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Improving Low Trap Strength With Manipulation

9/19/2015

1 Comment

 
Picture
As my clinical knowledge and understanding of the nervous system continues to develop, I am finding that "muscle strength" is a relative term. In a previous post, Chris discussed how performing repeated movements can immediately improve an individuals strength. Similar to repeated movements, joint manipulation has shown similar results clinically. The exact mechanism by which a manipulation works is unknown. The most recent evidence suggests that it is multi-factorial. 

Some proposed effects of manipulation include: 
1) Mechanical- breaking up intra-articular lesions
2) Neurological- "resets" nocioceptive pathways and mechanoreceptors 
3) Hydraulic- changes in synovial fluid viscosity
4) Relaxation- alter muscle tonicity & restore blood flow
5) Psychological- both laying hands on the patient & hearing a "pop" are strong influences 

A clinical example you can test tomorrow is assessing lower trapezius strength, then performing different manipulations, and reassessing the strength after each manipulation. The three manipulations I recommend performing are a supine thoracic manipulation, a CT junction manipulation, and C3-C4 manipulation. I want to note that restrictions may not always be found in these regions. Remember: neurophysiological effects can have a profound impact on pain and function. 

Why Perform These 3 Manipulations?
Supine Thoracic Manipulation
Manipulating the thoracic spine has shown to change sympathetic nervous system activation. Additionally, due to the muscle insertion of the lower trap, manipulating the lower thoracic spine should have direct mechanical effects.
CT Junction Manipulation
Manipulating the CT Junction can have mechanical and relaxation effects on the lower trapezius muscle. Many people rest in a forward head posture which allows the CTJ to become hypomobile. Since the trapezius runs from the occiput to T12, the muscle is placed on extra tension across the CTJ.
C3-C4 Manipulation
The trapezius muscle is innervated by the spinal accessory nerve & cervical spinal nerves 3 and 4. Manipulating C3-C4 can change the tonicity of the trapezius muscle, allowing for better muscle firing. 
Like this post? Check out our insider access page to see more clinical reasoning similar to this! 
1 Comment
Beau link
9/29/2015 09:39:38 pm

impressed with your thought process. Better than most chiro's I know. But your extremely close segmentally, you're missing the big picture of supra segmental activation and interpose nucleus activation along with somatosensory activation. These guys will give you the long term response. That's why some get better then some get worse or no change at all.

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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
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    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test