PHYSICAL THERAPY

Figure 3a. Scapular-spinal coupling

Figure 3b. Introduce a shoulder movement

begin to improve dramatically, resulting in greater voluntary con- trol and subsequent changes in posture. This type of exercise is often performed in a lying position, so that the nervous system’s learned muscular responses to gravity are put on hold. This reduces the overall neurological excitation within the nervous sys- tem, thus providing an environment conducive for learning. The effectiveness of coupled movement is highlighted in the following exercise that explores the relationship between scapular, spinal and pelvic movement. The result is increased sensory awareness and control of these structures during habitual postures.

Scapular-spinal coupling - the client should lie on their side with both legs bent, their lower arm extended so they can rest their head on it. The top arm should be extended outwards, perpendic- ular to the body, with the palm facing down on the floor (Figure 3a). Instruct them to begin the movement by rotating the head gently towards the floor before coming back to the start position. As they repeat this movement, they should notice how the upper- most shoulder is involved, as it begins to move forward also. As they continue this gentle rotation, they should actively introduce a shoulder movement by allowing it to gently drop forward towards the floor, continuing to rotate the head (Figure 3b). They should notice that the head will begin to rotate further and more freely. As this movement is continued the palm should begin to slide further forwards on the floor. They should try to focus on the

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