Wing-Arch-High-Knee-Std St. Screw-twisting (Fig. 114). - Patient kneels on a plinth. Gymnast stands behind in step-standing position and grasps the axillae from below. Otherwise like the preceding.

Both the last forms of the exercise are strongly repleting to the pelvis, and must be given with the greatest care, at any rate for the first few times.

Sitting (or really Lax-sitting) High-ride-sitting Chest-lifting.

Sitting Chest-lifting (Fig. 115). - The gymnast stands behind the patient, supporting him in the back with his own hip or thigh.

Often a little cushion is placed behind the patient's back. Grasp under the axilla from in front or behind, and close to the body. The patient's shoulders are lifted so high that the ribs are also raised and a deep inspiration is caused, after which the shoulders are carried slightly back with firm pressure in the back so that the front of the chest is expanded; finally they are lowered again, and at the same time the pressure in the back is relaxed, so that the patient completely relaxes the trunk and breathes out strongly. These three movements ought to blend imperceptibly with each other. Movement is repeated six to ten times, with a short pause after each expiration. (N.B. - Pressure in the back must be steady enough for the patient not to be drawn back at the hip joints when the shoulders are drawn back.)

When The Movement Is Done In H.-r.-s. position (Fig. 116) the gymnast supports the patient's back with his chest. The axillae are grasped from behind.

Fig. 114.

Fig. 115.

In this way the movement is often used after a strong active trunk movement. Given three to five times.

Chest-lifting in different planes is the same movement given in the above positions, as well as in turn position to the right and to the left.

The movement takes place in the sterno-clavicular joints and in the joints of the spinal column and ribs.

Effects And Uses

(a) Particularly good respiratory exercise, which can be easily modified. For the effect of respiratory exercises, see Standing 2 (double) Arm-carrying-forward-upward-outward-downward.

(b) Stretches soft parts on front of the chest.

Used very much in medical gymnastics, both in general gymnastic treatment and in treatment of heart disease and diseases of the respiratory organs, and in treatment of weak and contracted chest.

Chest-lifting in different planes has a more general effect both on the mobility of the joints and the ventilation of the lungs, and is used especially for patients with deformed thorax.

Half-lying Chest-lift-stroking (Fig. 117). - The gymnast stands in front of the patient and puts his hands behind the back at the height of the shoulder-blades. While the patient breathes in, the gymnast lifts the chest upward and forward, not high enough to lift the head from the support, and strokes with the hands down the back and forward over the sides of the chest, finishing with slight pressure over the lowest ribs in front, while the patient breathes out. Repeated six to ten times. (N.B. - When the movement is given to heart patients the pressure in front of the chest is omitted. When given to emphysematous patients, on the contrary, a firm pressure is made on both sides and in front to assist expiration.)

Effects And Uses

Chiefly the same as the preceding, but Chestlift-stroking is a more gentle exercise for inspiration, while expiration can be greatly assisted by the pressure. It is used much, chiefly for weak patients in bed and for heart patients, and as a special movement in treatment of emphysema.

Fig. 116.

Fig. 117.

Neck-rest-standing Heave-sitting Heave-grasp-standing Stretch-grasp-standing Chest-expansion.

Chest-expansion is produced either by carrying the patient's arms backward, or backward and upward, while the trunk is fixed by support in the back, or by pressing the trunk forward by pressure in the back while the arms are fixed (generally in Heave-grasp or Stretch-grasp position).

It is common to all Chest-expansions that they produce a stretching of the soft parts in front of the chest. If the movement is given gently and in time with breathing, it acts as a gentle exercise for inspiration, because the ribs are raised and the chest expanded. If given more strongly, its most marked effects are a strong stretching of the soft parts in front of the chest and correction of the position of the shoulders. Chest-expansions are used also partly as respiratory exercises at the beginning and end of a table, partly in treatment of kyphosis, flat chest, etc.

Neck-Rest-Standing Chest-Expansion

The gymnast supports the patient's back with his own chest and grasps the elbows from below.

Heave-Sitting Chest-Expansion

The gymnast stands on a stool behind the patient, supporting the back with his own knee (often a little cushion between). The patient's arms are in heave position with palms turned forward. They grasp each other's elbows; the gymnast then gives a fairly strong and continuous, though not sudden, stretching, which is repeated four to six times with small pauses for respiration. Used for weak patients with contracted chest or kyphosis.

If The Movement Is To Be Given As A Respiratory Exercise The Patient May Preferably Take H. r.-s. position (with arms slightly outward, forearms slightly forward, and hanging loosely down). The gymnast stands behind and grasps the patient's arms from below and carries them backward and slightly upward, while he supports the patient with his own chest. After a short expansion the arms are lowered again to the starting position. Given in time with breathing five to eight times.

Heave-grasp-standing and Stretch-grasp-standing Chest-expansion (Fig. 118). - The gymnast stands behind the patient in walk position, or, if the expansion is to be strong, in fall-out position, and places one hand between the shoulders, while with the other he holds a strap going round the patient's hips to fix the pelvis. The expansion is made by the gymnast first pressing the patient forward as far as possible, and then by small pressures taking the expansion to the extreme limit. Movement is repeated three to five times with short pauses for respiration.