1-15-13 OPP forum

Question 1

Diagnose pelvis?

Answer 1

1. standing flexion test

2. Check levels of ASIS, PSIS, ischial tuberosities (pubes, medial malleoli)

Question 2

anterior innominate rotation

Answer 2

ASIS  inf
PSIS  sup
Med malleoli  inf
Pubes  approx.  neutral
Tubes  superior

Question 3

posterior innominate rotation

Answer 3

ASIS  sup
PSIS  inf
Med malleoli  sup
Pubes   approx neutral
Tubes  inf

Question 4

superior shear

Answer 4

ASIS  sup
PSIS  sup
Med malleoli  sup
Pubes  sup
Tubes  sup

Question 5

inferior shear

Answer 5

ASIS  inf
PSIS  inf
Med malleoli  inf
Pubes  inf
Tubes  inf

Question 6

combo of ant rotation and sup shear

Answer 6

ASIS  N
PSIS  SUP
Med malleoli  N
Pubes  N
Tubes  SUP

Question 7

anterior innonimate dysfunction treatment (prone)

Answer 7

1. Patient prone with the dysfunction hip flexed and off the table. The ipsilateral foot rests on the physician’s thigh.
2. Physician ipsilateral, one hand on the patient’s knee and the other on the dysfunctional sacroiliac (SI) joint.
3. Patient is instructed to extend the lower extremity into the physician’s thigh while the physician resists.
4. Hold for 3-5 seconds then relax.
5. Engage new barrier and repeat two more times.
6. Passive stretch.
7. Reassess

Question 8

anterior innominate (supine)

Answer 8

1. Patient supine
2. Physician sits/stands on dysfunction
3. Flexes knee and hip
4. Physician with one hand (palm up) against ischium, other hand on knee (for resistance)
5. Patient attempts to straighten leg isometrically
6. 3-5 seconds, patient relaxes, engage new barrier
7. Repeat twice more. Passive stretch. Recheck.

Question 9

posterior innominate dysfunction (prone)

Answer 9

1. Patient prone.
2. Stand opposite dysfunction.
3. Lower extremity extended, with one of physician’s hands grasping anterior thigh above knee, other hand monitors at SI joint.
4. Engage barrier.
5. Patient attempts to bring involved lower extremity towards table (the freedom)
6. Physician resists.
7. After 3-5 seconds patient relaxes.
8. New barrier, repeat twice more.

Question 10

posterior innominate dysfunction (supine)

Answer 10

1. Patient supine, lower extremity of dysfunction side extended off table
2. Physician ipsilateral, one hand supporting opposite ASIS, other below ipsilateral knee
3. Patient attempts to bring extremity towards ceiling
4. Resist in usual muscle energy fashion
5. 3-5 seconds, patient relaxes, engage new barrier
6. Repeat twice more
7. Reassess

Question 11

superior shear alternative

Answer 11

1. Patient supine.
2. Physician at the foot of the table with hands wrapped around area superior to the ankle of the superior shear and one forearm against the opposite foot.
3. While applying caudad traction the patient is asked to push against you with the opposite foot.
4. Repeat three times while taking up the slack.

Question 12

pubes abducted

Answer 12

ABducted Ilium (open pubes) dysfunction

1. Patient supine (close to one side of the table), hips and knees flexed to 90°, knees and feet pelvis-width apart
2. Physician standing at the side of the table facing the patient
3. Physician places his hands on the lateral aspect of each knee (close the pubes)
4. Patient is instructed to attempt to abduct knees and hold this contraction for 3-5 seconds (isometric contraction).
5. After a 2 second pause, the physician adducts the knees to the new restrictive barrier.
6. The isometric contraction is repeated 3-5 times. Reassess

Question 13

pubes adducted

Answer 13

ADducted Ilium (closed pubes) dysfunction

1. Patient supine (close to one side of the table), hips and knees flexed to 90°, feet together
2. Physician standing at the side of the table facing the patient
3. Physician’s forearm is placed between the patient’s knees (hand on medial aspect of far knee and elbow on medial aspect of close knee, trying to open pubes)
4. Patient is instructed to attempt to adduct knees and hold this contraction for 3-5 seconds (isometric contraction).
5. After a 2 second pause, the physician abducts the knees to the new restrictive barrier
6. The isometric contraction is repeated 3-5 times. Reassess

Question 14

ankle somatic dysfunction

Answer 14

1. Patient Supine
2. Physician standing at foot of table
3. Physician tests both ankles simultaneously for restrictions
   a. Dorsiflexion
   b. Plantarflexion
   c. Internal Rotation/External Rotation
   d. Inversion/Eversion
4. Names the Somatic Dysfunction correctly
5. Treat restriction(s) using muscle energy priniciples as previously discussed. See DiGiovanna pp. 506 for more information.

Question 15

treatment for a short leg

Answer 15

1. Patient is Supine
2. Physician grasps patient’s leg above the ankle on the short leg side.
3. Have the patient place other foot against the your forearm.
4. Have the patient push “normal” leg against forearm while you maintain traction on the short leg.
5. Relax, repeat 2-3 times, increase traction on short leg each time to gain “length”
6. Passive Stretch
7. Reassess

Question 16

info for fibular head

Answer 16

• Examine both sides, above and below the joint
• Test for SD by motion testing or grabbing the fibular head moving it with your thumb and index finger to see freedom of motion
• Range of motion (use these motions to help you feel motion at the fibular head
o When you dorsiflex or externally rotate the foot the fibular head moves anterior
o When you plantar flex or internally rotate the foot the fibular head moves posterior
• Treatments (mnemonic PED = posterior treatment by external rotation/eversion and dorsiflex)
o Anterior SD = treat by internal rotation, inversion, plantar flexion (pushes it posterior)
o Posterior SD= treat by external rotation, eversion, dorsiflexion (pushes it anterior)
 Posterior SD is much more common than anterior SD

Question 17

treatment of posterior fibular head with muscle energy

Answer 17

Treatment of a Posterior Fibular Head with muscle energy

1. Flex knee to 90 degrees, monitor fibular head with one hand
2. Externally rotate, evert, dorsiflex side of affected fibula
3. Have patient try to return foot to neutral against your resistance (have your hand on medial foot) then relax for 2-3 seconds
   a. While patient is turning foot, pull fibular head into the anterior restrictive barrier
   b.
4. Externally rotate, evert, dorsiflex into next restrictive barrier
   a. Repeat 3-5 times
5. Passively stretch at end
6. Reassess

Question 18

treatment of an anterior fibular head with muscle energy

Answer 18

1. Flex knee to 90 degrees, monitor fibular head with one hand
2. Internally rotate, invert, plantarflex side of affected fibula
3. Have patient try to return foot to neutral against your resistance (have your hand on medial foot) then relax for 2-3 seconds
   a. While patient is turning foot, push fibular head into the posterior restrictive barrier
4. Internally rotate, invert, plantarflex into next restrictive barrier
   a. Repeat 3-5 times
5. Passively stretch at end
6. Reassess