• Clinical work requires utilization of proper

body mechanics to effectively and efficiently

perform daily skills.
• Not only does a clinician risk injury if proper
techniques are not used, but fatigue because
of inefficient execution of those skills serves
to wear and tear on the clinician physically.
• To be stable, the body’s center of mass must fall within
its base of support.
• Stability during dynamic activity requires that the feet be
placed in the direction of forces applied.
• Further stability occurs if the center of mass is lowered.
• A “straight” spine provides the greatest stability for the
back and the most efficient transfer of forces from the
legs to the arms.
• In that same vein, to maximize effectiveness
and preserve the smaller joints, it is
advantageous to use the powerful leg muscles
to provide the clinician with the leverage and
power while minimizing repeated large
stresses to smaller and weaker upper body
segments.
 PATIENT PROTECTIVE MEASURES: SPOTTING DURING
AMBULATION
• Specific techniques are used to protect the patient as well as the
clinician during ambulation instruction and progression to
independence.
• We will assume that the patient has advanced from ambulation
instruction in the parallel bars to ambulation instruction with
crutches, and the clinician has already provided the patient with
instructions and demonstration so the patient is now ready to
begin ambulation. This patient is partial weight bearing on the
left lower extremity.
SEQUENCE OF MOVEMENT
Clinician stands behind the
patient. Clinician’s right
foot is positioned behind
the patient and aligned
patient’s right crutch and
right leg , and the
clinician’s feet is behind
and between the patient’s
2 feet
JOINT MOTION MUSCLE ACTIVITY
• Right hip slight flexion (R) LE
• Partial flexion of the • positioned by Iliopsoas and
knee Rectus femoris
• Plantar flexion of the • Gluteal muscles laterally rotate
ankle and stabilize it
• (L) Shoulder slight • Knees position by Quadricpes
flexion • Ankle by cocontraction of
• (L) Elbow flexed to 90 Gastrocnemius and soleus
• (L) Forearm supinated (L) LE
• (L) Wrist slight • Maintained eccentric
extension contraction of the G. max at the
• (R) Shoulder flexion hip, quadriceps at the knee,
• (R) Scapula upwardly and gastrocnemius-soleus at
rotated the ankle.
• (R) Elbow slightly • Hip by six small rotators
flexed assisted by the gluteals
• (R) Forearm pronated
• (R) Wrist flexion
MUSCLE ACTIVITY (CONTIUATION)

(R) UE
• Scapula Move into position by upper and
lower trapezius and serratus anterior
• Humerus by pectoralis major and deltoid
• Forearm by cocontraction of supinators
with both pronators
• Wrist by extensor carpi ulnaris
• Fingers by extensory digitorum longus
(L) UE
• Scapula stabilized by cocontraction of
rotators
• Forearm by supinators and bicep brachii
• Wrist by extensor carpi radialis longus
and brevis and extensor carpi ulnaris
• Fingers by flexor digitorum superficialis
and profundus
SEQUENCE OF MOVEMENT
As the patient moves the
crutches forward, and when
the patient takes a step, the
clinician moves her left food
forward
JOINT MOTION
• Right hip flexed
• Right knee flexed
• Right ankle plantaflexed
• (B) shoulders slightly
• Elbow extends
• Left hip flexed
• Left knee flexed
• Left ankle dorsiflexes
MUSCLE ACTIVITY
• Finger flexors
• Right hip flexes by
concentric contraction of
the iliopsas and rectus
femoris
• Right knee by quadriceps
• Flexion of the shoulders by
anterior deltoid and
pectoralis major
• Scapula stabilized by
trapezius, rhomboids,
pectoralis minor, and
levator scapulae
• Elbow by elbow flexors
(cocontraction of biceps,
brachialis, and
brachioradialis) and
triceps
SEQUENCE OF MOVEMENT
If the patient loses balance
and begins to flex at the
trunk, the clinician pulls on
the shoulder to extend the
trunk and pushes on the hips
at the belt to move the pelvis
forward and place his center
of mass over his BOS
JOINT MOTION MUSCLE ACTIVITY
• If the patient begins to • Abducts both hips by glutes
lose his balance as his medius and minimus
trunk move into flexion, • Flex knees by using
clinician abducts her eccentric contraction of the
hips and slightly flexes quadriceps
her knees to increase • ® hand by concentric
her base of support and contraction of flexor
lower her center of digitorum profundus and
gravity for increased superficialis
stability and • Elbow concentric contraction
simultaneously moves (Elbow flexors)
to pull his shoulder • Shoulder extension by
toward her, flexing her posterior deltoid, latissimus
left shoulder to move dorsi, and teres major
his pelvis forward • Isometric contraction of
wrist flexors
• Hands by long finger flexors
and adductors (palmar
interossei and lumbricals
SEQUENCE OF MOVEMENT
CLINICIAN ERGONOMICS: MANUAL RESISTANCE
• As mentioned earlier, it is vital that the clinician be
aware of correct body mechanics and use his or her
body safely and efficiently to both protect against
injury and conserve energy.

• To make the activities difficult, we will assume that

the patient in each example has a grade of 4/5
strength in the muscles resisted. We will also assume
that the patient is male and the clinician is female
UPPER EXTREMITY RESISTANCE

• If the patient is supine and the clinician

provides manual resistance to shoulder
abduction, the clinician stands at the side of
the patient with one hand just proximal to the
lateral wrist and the other hand just proximal
to the lateral elbow.
• Clinician’s forearms are supinated
(supinator)
• Wrist extended (eccentric activity
of flexor carpi radialis)
• Elbow slight flexion (biceps and
brachialis) and with triceps
• Thumbs placed in opposition
(opponens pollicis)
• (B) shoulders slightly flexed
(anterior deltoid and pecs major
with scapular rotators (trapz,
serratus anterior, and rhomboids)
• Hip extension by gluteals and
hamstrings
• Knee control by quadriceps
• Ankle dorsiflexion by tibialis
anterior
LOWER EXTREMITY RESISTANCE
• In this example, the patient is to receive manual
resistance to knee extension. The patient is sitting
over the side of a treatment table with the knees just
of the table and the legs hanging down. A rolled towel
is placed under the distal thigh with the table. The
knee to receive the exercise in the patient’s right knee
• Clinician kneels down on her right knee and
maintain good alignment
• The left leg is flexed at the hip and knee with
the foot flat on the floor ahead of the right
knee
• In this position, hip is extended by (gluteals
and hamstring) while left one is flexed by
(iliopsoas and rectus femoris)
• Knees flexed about 90 degrees (hamstrings)
• As the clinician leans forward from the hips,
her right gluteus maximus and hamstrings
contract eccentrically to control motion
• Right hand is positioned with thumb
opposing (opponens pollicis)
• Digits in some flexions (flexor digitorum
longus and brevis, flexor pollicis longus and
brevis)
• Wrist extended and radial deviated by (ECRL,
ECRB, and FCR)
• Elbow flexed (biceps, brachialis, and
brachioradialis), but once motion begins, the
tricpes and these muscles cocontract to hold
elbow in position
• Shoulder into flexion (Anterior deltoid)