Left foot and right arm support. The right leg and left arm can support or move in to a stepping forward pattern.
This position is the tripod is a variation of a static lunge taught as part of the Dynamic Neuromuscular Stabilisation programme according to Pavel Kolar, and correlates to the 8-9 month developmental age. The right arm and left foot are supporting and the left arm and right leg are stepping forward. The clinician can support the left knee and foot centration, trunk centration and uprighting of the spine. The most common zones of contact are the support leg VMO/ medial epicondyle and mid thoracic spine, most commonly at or just below the apex of the kyphosis.
The clinician can advise the patient to breathe diaphragmatically, using the inhalation to facilitate spinal extension and the exhalation to facilitate relaxation of tight musculature. E.g. support leg posterior hip rotators and soleus, stepping forward leg iliacus and rectus femoris, even the pectoral muscles and the more tonic cervical musculature. Similarly, the eyes can be used to facilitate trunk extension by encouraging the patient to look up, even if the head is kept in neutral. Alternatively, the patient could be encouraged to look down to facilitate the deep cervical flexors. Tongue position can be emphasised, by encouraging the patient to place the tongue on the roof of the mouth behind the teeth.
At the support stance foot the patient can be encouraged to spread the toes and load evenly through the foot, using tibial external rotation to facilitate a neutral longitudinal and medial arch. The patient can be encouraged to load the support leg heel and drive the knee forward to encourage soleus mobility and functional centration of the ankle. As this is done the middle of the patella should remain in line with the second toe in most patients. At the hip, the patient can be encouraged to increase the depth of the hip crease or find the centrated position. Frequently trigger points can be active in the TFL, and various parts of the hip flexors in this position. Often the clinician can use myofascial trigger pointing in the position to alleviate these symptoms. The trigger pointing will need to be applied prior to the trigger point becoming active. E.g. Apply as the patient gets in to this position.
On the stepping forward leg the patient can encouraged to start by loading the hallux and this position can be used to mobilise a hallux towards full plantarflexion. At the stepping forward hip the patient can be encouraged to maintain a neutral rotation of the thigh, by activating the internal rotators. Further, by encouraging loading of the supporting knee, centration of the supporting hip can often be better felt.
At the trunk the patient can be encouraged to elongate the cranium away from the coccyx to create upright of the spine. At the thoracic spine the patient can be encouraged to broaden the shoulder blades and lift the trunk up through the shoulders to promote serratus activation. On the support hand the patient can be encouraged to spread the fingers with the middle finger facing straight ahead, in conjunction with this the elbow should face backwards, facilitating activation of the external rotators of the right shoulder. As this is done loading should remain even across both the ulnar and radial sides of the hand. At the head retraction and cervical elongation can be cued, in very aware individuals this can sometimes be facilitated by promoting conscious relaxation of the tongue and throat.
The difficulty is choosing the correct cue to give, and just correcting the key dysfunction, as suggested by Lewitt. In the picture above I would probably suggest the patient focus on conscious elongation of the spine and then progress to using the breath to facilitate uprighting of the spine and relaxation of the posterior hip rotators of the support leg.
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