CPA 3 Flashcards
Spinous Process Locations
T1-3
T4-6
T7-9
T10
T11
T12
Level of Transverse Process
1/2 Segment Below Transverse Process
Level of Transverse Process of Vertebrae Below
Same as T7-9
Same as T4-6
Same as T1-3
Spinal Landmarks
T3 Spinous Process
T7 Spinous Process
L1 Spinous Process
L4 Spinous Process
Scapular Spine
Inferior Angle of Scapula
12th Rib
Iliac Crest
Vertebral Unit Components
Superior Facet Orientation
Two adjacent vertebrae + Associated IV Disc
Cervical (BUM) - Backwards, Upwards, Medial
Thoracic (BUL) - Backwards, Upwards, Lateral
Lumbar (BM) - Backwards, Medial
Type One Mechanics (TS/LS Only)
Neutral
Group
Rotation and Sidebending are Opposite
Type 2 Mechanics (TS/LS Only)
Non-Neutral (Flexed or Extended)
Single Segment
Rotation and Sidebending in Same Direction
Motion Testing (T1-L5)
Finger Pads at T1-3: Assess Flexion/Extension, Rotation, Sidebending
Finger Pads at T4-6: Assess Flexion/Extension, Rotation, Sidebending
T7-12: Assess Flexion/Extension, Rotation, Sidebending with hand on posterior shoulder to use trunk as lever
L1-5: Assess Flexion/Extension, Rotation, Sidebending with hand wrapped around front to opposite shoulder to use as a lever
Assess Motion in Dynamic Position (Lumbar - Sphinx/Downward Dog Positions & Thoracic - Sphinx Position and Flex/Ext the Head/Neck to determine Flex (Resistance to approximation) SD or Ext (Resistance to separation) SD)
Seated ART Upper Thoracic (T1-6) Type 2 SD
Seated ART Upper Thoracic (T1-6) Type 2 SD
Use head as lever
Seated MET Upper Thoracic Type 2 SD
Seated MET Upper Thoracic Type 2 SD
Seated MET Upper Thoracic Type 1 SD
Seated MET Upper Thoracic Type 1 SD
Seated MET Lower Thoracic Type 1 SD
Seated MET Lower Thoracic Type 1 SD
Seated ART Lower Thoracic Type 1 SD
Seated ART Lower Thoracic Type 1 SD
Seated MET Lower Thoracic Type 2 SD
Seated MET Lower Thoracic Type 2 SD
Seated ART Lower Thoracic Type 2 Extension SD
Seated ART Lower Thoracic Type 2 Extension SD
Seated ART Lower Thoracic Type 2 Flexion SD
Prone ART Lower Thoracic Sidebending
Prone ART Lower Thoracic Sidebending
Seated ART Lower Thoracic Sidebending SD
Seated ART Lower Thoracic Rotation SD
Seated MET/ART Lumbar Type 1 SD
Seated MET/ART Lumbar Type 1 SD
Seated MET/ART Lumbar Type 2 SD
Seated MET/ART Lumbar Type 2 SD
Seated ART Lumbar Sidebending SD
Seated ART Lumbar Type 2 Flexion/Extension SD
Seated ART Lumbar Rotation SD
MET Lumbar Type 1 SD Lateral Recumbent
(Lumbar Long Lever/Sidebending)
MET Lumbar Type 1 SD Lateral Recumbent
(Lumbar Long Lever/Sidebending)
NUDR
ART Lumbar Sidebending SD Lateral Recumbent
MET Lumbar Type 2 Extended SD Lateral Recumbent
(Lumbar Long Lever/Sidebending Extended)
MET Lumbar Type 2 Extended SD Lateral Recumbent
(Lumbar Long Lever/Sidebending Extended)
SUUE
MET Lumbar Type 2 Flexed SD Lateral Recumbent
(Lumbar Long Lever/Sidebending Flexed)
MET Lumbar Type 2 Flexed SD Lateral Recumbent
(Lumbar Long Lever/Sidebending Flexed)
FDDR
MET Lumbar Type 1 SD Lateral Recumbent
(Lumbar Long Restrictor/Rotation)
MET Lumbar Type 2 SD Lateral Recumbent
(Lumbar Long Restrictor/Rotation Extended & Flexed)
CS MET/ART
CS Bilateral Forearm Fulcrum Forward Bending
ST/MFR
ART
MET
Atypical OA and AA
OA: Type 1 Like - Rotate and Sidebend to Opposite sides with a Neutral or Flex/Ext Component (Primary)
AA: Rotation Only (Fully flex CS and rotate bilaterally assessing ROM) - Flex/Ext/SB NOT TESTED
OA (C0-C1) MET/ART
AA (C1-C2) MET/ART
Typical (C2-C7)
Type 2 Like - Rotation and Sidebending occur in Same direction with Flex/Ext Component (may be single or group dysfunction)
CS (C3-C7) MET/ART
Lymphatics
Evaluating Central Myofascial Pathways (Zink Pattern)
Cranial-Cervical Junction (Fingerpads suboccipitally on supine patient)
Cervical-Thoracic Junction (Palms on scapula and fingerpads infraclavicularly)
Thoraco-Lumbar Junction (Palms on lateral aspect of lower-most ribs)
Lumbo-Pelvic Junction (Pads of hands on posterolateral aspect of innominates/hip)
Induce rotation and compare L to R
Compensated (L/R/L/R or R/L/R/L)
Uncompensated = any other pattern
Fluid Pumps
Thoracic Inlet
Thoracic Diaphragm
Pelvic Diaphragm
- Open Pathways to remove restriction to flow
Thoracic Inlet MFR
Position: Pt supine, doc seated at head of table
• Index fingers above SC joint/angle of rib 1, thumbs over T1
transverse processes bilaterally
• Press toward pt’s feet and twist hands to feel for restriction
of motion
• Perform direct myofascial release, holding pt in barrier until
you feel tissue creep
- Maximize Diaphragmatic Functions
Doming the Diaphragm
Position: pt supine, doc at pt’s side facing cephalad
• Place hands in the infracostal region, directly below xiphoid
process, with fingertips/thumbs pointing cephalad.
