Just like I did in child's pose, I will ask for the patient's feedback. What feels uncomfortable? Any tightness? Pinching? This gives me further insight into asymmetries and the patient’s perception of pain or discomfort.
Here's an example. A patient comes into the clinic complaining of loss of strength and painful reaching in his R shoulder. Two months ago, he had an urgent care visit for arm pain due to misuse of crutches (unfortunately his gait training post-op Achilles surgery did not include instructions from a PT). First I had him start in a cobra pose. (Excuse the clutter in these pictures. This home visit occurred in a kid's playroom...real life folks!)
Here is what I see from this position:
Within 10-20 seconds the scapula winging and shoulder elevation escalated and he starting to experience a sensation of discomfort. While in this position, I inquired if he could perceive any changes in his shoulder position. He could not, so I gently placed my hands over his scapula to increased proprioceptive input. Immediately he commented that he could feel his scapula was not in the same place as on the L.
The misuse of crutches appears to have resulted in nerve damage. I have started him on a strengthening program for his scapula stabilizers.
If I had used traditional manual muscle tests, this patient would have been a 5/5 on every test. By using functional movements the deficit is more obvious and compensatory strategies can be monitored.
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Reference: Garner, G. 2001. Professional Yoga Therapy, Volume I. Professional Yoga Therapy Institute, Living Well, US.
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Dr. Christine Walker
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