Table 1 Physiotherapy and home exercise program
Technique/Exercise | Dosage | Weeks |
|---|---|---|
Postural taping * | Worn full time | 1 |
   from anterior aspect of each shoulder, posteriorly and obliquely down to opposite rib cage |  |  |
Soft tissue massage * | 5 mins | 1-10 |
   Performed in prone to erector spinae, rhomboids, upper trapezius -stroking, circular frictions and petrissage |  |  |
Passive accessory postero-anterior vertebral mobilisation * | 5 mobilising movements at each central level × 2 reps | 1-10 |
   In prone starting at T1 down to 2 levels below the most painful vertebral region Grade 2-3 depending on level |  |  |
Supine lying over rolled up towel | 5-10 mins | 1 |
   Towel placed lengthways along the back to facilitate thoracic extension |  | Daily |
Erect sitting with transversus abdominus stabilising | 10 sec hold × 5 reps | 1-10 |
   Sitting forward on a chair or stool with no back rest. Chin retraction, scapular retraction and TA contraction |  | Daily |
Elbows back in sitting | 5 sec hold × 5 reps | 1-10 |
   Hands behind head with elbows pointing out to side. Pressing elbows back by performing scapular retraction |  | Daily |
Trunk mobility in sitting | 5 reps in each direction | 1-10 |
   Hands on shoulders, gentle rotation in both directions and lateral flexion to each side |  | Daily |
Head to wall in standing | 10 sec hold × 5 reps | 1-10 |
   Back and heels against wall with rolled up towel behind head. Chin retraction |  | Daily |
Standing corner stretch | 10-30 sec hold × 3 reps | 2-10 |
   Facing corner, both hands at chest height placed on wall and moving in closer to stretch anterior chest |  | Daily |
Walking hands up wall in standing | 5 sec hold × 5 reps | 3-10 |
   Facing wall, walking hands up wall until arms upstretched then holding hands off wall |  | Daily |
Shoulder flexion in supine | 10 sec hold × 5 reps | 3-10 |
   Arms outstretched holding onto a cane/towel and taking arms over head to hold at end of range |  | Daily |
Standing wall push ups | 8-10 reps × 2 | 1-10 |
   Facing wall with arms in front at shoulder height. Keeping body straight, bending and straightening elbows |  | 3×/week |
Seated row with dumbbells | 8-10 reps × 2 | 1-10 |
   Upright sitting and pull hands up towards chest by bending elbows and then lowering |  | 3×/week |
Seated overhead dumbbell press | 8-10 reps × 2 | 3-10 |
   With elbows bent and out to side, press dumbbells straight up until arms extended overhead |  | 3×/week |
Bridging in supine | 5-10 sec hold × 5 | 1-2 |
   Knee bent and feet flat on ground. Pushing through feet to lift back and pelvis off ground |  | 3×/week |
Hip extension in prone | 8-10 reps × 2 | 3-10 |
   Raising one leg off the ground and then the other |  | 3×/week |
Half squats - progress to holding dumbbells | 8-10 reps × 2 | 1-2 |
   Standing in front of chair and squatting down to touch chair with buttocks then standing up |  | 3×/week |
Step ups - progress to holding dumbbells | 8-10 reps × 2 | 3-10 |
   Stepping up and down a 10 cm step. Alternate legs |  | 3×/week |
Scapular retraction with theraband in sitting | 8-10 reps × 2 | 1-10 |
   Holding theraband in both hands with elbows tucked into sides and performing wrist extension, supination and shoulder external rotation then scapular retraction |  | 3×/week |
Four point kneeling with transversus abdominus | 8-10 reps × 2 | 2 |
   Push into floor with hands, knees and feet then draw navel up and in. Hold 5 secs |  | 3×/week |
Four point kneeling with one arm and leg lift | 8-10 reps × 2 | 3-10 |
   As above, then lift one arm off ground. Progress to also lifting extended leg off ground at same time |  | 3×/week |
Prone lying with arm elevation | 5-10 sec hold × 5 | 2-3 |
   Arms at shoulder height and bent at elbows. Scapular retraction then lift arms off floor |  | 3×/week |
Prone trunk extension | 5-10 sec hold × 5 | 4-10 |
   Lift head and shoulders off floor while maintaining chin retraction |  | 3×/week |