Universidad de Chile Escuela de Kinesiología Asignatura de Kinesiología Klga. Giselle Horment L.

Guía para el alumno 2011.

EJERCICIOS DE REEDUCACION POSTURAL Y ESTABILIZACION CERVICAL

Trabajo Practico: 1. Practique con su compañero el entrenamiento postural para corregir una anteposición de cabeza (A) y una protacción escapular (B). Recuerde dar refuerzo verbal, táctil y visual.

2. Realice con su compañero la siguiente pauta de estabilización cervical. 2.1 Activación y entrenamiento de los flexores cervicales profundos. Pcte: supino Procedimiento: Enséñele al paciente a realizar flexión craneocervical y extensión axial suave, pidiéndole al paciente que realice movimiento suaves con la cabeza (“si”) Una vez que el paciente domina el movimiento, puede utilizar el Biofeedback de presión para evaluar la resistencia muscular durante la contracción. 2.2 Evaluación y entrenamiento de estabilización cervical. - Coloque el biofeedback bajo la columna cervical alta e infle hasta 20 mmHg. - Instruya al paciente a realizar flexión craneocervical aumentando la presión hasta 22 mmHg, y mantener 10 segs. - Si lo realiza adecuadamente (con mínima activación de musculatura superficial), le pide que relaje y que repita la flexion, aumentando hasta 24 mmHg. Repita esta activación incremental hasta 30 mmHg) - La presión final es la cual el paciente es capaz de mantener de forma adecuada, durante 10 segs. 2.3 Activación y entrenamiento de los extensores cervicales bajos y torácicos altos. Pcte: prono, con la frente apoyada en la camilla y los brazos a los lados. Procedimiento: Solicite al paciente elevar su cabeza de la camilla, manteniendo el mentón fijo y los ojos mirando hacia la camilla para mantener la posición neutra espinal. La elevación de la cabeza es un movimiento pequeño. Pcte debe ser capaz de mantener elevada la cabeza por 10 segundos, sin activación de musculatura extra.

Pelvic Tilt and Neutral Spine

Patient position and procedure: Sitting, then standing withthe back against a wall. Teach the patient to roll the pelvisforward and backward to isolate an anterior and posteriorpelvic tilt. After the patient has learned to isolate the move-ment, instruct him or her to practice control of the pelvisand lumbar spine by moving from extreme lordosis toextreme flat back and then assume mild lordosis. Iden-tify the mid position as the “neutral spine” so the patientbecomes familiar with the term. Show that the hand shouldbe able to easily slip between the back and the wall and

Visual reinforcement. Use mirrors so the patient cansee how he or she looks, what it takes to assume correctalignment, and then how it feels when properly aligned.Verbally reinforce what the patient sees.Tactile reinforcement. Help the patient position thehead and trunk in correct alignment and touch themuscles that need to contract to move and hold theparts in place.

Axial Extension (Cervical Retraction)to Decrease a Forward Head Posture

Patient position and procedure: Sitting or standing, witharms relaxed at the side. Lightly touch above the lip underthe nose and ask the patient to lift the head up and away(Fig. 14.15A). Verbally reinforce the correct movementof tucking the chin in and straightening the spine, anddraw attention to the way it feels. Have the patient moveto the extreme of the correct posture and then return tomidline.

Scapular Retraction

Patient position and procedure: Sitting or standing. Fortactile and proprioceptive cues, gently resist movement ofthe inferior angle of the scapulae and ask the patient topinch them together (retraction). Suggest that the patientimagine “holding a quarter between the shoulder blades.”The patient should not extend the shoulders or elevate thescapulae (Fig. 14.15B).

C H A P T E R 1 4 The Spine and Posture 399

FIGURE 14.15 Training the patient to correct (A) forward-head posture and(B) protracted scapulae.

Impairments• Pain (including headaches) from mechanical stress to sensitive structures and from muscle tension• Mobility impairment from muscle, joint, or fascial restrictions• Impaired muscle performance associated with an imbalance in muscle length and strength between antagonistic muscle

groups• Impaired muscle performance associated with poor muscular endurance• Insufficient postural control of stabilizing muscles• Decreased cardiopulmonary endurance• Altered kinesthetic sense of posture associated with poor neuromuscular control and prolonged faulty postural habits• Lack of knowledge of healthy spinal control and mechanics

BOX 14.1MANAGEMENT GUIDELINES—Impaired Posture

Plan of Care Intervention

1. Develop awareness and control of spinal alignmentin a variety of positions

2. Learn awareness between posture and pain

3. Increase mobility in restricting muscles, joints, fascia4. Develop neuromuscular control, strength, and

endurance in postural and extremity muscles5. Learn safe body mechanics6. Learn to correct stress provoking postures/activities7. Learn stress management/relaxation8. Improve aerobic capacity9. Develop healthy exercise habits for self-maintenance

