Competency 4

Question 1

A) Perform assessment of MYOFASCIAL tissues for EASE and RESTRICTION of MOTION and DETERMINE DIRECT and INDIRECT BARRIERS

Answer 1

1) Places hands on the THORACOLUMBAR PARASPINAL TISSUES and moves SUPERFICIAL and DEEP fascial layers with hands in MULTI-PLANES
2) Applies force to DESCRIBE the assessment for direction of ease within the tissue and the bind within the soft tissues
3) STATES the assessment of the tissues principle can be applied to any soft tissue
4) DESCRIBES correctly that ease of motion in DIRECTION OF NAMED DYSFUNCTION and the BIND IS IN DIRECTION OF RESTRICTIVE BARRIER
5) Correctly associates ease of motion with INDIRECT soft tissue barrier and techniques
6) Correct associates bind of motion with DIRECT soft tissue barrier and techniques
7) States the treatment forces applied are more deeply directed into the soft tissue and these forces are directed in a RHYTHMIC ALTERNATING FASHION
8) Defines PARALLEL TRACTION as a FORCE directed PARALLEL to muscle and fascial components causing overall INCREASE in LENGTH of structure
9) Defines PERPENDICULAR TRACTION as a force applied to soft tissue and is directed AWAY from the LONGITUDINAL AXIS causing RELAXATION of tissue

Question 2

B) Perform the SUPINE TRACTION CERVICAL SPINE soft tissue treatment

Answer 2

1) Patient appropriately places in SUPINE POSITION with DOC AT HEAD OF TABLE
2) One hand CRADLES PATIENT’S OCCIPUT
3) Other hand GRASPS gently the PATIENT’S CHIN
4) Student provides CEPHALIC TRACTION with both hands (keep head neutral or slightly flexed. Avoid extension)
5) Describes forces are MAINTAINED until RELAXATION of ELONGATION of the tissues are PALPATED

Question 3

C) Perform the FORWARD BENDING (Unilateral Fulcrum), SUPINE, CERVICAL spine soft tissue treatment

Answer 3

1) Patient SUPINE with student seated AT HEAD OF TABLE
2) Student uses one hand to FLE PATIENT’S neck in order to slide the other arm UNDER PATIENT’S HEAD with HAND PALM DOWN on OPPOSITE SHOULDER
3) Student provides a FORCE to place NECK IN FLEXION
4) Student repositions free hand to ROTATE the PATIENT’S head TOWARD and AWAY from the ELBOW of the ARM that’s under the patient’s head to determine the DIRECTION OF TENSION. Once the direction of tension is determined the student doctor will ROTATE THE PATIENT’S HEAD in the direction of TENSION
5) Provide a RHYTHMICAL PATTERN to the technique and/ or a constant force until TISSUE SOFTER and LENGTHENED
6) Repeats for the OPPOSITE SIDE of CERVICAL SPINE tissues

Question 4

D) Perform the FORWARD BENDING (Bilateral function), supine, cervical spine soft tissue treatment

Answer 4

1) Patient SUPINE with student SEATED at HEAD of TABLE
2) Students ARMS are CROSSED UNDER PATIENT’S HEAD and HANDS PLACED PALM DOWN on patient’s shoulders
3) Student provides FORCE to place NECK IN FLEXION
4) Student states he/ she is providing a LONGITUDINAL STRETCH of the PARAVERTEBRAL TISSUES
5) Provide a RHYTHMIC PATTERN to the technique and/or a CONSTANT FORCE until TISSUE SOFTER and LENGTHENED

Question 5

E) Perform the CONTRALATERAL TRACTION, supine, cervical spine soft tissue treatment

Answer 5

1) Doctor at side of table FACING PATIENT’S HEAD and NECK OPPOSITE the SIDE BEING TREATED
2) CAUDAD HAND reaches across and contacts PARAVERTEBRAL MUSCLES on side OPPOSITE of where you are STANDING (make sure to be lateral to spinous processes, not on them)
3) CEPHALAD HAND rests on PATIENT FOREHAND to stabilize head
4) Provides a VENTRAL and slightly LATERAL force with CAUDAD HAND while the CEPHALIC HAND simultaneously applies a ROTATORY FORCE to the HEAD and NECK towards the side being treated
5) States the COMBINED FORCES create a PERPENDICULAR STRETCH to the CERICAL PARASPINAL tissues
6) Forces are provided in a RHYTHMICAL manner as the student works up and down the CERVICAL SPINE PARASPINAL tissues
7) This is REPEATED for the OPPOSITE SIDE

