1. Suspension therapy

2. Suspension for the Lower Extremity
Hip joint: flexion ,extension, abduction, adduction.
Knee joint: flexion, extension.
Ankle joint: rare need to suspension.

3. 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.

4. 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.

5. Abduction and adduction of hip joint in axial fixation ( axial line).

6. Hip Flexion And Extension
The starting position is side lying with the underneath leg flexed as far as possible.
The fixation point and sling arrangements are as above, with the limb lifted until it is horizontal.
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.
Equally, when mobilizing extension the knee should be extended to overcome active insufficiency of the hamstrings.

7. Flexion and extension of hip joint in axial fixation (axial line).

8. 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.

9. A pillow is placed beneath the thigh for Flexion and extension of knee joint in axial fixation (axial line).

10. 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.

11. Suspension for the Upper Extremity
Shoulder : abduction, adduction, flexion, extension.
Elbow: flexion, extension.
Wrist: flexion, extension.
Whole arm: flexion, extension.

12. 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.

13. 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.

15. 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.

16. 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.

19. 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.

20. 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.

21. Wrist flexion and extension
This is more usually and conveniently performed on a polished board or table.

23. 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.

24. Thank you