CPA 1.1: Lab Stills, BLT, FPR

Question 1

FPR for hypertonic suboccipital muscles

Answer 1

1. Patient supine with head and neck off the table. Physician at head of table supporting patient’s head, monitoring hypertonic tissues with 3rd finger.
2. Slightly flex head and neck forward to flatten/neutralize cervical curvature.
3. Apply gentle axial compression (<1 lb of pressure) on the occiput towards feet.
4. While maintaining compression, extend the head and neck and SB to the same side of the hypertonic muscles (shortening and relaxing the muscles being treated).
5. Hold for 3-5 seconds waiting for tissue relaxation, return to neutral, and release compression.
6. Reassess muscular tonicity.

Question 2

FPR for cervical segmental dysfunction

Answer 2

1. Patient supine. Physician at head of table supporting patient’s head with one hand, monitoring articular pillars of the affected segment with index finger and thumb.
2. Slightly flex head and neck forward to flatten/neutralize cervical curvature.
3. Apply gentle axial compression (< 1 lb of pressure) on the occiput towards feet.
4. While maintaining compression, move the segment into its ease of motion (indirect barrier of the F/E, rotational, and SB component).
5. Hold for 3-5 seconds waiting for tissue relaxation, return to neutral, and release compression.
6. Reassess segmental motion.

Question 3

Stills OA SD

Answer 3

1. The patient is supine on the table. Physician at head of table.
2. Place the pad of the index or middle finger on the side of the side-bending component in the basiocciput, using the palm to support the patient’s head. Place the other hand on top of the patient’s head.
3. SB the head into its ease. Due to coupling of motion at the OA joint, slight rotation in the opposite direction will occur. Introduce F/E, depending on the diagnosis.
4. Compress through the top of the head.
5. While maintaining compression, take head into neutral and articulate through the restrictive barrier
6. Compression is released and the head returned to neutral.
7. Reassess.

Question 4

Stills AA SD

Answer 4

1. Patient supine on table (or may be seated). Physician at head of table.
2. Place index or middle finger on transverse process of the atlas (C1), on the side of rotation.

Rotate the head into its ease.

3. Compress through the top of the head.
4. While maintaining compression, take head into neutral and articulate through the restrictive barrier.
5. Compression is released and the head returned to neutral.
6. Reassess.

Question 5

Still’s Typical Cervical SD

Answer 5

1. Patient supine on table. Physician at head of table.
2. Place index or middle finger on articular pillar at level of somatic dysfunction, on the side of rotation.
3. Introduce F/E, depending on the diagnosis. SB and rotate the cervical segment into its the ease.
4. Compress through the top of the head.
5. While maintaining compression, take head into neutral and articulate through the restrictive barrier
6. Compression is released and the head returned to neutral.
7. Reassess.

Question 6

BLT: OA SD

Answer 6

1. Patient supine on table. Physician seated at head of table with forearms and elbows resting comfortably on table.
2. Use one hand in a “pincher” grasp of the laminae on either side of the midline for C1 to stabilize and monitor the OA through the atlas.
3. Place your other hand on the patient’s head to induce position of greatest BLT.
4. Test respiratory phases and have the patient hold breath as long as possible in the respiratory phase (either inhalation or exhalation) that provides best BLT.
5. Repeat until best motion obtained (1- 3x).
6. Reassess.

Question 7

BLT: Typical Cervical SD

Answer 7

1. Patient supine on table. Physician seated at head of table with forearms and elbows resting comfortably on table.
2. Place palms under patient’s head, palpate articular processes with index fingers bilaterally.
3. Establish point of BLT in cervical spine by inducing the position of greatest BLT through the head and neck.
4. Test respiratory phases and have the patient hold breath as long as possible in the respiratory phase (either inhalation or exhalation) that provides best BLT.
5. Repeat until best motion obtained (1-3x).
6. Reassess.

Question 8

OA BLT

Answer 8

1. With the supine patient use one hand in a “pincher” grasp of the laminae on either side of the midline for C1 to stabilize and monitor the OA through the atlas
2. Place your other hand on the patient’s head to induce position of greatest BLT
3. Test respiratory phases & have the pt. hold breath as long as possible in phase that provides best BLT
4. Repeat until best motion obtained (1- 3x)
5. Recheck

Question 9

C2-7 BLT

(C2 FSlRl)

Answer 9

1. With forearms supported by the table contact bilateral articular pillars w/index fingers, respectively.
2. Establish point of BLT in cervical by inducing flexion, sidebending left & rotation left through positioning the head and neck.
3. Test respiratory phases & have the pt. hold breath as long as possible in phase that provides best BLT
4. Repeat until best motion obtained (1-3x)
5. Recheck

Question 10

What is the most important part of FPR?

Answer 10

Flatten the curve

Question 11

Supine FPR

OA F RrSl

Answer 11

1. Neutralize Sagittal Curve: Monitor segment and flex spine to straighten lordotic curve at that level
2. Activating Force: Add compression of <1 lb. localized to the segment
3. Indirect Positioning: triplanar
4. Hold for 3-5 seconds
5. Return to neutral & retest TART

Question 12

Supine FPR

C2 F RrSr

Answer 12

1. Neutralize Sagittal Curve: Monitor segment and flex spine to straighten lordotic curve at that level
2. Activating Force: Add compression of <1 lb localized to the segment
3. Indirect Positioning: triplanar indirect positioning (FRRSR)
4. Hold for 3-5 seconds
5. Return to neutral & retest TAR T

Question 13

AA Stills

RL stills technique

Answer 13

1. The patient lies supine on the treatment table, and 4.
   the physician sits or stands at the head of the table.
   This may also be performed with the patient
   seated.
2. The physician places the hands over the 5. parietotemporal regions, and the left index finger
   pad palpates the left transverse process of C1.
3. The physician rotates the patient’s head to the left ease barrier.
4. The physician introduces gentle compression through the head directed toward C1 and then with moderate acceleration begins to rotate the head toward the right restrictive barrier
5. The release should occur before the restrictive barrier is engaged. If not, the physician should not carry the head and dysfunctional C1 more than a few degrees through the barrier.
6. Reassess

Question 14

OA Stills

OA F SlRr

Answer 14

1, The patient is supine on the table.

2. Place the sensing hand palm up under the occiput with the tip of the index finger on the occiput and the thumb on the temporal aspect of the patients head.
3. Place the operating hand on the dorsum of the head.
4. The head is slightly sidebent to the side of ease. Flex the head to relaxation in the suboccipital tissues.
5. Introduce light compression through the dorsum of the head.
6. The operating hand then moves the patient’s head from flexion through extension with slight rotation, maintaining compression.
7. Compression is released and the head returned to neutral.
8. Reassess for TART.

Question 15

Typical Cervical Stills technique

C4 E SrRr

Answer 15

1. The patient lies supine on the treatment table.
2. The physician’s right index finger pad palpates the patient’s right C4 articular process.
3. The physician places the left hand over the patient’s head so that the physician can control its movement.
4. The physician extends the head until C4 is engaged.
5. The physician then rotates and side bends the head so that C4 is still engaged.
6. The physician introduces a compression force through the head directed toward C4 and then with moderate acceleration begins to rotate and side bend the head to the left (curved arrows), simultaneously adding graduated flexion.
7. The release should normally occur before the restrictive barrier is engaged. If not, the physician should not carry the head and dysfunctional C4 more than a few degrees through the barrier.
8. The physician reevaluates the dysfunctional (TART) components.