C&T Active Treatment

• Active Treatment:

  • passive techniques only have limited and short term effect
  • its essential active treatment is through the form of task modification and exercises are tailored to the pts requirements inline with their SIN, impairments and tissue healing
  • can break exercises into categories:
  • "exercise to" improve mobility
  • improve strength
  • improve endurance
  • improve skill, timing and control
  • improve awareness
  • directed at nerve tissue
• Active Treatment - C&T Spine

  • exercises to improve skill, timing and control:
  • cranio-cervical flexors
  • starts position is same as assessment
  • progress to functional positions standing (or reduce height of pillows if in supine) + arm lift + weight
  • cervicothoracic extensors
  • position and instructions is same as assessment
  • bird-dog
  • on all 4's in line with shoulder, and knees in line with hips at 90 degrees
  • lift up 1 arm, progress to 1 arm and leg
  • works on static stability/control and is non-functional, unless function requires this position
• • AIM FOR 3 SETS OF 30 SECONDS AS A MIDPOINT FOR HOLDS
  • PROGRESS TO 1 MINUTE
  • REGRESS TO 15 SECONDS
• Active Treatment - C&T Spine

  • Exercises to improve mobility - Rotation:
  • supine: gentle rotation with bent knees side to side
  • perform with end range holds or purely static of as repetitions ROM - useful for higher SIN
  • side lying thoracic rotation (open book) - nonfunctional
  • side lying, hip and knees at 90 degrees, rotate trunk with arm following
  • add upper limb movements with abduction and elevation to add thoracic extension + lengthening to the pecs - good for high and low SIN
  • seated thoracic rotation: good functional ROM exercise - add in external equipment (e.g. broom) to over press
• Active Treatment - C&T Spine

  • Exercises to improve mobility - Rotation:
  • cervical rotation:
  • seated, rotate neck, apply overpressure with hand to increase rotation range
  • can use towel to further over press
  • archer
  • standing, arms out in front at 90 degrees. with one arm pull imaginary bow backwards, keeping head and other arm forwards
  • wall rotation stretch
  • stand against wall, arm closest to wall reach backwards, other arm reaches forward
  • keep hips facing forward, take a deep breath in and reach further forward and back
• Active Treatment - C&T Spine

  • Exercises to improve mobility - Extension:
  • baby cobra/crocodile - nonfunctional
  • prone, shoulders flexed to 90 degrees, pushing through forearm lift up chest and hold
  • full cobra - nonfunctional
  • prone, shoulders at 90 degrees, push up through arms, elbows at near full extension, liftin chest and extending thoracic spine
  • childs pose - nonfunctional 4 point kneeling, sit back onto heels, keep hands at the starting positioning
• Active Treatment - C&T Spine

  • Exercises to improve mobility - Extension:
  • wall stretch
  • back against the wall with feet slightly forward
  • add in cervical retraction to targert cervicothoracic junction
  • progress further by adding shoulders externally rotated with forearms against the wall
  • abduct more than 90 degrees to increase stretch
  • door stretch
  • stand in doorframe with target side upper limb shoulder abducted to 90 degrees, elbow at 90 degrees
  • anterior surface of forearm and hand on the doorframe
  • now step through into step stance/lunge position
• Active Treatment - C&T Spine

  • Exercises to improve mobility - Lateral flexion:
  • seated lateral flexion
  • hands behind head, lateral flex through thoracic spine and hold, can add rotation
  • cervical lateral flexion
  • seated, target side hand placed under ischial tuberosity
  • contralateral ear to contralateral shoulder
  • apply overpressure and deep breath to increase stretch
• Active Treatment - C&T Spine

  • Exercises to improve mobility - Lateral flexion:
  • mermaids
  • seated, place one hand with elbow extended by your side next to greater trochanter on bed
  • other arm reaches up into full flexion then across body to created side flexion towards stationary arm
  • aim is to increase mobility and stretch contralateral side that the lateral flexion is occurring towards
  • door frame thoracic side flexion stretch
  • holding onto doorframe or wall, step away to the side, transfer body weight away from your hands to help create the thoracic lateral flexion
• Active Treatment - C&T Spine

  • Exercises to improve mobility - Flexion:
  • not usually limited into this movement
  • seated:
  • hands on thighs and run them down the legs until you can touch the floor
  • progress by placing palms on floor
• Active Treatment - C&T Spine

  • Exercises to improve strength & endurance:
  • 4 point kneeling thoracic rotation (elephants) - non-functional
  • on all 4's, knees and hips at 90 degrees, hands in line with shoulders
  • lift one hand off the ground and rotate the thoracic spine that direction. Maintain weight distribution at the hips, tendency to side flex to the opposite side to assist with rotation
  • can add weight to progress
  • 2 point kneeling active thoracic rotation - functional
  • add resistance band or cable weight to increase difficulty
• Active Treatment - C&T Spine

  • Exercises to improve strength & endurance:
  • rows - functional
  • seated or standing, elbow at 90 degrees, pull theraband or cable back until just past midline of body
  • progress: bent over row, stand by side of plinth or table
  • place the side closest to plinth hand with elbow in full extension onto plinth to help stabilise and allow bent over position
  • with other arm perform the row action, add resistance to increase difficulty
  • overhead lifts progress to overhead squad
  • lift weight overhead until elbow in full extension
  • progress: make it functional - adding squat
• Active Treatment - C&T Spine

  • Exercises to improve strength & endurance:
  • standing wood chip and wood chop lift - dynamic whole body
  • stand feet wider than hips
  • place weight or resistance band by one side, reach down and rotate to pick up
  • grab then extend and rotate to opposite side with shoulders finishing at 90 degrees with elbows completely extended
  • can be progressed by adding a lift into more elevation or adding in more resistance
  • can add in speed element
• Active Treatment - C&T Spine

  • Exercises to improve strength & endurance:
  • lunge with thoracic rotation - functional high level
  • lunge forward and rest forearm of leg forward onto thigh, other side rotates and reaches up. Add weights or resistance hand to progress further
• Active Treatment - C&T Spine

  • Exercises to improve awareness
  • theres no ideal posture
  • useful in pts who move all or nothing
  • relate advice, education and prompts based on the pts presenting condition and impairments
  • encourages dissociation
• Active Treatment - C&T Spine

  • Exercises to target neural tissue (watch video to see how to do them)
  • median nerve
  • radial nerve
  • ulna nerve
  • sliders
  • tensioners (progression of sliders, by adding contralateral lateral flexion)