Wednesday 7 November 2007
Scapulothorasic posture
I have a pt, a 22 year old boy post with a TBI post MVA, with decreased truncal tone, ataxia and decreased segmental control of lumbopelvic movement among many other things. He remains in PTA and is unable to remember from one Rx session to the next. He also has marked bilateral scapular winging, thoracic stiffness and tight lats, pecs and teres. We had been focusing on his lumbopelvic mobility, increasing AP tilt and facilitating pelvic tilt within functional movement including gait and sit to stand. We have had some success in increasing his AP tilt and Lx mobility but this didn’t transfer into functional movement. Our supervisor assessed the pt with us today and suggested that working on his thoracic stability and posture and scapulothorasic posture may actually be more beneficial. We did some thoracic mobs, PNF style scapular strengthening, muscular releases and postural retraining with lateral thoracic support. I was quite surprised that this actually made a much bigger difference to sit to stand and walking ability. Our supervisor explained it that the pelvis and lumbar spine need a stable base of the scapulae and thorax to work off. Not really life-changing I know but I just thought this was interesting because I have always thought to work from the bottom up with the trunk and this was just another way to look at things.
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2 comments:
That is really interesting because the principle of working from the bottom up has been really enforced, especially when I was doing my neuro prac. But it is good to know that there are other options if that one doesn't work. Thanks for sharing that info Ali, I'm sure we'll find it useful!
I have had similar success on my neuro prac (see July post - Central Key Point). Especially once the supervisor showed us some Bo Bath techniques of Central Key Point. Not only did we find this helpful for balance, it also seemed to increase our patients O2 Sats! This doest only apply to neuro however. As in the 'Impingement' post, I have also found success in the treatment of many conditions of the neck and shoulder through the use of thoracic mobility and stability. Once again as you said, it makes sense that the head and shoulders need a stable base to work from which to work well.
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