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1
Q

Freyette’s Principle 1

A 
Neutral mechanics
Sidebend and Rotate in OPPOSITE directions
Multiple segments
Creates Lateral Curves
Gradual onset
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2
Q

Freyette’s Principle 2

A 
Flexed/ Extended
Sidebend and Rotate in SAME direction
Single segment
Creates flattening or exaggeration of AP curves
Abrupt onset
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3
Q

Freyette’s Principle 3

A

Motion in any single plane modifies motion in other planes

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4
Q

Spine of Scapula is at spinal level

A

T3

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5
Q

Inferior angle of scapula is at spinal level

A

T7

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6
Q

Sternal notch is at spinal level

A

T2

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7
Q

Sternal angle is at which levels anteriorly and posteriorly?

A

Anterior: 2nd rib
Posterior: T4

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8
Q

Iliac crest is at spinal level

A

L4

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9
Q

Spinous Process

Rule of 3’s

A 
T1-T3 same level as TP
T4-T6 is half level below TP
T7-T9 is level of TP below
T10 is level of TP below
T11 is half level below TP
T12 is same level as TP
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10
Q

Superior Facets of cervical spine

A

Oblique

Face backwards, upwards, medial (BUM)

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11
Q

Superior Facets of thoracic spine

A

Coronal

Face backwards, upwards, lateral (BUL)

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12
Q

Superior Facets of lumbar spine

A

Sagittal

Face backwards, medial (BM)

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13
Q

Anatomic Barrier

A

Anatomy limits motion

Limit of passive motion

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14
Q

Physiologic Barrier

A

Limit of active motion

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15
Q

5 Models of Osteopathy

A 
Biomechanical/ Structural Model
Respiratory-Circulatory Model
Metabolic Model
Neurological Model (CS, Chapman)
Behavioral Model
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16
Q

5 Components of Primary Respiratory Mechanism

A

Inherent brain motility is the driving force
CSF is hydraulics moving concurrently
Bones of the skull move
Membranes move –> reciprocal tension membrane
Involuntary motion of sacrum
CNS -> CSF -> Dura -> skull -> sacrum = PRM

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17
Q

Normal Rate of Cranial Rhythmic Impulse

A

Rate 8-14/ min

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18
Q

Factors that Increase CRI

A

Exercise
Fever
Following OMT of craniosacral mechanism

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19
Q

Factors that Decrease CRI

A

Stress (physical and emotional)
Depression
Chronic fatigue
Chronic Infections

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20
Q

Pterion is the joint of (4 bones)

A 
Frontal
Sphenoid
Parietal
Temporal
*at the temple*
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21
Q

Asterion is the joint of (3 bones)

A

Occiput
Parietal
Temporal
just above mastoid

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22
Q

Bregma is the junction of (2 sutures)

A

Coronal

Sagittal

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23
Q

Lambda is the junction of (2 sutures)