Question 6

F) Perform the Cradling with TRACTION, SUPINE

Answer 6

1) Patient SUPINE with student seated AT HEAD OF TABLE
2) Student contacts the cervical spine paraspinal muscles BILATERALLY, just LATERAL to the SPINOUS PROCESSS
3) Student provides a VENTRAL and LATERAL FORCE to the tissues BILATERALLY to provide PERPENDICULAR stretch
4) Student provides a LONGITUDINAL TRACTION by moving CEPHALAD along the soft tissues
5) States the goal is relaxation of the CERVICAL SPINE TISSUES

Question 7

G) Perform the SUBOCCIPITAL RELEASE, cervical spine soft tissue treatment

Answer 7

1) Patient is SUPINE with student seated AT HEAD OF TABLE
2) Student places FINGER PADS in the SUBOCCIPITAL region
3) Student provides an UPWARD PRESSURE into tissues slightly extend the OA JOINT and tissues
4) The student maintains the STEADY FORCE
5) States they are palpating for a release of the TENSION and the HEAD will EXTEND SLIGHTLY over their fingers

Question 8

H) Perform the PRONE PRESSURE THORACIC spine soft tissue treatment

Answer 8

1) Patient is in a PRONE POSITION
2) Physician is standing at SIDE of TABLE OPPOSITE the SIDE BEING TREATED
3) Student places the THENAR and HYPOTHENAR EMINENCE of one hand on THORACIC PARAVERTEBRAL muscles OPPOSITE the side he/she is STANDING
4) Student places their OTHER HAND on TOP of the hand contacting the paraspinal thoracic tissues
5) Keeping the elbows straight and using their own body weight, the student provides an ANTERIOR and LATERAL FORCE creating a PERPENDICULAR STRETCH
6) The forces are REPEATED in a RHYTHMICAL MANNER
7) States the GIAL is to PALPATE RELAXATION in the THORACIC PARASPINAL tissues

Question 9

I) Perform the PRONE PRESSURE with COUNTER PRESSURE thoracic spine soft tissue treatment

Answer 9

1) Patient placed in PRONE POSITION
2) Student is STANDING at SIDE of the TABLE OPPOSITE the SIDE BEING TREATED
3) Student places THENAR EMINENCE and THUMB on CAUDAD HAND over the thoracic paravertebral muscles OPPOSITE the side you are STANDING
4) Student places HYPOTHENAR EMINENCE of CEPHALAD HAND on paravertebral muscles on the SAME SIDE you are standing
5) Engage tissues with a VENTRAL FORCE and then move your hands in DIRECTION in which the fingers are POINTING (fingers pointing CEPHALIC will move CEPHALIC etc..) creating a LONGITUDINAL STRETCH
6) Demonstrates a RHYTHMICAL MANNER of FORCE APPLICATION until tissues are relaxed

Question 10

J) Perform the SUBSCAPULAR STRETCH thoracic spine soft tissue

Answer 10

1) Patient place in PRONE POSITION
2) Student is STANDING at side of THORACIC SPINE to be TREATED
3) Student places PATIENT’S IPSILATERAL HAND in behind their BACK
4) Student places fingers on BOTH HANDS around MEDIAL BORDER of patient’s SCAPULA
5) Student provides a FORCE to engage the tissue then give GENT and ANTEROLATERAL TRACTION, pulling scapula AWAY FROM RIB CAGE
6) FORCE is MAINTAINED until tissues soften and relax

Question 11

K) Perform the UPPER THORACIC with SHOULDER BLOCK, Lateral Recombent, thoracic spine soft tissue treatment

Answer 11

1) Patient is PLACED in a LATERAL RECOMBINANT position with SIDE being TREATED UP
2) Student is STANDING at side of table FACING PATIENT
3) Student passes CAUDAD HAND under IPSILATERAL PATIENT’s ARM and contacts the UPPER THORACIC PARAVERTEBRAL muscles
4) Student’s CEPHALAD HAND contacts ANTERIOR PORTIN OF IPSILATERAL SHOULDER (Drape patient’s IPSILATERAL arm over students CEPHALIC FOREARM)
5) With CEPHALAD ARM a POSTERIOR COUNTERFORCE is provided with SIMULTANEOUS FORCE from the CAUDAL HAND, VENTRALLY and LATERALLY to create a PERPENDICULAR TRETCH to engage soft tissues
6) Forces are provided in RHYTHMICAL manner until tissues are softened and relaxed
7) Repeat procedure for the OPPOSITE SIDE

