LT activation

I have had numerous patients during my musculoskeletal placement that have decreased activation of their lower traps (LT). Most patients whom I have taught to activate LT normally take approx 5 minutes to understand what action I am actually asking them to do. However the other day after 10 minutes of explaining the concept in different ways and trying PROM > active assisted ROM in side lying, the patient was still unable to activate LT. By the end of the session I was getting annoyed with myself for not being able to explain in a way that the patient could understand what I wanted.

After the session I revised all the possible positions that I could possibly retrain LT in; this included side lying, prone, sitting and standing. I also asked the supervisor what she thought was the best way to activate LT and she thought that pushing your fingers onto the scapula where LT attaches and getting the patient to push against it worked well to activate LT. I also sat in on another student activating LT which was probably the most helpful, as it made me realise that I might have given up too early. This student took 15minutes to get the idea across to their patient, but once they had the patient was able to activate LT without any proprioceptive input.

The next session when my patient came in, I used all the ideas I had found and been told. Plus I took more time during the active-assisted phase of retraining LT. By the end of the session the patient had the idea of LT activation and I was able to give them home exercises as they could do the movement properly.

WHAT I HAVE LEARNT FROM THIS EXPERIENCE IS THAT SOMETIMES IN CERTAIN CASES, YOU WILL HAVE TO SPEND A GREAT DEAL OF TIME GETTING THE PATIENT TO PRACTICE A MOVEMENT OR MUSCLE CONTRACTION BEFORE THEY ARE ABLE TO DO IT INDEPENDENTLY. IF WHAT YOU DO IN THE FIRST SESSION DOESN’T WORK, DON’T TRY THE SAME THING NEXT SESSION, RESEARCH AND FIND AN ALTERNATIVE.