Barrier Concepts, ROM, Landmarks, Palpation, Structural Exam (Practical)

Question 1

Where does spine of scapula, inferior angle of scapula, and iliac crest direct to?

Answer 1

Spine of scapula = T3, Inferior Angle of Scapula = T7, Iliac Crest = L5 (woman) or L4 (man)

Question 2

Where does T4 line up with?

Answer 2

Nipple line

Question 3

What’s the rule of 3’s?

Answer 3

Since the transverse processes begin to angle down as you go down the spine, the rule of 3’s provides you the correct lining of transverse process to spinous process. T1-T3 are in line with transverse processes, T4-T6 are half step below, and T7-T10 are a full step below. And then T11 is 1/2 and T12 is same level.

Question 4

What’s physiological range?

Answer 4

normal range of motion

Question 5

What’s anatomical barrier?

Answer 5

firm, challenged, painful because past this point is tissue damage and broken bones

Question 6

What’s physiological barrier?

Answer 6

End of motion or active range for a patient

Question 7

Elastic barrier

Answer 7

the range between physiological and anatomical that we can find by passive movement

Question 8

Restrictive barrier

Answer 8

If someone has a functional limit limit that diminishes normal physiological range, so less movement required than physiological range

Question 9

Where do you begin your structural exam?

Answer 9

The feet up

Question 10

What are the axises relative to there cross sections?

Answer 10

Sagittal is on horizontal axis, examines flexion/extension
Coronal is on AP axis, side bending
Transverse is on vertical axis, examines rotation

Question 11

What are normal degrees of cervical spine?

Answer 11

Flexion = 45-90
Extension = 45-90
Rotation = 70-90
Side bending = 30-45

Question 12

What are normal degrees of motion for thoracic spine?

Answer 12

Side bending: T1-T4 = 5-25, T5-T8 = 10-30, T9-T12 = 20-40
Rotation: T9-T12 = 30-45

Question 13

What are normal degrees of motion for lumbar spine?

Answer 13

Flexion: 70-90
Extension: 30-45
Side bend: 25-30

Question 14

What does hip drop test show?

Answer 14

It is active motion on one side that leads to passive motion on the other. EX. right knee bent causes your left lumbar region to passively bend; normal degrees: 25-30

Question 15

What do you look for when observing and palpating skin?

Answer 15

Texture: rough or smooth, Temperature: cool = somatic dysfunction or chronic and warm = acute dysfunction or inflammation
Do this by comparing both sides of person’s body at same time

Question 16

How to palpate fascia?

Answer 16

place hands on skin and move around to see if there’s difference in feeling when moving around.

Question 17

How do you palpate muscle?

Answer 17

Press deeper than fascia and look for stringiness, bogginess, thickness, and ropiness.

Question 18

What’s the erythema friction rub?

Answer 18

Last step of palpation exam. Take your fingers paraspinally and move them down three times. This should create a red mark, but it should quickly fade away. If it remains on either side that could be sign of somatic dysfunction.

Question 19

What is order of palpating a patient?

Answer 19

Temperature>Skin Topography>fascia>muscle>tendons>ligaments>erythema friction

Question 20

Where do you stand for lumbar side bending vs. forward bending?

Answer 20

For side bend you want to be behind patient and for forward bend you want to be at the side of patient.

Question 21

How to perform Thoracic rotation test?

Answer 21

Patient is seated and the physician is monitoring the transverse processes of T12 and L1, while the patient rotates. Tell patient to stop once you feel L1 move; should be 30-45 degrees.

Question 22

How to perform a thoracic side bending test for T1-T4, T5-T8, T9-T12?

Answer 22

T1-T4: Place fingers monitoring T4-T5 transverse processes (remember rule of 3s, so transverse are half below). Place your other hand on shoulder with thumb lined with T1, and push down softly until you feel movement in T4-T5 (5-25 degrees). Do same monitoring for T8-T9 (10-30 degrees), and T12-L1 (20-40 degrees).

Question 23

How to perform thoracic rotation test ONLY at T9-T12?

Answer 23

Monitor T12 and L1, and have patient rotate until L1 starts moving. (30-45 degrees)

Question 24

How to perform cervical flexion/extension, side bending, and rotation exam?

Answer 24

Monitor C7-T1. Tell patient to bend forward/backward until you feel movement of T1. (45-90 degrees). Same for side bending (30-45 degrees), and rotation (70-90)

Question 25

What to look at when performing lateral structural exam?

Answer 25

Alignment of ear, head of humerus, third lumbar vertebra, greater trochanter, femoral condyle, and later malleolus.

Question 26

What to look for when performing anterior structural exam?

Answer 26

See if shoulders unlevel, if ASIS level, level of tibial tuberosities/ or knee height

Question 27

What to look for in posterior static exam?

Answer 27

level of shoulders, scoliosis, level of iliac crest, level of PSIS