John Christopher Examen, BSPT4

 Initial position (IP) which precedes any body

motion
 Execution (E) which consists of a series of
successive counts
 Final Position (FP) which is the position at the
end of the exercise
 Rest (R) for the recovery of energy spent for the
first 3 steps
 Return to initial position (RSP) necessary to
begin the exercises again (repetition)
 SEGMENTAL which immobilizes one or more
several joints without actual motion of the
whole body, and since they are done in place,
may be performed in a relatively small area and
even in the home of the patient.
 GENERAL AMBULATION in the course of which
the subject moves his entire body in different
directions and consequently requires a more or
less large space such as a gymnasium or stadium
 DORSAL RECLINING
 ABDOMINAL RECLINING
 HORIZONTAL QUADRUPED
 Position of reduction
 Easiest to take but often hard to teach in a
patient with an old functional scoliosis
 Begin by attempting an execution and
reception of trunk hypertension
 Example 1
 IP: Head, neck, trunk and LE in straight line with
feet in PF, arms oblique toward the feet, palms
facing the ceiling
 E: Arch the back, touching the floor with the nape
of the neck and the sacrum
 FP: Maintain for 5-10 SH at the beginning, rest,
then return to IP then begin again and repeat for
10 reps.
 Example 2
 To produce longitudinal stretching of the spine
 IE: arms overhead and parallel, with the head,
neck, trunk and LE between them in a straight line
 E: simultaneously push both arms above the head,
with forced dorsal flexion of feet
 FP: maintain for 6-8 SH, rest, return to IP begin
again and repeat for 10 reps
a. Have the patient try to place all body segments
in a straight line with symmetry of the UE, first
with eyes open then with eyes closed.
b. Emphasis on relaxation is a must
c. Static stiffening without losing the position or
symmetry of the segments.
d. Progressive, actual mobilization of all distal
parts, then the proximal segments of the
extremities
e. Static progressive effort to straighten the spine
 Exercises #1
 IP:Head and neck in straight line, forehead
supported on hands placed on one another, trunk
and LE in straight line.
 E:Raise Slowly and alternately each LE,
maintaining rigid exercises
 FP: Rest, repeat for 10 reps. Then progress will
vary with the height and number of successive
elevations..
 Exercise #2
 IP: Same as #1
 E:Raise both LE together in stiff extension to a
predetermined height
 FP: The duration will be variable and progressive for 8
S. Rest then return to IP and repeat 10 times.
Progression is done by varying the height of elevation,
duration of FP, increasing the number of reps.
We can also graduate the progression by executing all
movements several times without rest in between.This
consists of a continuous cycle in successive elevations, the
number of which will vary with the progress and strength of
the patient.
 Exercise #3
 IP: same as exercises #1
 E: first raise both LE together in extension
 raise and lower each LE alternately in still
extension (similar to alternate motions of the legs
in swimming crawl)
 Execute in slow cadence 10 times, rest then begin
again. Progression is similar to the preceding
exercises.
 Exercise #1
 IP: same. First, extension of dorsal spine without
extension of the neck. Second, with arms
obliquely down, simultaneously lift both UE and
LE in stiff extension.
 FP: maintain the position for 8 SH. Rest, the
repeat for 10 times.
 In this exercise, the progression of static work of
the dorsal extensors is governed by varying the
position.
 The higher the UE are raised, the more effect is required.
Progression will result from starting successively as indicated:
a. Oblique and down
b. Elbows bent
c. Hands on shoulders
d. Arms at right angle
e. Hands on the nape of the neck
f. Arms Crossed
g. Arms oblique and overhead
h. Arms vertical and parallel
 We may also obtain a good progression from the preceding
exercises by adding movement of the legs in association with
those of the arms.
 Crossed Stretching
 IP: Abdominal Reclining, LE in a straight line, hands
under the forehead.
 E: 1. Simultaneously raise the head, the left arm
oblique and above, and the right leg in extension.
2. Return to same position
3. In the same manner, simultaneously raise the R
arm and the L leg
4. Return to starting position
5. Rest and repeat for 10 times.
 IP: Abdominal Reclining, LE in a straight line,
hands under the forehead
 E: The beginner in this exercises proceeds:
1. The movements of the arms in three counts
beginning from the IP
2. The movements of the legs in 3 counts again
from the starting position – hands under the
forehead, knees flexed.
3. The synchronization of the two groups of
movements again in 3 counts.
 Patient gets on his knees and places his
hands on the ground with fingers facing
forward
 The position is correct when the arms and
thighs are parallel to each other and
perpendicular to the ground
 This position temporarily reduces the
scoliosis posture as confirmed by radiologic
examinations
 IP: Horizontally Quadruped
 E: Hollow back by raising the head
 FP: Maintain the lordotic quadruped posture
for 6-8 SH. Return to IP, repeat 10 reps before
rest.
 IP: same
 E: Pull in abdomen or raise the back by
lowering the head
 FP: maintain the kyphotic for 6-8 SH. Return
to IP, repeat 10 reps before rest.
