PMC

Quadruped with tubing to facilitate core/scapular/pelvic stability.

Quadruped with tubing to facilitate scapular control/stability.

Side plank with lower extremity abduction.

(Left) Diagonal axes of rotation shown in supine, and beginning position for supine to prone rolling.

(Right) Diagonal axes of rotation shown in prone, and beginning position for prone to supine rolling.

Intermediate position for rolling supine to prone, leading with left upper extremity.

Intermediate position “Starfish 2” pattern. Patient will finish in the supine position with all four extremities slightly abducted.

Example mobility technique for upper thoracic rotation. Again, note pelvic position to ensure locking of lumbar segments.

Intermediate position “Starfish 1.” Patient will finish in the prone position with all four extremities extended and slightly abducted.

Intermediate position for rolling prone to supine, leading with right upper extremity, using manual contact on scapula for facilitation.

Intermediate position for rolling prone to supine, leading with right lower extremity, using manual contact to the pelvis for facilitation.

Intermediate position for rolling prone to supine, leading with left upper extremity, with therapist placed in visual field for cueing, also using auditory cueing by snapping fingers.

Example mobility technique for lower thoracic rotation, note pelvic position to ensure locking of lumbar segments. Therapist can use an interlocked arm to assist patient into rotation.

Assisted rolling supine to prone, left upper extremity led. Note the use of a half foam roll behind the trunk for assistance.

Sidelying hip abduction with core resistance. Note that tube is anchored to bottom lower extremity and also anchored at top of door height. During the exercise the trunk is held stabilized in sidelying while upper extremities perform the lift pattern.

Start position for “Starfish 2” pattern, used for training of prone to supine rolling, leading with the lower extremity. Tubing placed as described previously, the lead leg then is flexed, abducted, and externally rotated. The rolling movement is initiated by extending, adducting, and internally rotating the hip, while extending the knee. Note that the patient is concurrently elongating the opposite lower extremity (axis lower extremity) against the tubing.

Seated rotation test used to identify thoracolumbar rotational mobility. Begin in a seated position with knees and feet together, body upright and erect, arms crossed across the chest, while maintaining a gaze to the front. Ask patient to rotate the trunk to the right and to the left as far as possible. Examine for asymmetry by measuring with a goniometer. Normal is 30° bilaterally.

Start position for “Starfish 1” pattern, used for training of supine to prone rolling, leading with the lower extremity. Note tubing loops have been placed around both feet; with the length of the band around both upper extremities. To start, the lead hip is flexed, abducted, and slightly internally rotated while the knee is flexed. The rolling movement is initiated by extending, adducting, and externally rotating the hip while extending the knee. Note that the patient is concurrently elongating the opposite lower extremity (axis lower extremity) against the tubing.