A

Lambdoid

Sagittal

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24
Q

Basion location

A

Ventral aspect of Foramen Magnum

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25
Opisthion location
Dorsal aspect of Foramen Magnum
26
Midline Bones pertinent to cranial motion
Sphenoid Occiput Sacrum
27
Paired Bones pertinent to cranial motion
``` Frontals Parietals Temporals Nasals Zygomas Maxillae ```
28
Motion of midline bones
Flexion and Extension
29
Motion of Paired bones
Internal and External Rotation
30
_____ influences motion of anterior cranial bones
Sphenoid
31
_____ influences the motion of bones of posterior cranium
Occiput
32
``` During Cranial Flexion SBS _____ Sacrum _____ Midline bones _____ Paired bones _____ AP diameter _____ ```
``` SBS rises Sacrum extends (counternutation) Midline bones Flex Paired bones External Rotation ("flEXternal") AP diameter Decreases (widened head) ```
33
``` During Cranial Extension SBS _____ Sacrum _____ Midline bones _____ Paired bones _____ AP diameter _____ ```
``` SBS falls Sacrum flexes (nutation) Midline bones Extend Paired bones Internally rotate AP diameter Increases (narrowed head) ```
34
Cranial Vault Hold
``` Forearms on table Index- Great wing Middle- Temporal bone, just anterior to EAM Ring- Petrous temporal Pinky- Occiput Thumbs- Sagittal suture Palms conform to skull ```
35
Galbreath Technique
``` For Otitis Media (drain middle ear) Pt supine, head elevated 30 deg Turn head so affected ear is up Sit on side OPP dysfunction Cephalic hand on forehead Caudad hand on mandible Gently press down and in Repeat every 3-5 sec over 30-60 sec (up to 10-20 mins as needed) ```
36
Sphenoid motion during cranial flexion
Sphenoid body rises and slightly anterior Wings move anterior, laterally, and slightly inferior *extension motion is opposite
37
Occiput motion during cranial flexion
Base rises and moves slightly posterior Squamous portion moves inferior and laterally *extension motion is opposite
38
Sphenoid and Occiput circumduct in _____ direction about _____ axis(es)
Circumduct in OPPOSITE directions | About 2 TRANSVERSE axes
39
Axis of Cranial Torsion
AP | Opposite directions
40
Cranial torsion is named for
High sphenoid
41
Axis of Cranial Sidebending Rotation Strain Pattern
2 vertical = sidebend (opposite directions) | AP = rotation (same direction)
42
Physiologic Cranial Strain Patterns
Torsion | Sidebending Rotation
43
Pathologic Cranial Strain Patterns
Lateral Strain | Vertical Strain
44
Sidebending Rotation Cranial Strains are named for
Convex side
45
Lateral Cranial Strain is named for
Freer motion of sphenoid
46
Axis of Cranial Lateral Strain
2 vertical axes | Both same direction
47
Axis of Cranial Vertical Strain
2 transverse axes | Both same direction
48
Cranial Vertical Strain is named for
Base of sphenoid
49
Motion testing of Cranial Sidebending Rotation Strain
Inferior motion separates fingers | Superior motion brings fingers together
50
Internally rotated Temporal bone will cause
High pitched tinnitus
51
Externally rotated Temporal bone will cause
Low pitched tinnitus | Jaw deviates toward Ext Rot temporal
52
Occipital-Mastoid Suture Compression can affect _____ and is treated with _____
Can affect Jugular foramen (CN 9. 10, 11) | Treated with V-Spread
53
CN 2-6 Issues can be caused by a _____ dysfunction
Sphenoid * CN 2,4,6 = Diplopia * CN 3,4,6 = Strabismus * Trigeminal Neuralgia * Pituitary Dysfunctions
54
Suckling disorders in Newborn should clue you into
``` Jugular foramen (CN 9, 10, 11) Compression of occipital condyle (Hypoglossal canal, CN 12) ```
55
Typical Cervical Vertebrae
C2-C7 | Sidebend and Rotate in SAME direction
56
Occiput Sidebends and Rotates to _____ side
OPPOSITE | Major motion is flexion and extension
57
Motion of the Atlas
Rotation only
58
Superior articular facets of C2-C7 are at a _____ angle
45 deg
59
Biceps Reflex tests what muscles
Deltoid | Biceps
60
Biceps Reflex tests what disc and nerve root
Disc C4-C5 | Nerve root C5
61
Biceps Reflex tests sensation to
Lateral Arm | Axillary nerve
62
Brachioradialis Reflex tests what muscles
Wrist extensors | Biceps
63
Brachioradialis Reflex tests what disc and nerve root
Disc C5-C6 | Nerve root C6
64