 IP: same
 E: pass slowly from the lordotic posture to
the kyphotic position several times always
keeping the spinal axis in a straight line and
without changing the parallel relationship of
the extremities.
 FP: Rest, then begin again with the
progression by increasing the number of to
and fro motion.
 Alternate Crossed Equilibrium
 IP: same
 E: Slowly and simultaneously raise the R arm
obliquely over the head and the L in extension;
stretch with both extremities to elongate the
back.
 FP: maintain in this position for 6-8 SH. This
attempts to maintain equilibrium by exercising
all the dorsal muscles.
 Return to IP without stopping and continue the
same exercise with the opposite extremities.
Repeat for 10 times.
 IP: same but with feet hooked under the lowest
bar of stall bars or held by PT
 E: remove hands from the floor and place them
oblique and back
 FP: Maintain the position for 6-8 SH, rest and
begin for 10 times. The progression is made by
increasing SH and reps, or by following the arm
placements.
 Each of these FP require increasing force of the
spinal extensors to maintain the trunk parallel to
the floor.
 IE: same with exercise #5 with hands oblique
and back
 E: bend trunk laterally to right then left.
Maintain nape of the neck, shoulders and
back must be in the same horizontal plane.
 FP: maintain for 6-8 SH, repeat for 10 reps.
May vary arms placements as above to obtain
progression of effort of lateral trunk flexors.
 Lower Quadruped
 This leads to a lowered quadruped position,
stretching the spinal column
 IP: horizontal quadruped
 E: bend elbows bringing the chest to the floor
 FP: maintain the 6-8 SH, 10 reps.
 Raised Quadruped
 IP: Horizontal quadruped
 E: Raise trunk with arms oblique and down,
palms facing forward PT may hold feet
 FP: maintain for 6-8 SH, repeat for 10 reps.
 IP: lowered quadruped
 E: laterally flex trunk to the right an left
 Presented in the form of games or athletic
movements or in motion of sports, useful
exercises, dances, rhythmic exercises or any
other kind of body motion, more or less
artificially conceived with a determined goal.
 Volleyball, deck tennis, basketball for trunk
extension
 Avoid twisting and bending activities and
asymmetrical games such as tennis, shooting
and golf.
 The functional form of scoliosis react
favorably to the therapeutic exercises in
about 90% of the cases. But in order to
obtain, such, 2 conditions are necessary:
1. That the choice of exercises will ensure real
progression
2. That training can continue without interruption
 Should be given segmental, unilateral or
asymmetrical and always ending with
corrective FP
 These have been designed in relation to the
site, direction and number of pathologic
curves.
 Their use depend on individual indications
and contraindications and will require
cooperation between the physician and
therapist
 Sometimes, the curve will not progress. On the
other hand, progress may force additional
prescription of apparatus (day or night, permanent
or movable) or the eventual possibility of surgery.
 Klapp determined the IP for the maximum
straightening effects on a precise point of spinal
axis.
 He showed that when lateral flexion of the spine
and the previous direction of the plane of the back
with the respect of the ground as follows:
 T3 – Lowered
 T6 – Semi-lowered
 T8 – Quadruped
 T11 – Semi Erect
 L2 – Erect
 L4 – Reverse Erect
 There are 2 exercise techniques of quadruped
ambulation:
1. Crossed Walking/ Ordinary quadruped
walking.
2. Ambling Walk
 May be executed in the lordotic, kypotic or in
neutral position.
 Start with one of the 6 basic position of Klapp
depending in the level
 Avoid direction of pathologic curve
 Crossed Walk
 RUE forward → LLE forward → LUE forward → RLE
forward
 Move entire body forward in rhythmic manner
 For C curves
 Ambling Walk
 RUE forward → RLE forward → LUE forward → LLE
forward
 For S curves
 Indication: Scoliosis
 Techniques Components:
 Elongation
 Derotation
 Lateral Flexion
 Standing position depends on the apex of the
curve:
 L4 – Erect/upright posture
 L2 – Semi-leaning
 T11 – Semi straight
 T8 – Quadruped
 T6 – semi fowler quadruped
 T3 – lower quadruped
 T1 – kissing the floor
 Procedures
1. Stabilize the patient at the pelvis (PT at the back)
2. Ask the patient to stretch the arm and flex his trunk
forward to elongate the trunk
3. Ask the patient to rotate, and laterally flex his trunk
against the curve
4. At the limit of that range, hold 5 secs
5. Relax
6. Back at the starting position
7. Repeat the exercises
 Cotrel’s exercises has been used in conjunction with
Cotrel’s Traction prior to spinal fusion to minimize
the curve.
 RATIONALE: by increasing the flexibility of the
trunk with exercise prior to surgery, the best
possible correction at the time of surgery can be
achieved
 GOAL: increase the mobility of the structures of the
spine that have become tight because of the spinal
curvature
 The exercise is performed several times during the
day while the px is out of traction