In fact, most the manual therapies I employ have 1 purpose, to reduce threat, raise pain and movement thresholds so the patient can perform their HEP. Here are 5 More Ways to Get to End Range. Another post on End Range can be found here.
1) Slow Movements
- for a vigilant nervous system, faster or even movements at a regular speed may be threatening
- try having someone perform a repeated extension in lying or cervical retraction with SB as slowly as possible
- decreased speed = decreased threat which leads to increased movement tolerance
2) IASTM at the sticking or painful point
- is there a sticking or painful point at mid range?
- back off of the mid range or keep them there if it's tolerable, then perform light IASTM to modulate the discomfort at that point
- retest the movement, and keep it slow!
3) Diaphragmatic breathing at the sticking point
- example: limited cervical retraction and SB to the left
- have patient lie supine, and passively position them to the point they are have difficulty moving past
- either just short of the discomfort point or on it if tolerable, have them practice diaphragmatic breathing to reduce tone and decrease a sympathetic response
- after 5-10 minutes of relaxation in this position, retest the movement
4) Wrap it up!
- for dynamic warmups or repeated loading resets, compression wrapping with an EDGE Mobility Band or similar product is a great way to reduce threat
- compression is comfortable and may also help redefine the limb in a smudged homunculus
- light wrapping with very little stretch is all you need and thus can avoid recommendations like no greater than 30 seconds of wrapping
5) Use distal muscles along a fascial line
- whether it's a form of distraction, or activation something distally really helps with proximal motor control, this strategy is very useful
- example 1: cervical retraction with sidebending left limitation
- have the patient in standing squeeze their left adductor by pulling their left foot medially
- this may assist other muscles along the deep front line including cervical muscles used to sidebend the head/neck
- example 2: limitation in standing REIS or MSE
- light adductor contraction and cueing of pelvic floor muscles may help this motion just like in yesterday's post in case you missed it
In the end, it's all about distraction, threat reduction and a full motion to end range that helps the neurophysiologic reset. Hope these strategies help more of your cases that have difficulties with movement!
Keeping it Eclectic...