SUSPENSION THERAPY
Suspension for the Lower Extremity
• Hip joint: flexion ,extension, abduction, adduction.
• Knee joint: flexion, extension.
• Ankle joint: rare need to suspension.
Hip Abduction And Adduction
The starting position is lying with the
opposite leg abducted to its limit, even if the
knee has to be bent over the side of the
plinth and the foot supported on a footstool.
The fixation point is immediately above the
hip joint.
One sling is put under the lower thigh and one
three-ring sling on the foot and ankle;
 each is attached to a rope hung from the fixation
point.
 The limb is lifted just clear of the plinth.
Using this method of support the movements of
abduction and adduction may be mobilized or the
abductor or adductor muscles may be especially
worked with or without manual resistance.
Abduction
and
adduction of
hip joint in
axial fixation
( axial line).
Hip Flexion And Extension
o The starting position is side lying with the underneath leg flexed
as far as possible.
o The fixation point and sling arrangements are as above, with the
limb lifted until it is horizontal.
o If the movement of flexion is to be mobilized the knee and hip
must be flexed together to overcome the passive insufficiency of
the hamstrings.
o Equally, when mobilizing extension the knee should be extended
to overcome active insufficiency of the hamstrings.
Flexion and
extension of
hip joint in
axial fixation
(axial line).
Knee Flexion And Extension
The starting position is side lying with one or two pillows
between the slightly flexed thighs.
One three-ring sling is applied to the foot and ankle and one
rope attached to a fixation point above the knee joint.
 By keeping the hip slightly flexed on the trunk the foot can be
seen each time the knee is extended and part of the arc of
movement is thus observed by the patient.
 This position may be used to mobilize the knee joint or to work
the flexors or extensors of the knee.
A pillow is
placed beneath
the thigh for
Flexion and
extension of
knee joint in
axial fixation
(axial line).
Ankle joint
•It is rarely necessary to use suspension as
in this case it is easier to perform
supported movements by using a
polished board.
Suspension for the Upper Extremity
• Shoulder : abduction, adduction, flexion, extension.
• Elbow: flexion, extension.
• Wrist: flexion, extension.
• Whole arm: flexion, extension.
Shoulder Abduction And Adduction
•
The starting position is lying, quarter turned towards arm which is to be
moved
•
This allows the normal anatomical movement to be performed in the
plane of the scapula.
•
Alternatively, the starting position is prone lying, quarter turned
towards side lying with a pillow under the trunk on the side of the arm
which is to be moved
•
The advantage of prone lying is that the therapist can see the
movements of the scapula as well as those of the arm.
•
Two single ropes are required, one attached to a single sling under the
elbow and one to a three-ring sling applied to the wrist and hand.
• The fixation point is over the shoulder joint.
• If the movement is to be only of the glenohumeral joint, the
therapist must stand on the opposite side with one hand on the
point of the shoulder depressing the scapula.
•
In this form of support either abduction and adduction of the
glenohumeral joint, or movements of the shoulder girdle, may
be mobilized.
• Glenohumeral rhythm may be re-educated and all the muscles
performing shoulder girdle movements may be worked.
Shoulder Flexion And Extension
The starting position is side lying on pillows and quarter
turned to the back.
Female patients need two pillows under the head and one
under the shoulder to allow the forearm to clear their wider
pelvis.
The slings and ropes are arranged as described above and
again the movement may be limited to the glenohumeral
joint and the muscles working over it, or movements of the
shoulder girdle may be included.
If in addition to the angular movements it is desired to perform
rotation of the glenohumeral joint, then only one sling should be
used at the level of the elbow and a single pulley rope should be
attached to the fixed point above the shoulder.
The ends of the sling are attached to each end of the pulley
circuit and it will then be possible to perform medial or lateral
rotation with two angular movements.
It will be necessary to turn the patient further towards the side
or more prone.
It is then possible to perform flexion, adduction and lateral rotation
alternately with extension, abduction and medial rotation,
or flexion, abduction and lateral rotation alternately with extension,
adduction and medial rotation.
Elbow Flexion And Extension
• Because of the carrying angle of the forearm it is easier
to perform these movements when the arm is
suspended in abduction.
• The starting position is sitting on a low-backed chair.
• A single sling and rope supports the arm in vertical
fixation, and a three-ring sling and single rope are fixed
to a point above the elbow joint .
• The therapist should stand behind as she may need to
give additional support by holding the arm with a grasp
inside the sling, which will allow palpation of the flexors
and extensors which are covered by the supporting
sling.
• Alternatively, a folded single sling under the palm,
attached to a single pulley rope, will allow pronation and
supination to occur with extension and flexion of the
elbow joint.
Wrist flexion and extension
This is more usually and conveniently performed
on a polished board or table.
Flexion And Extension Of The Whole Arm
As a functional movement this may be performed with the patient in the
sitting position, e.g. practicing taking the hand to the mouth may be done
by using two single slings attached to two single pulley rope circuits.
 One sling is placed round the arm and one round the forearm. If the ropes are
sufficiently tightened the patient can grasp, supinate and flex the elbow and
shoulder while adducting and laterally rotating.
This sort of support is used for patients who have difficulty in
performing personal facial toilet, feeding, turning the pages of a
book fixed at eye level, or working in front of themselves.
Thank you