1. Teach procedures to develop active control of spinal andextremity movement

2. Demonstrate relationship of symptoms with sustained orrepetitive postures

3. Manual stretching and joint mobilization; teach self-stretching4. Stabilization exercises; progress repetitions and challenge;

progress to dynamic strengthening exercises5. Functional exercises to prepare for safe mechanics6. Adapt work, home, recreational environment7. Relaxation exercises and postural stress relief8. Implement and progress an aerobic exercise program9. Integration of a fitness program, regular exercise and safe

body mechanics into daily life

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Nota: Para la extensión axial cervical, además realícelo en posición supino y sedente contra el extremo de una pared.  

2.4 Estabilización cervical con carga progresiva de las extremidades, énfasis en flexores cervicales.

2.5 Estabilización cervical con carga progresiva de las extremidades, énfasis en extensores cervicales.

2.6 Diseñe ejercicios variando la carga de las extremidades (uni o bilateral), la carga

externa y en superficies inestables.

C H A P T E R 1 6 The Spine: Exercise Interventions 457

B

C

D

FIGURE 16.23 (continued) (B) shoulder abduction to 90!; (C) shoulder external rotation arms at the side. Moderate protection phase: (D) shoulder flexion andabduction to end range; (E) diagonal patterns.

E

TABLE 16.3 Cervical Stabilization with Progressive Limb Loading—Emphasis on Cervical Flexors

Instructions: Determine amount of sup-port needed and amount of protec-tion. Begin each exercise with axialextension to the neutral spinal posi-tion and maintain it while exercis-ing; increase extremity repetitions,then increase resistance beforeprogressing to a new challenge.

Core ActivationMinimum limb

loading

Maximum limbloading

Maximum Support Minimum Support

Supine Sitting(sitting on ball forless stability)

Standing withwall support

Standing with nosupport

Maximum to moderate protection

Moderate to minimum protection

Minimum to no protection

Gentle craniocervical flexion/axial extension hold 10 seconds " 10 repetitions

Shoulder flexion to 90!

Shoulder abduction 90!

Shoulder external rotation with arms at sides

Shoulder flexion to end of range

Shoulder abduction combined with external rotation to end of range

Diagonal patterns

Reaching forward, outward, upward in functional patterns

Standing, no support: pushing/pulling and lifting activities

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Table 16.4 summarizes limb-loading exercisesthat emphasize the lower cervical/upper thoracicextensor muscles, and Figure 16.24 illustrates abasic exercise progression in the prone position.

458 STABILIZATION TRAINING—FUNDAMENTAL TECHNIQUES AND PROGRESSIONS

C DA

TABLE 16.4 Cervical Stabilization with Progressive Limb Loading—Emphasison Cervical and Thoracic Extensors

Instructions: Determine amount ofsupport needed and amount of pro-tection. Begin each exercise withaxial extension to the neutral spinalposition and maintain it while exer-cising; increase extremity repetitions,then increase resistance beforeprogressing to a new challenge.

Core activation—gentle craniocervicalflexion/axial extension

Minimum limbloading

Maximum limbloading

Maximum Support Minimum Support

Prone foreheadon treatmenttable—liftforehead offtable (Fig.16.19)

Quadruped overpadded stoolor gym ball—maintain eyesfocused onfloor

Standing backsupported bywall (ballbehind headfor lessstability)

Standing, nosupport

Arms at side: laterally rotate shoulders and adduct scapulae

Arms in 90/90 position (abducted and laterally rotated), horizontally abductshoulders and adduct scapulae

Elevate shoulder in full flexion

Arms abducted to 90! and laterally rotated, elbows extended: horizontallyabduct shoulders and adduct scapulae

Upper extremity diagonal patterns

Standing: reaching forward, outward, upward in functional patterns

Standing, no support: pushing/pulling and lifting activities

Lift forehead off exercise mat; hold 10 seconds " 10 repetitions

Maximum tomoderateprotection

Moderate tominimumprotection

Minimum to noprotection

It is important to note that these exercises do notisolate the flexors or extensors, but that the desig-nation is primarily for emphasis due to the effectsof gravity.

FIGURE 16.24 Limb loading for basic stabilization progression of cervical musculature in prone position. Maximum protec-tion phase: (A) arms at side, shoulder lateral rotation, and scapular adduction; (B) arms at 90/90, horizontal abduction, andscapular adduction. Moderate protection phase: (C) shoulder elevation full range, (D) shoulders 90! with lateral rotation andelbow extended, horizontal abduction, and scapular adduction.

BA B C D

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