Brachioradialis Reflex tests sensation to
Lateral forearm | Musculocutaneous Nerve
65
Triceps reflex tests what muscles
Wrist flexors Finger extension Triceps
66
Triceps reflex tests what disc and nerve root
Disc C6-C7 | Nerve root C7
67
Triceps reflex tests sensation to
Middle finger
68
C8 provides motor innervation to what muscles
Finger Flexors | Hand intrinsics
69
C8 provides sensation to
Medial forearm | Medial Ant. Brachial Cutaneous Nerve
70
T1 provides motor innervation to what muscles
Hand intrinsics
71
T1 provides sensation to
Medial arm | Medial Brachial Cutaneous Nerve
72
Ulnar Nerve Palsy results in
Claw Hand - No finger extensors at IP joint - Permanent flexion of fingers
73
Median Nerve Palsy results in
Ape Hand | -Inability to oppose thumb
74
Radial Nerve Palsy results in
Wrist Drop - No wrist extension - No forearm extension
75
Ulnar Nerve can be impinged at what locations
``` Cubital Tunnel (medial epicondyle) Ulnar/ Guyon's Canal (pisiform, hook of hamate) ```
76
Medial Nerve can be impinged at what locations
``` Pronator Teres Syndrome Carpal Tunnel (flexor retinaculum) ```
77
Most common Dysfunction of the Elbow
Cubitus Valgus / ABducted Ulna Olecranon --> medial Distal Ulna --> lateral Wrist is ADducted
78
Lateral Epicondylitis
Tennis elbow Overuse Extensor Carpi Radialis Brevis Resisted wrist extension
79
Medial Epicondylitis
``` Golf Elbow Overuse Pronator Teres and Flexor Carpi Radialis Resisted pronation and wrist flexion "Medial --> Masters --> Golf" ```
80
_____ Radial Head favors Supination
Anterior Radial Head
81
_____ Radial Head favors Pronation
Posterior Radial Head | "P for posterior and pronation"
82
Radial Head Dysfunction expected from a backward FOOSH
Anterior Radial Head
83
Muscle Energy for Anterior Radial Head
Posterior pressure on radial head | Pronate hand against resistance
84
Radial Head Dysfunction expected from a forward FOOSH
Posterior Radial Head
85
Muscle Energy for Posterior Radial Head
Anterior pressure on radial head | Supinate hand against resistance
86
Nursemaids elbow
Subluxation of annular ligament Sudden longitudinal traction to hand Tx: closed reduction --> either supination or hyperpronation techniques
87
Spurling's Test
Nerve root compression Sidebend, extend, compress neck + if reproduces radicular symptoms
88
Neer's Test
Impingement / Irritation of Supraspinatus Shoulder INT ROT and ADducted Doc passively flexes humerus "Neer to the ear"
89
Hawkin's Test
Impingement of Supraspinatus Shoulder ADducted and flexed Doc passively INT ROT humerus
90
Jobe's Test (Empty Can Sign)
Tear of Supraspinatus Arms ABducted and in plane of scapula Thumbs down and resist down pressure
91
Speed's Test
Irritation of Long Head of Biceps Brachii Arms 90 deg flexion, palms up Doc presses down on forearm
92
Apprehension Sign
Anterior and Inferior Instability secondary to shoulder dislocation Arm ABducted and elbow flexed Doc pushes shoulder joint from behind
93
Sulcus Sign
Inferior instability of Glenohumeral joint | Bone sticking out w indent where deltoid should be
94
Drop Arm Sign
Tears of Rotator Cuff
95
Apley Scratch Test
Decreased ROM of the shoulder Reach hand behind head down back Reach hand behind back and up spine
96
Anterior/ Posterior Drawer Test of Arm
Anterior / Posterior Instability of Glenohumeral Joint
97
Jobe's Test or Empty Can Sign can give a false positive for _____
Subacromial Brusitis
98
Upper Ribs (1-5) have primarily _____ motion
Pump handle
99
Middle Ribs (6-10) have primarily _____ motion
Bucket handle
100
_____ Ribs have a larger spinotransverse angle
Upper Ribs (1-5)
101
_____ Ribs have a smaller spinotransverse angle
Middle Ribs (6-10)
102
Lower Ribs (11-12) have primarily _____ motion
Caliper
103
Secondary muscles of respiration
``` Scalenes (ribs 1-2) Pectoralis minor (ribs 3-5) Serratus ant and post (ribs 4-9) Latissimus dorsi (ribs 10-11) Quadratus lumborum (rib 12) ```
104
Atypical Ribs
1, 2, 11, 12 | *all have 1s and 2s
105
Ribs _____ are true ribs
1-7 | Attach directly to sternum
106
Ribs _____ are false ribs
8-12 Ribs 8-10 indirectly attach via cartilage Ribs 11-12 do not attach to sternum (floating)
107
Treatment of Key Rib of group dysfunctions
