Competency 9

Question 1

1a: Posterior cervical points

Answer 1

• PC 1 inion: 1-2 cm inferior to external occipital protuberance, slightly lateral, on insertion of semispinalis capitis
• PC1: 3 cm below inion, 1 cm medial to OM suture; press anterior and medial
• PC2: in main muscle mass about 2-3 cm lateral to midline and just below occiput
• PC3: Inferolateral aspect of C2 spinous process
• PC4-8: Inferolateral aspect of SP, named for spinal nerve that exits below (PC5 are on C4 SP)

Question 2

1a: Posterior cervical treatments

Answer 2

• PC1 inion: Cradle head in monitoring hand; non monitoring hand on forehead and flex neck with finetuning
• PC1: ESARA
• PC2: ESARA
• PC3: FSARA–flex 45 degrees (may need to STRA instead)
• PC4-7: ESARA
• PC8: FSARA or ESARA depending on patient

Question 3

b) Posterior thoracic points

Answer 3

-PT1-12: spinous process of respective vertebrae

Question 4

b) Posterior thoracic treatment

Answer 4

Patient prone; stand at head of table

• PT1-3: patients arms draped over side of table; cup chin with one hand and monitor TP with the other; slowly and passively extend neck finetuning with R and SB away
• PT4-6: Patients arms draped over the top of the table (adds extension); cup chin with one hand and monitor TP with the other; slowly and passively extend neck finetuning with R and SB away
• PT7-9: Patients arms draped over the top of table with pillow under chest (adds extension); cup chin with one hand and monitor TP with the other; slowly and passively extend neck, fine tuning with R and SB away from TP
• PT10-12: Patients arms draped over top of table with pillow under chest (adds extension); stand at side of table and grasp ASIS opposite the dysfunction and raise patients hip inducing further extension of lower T spine

Question 5

C) Posterior rib points

Answer 5

• PR1: Posterior margin of rib head beneath the margin of trapezius
• PR2-6: Superior surface of angle of ribs, at medial border of scapula, 2.5 inches lateral to midline

Question 6

c) Posterior rib treatment

Answer 6

Patient seated, doc standing behind; place patients arm on dysfunctional side on docs knee

• PR1: slightly extend head, sidebend and rotate head towards dysfunctional side
• PR2: Flex head, SB and R trunk away then R and SB neck away
• PR3-6: Grasp patients shoulder on dysfunctional side and SB and R trunk away at level of dysfunction

Question 7

d) Posterior lumbar points

Answer 7

• PL1-5 SP: midline, spinous processes
• PL1-3 TP: bilateral on respective TPs
• UPL5: superior, medial edge of PSIS
• LPL5: inferior aspect of PSIS
• PL3 lateral: 2/3 lateral from PSIS to TFL
• PL4 lateral: posterior margin of TFL

Question 8

d) Posterior lumbar treatments

Answer 8

Patient prone

• PL1-5 SP: stand on same side of TP; extend patients ipsilateral hip to TP, fine tuning as necessary
• PL1-3 TP and UPL5: stand opposite side of TP; extend patients ipsilateral hip to TP and rotate leg towards TP, finetuning as necessary
• LPL5: thigh on dysfunctional side suspended over table. Doc at same side of dysfunction. Flex hip and knee to 90. Add adduction and internal rotation
• PL3 lateral & PL4 lateral: stand on whichever side you want, Extend hip on same side of dysfunction and fine tune as necessary

Question 9

e) Pelvis counterstrain points

Answer 9

• High ilium: press on lateral aspect of PSIS
• High ilium Flair out: 1 and 3/4 inches below and 1/4 inch medial to lower edge of PSIS
• Piriformis: 1/2 to 2/3 distance between ILA to greater trochanter
• Flair in Sacroiliac: 4 in below PSIS, slightly lateral, related to attachment of gluteus maximus

Question 10

e) Pelvis counterstrain treatments

Answer 10

Patient prone

• High ilium: stand on same side of dysfunction, while monitoring TPm extend hip and fine tune with ab/adduction
• High ilium flair out: stand on whichever side is comfortable; extend patients leg ipsilateral to TP enough to clear opposite leg and induce adduction and external rotation
• Piriformis: SIT on same side of dysfunction and while monitoring TP, flex patients leg over side of table to 135 deg, abducting and externally rotating the hip
• Flair in Sacroiliac: Patient prone, stand on same side of dysfunction and flex hip only enough to allow knee to clear table. Fine tune with external rotation

Question 11

f) Posterior sacral points

Answer 11

• PS1 bilateral: 1/2 inch medial to inferior aspect of PSIS
• PS2-4: midline on sacrum below/between sacral spines
• PS5: bilateral- 1/4 inch medial and superior to ILA bilaterally

Question 12

f) Posterior sacral treatments

Answer 12

Patient prone, standing beside patient

• PS1 bilateral: apply posterior to anterior force diagonally opposite the TP (if left PS1 tender, apply force to right ILA)
• PS2-4: apply force posterior to anterior on midline apex or base of sacrum to provide transverse axis rotation
• PS5 bilateral: Apply posterior to anterior pressure diagonally opposite the TP (if PS5 on left is tender, apply pressure on right sacral sulcus)