Supine flexion, also known as the 'crunchie' position, refers to the act of lying on one's back with the arms crossed over the chest and the legs bent at the knees. This position places significant strain on the shoulder girdle muscles, particularly the pectoralis minor, and can serve as an effective assessment tool for assessing the integrity of the shoulder joint complex, including the rotator cuff and glenohumeral joints. It is a common challenge that individuals with shoulder or arm issues may encounter and can be a sign of weakness in the core musculature or poor posture.
Normal Values for Supine Flexion in Children:
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Four-year-olds typically exhibit a normal range of 10-25 seconds before needing to modify or stop the movement.
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Six-year-olds may hold the position for 25-31 seconds.
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Eight-year-olds often maintain the position for 31-60 seconds without assistance.
Supine flexion resistance tests are performed with the patient in a seated position with their arms elevated, hands hanging down, and the examiner holding the patient's wrist to resist arm internal rotation. A positive test is indicated by pain or a sense of weakness in the shoulder girdle muscles, which may be indicative of a SLAP lesion, bicipital tendinitis, or a bankart lesion.
Children with poor posture or weaknesses in the core musculature may struggle to maintain this position for as long as an adult, which can be a sign of underlying musculoskeletal disorders. Encouraging children to practice good posture and incorporating core-strengthening exercises into their daily routines can help improve their ability to maintain this position and potentially prevent future shoulder problems.
For children who are experiencing difficulty maintaining supine flexion, physical therapists may recommend specific exercises to improve strength, flexibility, and coordination in the shoulder girdle. These exercises may include variations of the prone extension test, such as having the child lie on their stomach and lift their head, chest,arms, and legs off the floor, or using resistance bands to enhance muscle action.
Assessment of Core Strength through Supine Flexion:
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The supine flexion test can also be used to assess core strength in children by asking them to perform a prone extension or prone extension with their arms and legs extended.
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A longer duration in seconds while maintaining the position suggests better core strength and stability.
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A decrease in seconds in the presence of pain indicates a more serious condition.
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The results of the test should be compared to age-appropriate norms to determine if there are any deviations from what is considered normal., supine flexion is an important movement to assess for shoulder and core strength. By understanding the normal values for supine flexion and monitoring for deviations from these norms, children and adolescents with shoulder or arm weakness, pain, or instability can be better supported through physical therapy interventions that focus on improving posture, core strength, and shoulder girdle function.