BITE Bottom rib for Inhaled group Top rib for Exhaled group
108
_____ pulls the 11th and 12th ribs up
Latissimus dorsi
109
_____ pulls the 12th rib down
Quadratus lumborum
110
Rib 1 uses __(muscle)___ for treatment using muscle energy
Anterior and Middle Scalenes
111
Rib 2 uses __(muscle)___ for treatment using muscle energy
Posterior Scalenes
112
Ribs 3-5 use __(muscle)___ for treatment using muscle energy
Pectoralis minor
113
Ribs 6-9 use __(muscle)___ for treatment using muscle energy
Serratus anterior
114
Ribs 10-11 use __(muscle)___ for treatment using muscle energy
Latissimus dorsi
115
Rib 12 uses __(muscle)___ for treatment using muscle enertgy
Quadratus lumborum
116
Thoracic and Lumbar Intervertebral foramina are located _____ on the spine
Laterally
117
Zygapophyseal Facets of the Thoracic Spine
60-70 deg angle
118
Rib Articulations with thoracic vertebrae occur in whole and demi facets
``` Demi = Ribs 1-9 Whole = 1, 10-12 ```
119
Spinal Group Curves are measured by
Cobb Angle 5-15 deg = mild 20-45 deg = moderate >50 deg = severe
120
Respiratory compromise begins at Cobb angle of _____ | Cardiovascular compromise at _____
Respiratory 45-50 deg | Cardiovascular approx 75 deg
121
Most common spinal group curve
Upper thoracic dextroscoliosis (convex right)
122
Short Leg syndrome creates spinal compensation with a crossover point of _____ between the thoracic and lumbar curves
T7
123
Ilium rotates _____ to compensate for a short leg
Anteriorly
124
Short leg treatment goal
Level sacral base - heel lift (1/2 the LLI) - start at 1/8" and recheck in 2 weeks - 3/8 is maximum inside shoe before building up sole - Heilig formula
125
Piriformis Syndrome
``` Creates Sciatica (stops at knee) Caused by opposite side iliopsoas spasm (body flexes forward and to one side, stretches contralateral piriformis) ```
126
Piriformis treatment goals
``` Improve sciatica Improve hip extension Improve pelvic side shift TREAT CONTRALATERAL PSOAS FIRST Strengthen core muscles and glutes ```
127
Tentorium Cerebelli
Transverse dura Separates cerebellum and cortex Area of automatic shifting suspension fulcrum (of Sutherland)
128
Sibson's Fascia
Thoracic Inlet Attaches C7-T1 around 1st rib to manubrium Attaches to capula of lung Made of fascia from scalenes and longs colli muscles Thoracic duct travels through it
129
Thoracoabdominal Diaphragm
60% of motive force for inhalation Innervated by C3-C5 Hiatuses
130
Vena Caval Hiatus in thoracoabdominal diaphragm is located at spinal level
T8
131
Esophageal Hiatus in thoracoabdominal diaphragm is located at spinal level
T10
132
Aorta and Thoracic Duct pass thru thoracoabdominal diaphragm at spinal level
T12
133
Pelvic Diaphragm
Comprised of Levator ani and Coccygeus muscles Somatic and parasympathetic innervation via S2-S4 and pelvic splanchnics
134
Medial Longitudinal Arch of the Foot is made of
Navicular and Plantar fascia
135
Zink Fascial Pattern Locations
``` OA Thoracic Inlet Thoracolumbar Lumbosacral *coincide w diaphragms of the body ```
136
Most common Zink Fascial Pattern
LEFT OA RIGHT Thoracic LEFT Thoracolumbar RIGHT Lumbosacral
137
Zink Fascial Patterns are considered physiologic or compensated as long as the pattern ______
Alternates
138
Zygopophyseal Joints of the Lumbar Spine
30-60 deg angle
139
Spondylolysis
Fracture of the Pars Interarticularis Scotty Dog Collar on oblique view Unilateral or Bilateral Bilateral --> Slippage (spondylolisthesis)
140
Spondylolisthesis Slippage Grading
Grade 1: <25% Grade 2: 25-50% Grade 3: 50-75% Grade 4: >75%
141
Sacral Axis of Motion Mnemonic
CRAIN Cranial-Superior Axis-(craniosacral flex/extend) Respiratory-Middle Axis- (flex/extend) Anatomical-Inferior Axis-(bending over) INnominate-Oblique Axis-(changes in weight bearing)
142
Nutation
Sacral base moves anteriorly and inferiorly (flexes) | Cranial Extension
143
Counternutation
Sacral base moves posteriorly and superiorly (extends) | Cranial Flexion
144
Sacral Torsions are in relation to
L5
145
Seated flexion test is positive on the _____ side of the oblique axis
Opposite
146
L5 rotation is _____ sacral rotation
Opposite
147
Spring test differentiates _____
Forward or Backward Sacral Torsions
148
Sphinx Technique and Interpretation
