Chapter 6 Upper body, stretching and overall joint mobilization exercises
The pectoral girdle is the most mobile set of articulating surfaces in the body allowing, with respect to the trunk, approximately 180 degrees of shoulder flexion, abduction and rotation, and 90 degrees of shoulder extension. However, this mobility is to some degree at the expense of shoulder stability, which is nevertheless essential for providing a firm base for upper limb movement and weight bearing.
As discussed in Chapter 1, poor pectoral girdle alignment and its consequences are both associated with postural faults, and they must always be con-sidered together when dealing with defective pectoral girdle function.
BASIC UPPER BODY EXERCISES
Supine pectoral girdle mobilization (Exercises UBE1–5)
| UBE1 | Shoulders forwards and back |
| UBE2 | Shoulder shrugs |
| UBE3 | Bilateral arm arcs |
| UBE4 | Chest opener |
| UBE5 | Arm arcs with arms in opposition, arm arcs with half circles, arm circles |
Sitting spine and pectoral girdle mobilization (Exercises UBE8–10)
| UBE8 | Spine twist |
| UBE9 | Side bending |
| UBE10 | Spine curls |
STRETCHING, JOINT MOBILIZATION AND EXERCISES TO IMPROVE FOOT ALIGNMENT, MOBILITY AND STRENGTH
Improving foot alignment, mobility and strength (Exercises FM1–3)
| FM1 | Exercising the forefoot |
| FM2 | Ankle mobilization |
| FM3 | Exercising the lower limb and foot |
Stretching the posterior hip and lower limb (Exercises ST1–18)
| ST1 | Calf muscle stretch |
| ST2 | Hamstring muscle stretch |
| ST3 | Tensor fasciae latae stretch |
| ST4 | Gluteal and hamstring stretch |
| ST5 | Iliopsoas stretch |
| ST6 | Quadriceps stretch |
| ST7 | Adductor stretch |
| ST8 | Supine back stretch |
| ST9 | Spine stretch |
| ST10 | Neck stretch |
| ST11 | Neck, shoulder and upper back stretch |
| ST12 | Sitting back stretch |
| ST13 | Prone back stretch |
| ST14 | Standing back stretch |
| ST15 | Spine roll down and up |
| ST16 | Spine curl |
| ST17 | Hip rolls with stretch |
| ST18 | Front of chest stretch |
SUPINE PECTORAL GIRDLE MOBILIZATION (EXERCISES UBE1–5)
Exercise UBE1 – Shoulders forwards and back (scapular protraction and retraction)
Target muscles
For shoulder flexion – pectoralis major (up to 60 degrees then the deltoid takes over), coracobrachialis and the anterior fibres of the deltoid.
For scapular protraction (abduction) – serratus anterior acting to draw the scapula forwards and downwards over the underlying ribcage; pectoralis minor helps to produce medial rotation of the scapula against resistance, thereby drawing its upper lateral border downwards onto the ribcage.
For scapular retraction (adduction) – the middle fibres of trapezius acting to draw the medial border of the scapula towards the spine, the rhomboids acting to draw the scapulae towards each other.
For scapular stability – all three parts of trapezius acting together to pull each scapula towards the midline, assisted by the rhomboids, latissimus dorsi and teres major.
Body position
Supine, the legs hip distance apart with approximately 90 degrees of hip/knee flexion. The shoulders are flexed approximately 90 degrees with the fingers reaching for the ceiling and the palms of the hands facing each other. The scapulae are drawn gently downwards over the lower ribs and the anterior chest muscles are released, allowing the shoulders to drop back to the floor (Fig. 6.1).
Action
Breathing out – gently activate the pelvic floor and lower abdominal muscles to stabilize the lumbar spine.
Breathing in – maintaining breadth across the front of the chest, protract the pectoral girdle, allowing the scapulae to abduct and glide forwards around the ribcage.
Breathing out – adduct the scapulae and glide them back to their starting position, allowing the shoulders to release back to the floor.
Common problems
Upper body/neck tension: Ensure sufficient head and neck support for correct alignment and comfort. On the exhalation, cue for the neck muscles to release, the thoracic cage to relax and monitor abdominal muscle control over lumbar spine stability.