• Have pt take a deep breath while pressing fingers/thumbs
posteriorly and superiorly.Push further on exhalation, resist
on inhalation. Repeat 3-4 times.
• On last time, move thumbs cephalad, slightly under the
ribcage during exhalation.
Doming the Pelvic Diaphragm/Ischiorectal Fossa Release
Position: pt prone, physician seated at side of table facing
cephalad
• Place thumbs medial to ischial tuberosities bilaterally
• Apply a cephalad and lateral force, increasing the force
during exhalation and maintaining force on inhalation
- Increase Pressure Differentials or Transmit Motion
Pectoral Traction
Position: pt supine, doc standing at head of table
• Grasp inferior border of pectoral muscles at anterior axilla
• Extend arms and lean back to apply cephalad traction
bilaterally. Pull when pt inhales and resist on exhalation
Rib Raising (Supine)
Position: pt supine, doc sitting on side to treat
• Contact rib angles by flexing fingers
• Starting with T12, apply anterolateral traction by rocking
backward. Continue up ribs.
• May use respirations to assist you – apply pressure w/ inhale,
release w/ exhale
Rib Raising (Seated)
Position: pt seated, doc standing facing pt
• Pt crosses and places arms over doc’s shoulder. Grasp bilateral posterior/inferior rib angles (lateral to TP).
• Starting with T12, apply anterolateral traction while pulling
cephalad and toward you. Continue up ribs.
• May use respirations to assist you – apply pressure w/ inhale,
release w/ exhale
Thoracic Pump (Repetitive/Oscillatory)
Position: pt supine, doc at head of table
• Place thenar eminence of each hand over the pectoral
muscles just inferior to the clavicles on ribs 2-4 (offer women
a pillow or place their hands under yours).
• Apply rhythmic pumping at a rate of 110-120x/min.
Appropriate pace should provide a rebound force at your
hands, and appropriate power should move feet
rhythmically.
Thoracic Pump (Vacuum/Atelectasis Modification)
Position: pt supine, doc at head of table
• Place thenar eminence of each hand over the pectoral
muscles just inferior to the clavicles on ribs 2-4 (offer women
a pillow or place their hands under yours).
• As patient exhales, apply a compressive force downward and resist during inhalation. Continue for 4-5 breaths. Midway
through the last inhalation, briskly remove hands to allow for
rapid, deep inhalation (inflates atelectatic lung).
Abdominal Pump
Position: pt supine, doc at pt’s side facing caudad
• Place palms on abdomen with fingers towards the pt’s head, thumbs side by side
• Pump posteriorly in a rhythmic manner at 20-30x/min
Sacral Rocking
Position: pt prone, doc at pt’s side
• Place heel of cephalad hand on the sacral base with fingers
pointing towards the coccyx, caudad hand on top, facing
opposite.
• Exert a gentle pressure downwards to gap SI joint. Alternate
directions following respiration.
• Inhalation = sacral apex anterior
• Exhalation = sacral base anterior
Pedal Pump
Position: pt supine, doc at foot of table
• Contact plantar portion of feet, dorsiflex the feet
• Apply an on-and-off rhythmic cephalad force to
hyperdorsiflex the feet, watching nose for movement and
feeling rebound wave at feet. Rate should be ~100-120x/min.
- Mobilize Targeted Tissue Fields
Tapotement (Lungs)
Position: pt prone, doc at pt’s side
• Apply rhythmic forces to the thoracic region
– Hacking = “karate chop” with ulnar side of hands
– Cupping/Clopping = cup hands into a slight “C” shape
– Slapping = use palmar surface of hands
Effleurage and Petrissage
&
IT Band Effleurage
Position: pt supine, doc on side to treat
• Raise pt’s arm or leg to treat
• Effleurage: induce stroking force distally to proximally
• Petrissage: induce a kneading/twisting force distally to proximally
• Position: pt lateral recumbent w/ affected side up, top foot
in popliteal fossa of bottom leg. Doc on side to treat.
