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

http://www.pasadenapt.com/

loc@pasadenapt.com

"Buy-In" for the Tripod Foot Position

After being exposed to the Movement LinksⓇ  approach to the tripod foot position, I began applying it in the clinic to patients who would benefit from getting better foot centration and stability  during their home exercise program (HEP), as well as in their daily activities.

As with all programming, some patients will readily accept anything you say while others might be more hesitant.  This blogpost serves to give you some strategies that I have found helpful with the latter population.

After introducing and setting up the patient for the foot tripod position (see video below), here are some options that reinforce its functionality to get the buy-in so that the patient is more likely to carry over the training at home.

Tripod Foot Training

Standing Isometric Contractions

The patient begins in standing, I then ask for a near maximal quadriceps contraction, and direct the patient’s attention to the quality and intensity of the contraction.  After ensuring a good foot tripod, I will ask for a second maximal quadriceps contraction, and ask if there's a difference.

I will repeat the position, but this time with gluteal activation.

Step Up

The patient will perform a 12" step-up, both with and without the tripod in place.  I will direct the patient to compare the effort it takes and the power perceived in the legs between the step up with and without the tripod position of the foot.

Half-Lunge

The patient performs a forward lunge, with attention to the lead knee and thigh.  Should the movement result in a dynamic valgus (excessive pronation leading to tibial internal rotation distally concurrent with hip adduction and internal rotation proximally), cue the foot into a tripod position.  This centration tripod position should mitigate this dynamic valgus significantly.

I won't necessarily use all three strategies.  I will pick and choose based on what the patient has issues with and what I think will get the most buy-in.

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

http://www.pasadenapt.com/

loc@pasadenapt.com