Thumbs in sulci and pt assumes Sphinx position Asymmetry improves = forward torsion or unilateral flexion Asymmetry worsens = POSITIVE result, backward torsion or unilateral extension
149
Spring Test Technique
Anterior force on L5
150
Spring Test - Negative
L5 springs anterior Increased lumbar lordosis Forward Torsion
151
Spring Test - Positive
L5 resists anterior pressure Flattened lumbar lordosis Backward Torsion
152
Innominates move about the _____ axis of the sacrum
Inferior Transverse Axis
153
Positive Standing Flexion test is _____ side of innominate dysfunction
SAME side
154
Superior innominate is commonly caused by a _____
Laxity of Sacrotuberous ligament *tightness causes an inferior innominate
155
Standing Flexion test is positive on _____ side of a pubic dysfunction
SAME side
156
Normal Femoral Neck and Shaft angle
120-135 deg < 120 Coxa Vara > 135 Coxa Valga
157
Q (quadriceps) Angle landmarks for measurement
ASIS- Patella | Tibial Tubercle- Patella
158
Normal Q (quadriceps) Angle
10-12 deg < 10 Genu Varum (bowlegged) > 12 Genu Valgum (knock-kneed)
159
Features of Posterior Fibular Head
Anterior Malleolus Internal rotation of talus --> Ankle Inversion and Plantarflexion are free
160
Features of Anterior Fibular Head
Posterior Malleolus External rotation of talus --> Ankle Eversion and Dorsiflexion are free
161
Structure commonly injured with Fibular head dysfunctions
Common Peroneal Nerve
162
Obers Test
IT Band tightness Pt on side, affected leg up, hip neutral Bottom knee bent and hip flexed to 90 deg Doc lifts (ABducts) top thigh, extends, lowers Stabilize pelvis POS- knee does NOT touch table Bounce Up Sign: leg bounces up after the release of slight ADduction pressure
163
Bounce Home Test
Torn Meniscus, Capsular Sprain, Joint Fluid, Laxity Pt supine, Doc on side of bad knee Support ankle/heel w one hand Other hand under knee/calf Completely flex knee and allow to passively extend POS- incomplete extension, rubbery end, pain, guarding
164
Lever Sign
``` Integrity of ACL Pt supine Fist under proximal tibia (top of calf) Press down on distal femur POS- foot does NOT lift off table ```
165
Apley Distraction Test
Torn Collateral Ligaments Pt prone, knee flexed 90 deg Doc stabilizes thigh and hand on pt's foot After compression test, distract and repeat internal and external rotation POS- pain with both compression and distraction
166
Apley Compression Test
Torn Meniscus Pt prone w knee flexed 90 deg Stabilize thigh and place hand on pt's foot Compress down tibia Internally and Externally Rotate leg Follow with Apley's Distraction Test POS- pain with compression that is relieved w distraction
167
McMurray's Test
Torn Meniscus Pt supine, Doc flexes knee w one hand on heel Other hand fingers medial joint line, thumb lateral line Medial Meniscus: -Apply medial pressure (valgus stress) and -Externally rotate tibia and extend leg Lateral meniscus: lateral (varus) pressure, internally rotate POS- pain, +/- click
168
Patellar Apprehension Test
Subluxation of the patella Pt supine, leg extended Translate patella laterally POS- pain, apprehension, subluxation of patella
169
Patellar Grind Test
Chondrolalacia of Patella or Inflammation at Patellofemoral Joint Thumb and Fingers of both hands on margin of patella Gentle inferior/ superior and medial/ lateral motion Provocative test: downward/ posterior pressure and ask pt to contract quad POS- pain, grinding
170
Squeeze Test
Integrity of Interosseous Membrane Hang foot off table Grasp leg w both hands, squeeze tibia against fibula POS- pain, high ankle sprain, syndesmosis, fx of fibula, stress fx, compartment syndrome, DVT Sensitivity > specificity
171
Thompson Test
Ruptured Achilles Pt prone w foot up, apply dorsiflexion force to foot Squeeze calf and foot plantar flexes if Achilles is intact
172
Anterior Drawer Test of Ankle
Anterior Talofibular Ligament Foot hangs off table, natural neutral position (20 deg plantar flexion) Stabilize lower leg, other hand grasps foot Pull talus forward POS- increased anterior translation of talus, pain w motion
173
Talar Tilt
Calcaneofibular Ligament Foot hangs off table One hand stabilizes lower leg, other grabs calcaneus Foot in anatomic position Attempt to invert ankle POS- increased inversion or instability, pain w motion