Note: if there is impaired scapular alignment and mobility associated with postural faults (e.g. exaggerated thoracic kyphosis), consider:
Table 6.1 Teaching points – Shoulders forwards and back
| Focus on | Examples of verbal/visual cues |
|---|---|
| Relaxation of the neck and upper body | |
| Vertebral column length | Reach the crown of the head and the sitting bones away from each other |
| Correct resting scapular alignment | |
| Length through the arms as they reach for the ceiling | |
| Maintaining a stable lumbar spine | |
| Scapular mobility during protraction | Imagine the shoulder blades gliding forwards around the ribcage |
| Scapular mobility during retraction | Imagine the shoulder blades gliding around and hugging the ribcage as they move back and down to rest on the floor |
| Lower limb stability | Imagine the knees are suspended from the ceiling by strings |
Precautions
Neck and shoulder pathology – provide sufficient support for comfort; monitor to ensure that the range of movement is appropriate and pain free; seek medical/physiotherapy advice if unsure.
Contraindications
1. To cue transversus abdominis muscle activation – before exercising, instruct the student to place the fingers on the lower part of the anterior abdominal wall just above the pubic bone to feel the area tightening as the pelvic floor and lower abdominal muscles contract. Then instruct the student to place the hands around the waist to feel that the oblique abdominal muscles remain comparatively relaxed as the lower abdominal muscles are activated.
2. To correct the relationship between the upper and lower torso – before exercising, instruct the student to place the thumbs over the lowest floating ribs and the little fingers over the ASIS to feel the space between these two landmarks. Explain that this space should be maintained as the pectoral girdle muscles are activated and the upper limbs move. The teacher may use the hands to direct the ribs in and down towards the pelvis.
Exercise UBE2 – Shoulder shrugs (scapular elevation and depression)
Target muscles
For scapular depression – lower fibres of trapezius acting to pull the medial border of the scapula downwards; the lower fibres of serratus anterior acting to draw the lower, lateral border of the scapula downwards and forwards; pectoralis minor acting to pull the upper part of the scapula downwards onto the ribcage.
For scapular stability – all three parts of trapezius acting together to pull each scapula towards the midline, assisted by the rhomboids, latissimus dorsi and teres major.
Body position
Supine, the legs hip distance apart with approximately 90 degrees of hip/knee flexion. The arms rest beside the body with the palms facing the floor. The scapulae are drawn gently downwards over the lower ribs and the anterior chest muscles are released, allowing the shoulders to drop back to the floor (Fig. 6.2A).
Action
Breathing out – gently activate the pelvic floor and lower abdominal muscles to stabilize the lumbar spine.
Breathing in – maintaining the anterior chest muscle release so that the backs of the shoulders still make contact with the floor, raise the shoulders towards the ears (Fig. 6.2B).
Breathing out – release the shoulders and allow the scapulae to glide down the back to the starting position (Fig. 6.2C).
Breathing in – maintaining the anterior chest muscle release, lightly press the little fingers into the floor and depress the shoulders. Reach the hands for the heels and allow the scapulae to slide over the floor as they draw down towards the centre of the back.
Breathing out – release shoulder depression and allow the scapulae to glide back to their starting position.
Common problems
Upper body/neck tension: Provide sufficient head/neck support for correct alignment and comfort. On the exhalation, cue for the neck muscles to release, the thoracic cage to relax and monitor abdominal muscle control over the lumbar spine stability.
Table 6.2 Teaching points – Scapula elevation and depression
| Focus on | Examples of verbal/visual cues |
|---|---|
| Relaxation of the neck and upper body | |
| Breadth across the front of the torso | Broaden across the collarbones and allow the shoulders to drop back to the floor. Maintain this contact throughout |
| Spine elongation | Lengthen from the crown of the head through to the sitting bones |
| Length through the arms with the shoulders dropping back towards the floor | Imagine the arms begin where the breastbone and collarbones join before reaching the fingers for the toes |
| Maintaining a stable lumbar spine | |
| Scapular mobility during elevation | Imagine the outer tips of the shoulders touching the posterior portion of the ear lobes |
| Scapular mobility during depression | Imagine the shoulder blades as skis gliding down and across the back to the opposite sides |
| Lower limb stability | Imagine the knees are suspended from the ceiling by strings |
Precautions
Neck and shoulder pathology – provide sufficient support for comfort; monitor to ensure that the range of movement is appropriate and pain free; seek medical/physiotherapy advice if unsure.
