In a previous post, I talked about how I use child's pose as part of my upper-quarter screen. Child's pose assesses flexion-based deficits. To look at extension-based deficits I use a cobra or up dog pose.
Here is a list of objective findings you can gather from using cobra:
- Extension ROM of the spine, hips, knees, and ankles.
- Flexion ROM of the knee and ankles (ask patient to bend each knee, then add ankle dorsiflexion)
- GH and ST strength and compensatory patterns (ability to perform scapula depression in weight bearing, scapula positioning)
- Extension-based spinal abnormalities (hinging at a particular vertebrae level, global trunk rotation)
- Palpation of paraspinals
- Pelvic and SI joint landmark position in extension bias (look for pelvic tilt as well)
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.)
Here is what I see from this position:
- R scapula elevation
- Global trunk rotation to R
Next, I had him push up onto his hands into an Up Dog pose. Quickly, some of his deficits became more obvious.
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.
Reference: Garner, G. 2001. Professional Yoga Therapy, Volume I. Professional Yoga Therapy Institute, Living Well, US.
Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!
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