174
Metatarsal Compression Test
InterMetatarsal (Morton's) Neuroma (3rd-4th metatarsals) Foot hangs off table Squeeze medial and lateral sides of metatarsals POS- reproduction of symptoms
175
Tinel's Sign of Lower Extremity
Irritation to Tibial Nerve Foot hangs off table Percuss area of tarsal tunnel in medial ankle POS- pain, reproduction of neurological symptoms
176
SA node is innervated by
Right sympathetic fibers
177
AV node is innervated by
Left sympathetic fibers
178
Path of Sympathetics of Head and Neck
T1-T4 --> Superior Cervical Ganglia at level C1-C3 Follow arterial supply thru Spenopalatine Ganglion (WITHOUT synapsing) to eyes, nose... etc
179
_____ Nerve carries Sympathetic Fibers within the head
Deep Petrosal Nerve
180
_____ Ganglion is a Parasympathetic mechanism mainly from CN 7 to throat, sinus, ears, etc
Sphenopalatine Ganglion
181
_____ Nerve carries Parasympathetic Fibers in the head
Greater Petrosal Nerve
182
Right Vagus Nerve (CN X)
``` aka Posterior Vagal Trunk Gives rise to Celiac Branch Innervates SA node Innervates Ascending Colon and first 2/3 of Transverse Longer than the Left Vagus ```
183
Left Vagus Nerve (CN X)
Gives rise to Hepatic Branch Innervates AV node Innervates liver and part of duodenum
184
Hering- Breuer Reflex
Mediated by CN X Occurs when lung air sacs are filled w fluid Respiratory centers perceive need for more O2 Increase diaphragmatic rate Rapid and Shallow breaths
185
There is no parasympathetic innervation to the _____
Extremities
186
_____ innervate from left colon to genital cavernous tissue (except adrenals)
Pelvic Splanchnic Nerves (S2-S4)
187
Pupils receive parasympathetic innervation via _____
CN 3- occulomotor | Thru Ciliary Ganglion
188
Submandibular and Sublingual glands receive parasympathetic innervation via _____
CN 7- facial | Thru Submandibular Ganglion
189
Parotid Gland receives parasympathetic innervation via ____
CN 9- Glossopharyngeal | Thru Otic Ganglion
190
Nasal and Lacrimal Glands receive autonomic innervation from ____
CN 7- facial | via Pterygopalatine Ganglion
191
Left Colon and Pelvis receive autonomic innervation from _____
Pelvic Splanchnic Nerves (S2-S4)
192
Carotid Body and Sinus receive autonomic information via _____
CN 9 and CN X- Glossopharyngeal and Vagus | Blood pressure regulation and CO2/O2 tension
193
Vagus Nerve supplies Parasympathetic innervation to _____
All viscera above diaphragm GI tract up to Splenic Flexure (esophagus to transverse colon) Upper GU tract including kidneys and upper ureters Ovaries/ Testes
194
Pelvic Splanchnic Nerves supply Parasympathetic Innervation to _____
GI tract below splenic flexure (transverse colon to anus) Lower GU tract (lower ureters and bladder) All reproductive organs (except ovaries/ testes)
195
Sympathetic Innervation to the head and neck comes from spinal levels _____
T1-T4
196
Sympathetic Innervation to the Heart comes from spinal levels _____
T1-T5
197
Sympathetic Innervation to the Lungs comes from spinal levels _____
T2-T7
198
Sympathetic Innervation to the Upper Extremities comes from spinal levels _____
T2-T8
199
Sympathetic Innervation to the Upper GU (kidneys, upper ureters) comes from spinal levels _____
T10-T11
200
Sympathetic Innervation to the Lower GU (lower ureters, bladder) comes from spinal levels _____
T11-T12
201
Sympathetic Innervation to the Reproductive Organs comes from spinal levels _____
T10-L2
202
Chapman's Points
Anterior and Posterior fascial tissue abnormalities assumed o be reflections of visceral dysfunction Thought to be NEUROLYMPHATIC response of tissue Nodular, firm, small, painful, non-radiating Treat 10-30 sec circular pressure to point
203
Theory of Muscle Energy
Direct technique Golgi Tendon Organ Reflex Pulling tendon --> Activation of Lg myelinated Group 1B afferent fibers --> Golgi tendon organ signals spinal cord --> Inhibitory interneurons signal a-motor neurons for reflex relaxation
204
Theory of Counterstrain
Indirect Technique Employs Muscle Spindle Reflex (so does FPR) Decreases gamma gain Stops inappropriate proprioceptor activity Apply mild strain to a muscle's antagonist Put in position of ease, Slow return after 90 sec
205
Theory of HVLA