• Place cephalad hand on pt’s greater trochanter for stabilization.
• With the caudad hand, make a “C” shape and contact pt’s IT band. Start halfway between the greater trochanter and knee, stroking distal to proximal with gentle pressure.
• After some congestion frees, start just superior to the knee and continue stroking in a distal to proximal fashion.
Anterior Tracheal/Deep Cervical Arches Release
Position: pt supine with doc at pt’s side facing cephalad, OR pt seated with doc facing pt
• Place fingers lateral to the trachea.
• Move trachea from side to side working cephalad to caudad
Cervical Stroking
Position: pt supine, doc at head of table
• Place hands along paravertebral muscles
• Slowly stroke the region in a caudad to cephalad direction.
Cervical Chain Drainage
Position: pt supine, doc at head of table
• Locate anterior and posterior border of the SCM’s superior
portion. Place your thumb along the anterior margin, the second through fifth digits along the posterior margin.
• Gently lift and milk anteriorly until you note relaxation, working caudad along the SCM
• Treat one side at a time to prevent pressing on carotid sinuses bilaterally.
Submandibular Drainage
Position: pt supine, doc at head
• Apply a raking motion under the angle of the mandible towards the mentum
Mandibular Drainage (Galbreath Technique)
Position: pt supine, rotate head towards doc. Doc standing
opposite side to treat
• Stabilize patient’s head w/ cephalad hand. Place fingers of
caudad hand posterior to ramus.
• Apply a slow, repetitive downward & midline traction on the
mandible.
Auricular Drainage
Position: pt seated, doc in front or behind pt
• Place 3rd and fourth finger in front of and behind ear
• Apply a clockwise & a counterclockwise motion to the auricular lymph nodes
TS & LS BLT/FPR/Stills
Supine BLT Upper Thoracics
- Position: Patient supine & Physician at head of table
- Hand Placement:
- With hand ipsilateral to PTP, place the index finger on the TP of the dysfunctional segment. With hand contralateral to PTP, support the patients head
- Technique:
- Move patient into flexion (to move T2 into neutral) with rotation and sidebending to the EASE of motion (indirect) until reaching the point of balanced ligamentous tension
- Assess respiratory phases, have patient hold breath in inhalation or exhalation based on the position that best achieves ligamentous balance
- Minor adjustments to flexion, rotation and sidebending may be needed to maintain ligamentous balance; repeat until best motion is obtained
- Reassess
Seated BLT Lower Thoracics
- Position: Patient seated and physician behind patient
- Hand Placement
- Use thumb ipsilateral to PTP to contact the TP of the inferior vertebra in the vertebral unit
- Use thumb contralateral to PTP to contact the TP of the superior vertebra in the vertebral unit
- Technique
- Instruct patient to lean back at the hips then sit up straighter or slouch forward to localize the sagittal plane at the dysfunctional unit
- Instruct patient to “lean a little towards” the ease of sidebending motion and “turn a little towards: the ease of rotation motion in small increments to achieve balanced ligamentous tension
- Assess respiratory phases, have patient hold breath in inhalation or exhalation based on the position that best achieves ligamentous balance
- Minor adjustments to flexion, rotation and sidebending may be needed to maintain ligamentous balance; repeat until best motion is obtained
- Reassess
Prone BLT Thoracic/Lumbar
- The patient lies prone, physician stands beside the table.
- The physician places the left thumb over the left transverse process of affected segment and the index and third finger pads of the left hand over the right transverse process of affected segment
- The physician places the right thumb over the left transverse process of
- segment inferior and the index and third finger pads over the right transverse process of same segment
- The patient inhales and exhales, and physician encourages patient to hold the more relaxing of the two and follows the motion of these two segments.
- The physician adds a compression/separation force (long arrows) approximating/separating the segments and then directs a force downward (short arrows) toward the table to vector it to the extension barrier.
- Next, the physician’s thumbs approximate the left transverse processes, which produces side bending left (horizontal arrows) while simultaneously rotating superior segment to the left (left index finger arrow) and inferior segment to the right (right thumb, downward arrow).
- When this total balanced position is achieved, the physician holds the position until air hunger. Repeat as needed (usually 3 times).
- Reassess for 2-4 TART findings
Seated FPR Thoracics
Prone FPR Lumbar Flexed Type II SD
Prone FPR Lumbar Extended Type II SD
Seated Still Upper Thoracics (T1-T4)
Seated Still Lower Thoracis (T5-T12)
Supine Still Lumbar (L1-5)
CS BLT/FPR/Still
BLT OA SD
BLT Typical C3-7 SD
FPR Cervical Superficial Muscles SD (Hypertonic Suboccipitals)
