Manual Medicine Therapy edited by Wolfgang G. Gilliar and Philip E. Greenman

6 Home Training 13 Stretching of the hip flexor and long knee extensor 14 Stretching of the calf muscles muscles Instructions Instructions - Lift heel of the posterior leg off the floor - Assume position similar to that of starting for a sprint - Push heel flat against the floor - Push straightened (posterior) knee toward the floor - With the back straight, move trunk slowly forward - Relax - Lift heel off the floor, then push it down again - Extend hip further - Stretch further 1S Stretching of the lower back extensor muscles 16 Stretching of the lower back extensor muscles Instructions Instructions - Sit with legs slightly apart and feet raised (i.e., on books, etc.) - Bring knees toward the chin until the pelvis begins to lift off the - Lean upper body forward - Inhale floor - Exhale while pulling the arms below the chair - Press thighs against arms and Inhale - Inhale and exhale - Exhale and relax - Pull arms further below the chair - Bring knees further toward your chin 142

Home Training 17 Stretching of the chest muscles 18 Unilateral stretching of the chest muscles Instructions Instructions - Walking position - Stand sideways to the door frame; rest forearm against the - Press hands against door frame - Relax frame - Lean upper body forward - Press forearm against door frame - Rotate trunk away (in small rotational steps) with the forearm remaining stationary 19 Stretching of the neck and shoulder muscles 20 Stretching of the neck and shoulder muscles Instructions Instructions - Bend head to one side - Bend head to one side (i.e., left) and hold in place with one hand - Rotate arm outward and push it toward the floor - Grasp chair with the other hand - Inhale and lift shoulder - Lean trunk to the same side (i.e., left) - Exhale and pull arm toward the floor - Move back somewhat toward the original position and place hand on the chair closer to the floor - Repeat side-bending of the trunk 143

6 Home Training 21 Strengthening of the shoulder blade muscles 22 Strengthening of the shoulder blade muscles Instructions Instructions - Lean with shoulder blades against the wall at an angle - Place fingertips against the wall at shoulder level - Push trunk off with the elbows, while maintaining normal lumbar - Push body off slightly - Maintain normal lumbar lordosis (do not arch back) lordosis <do not arch back) 23 Strengthening of the shoulder blade muscles 24 Strengthening of the anterior thigh muscles Instructions - Rest on knees and hands Instructions - Slowly drop upper body between hands - Rotate leg slightly outward - Keep knee straight 144 - Pull great toe and foot toward you - Pull kneecap toward you - Contract anterior thigh muscles

Home Training 25 Strengthening of the gluteal muscles 26 Strengthening of the gluteal muscles Instructions Instructions - Lift one leg (with knee bent) up toward the horizontal while - Press heels together pushing the opposite leg under the table top - Contract buttock muscles maximally 27 Strengthening of the gluteal muscles Instructions - Raise heels and rest them on support - Contract buttock muscles and simultaneously lift pelvis and lower back off the floor 145

6 Home Training 28 Strengthening of the abdominal muscles 29 Strengthening of the abdominal muscles Instructions Instructions - Push knees toward the ceiling - Pull toes toward you while pressing heels against the floor - At the same time, lift pelvis slightly off the floor - Rotate arms slightly inward - Bend hands upward and push in direction of the feet - Lift head and shoulders off the floor 30 Strengthening of the abdominal muscles Instructions - Bend knee and press against resistant hand - Slightly lift head off the floor Translated by W.G. Gilliar, D.O. (with permission from F. Hoffmann-La Roche Company. Basel, Switzerland) 146

Index A Calf muscles, stretching 139,142 - spine 21 Carpal bones, mobilization without im­ Hypomobility, segmental 14 abdominal muscles, strengthening 146 pulse: I Abduction 2 posterior/palmar 122 Imbalance, muscular 14 Cervical spine, instability 18 Impulse 6 Acromioclavicular joint, NMT1: superior - soft tissue injury 18 Indications, manual therapy 14 113 Chest muscles, stretching 143 Inhibition, reciprocal 13 Concave rule 4 Adduction 2 Contraction, isometric 11 J Agonsits 9 Convex rule 4 Joint, peripheral 6 Anatomy, functional 8 Coordinate system, three-dimensional 2 Joint-play 3 Ankle joint, mobilization without impulse: - flexion/extension 2 - inclination 2 K traction 133 - reclination 2 Knee extensors, stretching 141 - anterior (posterior ) 134 - Y-axis 2 - long, stretching 142 Ankylosing spondylitis 21 Knee joint, mobilization without impulse: Antagonists 13 D Arthritis, rheumatoid 21 Depression 2 anterior (posterior) 131 Axis, X 2 Disk herniation, acute cervical 18 - traction 130 - Y2 - lumbar 17 Distance/time diagram 7 L - Z2 Lateral flexion, see side-bending 2 E LI to L5, mobilization with impulse: B Elbow joint, mobilization without impulse: rotation 62-65 back extensor muscles 8 traction 16 - rotation and flexion 66 - lower, stretching 142 Elevation 2 L2 to L5, mobilization with impulse, rota­ Barrier, engage 7 Examination findings, documentation 22 Endfeel, hard 3,15 tion and sidebending 68 C - soft 3,15 L5-S, mobilization without impulse and CO to C3, mobilization with impulse: F NMT2: flexion 69 traction pp. 28 Finger joints, mobilization without im­ - reclination 27 M - mobilization without impulse: pulse: Malformations, bony 20 palmar (posterior) 124 Manipulation, definition 5 traction, axial 25 - traction 123 Manual therapy, concepts 1 - NMT 2: inclination restriction 36 Force/time diagram 7 - contraindications 17 C0-C1. mobilization without impulse: Femoropatellar gliding, mobilization - documentation 22 without impulse: - indications 14 inclination/reclination 24 distal (medio-lateral) 129 - mechanism of action 1 - NMT1 and self-mobilization: Migraine, cervical 19 G Mobility gain 5,7 inclination/reclination 32 Gluteal muscles, strengthening 145 Mobilization 5,14 C1-C2. mobilization with impulse: - stretching 140 - passive 12,13 - self-9 rotation 31 H - with impulse 6 - mobilization without impulse: Hindfoot joint, mobilization without im­ - without impulse 6 Mobilization levels 4 rotation 26 pulse: Motion, angular 2 - NMT 1 and self-mobilization: plantar (posterior) 135 - translatory 2 Hip flexors, stretching 140,142 Motion barrier, anatomic 3 rotation 33 Hip joint, mobilization without impulse: - pathologic 3 - NMT2 and self-mobilization: anterior 128 - physiologic 3 - posterior 126 Muscle, adductor brevis, NMT2104 rotation 34 - traction (inferior) 125 - adductor longus, NMT2104 C2 to T3, mobilization with impulse: - traction (lateral) 127 - adductor magnus, NMT2104 Home exercises, pp. 139 - biceps femoris, NMT2 105 rotation 38 Home exercise program, pp. 138 - erector spinae, lumbar region, NMT2 97 - rotation and sidebending 41 Hypermobility, segmental 14 - mobilization without impulse: rotation 37 - NMT1 and self-mobilization: rotation 42 - NMT2 and NMT3: sidebending 44 - NMT2, rotation 43 C5 to T4, mobilization with impulse: rotation and sidebending 45 C6 to T4, Mobilization with impulse: — rotation, sidebending, extension 48 - NMT1, self-mobilization, mobilization without impulse, extension 46 147