Direct Technique Golgi Tendon Organ and Muscle Spindle Reflex Thrust initiates massive afferent input to CNS --> CNS turns down gamma gain to muscles (relaxation) 1/8" to 1/4" Stretch may produce barrage of inhibition Central Inhibitory Reflex
206
Counterstrain- Cervical- Anterior Tender Points C2-C6
``` Points located on lateral masses Seated at head Flexion, SR away (F SaRa) Monitor TP, hold position 90 seconds Return to neutral ```
207
Counterstrain- Cervical- Posterior Tender Points C4-C7
Points located on sides of spinous processes SEGMENT ABOVE Seated at head, may suspend pt's head off table Extension, SR away Not too much extension *can use anterior translation instead of extension Fine tune with SR, hold 90 seconds Return to neutral
208
Posterior C4 tender point pay present as
Anterior shoulder pain
209
Muscle Energy- Rib 1 and Rib 2- Exhaled Dysfunction (inhalation restriction)
Pt supine, Doc opposite side dysfunction Pt rotate head 30 deg away from dysfunction Dysfunction side wrist on forehead Your head hand on wrist Caudad hand lateral caudal traction on rib angle Deep breath (inhale engages barrier) Same time as breath, pt raises head, you resist Maintain 30 deg rotation Muscle energy it
210
Muscle Energy- Ribs 3, 4, 5- Exhaled Dysfunction (inhalation restriction)
Pt supine, Doc opposite side dysfunction Dysfunction side palm behind head Your head hand on flexed elbow Caudad hand lateral caudal traction on rib angle Deep breath (inhale engages barrier) Same time as breath, pt raises elbow, you resist Muscle energy it
211
Muscle Energy- Ribs 6, 7, 8, 9, 10- Exhaled Dysfunction (inhalation restriction)
Pt supine, Doc same side as dysfunction ABduct arm 90 deg Caudad hand on angle of dysfunctional rib Anterior Lateral traction to disengage rib Same time as deep breath, pt pushes arm against your hip Pull Inferior and Lateral on rib angle Muscle energy it
212
Muscle Energy- Ribs 2, 3, 4, 5, 6- Inhaled Dysfunction (exhalation restriction)
Pt supine, Doc at head on side of dysfunction Thumb and thenar eminence on intercostal space above dysfunctional key rib's anterior superior surface Support pt head/ neck in flexion w other hand or leg Deep breath in and out thru mouth On exhalation, exaggerate pump handle (push inferior) Exaggerate bucket handle motion by sidebending down to rib Hold at new position as pt inhales deeply (isometric contraction) Muscle energy it
213
Muscle Energy- Ribs 7, 8, 9, 10- Inhaled Dysfunction (exhalation restriction)
Pt supine, Doc near head on side of dysfunction Sidebend torso to side of dysfunction to specific rib Thumb and index on superior lateral of rib Inhale and Exhale deeply On exhalation, exaggerate bucket handle On inhalation, resist motion of the rib Muscle energy it
214
Counterstrain - Rib 1-5 - Anterior (depressed) Tender Points - Pt Supine
Pt supine, doc stands side of tender point 2-3 pillows under head for flexion Good side hand under head Sidebend torso to dysfunction Pad of your thumb on tender point to monitor Grasp dys side forearm to fine tune w Int/ Ext rotation, ADduction Simultaneously depress and protract shoulder with monitor hand Hold 90 sec, return to neutral
215
Anterior Rib tender points are located
Bilaterally over anterior chest
216
Rib 1 Anterior tender point location
Costosternal Junction | Just inferior to SC junction
217
Rib 2 Anterior tender point location
Over 2nd rib | Midclavicular line
218
Ribs 3-10 Anterior tender point location
Over respective ribs | Anterior axillary line
219
Muscle Energy- Anterior Fibular Head
Pt supine, Knee and hip both 90 deg Doc on side of dysfunction Thenar eminence of head hand pushes down on anterior fibular head Other hand grasps ankle just inferior to malleoli Thumb pushes upward on lateral malleolus Fingers around arch of foot Internally rotate tibia and maintain as pt rotates out Muscle energy it
220
Muscle Energy- Posterior Fibular Head
Pt supine, Knee and hip both 90 deg Doc on side of dysfunction 1st MCP joint of index behind posterior fibular head Thumb over anterior surface of fibula Other hand grasps just superior to malleolus Thumb pushes down on lateral malleolus Externally rotate tibia and maintain as pt rotates out Muscle energy it
