Thursday, January 25, 2018

Spinal Wave and Developmental Prone 3 Month Position

The developmental prone 3 month position may be used both in the assessment and intervention phases of the client interaction. The information gleaned from this position is rooted in principles of developmental kinesiology. The client is placed in prone with arms overhead and forming a 90 degree angle between the trunk and arm. The client is asked to lift her head, extending the spine slightly. The movement pattern is observed. The clinician assesses for ideal co-activation between the spinal muscles, axioscapular muscles, and the activation of the latero-dorsal abdominal wall. In an ideal pattern, the clinician should see spine extension initiated from T4 and well-balanced activation between the back muscles and the lateral abdominal muscles. 

Common movement and activation faults include:
-       Spinal segmental mobility: areas of hypermobility including cervical spine, thoracolumbar and lumbar spine vs areas of hypomobility including upper/mid/lower thoracic spine
-       Imbalance/in-coordination in muscle activation
o   Hyperactivation of: cervical extensors, accessory muscles of respiration, upper scapular fixators (upper traps, levator scapulae), thoracolumbar extensors
o   Insufficient activation of deep cervical flexors, lower scapular fixators, laterodorsal aspect of abdominal wall

When using the developmental prone 3-month position as a training position, one of the challenges is the patient’s ability, or inability, to find and control specific segments in their spine. 

Prone Developmental 3-month position: Pre-Intervention

Various rehabilitative and fitness approaches utilize concepts surrounding motor control of spinal segmental mobility.  The Spinal Wave is an assessment and exercise that is taught during the Functional Conditioning Range (FRC) seminar.  One of the mantras of FRC is “joint independence before joint interdependence” and the Spinal Wave allows the clinician to assess and train spinal joint independence in their patient. 

In this video I am taking my client through the Spinal Wave as a way to train segmental spine mobility.

Segmental Spinal mobility assessment from quadruped (Spinal Wave)

The Spinal Wave can be modified or biased to change the emphasis.

 Options include:
Out of quadruped, the client can rock back onto his heels to lock out his L/S and focus on segmenting through the lower thoracic spine up through the cervical spine.  

Segmental spinal mobility (Spinal Wave) training with lumbar spine locked

Prone Developmental 3 month position: Post-Intervention

Alternatively, the patient can go into a supported (hands behind neck) “rabbit pose” to lock out the cervical and thoracic regions and thereby focus on the lumbar spine.

Most patients are better able to start the spinal wave from the pelvis and work cephalad vs. at the occipito-atlantal articulation and working caudally.  The clinician can use the latter as a progression of the Spinal Wave.

Try this with the patients that you’re having a hard time getting them to be completely neutral during the developmental prone 3 month position, and I think you’ll find that it will become one of your primers to quality activation in this position.

Blogpost by Locatelli Rao, DPT, OCS
Movement Links Certified Clinician
Pasadena Physical Therapy