Question 12

L) Perform the LOWER THORACIC under the SHOULDER, Lateral Recumbent, thoracic spine soft tissue treatment

Answer 12

1) Patient is placed in LATERAL RECUMBENT position to be TREATED UP
2) Student is standing at SIDE of TABLE FACING PATIENT
3) Student contacts LOWER THORACIC paravertebral muscles, LATERAL to the SPINOUS PROCESSES with finger pads on BOTH HANDS
4) Student engages tissues with ANTERIOR and LATERAL FORCE to provide a PERPENDICULAR STRETCH
5) Forces are provided in a RHYTHMICAL manner until tissues are softened and relaxed
6) Repeat procedure for the OPPOSITE side

Question 13

M) Perform the PRONE PRESSURE LUMBAR spine soft tissue treatment

Answer 13

1) Patient is in PRONE POSITION
2) Physician is standing at SIDE of TABLE OPPOSITE the side being TREATED
3) Student places the THENAR and HYPOTHENAR EMINENCE of one hand on LUMBAR PARAVERTEBRAL muscles opposite the side he/she is standing
4) Student places their OTHER HAND on top of the hand CONTACTING the paraspinal lumbare tissue
5) Keeping the ELBOWS STRAIGHT and using their own body weight, the student provides an ANTERIOR and LETRAL FORCE creating a PERPENDICULAR STRETCH
6) The FORCES are REPEATED in a RHYTHMICAL manner
7) States the GOAL is to PALPATE RELAXATION in the thoracic parapsinal tissues

Question 14

N) Perform the PRONE PRESSURE with COUNTERLEVERAGE Lumbar Spine soft tissue treatment

Answer 14

1) Patient PRONE
2) Physician standin on the OPPOSITE SIDE of the table from the DYSFUNCTIONAL tissues
3) CEPHALAD HAND contacts paravertebral muscles with THENAR/ HYPOTHENAR EMINENCE
4) CAUDAD HAND contacts ASIS OPPOSITE side of the doctor
5) Doctor gently lifts ASIS POSTERIORLY (UP)
6) Simultaneously applies an ANTEROLATERAL PRESSURE to the PARAVERTEBRAL MUSCLES creating a PERPENDICULAR STRETCH
7) Continues in a RHYTHMICAL manner noting release of tension of tissue
8) Patient is BROUGHT BACK to a NEUTRAL POSITION and reassessed

Question 15

O) Perform the LATERAL RECUMBENT POSITION lumber spine soft tissue treatment

Answer 15

1) Patient is placed in a LATERAL RECUMBENT POSITION with SIDE to be treated UP
2) Student is standing at SIDE of TABLE FACING PATIENT
3) Student contacts LUMBAR PARAVERTEBRAL muscles, LATERAL to the SPINOUS PROCESSES with FINGER PADS on BOTH HANDS
4) Student engages tissues with ANTERIOR and LATERAL FORCE to provide a PERPENDICULAR STRETCH
5) FORCES are applied in a RHYTHMICAL manner until tissues are softened and relaxed
6) Repeat procedure for the OPPOSITE SIDE

Question 16

P) Perform the ILIOTIBIAL BAND, Prone (Fascia Lata), lower extremity soft tissue treatment

Answer 16

1) Patient is placed in PRONE POSITION
2) Student stands on side OPPOSITE IT BAND to be TREATED
3) Student uses CAUDAD Hand to GRAD foot or ankle and FLEX KNEE to 90 DEGREES
4) Student placed CEPHALAD HAND along the LATERAL THIGH over the ILIOTIBIAL tissue
5) Student provides a LETRAL FORCE to the FOOT and ANKLE (providing internal rotation at the hip) while simultaneously engaging the IT BAND by PULLING in a POSTEROMEDIAL DIRECTION
6) Forces are provided in a RHYTHMICAL manner while working along the entire IT BAND until it is softened and relaxed

Question 17

Q) Perform the ILIOTIBIAL BAND, Lateral Recumbent (Fascia Lata), lower extremity soft tissue treatment

Answer 17

1) Patient placed in a LATERAL RECUMBENT position with TREATED SIDE UP toward the CEILING
2) Student STANDS FACING the patient
3) Student stabilizes patient by placing CEPHALAD HAND on the POSTEROLATERAL aspect of the IPSILATERAL ILIAC crest
4) Student contact the IT band by MAKING a FIST with CAUDAD HAND and place the flat portion of the PROXIMAL PHALANGES over the DISTAL LATERAL THIGH
5) Student provide a SLIGHT DOWNWARD PRESSURE into IT BAND and SLIDE FIST DISTAL to PROXIMAL towards the GREATER TROCHANTER region in a RHYTHMIC manner
6) Student demonstrates the procedure can be repeated by moving PROXIMAL to DISTAL
7) Forces are repeated until IT BAND is softened and relaxed

