hip extension when the trunk extensor muscles are strong

— Facilitating functional motions such as rolling backward or coming to erect sitting from a slumped position.

Lifting to the left is illustrated in O Fig. 10.4. Its components are:

— Left arm (the lead arm): flexion-abduction-external rotation

— Right arm (the following arm): flexion-adduction-external rotation. The following (right) hand grips the lead (left) wrist

— Neck: extension to the left

Patient Position

The patient is supine and close to the left side of the table (O Fig. 10.4 a, b).

Body Position and Mechanics

Stand in a stride position at the head of the table on the left side facing toward the patient's hands. Let the patient's motion push your weight back. As the patient's arm nears the end of the range, step back in the line of the diagonal.

Fig. 10.3. Reversal of chopping

Grip

Distal hand

Your left hand grips the patient's left hand (leading hand). Use the normal distal grip for the pattern of flexion-abduction-external rotation.

Proximal hand

Place your right hand on the crown of the patient's head with your fingers pointing toward the left side of the patient's neck.

Elongated Position

The patient's left arm is in extension-adduction-internal rotation. The right hand grips the left wrist with the right arm in modified extension-abduction-internal rotation. The patient looks at the left hand putting the neck in flexion to the right (O Fig. 10.4 a).

Stretch

Traction the left arm and scapula until you feel the arm and trunk muscles elongate. Continue the traction to give stretch to the arms and the trunk. Traction the patient's head to elongate the neck extensor muscles.

Command

"Lift your arms up to me and push your head back. Follow your hands with your eyes. Now keep your arms and head back here and push some more."

Movement

The patient's left arm moves through the pattern of flexion-abduction-external rotation with the right arm following into flexion-adduction-external rotation. The patient's head and neck come into extension to the left. At the same time the patient's upper trunk begins to move into extension with rotation and lateral flexion to the left.

Resistance

The resistance is to the arm and head motion and through them into the trunk in the direction of the opposite hip joint. Use resistance to hold back on the beginning arm and head motion until you feel and see the back extensor muscles begin to contract. Then allow the arms and head to complete

Fig. 10.3. Reversal of chopping

Fig. 10.4. Lifting: a, b lifting to the left in supine; c lifting to the right in prone; d, e lifting to the left in sitting a b c d e

Fig. 10.4. Lifting: a, b lifting to the left in supine; c lifting to the right in prone; d, e lifting to the left in sitting their motion against enough resistance to keep the trunk extensor muscles contracting.

End Position

The arms are fully flexed with the left arm by the patient's left ear. The patient's head is extended to the left. The trunk is extended and elongated to the left. The extension continues down to the legs if the patient's strength permits.

Normal Timing

The back extensor muscles begin to contract as soon as the arms and head begin their motion. By the time the arms and head have finished their movement the trunk is elongated to the left with left rotation and slight left lateral flexion.

Reversal of Lifting

This is different from the chopping pattern in that there is no stopping to change grips.

It is useful when you desire to use a reversal technique such as going from rolling backward to rolling forward. In this way no stopping or relaxation occurs between the movements (O Fig. 10.5).

Timing for Emphasis

Lock in the arms and head at their end range. Lock in the arms using resistance to rotation and approximation, the neck with resistance to rotation and extension. Use the arms and head as a handle to exercise the trunk extension (elongation). Neither the arms nor the head should move while the trunk is exercising. Use the reversal of lifting when the patient is lying on the mat with the goal of rolling forward (O Fig. 10.5).

Fig. 10.5. Reversal of lifting

Alternative Positions Prone

Exercise in the end range against gravity. This position is particularly good with stronger and heavier patients (O Fig. 10.4 c).

Sitting

Your goal is elongation of the trunk. Do not allow the patient to move into hyper lordosis in the cervical or lumbar spine.

Use lifting to facilitate moving from a bent (flexed) to an upright (extended) position. Lifting is also good for teaching the patient erect posture (O Fig. 10.4 d, e).

Points to Remember

At the end of the pattern only the trunk moves, the arms are the handle The desired activity is trunk elongation, not lumbar spine hyperextension

Fig. 10.6. Lifting for irradiation

Fig. 10.5. Reversal of lifting

Fig. 10.6. Lifting for irradiation

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