Contraindications
1. To cue transversus abdominis muscle activation – before exercising, instruct the student to place the fingers on the lower part of the anterior abdominal wall just above the pubic bone to feel the area tightening as the pelvic floor and lower abdominal muscles contract. Then instruct the student to place the hands around the waist to feel that the oblique abdominal muscles remain comparatively relaxed as the lower abdominal muscles are activated.
2. To correct the relationship between the upper and lower torso – before exercising, instruct the student to place the thumbs over the lowest floating ribs and the little fingers over the ASIS to feel the space between these two landmarks. Explain that this space should be maintained as the pectoral girdle muscles are activated and the upper limbs move. Use the hands to direct the lower ribs in and down towards the pelvis.
Exercise UBE3 – Bilateral arm arcs (shoulder joint flexion)
Target muscles
For shoulder flexion – pectoralis major (up to 60 degrees then the deltoid takes over), coracobrachialis and the anterior fibres of the deltoid.
For scapular stability – all three parts of trapezius acting together to pull each scapula towards the midline, assisted by the rhomboids, latissimus dorsi and teres major.
Body position
Supine, the legs hip distance apart with approximately 90 degrees of hip/knee flexion. The glenohumeral joints are medially rotated and flexed approximately 90 degrees. The elbows are slightly flexed and the hands are approximately shoulder width apart holding a small gym ball or magic circle above the sternum. The anterior chest muscles are released, allowing the shoulders and upper back to release back to the floor. The scapulae are drawn gently down across the back (Fig. 6.3A).
Action
Breathing out – gently activate the pelvic floor and lower abdominal muscles and allow the sternum to drop downwards with the passive spinal flexion that occurs during exhalation. Maintaining the upper back in contact with the floor, increase shoulder flexion to carry the hands over the head to the end range of independent shoulder joint flexion (Fig. 6.3B).
Breathing out – improve abdominal muscle engagement and begin gently extending the elbows, allowing the scapulae to abduct.
Breathing out – reverse the motion, allowing the scapulae and arms to return to the starting position.
Repeat three to five times and build to 10 repetitions, aiming to increase the range of scapula motion with each repetition.
Progression 2
Common problems
Limited range of independent shoulder joint movement (observed by the occurrence of lumbar spine extension during shoulder joint flexion): Reduce the range of flexion by blocking the overhead motion of the arm with a stack of yoga blocks, a triangle or pillow placed near the head; cue to maintain the relationship between the lower ribs and the pelvis and for stronger pelvic floor and lower abdominal engagement.
Table 6.3 Teaching points – Bilateral arm arcs
| Focus on | Examples of verbal/visual cues |
|---|---|
| Relaxation of the neck and upper back | Imagine the body imprinting itself in warm sand |
| A correctly aligned and lengthened spine | |
| Maintaining a stable lumbar spine and the correct relationship between the upper torso and the pelvis throughout | |
| Breadth across the front and back of the torso | Broaden across the collarbones and the back of the chest |
| Length through the arms | Imagine the arms begin where the collarbones join the breastbone before reaching the arms away. As the arms lift, allow the arm bones to drop down into the shoulder joints and visualize the shoulder blades gliding down the back |
| Scapular depression at the end range of flexion | As the arms move to the ear, imagine the shoulder blades sliding down the back |
| Lower limb stability |
Precautions
Neck and shoulder pathology – provide sufficient support for comfort; monitor to ensure that the range of movement is appropriate and pain free; seek medical/physiotherapy advice if unsure.
Contraindications
1. To cue transversus abdominis muscle activation – before exercising, instruct the student to place the fingers on the lower part of the anterior abdominal wall just above the pubic bone to feel the area tightening as the pelvic floor and lower abdominal muscles contract. Then instruct the student to place the hands around the waist to feel that the oblique abdominal muscles remain comparatively relaxed as the lower abdominal muscles are activated.