Question 18

R) Perform the PLANTAR FASCIA lower extremity soft tissues treatment

Answer 18

1) Patient placed in a SUPINE POSITION
2) Student SEATED at FOOT of TABLE
3) Student stabilizes patient foot by placing HAND over DORSUM of FOOT
4) Student contacts PLANTAR FASCIA just proximal to METATARSAL HEADS by making a CLOSED FIST with your OTHER HAND
5) Student provides a MODERATE PRESSURE to PLANTAR FASCIA and SLIDES fist DITAL to PROXIMAL (towards Calcaneus) along the PLANTAR FASCIA
6) Forces are provided in a RHYTHMICAL manner until the tissue is softened and relaxed

Question 19

S) Perform the SUPINE CRADLING cervical spine myofascial release treatment

Answer 19

1) Patient is placed in SUPINE POSITION
2) Student seated at the HEAD of the TABLE
3) Student contacts the CERVICAL SPINE paraspinal tissues by PLACING fingers on TRANSVERSE PROCESSES at the level of the dysfunction
4) Student provides a VENTRAL FORCE to the Cervical tissue
5) Student demonstrates and explain an ASSESSMENT by moving the tissue through INFERIOR and SUPERIOR motions noting where there is ease of motion and restriction of motion
6) Student demonstrates and explains an assessment by moving the tissue through ROTATION to the RIGHT and LEFT noting where there is ease of motion and restriction of motion
7) Student provides forces into EASE of MOTION for an INDIRECT TREATMENT waiting for tissue relaxation before releasing the force
8) Student provides forces into restriction of motion for a DIRECT TREATMENT waiting for tissue relaxation before releasing the force

Question 20

T) Perform the PRONE THORACIC spine myofascial release treatment

Answer 20

1) Patient is in PRONE position
2) Student is standing at SIDE of table OPPOSITE the side to be TREATED
3) Student places the THENAR and HYPOTHENAR EMINENCE of one hand on THORACIC paravertebral muscles OPPOSITE the side he/she is STANDING
4) Student places their OTHER HAND ON TOP of the hand contracting the paraspinal thoracic tissue
5) Keeping the ELBOW STRAIGHT and using their won body weight, the student provides an ANTERIOR and LETRAL FORCE creating a PERPENDICULAR STRETCH
6) Student demonstrates and explains an assessment by moving the tissue through INFERIOR and SUPERIOR motions noting where there is ease of motion and restrictor of motion
7) Student demonstrates and explains an assessment by moving the tissue through ROTATION to the RIGHT and LEFT noting where there is ease of motion and restriction of motion
8) Student demonstrates and explains an assessment by moving the tissue through CLOCKWISE and COUNTERCLOCKWISE MOTION, noting the direction of ease of motion or restriction of motion
9) Student provides forces into EASE OF MOTION for INDIRECT TREATMENT waiting for tissue relaxation before releasing the force
10) Student provides forces into RESTRICTION OF MOTION for DIRECT TREATMENT waiting for tissue CREEP before releasing the force

Question 21

U) Perform the PRONE LUMBOSACRAL spine myofascial release treatment

Answer 21

1) Patient is in a PRONE POSITION
2) Student is STANDING at SIDE of TABLE
3) Student places one HAND OVER the INFERIOR LUMBAR SEGMENT and the other HAND over the SUPERIOR SACRAL SEGMENT
4) Student demonstrates and explains an assessment by moving the tissue through INFERIOR and SUPERIOR noting the direction of ease of motion or restriction of motion
5) Student demonstrates and explains an assessment by moving the tissue through RIGHT and LEFT TRANSLATIONAL MOTION noting the direction of ease of motion or restriction of motion
6) Student demonstrates and explains an assessment by moving the tissue through CLOCKWISE and COUNTERCLOCKWISE MOTION, noting the direction of ease of motion or restriction of motion
7) Student provides forces into EASE OF MOTION for an INDIRECT TREATMENT waiting for tissue relaxation before releasing the force
8) Student provides forces into RESTRICTION OF MOTION for a DIRECT TREATMENT for tissue CREEP before releasing the force