Over the last few months, I have incorporated repeated motions into my exams and treatments more and more frequently. In fact, I probably prefer using these techniques prior to my manual treatments. More often than not; however, they are used in conjunction. Repeated motions are an excellent way to sustain any changes you might get with your manual treatments.
The key to repeated motions is getting to end-range. With lumbar complaints, the majority of the time the patients will respond to repeated extension, either bilaterally or unilaterally. Typically, unilateral complaints respond to repeated sideglides (extension on involved side) and bilateral complaints respond to lumbar extension. There are a couple different ways to get to end-range: in a loaded position and an unloaded position. For extension, the options are standing lumbar extension and prone press-ups. In the past, the reason why I would choose loaded versus unloaded repeated motions was patient irritability. If a patient was unable to complete the loaded repeated motion due to irritability, an unloaded motion may be permitted as the tissues aren't as sensitive.
Recently, I discovered another reason for switching to prone press-ups versus standing extensions. I had several patients that had reduction in symptoms with repeated standing extensions, but their symptom reduction plateaued. Upon examination of their technique with the backwards bending, I realized they were unable to get to end-range as the majority of motion was coming from the hips, even when using a table to block the thighs. I then reassessed the repeated motions with prone press-ups and the patients had significantly greater range and reduction in symptoms with the press-ups. This is a perfect example of a motor control issue that limits end-range. It can also be useful for patients with unilateral losses of extension. By shifting the shoulders to the involved side, prone press-ups can bias the side that has a loss of loading. If you find your patient's plateauing with upright repeated motions, try switching to a position that isolates the motion and allows end-range to be reached.
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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