Intervention

1. Teach procedures to develop active control of spinal and extremity movement Universidad de Chile pain 2. Demonstrate relationship of symptoms with sustained or Escuela de Kinesiologa repetitive postures Kinesiologa Asignatura de Klga. Giselle Horment L. , joints, fascia 3. Manual stretching and joint mobilization; teach self-stretching Gua para el alumno 2011. h, and 4. Stabilization exercises; progress repetitions and challenge; uscles progress to dynamic strengthening exercises EJERCICIOS DE REEDUCACION POSTURAL Y ESTABILIZACION CERVICAL 5. Functional exercises to prepare for safe mechanics res/activities 6. Adapt work, home, recreational environment Trabajo Practico: 7. Relaxation exercises and postural stress relief 8. Implement and progress an aerobic exercise program -maintenance 9. Integration of a fitness program, regular exercise and safe postural para corregir una anteposicin 1. Practique con su compaero el entrenamiento bodycabeza (A) y una protaccin escapular (B). de mechanics into daily life

al alignment

Recuerde dar refuerzo verbal, tctil y visual. Nota: Para la extensin axial cervical, adems realcelo en posicin supino y sedente contra el extremo de una pared.

e patient can assume correct operly aligned.

osition the ouch the d hold the

tanding, with ve the lip under up and away t movement spine, and patient move en return to

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

2. Realice con su compaero la siguiente pauta de estabilizacin cervical.

Pelvic Tilt and Neutral Spine

tanding. For t movement of he patient to hat the patient oulder blades. s or elevate the

2.1 Activacin y and procedure: Sitting, then standing with profundos. Patient position entrenamiento de los flexores cervicales Pcte: back against a wall. Teach the patient to roll the pelvis the supino Procedimiento: Ensele al pacienteanterior and posterior forward and backward to isolate an a realizar flexin craneocervical y extensin axial suave, pidindole al paciente que realice movimiento suaves con la cabeza (si) Una vez que el pelvic tilt. After the patient has learned to isolate the movepaciente domina el movimiento, puede utilizar theBiofeedback de presin para evaluar la ment, instruct him or her to practice control of el pelvis and lumbar spine by moving from extreme lordosis to resistencia muscular durante la contraccin.

extreme flat back and then assume mild lordosis. Identify the mid position as the neutral spine so the patient 2.2 Evaluacin y entrenamiento de estabilizacin cervical. becomes familiar with the term. columna the hand should - Coloque el biofeedback bajo la Show that cervical alta e infle hasta 20 mmHg. be able al paciente between flexin craneocervical - Instruyato easily slip a realizarthe back and the wall andaumentando la presin hasta 22 mmHg, y

mantener 10 segs. - Si lo realiza adecuadamente (con mnima activacin de musculatura superficial), le pide que relaje y que repita la flexion, aumentando hasta 24 mmHg. Repita esta activacin incremental hasta 30 mmHg) - La presin final es la cual el paciente es capaz de mantener de forma adecuada, durante 10 segs. 2.3 Activacin y entrenamiento de los extensores cervicales bajos y torcicos 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 mentn fijo y los ojos mirando hacia la camilla para mantener la posicin neutra espinal. La elevacin de la cabeza es un movimiento pequeo. Pcte debe ser capaz de mantener elevada la cabeza por 10 segundos, sin activacin de musculatura extra.

C 2.4 Estabilizacin cervicaltocon(C)cargaexternal rotation arms at the lasModerate protection phase: (D) shoulder flexion and progresiva deE side. extremidades, nfasis en flexores FIGURE 16.23 (continued) (B) shoulder abduction 90 ; shoulder abduction to end range; cervicales. (E) diagonal patterns.

TABLE 16.3

Cervical Stabilization with Progressive Limb LoadingEmphasis on Cervical Flexors

Maximum Support Supine Sitting (sitting on ball for less stability) Standing with wall support Minimum Support Standing with no support

Instructions: Determine amount of support needed and amount of protection. Begin each exercise with axial extension to the neutral spinal position and maintain it while exercising; increase extremity repetitions, then increase resistance before progressing to a new challenge.

Core Activation Minimum limb loading

Gentle craniocervical flexion/axial extension hold 10 seconds Maximum to moderate protection Moderate to minimum protection Minimum to no protection
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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

16Kisner

Maximum limb (F)-16 3/9/07 loading

2.5 Estabilizacin cervical con carga progresiva de las extremidades, nfasis en extensores 458 STABILIZATION TRAININGFUNDAMENTAL TECHNIQUES AND PROGRESSIONS cervicales.
TABLE 16.4

Cervical Stabilization with Progressive Limb LoadingEmphasis on Cervical and Thoracic Extensors
Maximum Support Prone forehead on treatment tablelift forehead off table (Fig. 16.19) Quadruped over padded stool or gym ball maintain eyes focused on floor Standing back supported by wall (ball behind head for less stability) Minimum Support Standing, no support

Instructions: Determine amount of support needed and amount of protection. Begin each exercise with axial extension to the neutral spinal position and maintain it while exercising; increase extremity repetitions, then increase resistance before progressing to a new challenge. Core activationgentle craniocervical flexion/axial extension

Lift forehead off exercise mat; hold 10 seconds

10 repetitions

Minimum limb loading

Maximum to moderate protection Moderate to minimum protection

Arms at side: laterally rotate shoulders and adduct scapulae Arms in 90/90 position (abducted and laterally rotated), horizontally abduct shoulders and adduct scapulae Elevate shoulder in full flexion Arms abducted to 90 and laterally rotated, elbows extended: horizontally abduct shoulders and adduct scapulae Upper extremity diagonal patterns

Maximum limb loading

Minimum to no protection

Standing: reaching forward, outward, upward in functional patterns Standing, no support: pushing/pulling and lifting activities

Table 16.4 summarizes limb-loading exercises is important to note that these exercises do not 2.6 Disee ejercicios variando la carga de lasItextremidadesextensors, but that the desig- carga (uni o bilateral), la that emphasize the lower cervical/upper thoracic isolate the flexors or externa y enmuscles, and Figure 16.24 illustrates a extensor superficies inestables. nation is primarily for emphasis due to the effects basic exercise progression in the prone position. of gravity.