221
Counterstrain- Rib- Anterior (depressed) Tender Point- Pt Seated
Pt seated, Doc standing behind Index finter on tender point (monitor) Your knee in GOOD side armpit Pt puts foot of good side (where your foot is) under dysfunctional side knee Pt drops dysfunctional side arm off table behind with internal rotation Translate pt by moving your knee Fine tune thru Flexion and RS toward dysfunction Use your free hand to control pt's head Hold 90 secs, return to neutral
222
Counterstrain- Rib- Posterior (elevated) Tender Point- Pt Supine
``` Pt supine, Doc same side of dysfunction Head hand under pt's scapula Index or middle contacting tender point Other hand grasps wrist and flexes GH joint Fine tune w all planes of arm motion Hold 90 sec, return to neutral ```
223
Counterstrain- Rib- Posterior (elevated) Tender Point- Pt Seated
``` Pt seated, Doc standing behind Thumb on tenderpoint (monitor) Your knee in BAD side armpit, translate pt Other hand guides head Fine tune with Flexion, RS away Hold 90 sec, return to neutral ```
224
Muscle Energy- Sacrum- Backward torsion
Pt lying on side dys DOWN Top foot on table in front of back foot Monitor Lumbosacral junction throughout Move bottom leg into extension Grasp pt's bottom arm and pull anterior, caudad (neutral, opp SR) Contact pt's top shoulder and have them grasp table 3-5 inhalation/ exhalation cycles Shoulder to table with each Drop top leg off table and contact proximal tibia Have pt lift (ABduct) their leg to ceiling Muscle energy it and return to neutral
225
Muscle Energy- Sacrum- Forward Torsion
Pt prone w arms off table Move hips so pelvis and knees 90 deg, axis DOWN Legs off edge of table, ankles drop to floor Monitor Lumbosacral junction Using your thighs, flex pt's lumbars L5 must be neutral Hand on scapula, Breath into reaching for floor During breathing bring knees up to head Hold feet down and muscle energy em
226
Articulation- Spencer Technique
Extend 6-8x (you want ice cream) Flex 6-8x (I want ice cream) Circumduct both directions elbow bent (small cone) Circumduct both directions w wrist traction (big cone) ABduct 6-8x (fly there?) INT ROT w hand behind back and anterior pressure on elbow (who's gonna pay) Traction stretch (let's be friends)
227
HVLA- Anterior Radial Head
Grasp pt's hand as if to shake Other hand grasps elbow, thumb in AC w firm pressure to radial head Fingers contact olecranon Induce PRONATION and FLEXION of forearm and wrist *can articulate barrier rather than HVLA it
228
Muscle Energy- Anterior Radial Head
Grasp pt's hand as if to shake Other hand grasps elbow, thumb in AC w firm pressure to radial head Fingers contact olecranon Induce PRONATION and SLIGHT FLEXION Pt supinates and extends against resistance Muscle energy it and return to neutral
229
HVLA- Posterior Radial Head
Grasp pt's wrist and proximal forearm Thumb applying anterior pressure to radial head Maintain anterior pressure on radial head Corrective SUPINATION and EXTENSION of elbow
230
Muscle Energy- Posterior Radial Head
Grasp pt's wrist and proximal forearm Thumb applying anterior pressure to radial head Maintain anterior pressure on radial head Engage barrier with supination and slight extension Pt pronates arm and slightly flexes elbow Muscle energy it and return to neutral
231
Counterstrain- Lateral Epicondylitis- Tennis Elbow Tender Point
Your thumb monitors tender point in proximal extensor tendons Other hand contacts pt's hand to hold it in extension Fine tune w pronation/ supination Maximal release, hold 90 sec, return to neutral
232
Muscle Energy- Anterior Lateral Malleolus
Pt supine, Doc at foot Cup pt's heel w your dys side thumb over anterior lateral malleolus Other thumb over first one Use your body to press foot into dorsiflexion Maintain posterior pressure on malleolus Pt plantar flexes and holds 3-5 seconds for each muscle energy action
233
Muscle Energy- Posterior Lateral Malleolus
Pt prone, Doc at foot Your dys side thumb over posterior lateral malleolus Other thumb over first one, encircle ankle Put foot in plantar flexion Maintain anterior pressure on malleolus Pt dorsiflexes and holds 3-5 sec for each muscle energy action

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