Index Muscle, gastrocnemius, NMT2 106 Rib I, mobilization with impulse: inferior- T - iliopsoas, NMT2 100 anterior 85 T3 to T10, mobilization with impulse, ex­ - levator scapulae, NMT2 95 - pectoralis major, NMT2 96 - mobilization without impulse: inferior 82 tension and rotation 54 - piriformis, NMT2 102 Ribs II to VI, mobilization with impulse: — rotation 55 - quadratus lumborum, NMT2 98 - mobilization without impulse: rotation - quadriceps, femoris, NMT2 103 anterior 86 - rectus femoris, NMT2103 Ribs II to XII, mobilization without im­ 49 - semimembranosus, NMT2105 - semitendinosus, NMT2 105 pulse and NMT I: anterior 89 - mobilization without impulse and - soleus,NMT2106 - NMT2: anterior 91 NMT2: - sternocleidomastoid, NMT2 92 Ribs V to XII. mobilization with impulse: extension 50,51 - tensor fasciae latae, NMT2 99 - trapezius, descending, N MT2 94 anterior and inferior 88 T8 to T12, mobilization with impulse: - triceps surae, NMT2106 Ribs VI to XII, mobilization with impulse: rotation 57 Muscles, scalene, NMT2 93 Muscle strenght, direct 9 anterior and lateral 87 T10 to S, mobilization without impulse: Myotendinosis, spondylogenic 14 - mobilization without impulse: anterior rotation 59 N 84 - NMT 1 and self-mobilization: rotation 61 Neck and shoulder muscles, stretching 143 Rolling-gliding movement 2 T12 to S, mobilization without impulse and Neuromuscular therapy pp. 8 NMT19 S NMT2: rotation 60 NMT2pp. 10 Sacro-iliac joint, mobilization with im­ Tarsal/tarso-metatarsal joints, mobilization NMT3 pp.13 pulse, extension restriction 78 without impulse: plantar (posterior) 135 O - anterior restriction 74 Therapy, neuromuscular 8 Orthotics 15 - anterior-inferior restriction 72 Thigh muscles, stretching, lateral 39 Osteopathic physicians 2 - flexion restriction (superior-axial) 76 — posterior, 139 Osteoporosis 20 - mobilization without impulse and - - medial 140 - strengthening 144 P NMT1: Thrust technique 6 Palpatory assistance 9 anterior restriction 70 Tibiofibular joint, proximal (distal), Pain, acute 15 - mobilization without impulse and - chronic 15 NMT2: mobilization without impulse: anterior - localized 14 anterior restriction 71 or posterior 132 - referred 14 - NMT1 and NMT2: nutation 81 Toe joints, mobilization without impulse: Position, anatomic 3 - NMT1: nutation 80 plantar-dorsal 137 - present neutral 3 Shoulder blade, mobilization without im­ — traction 136 Provisional treatment, see trial treatment pulse: Traction level 4 superior/inferior, medial/lateral 114 Treatment plane 4 14 Shoulder blade muscles, strengthening 144 Treatment techniques 6 Provocative testing 5 Shoulder joint, mobilization without im­ Trial treatment 14 pulse: R anterior 111 V Radio-ulnar joint, distal, mobilization - inferior 109 Vertebral fracture, pathologic 20 - posterior 110 Vertigo, cervical 19 without impulse; posterior-cubital 118 - traction 108 - proximal, mobilization without impulse, Shoulder and neck muscles, stretching 143 W Sidebending 2 Wrist extensors, NMT2102 posterior-cubital 117 Slack, taking out 6,7 Wrist joint, proximal mobilization without Ranges of motion 3 Spine, hypermobility 21 Relaxation phase 13 Spondylolisthesis 19 impulse: ulnar (radial) 121 Relaxation, postisometric 10 Spinal cord, malformations 20 — and distal, mobilization without im­ Sternoclavicular joint, mobilization without impulse: posterior/inferior 112 pulse: Strengthening 10,14 palmar (posterior) 120 Stretching 10,13 — and distal, mobilization without im­ pulse: traction Z zone of irritation 5,14 148