2. To correct the relationship between the upper and lower torso – before exercising, instruct the student to place the thumbs over the lowest floating ribs and the little fingers over the ASIS to feel the space between these two landmarks. Explain that this space should be maintained as the pectoral girdle muscles are activated and the upper limbs move. Use the hands to direct the lower ribs in and down towards the pelvis.
3. To improve scapular stability – before exercising, instruct the student to flex the right shoulder approximately 90 degrees so that the right arm is raised, with the elbow softly bent. The teacher’s left hand should be placed over the right scapula to hold and stabilize it (the thumb forward in the armpit and the fingers on the back just below the spine of the scapula). The right hand is placed over the shoulder with the fingers just medial to the acromion process. As the right shoulder increases flexion, the hands are used firmly to assist scapula depression (Fig. 6.3C).
Exercise UBE4 – Chest opener (shoulder joint flexion, abduction and adduction)
Target muscles
For shoulder abduction – the deltoid and supraspinatus, assisted by infraspinatus and the long head of biceps.
For shoulder adduction – pectoralis major, latissimus dorsi and teres major, assisted by teres minor, short head of biceps and coracobrachialis.
For scapular stability – all three parts of trapezius acting together to pull each scapula towards the midline, assisted by the rhomboids, latissimus dorsi and teres major.
Body position
Supine with the legs hip distance apart. The chest is open with breadth across the clavicles, the upper back is relaxed and the scapulae are drawing gently down the back. The glenohumeral joints are flexed to 90 degrees. The elbow joints are slightly flexed so that the arms create a rounded position as if hugging a large ball. The palms of the hands face toward the sternum with the fingers in a neutral position (Figs 6.4A&B).
Action
Breathing out – gently activate the pelvic floor and lower abdominal muscles to stabilize the lumbar spine. Maintaining elbow flexion, increase scapular stabilization before abducting the arms fully or until a stretch is felt across the front of the chest.
Breathing in – maintaining breadth across the clavicles and, with the upper back in contact with the floor, return the arms along the same pathway to the starting position.
Progression 3
Perform lying along a foam roller. Although this progression requires greater mental concentration and core control, the instability of the roller also increases pelvic floor and lower abdominal muscle action.
Common problems
Upper body/neck tension: Ensure sufficient head and neck support for correct alignment and comfort. On the exhalation, cue for the throat to soften, the thoracic cage to relax and for pectoral girdle stabilization.
Insufficient abdominal muscle control over lumbar spine stability: Consider raising the feet, performing the exercise with an imprinted lumbar spine throughout and cue for improved pelvic floor and lower abdominal muscle action.
Table 6.4 Teaching points – Chest opener
| Focus on | Examples of verbal/visual cues |
|---|---|
| Relaxation of the neck and upper body | |
| Vertebral column length | Reach the crown of the head and the sitting bones away from each other |
| Maintaining a stable lumbar spine | Imagine the pelvis as a bowl of water and the surface of the water is absolutely level and still |
| Breadth across the front and back of the torso | |
| Length through the arms | Imagine the arms begin where the collarbones join the breastbone as the arms curve as if around a large ball |
| Scapular stability throughout | |
| Lower limb stability |
Precautions
Neck and shoulder pathology – provide sufficient support for comfort; monitor to ensure that the range of movement is appropriate and pain free; seek medical advice if unsure.
Contraindications
1. To cue transversus abdominis muscle activation – before exercising, instruct the student to place the fingers on the lower part of the anterior abdominal wall just above the pubic bone to feel the area tightening as the pelvic floor and lower abdominal muscles contract. Then instruct the student to place the hands around the waist to feel that the oblique abdominal muscles remain comparatively relaxed as the lower abdominal muscles are activated.
2. To correct the relationship between the upper and lower torso – before exercising, instruct the student to place the thumbs over the lowest floating ribs and the little fingers over the ASIS to feel the space between these two landmarks. Explain that this space should be maintained as the pectoral girdle muscles are activated and the upper limbs move. Use the hands to direct the lower ribs in and down towards the pelvis.
