CPA: Cervical And Ribs

Question 1

What are the 5 treatment modalities being tested on?

Answer 1

ME
HVLA
Still's technique
FPR
Counterstrain

Question 2

Do inhalation or exhalation dysfunction txs require the pt to place the dorsum of their hand on their forehead?

Answer 2

Exhalation

Question 3

In exhalation dysfunctions, ribs are stuck..

So tx the..

Answer 3

Down

Top rib

Question 4

In inhalation dysfunctions, ribs are stuck..

So tx the..

Answer 4

Up

Bottom rib

Question 5

Dysfunctions of the ribs include:

Answer 5

Bucket handle (lateral)

Pump handle (anterior)

Question 6

Why for 1st rib bucket handle exhalation dysfunction tx do you turn the pts head 30 degrees? Which way do you turn?

Answer 6

You need to pull the lateral aspect of the rip superiorly, turning head activates muscles on that part of the bone helping to encourage movement towards inhalation

Turn away from affected rib

Question 7

Pump-handle motion predominantly occurs at what ribs? Bucket-handle?

Answer 7

Upper ribs

Lower ribs (not 11 and 12, caliper)

Question 8

What mm are being activated in a rib 1 exhalation dysfunction tx? 2-10?

Answer 8

Neck muscles

Peck muscles (pt lifts arm, not head)

Question 9

What direction is the arm moving in exhalation rib 2-10 dysfunction tx?

Answer 9

Pump handle = up

Bucket handle = 45 deg up and out (activates lateral fibers of seratus anterior)

Question 10

Before treating caliper dysfunctions of ribs 11 & 12, what should you do?

Answer 10

Side-bend the pt’s legs towards you (away from the dysfunctioned side) and abduct their arm on the dysfunctioned side

Question 11

When dealing w/ AA txs (axis, C2), what does every tx process include?

Answer 11

Completely flexing the cervical spine to lock out movement elsewhere BUT the axis..

Question 12

What are you doing to set up tx for an inhalation pump handle dysfcn of rib 1?

Answer 12

Flexing the pt’s cervical spine to relax the SCM muscles

Placing my thumb on the superior portion of the anterior portion of rib 1 (between the SCM muscle bodies that split)

Question 13

Where’s the thumb go in rib 1 inhalation dysfcn bucket handle tx?

Answer 13

Lateral to the SCM around the midaxiallary line, superiorly over the lateral part of rib 1

Question 14

What should you be doing to encourage movement of the rib 1 bucket handle motion in an inhalation dysfunction?

Answer 14

Side-bending pt’s head towards dysfunction to relax those mm

Question 15

What position does the doc put the pt when tx an inhalation rib 2-10 dysfcn?

Answer 15

Doc puts their knee down to the rib level they’d like to tx, if it’s a bucket handle dysfcn the pt can reach their hand down on the affected side

Question 16

What’s the difference between inhalation and exhalation caliper motion dsfnc tx set-ups?

Answer 16

In inhalation, the pts arm isn’t extended above their head

Question 17

For Stills and FPR, what are you always doing when putting the pt into a tx position?

Answer 17

Monitor at the site of dysfunction with one hand

Question 18

During a Still’s tx, what is the doc including?

Answer 18

Pressure/compression

Question 19

What must the doc do ALWAYS after a tx?

Answer 19

Return pt to neutral and re-access

Question 20

For Still’s of the OA, where does your monitoring hand go?

Answer 20

In the occipital sulcus by the OA on the side of sidebending

Question 21

What does FPR stand for?

Answer 21

Facilitated Positional Release

Question 22

For stills regarding anterior inh or exh TP rib dysfunctions, in which does the pt take a deep breath in during tx, and in which does the pt exhale?

Answer 22

Inhales in exhalation dysfcn

Exhales in inhalation dysfcn

Question 23

What what be done in every FPR tx technique?

Answer 23

Must flatten the curve, place the region in a neutral position (which means flat, no lordosis or kyphosis)

Compression

Question 24

What’s the order of FPR?

Answer 24

Flatten
Compress
Put pt into ease of motion
Hold for 3-5 seconds
Return to neutral
Reaccess

Question 25

When doing cervical FPR, where's the pt's head?

Answer 25

Off the table in the hands of the doc

Question 26

In an anterior rib dysfunction, FPR tx for it requires what hand placement?

Answer 26

Contralateral hand comes around the front to monitor anterior rib point Ipsilateral hand monitors at the cervicothoracic junction Both forearms are on the pts shoulders to induce < 1lb of compression

Question 27

What must be established in FPR txs for cervical dysfcns? Ribs?

Answer 27

Lordosis os the c spine Kyphosis of the t spine for ribs

Question 28

How many seconds do you maintain counterstrain positions of comfort?

Answer 28

90 seconds for non-ribs 120 seconds for ribs

Question 29

What is the order of things for performing counterstrain?

Answer 29

Locate a somatic dysfcn Find a tenderpoint associated w/ that SD Establish a pain scale Wrap around that TP until the pt is in a position of comfort where there's a 70% reduction in pain Hold that position for 90 sec (120 if it's rib) Return pt slowly back to neutral and reaccess

Question 30

Where's the AC1 TP?

Answer 30

Posterior aspect of the mandible's ascending ramus

Question 31

Where are the AC2-6 TPs?

Answer 31

On the anterolateral aspects of the transverse processes of the respective cervical vertebra

Question 32

In counterstrain of the anterior neck, what action is always performed (except for AC1)?

Answer 32

Flexion of the neck

Question 33

For AC7, what's the position of tx?

Answer 33

Flexed SB towards Rotated away

Question 34

Where are AR1 and AR2 located? What does counterstrain often tx regarding these points?

Answer 34

AR1 is just below the SC joint on rib one just lateral to the manubrium AR2 is at the mid-clavicular line on rib 2 Exhalation dysfunction of the ribs

Question 35

AC7 and AC8 are associated w/ what?

Answer 35

The insertion of the SCM m

Question 36

What do AR TP tx? What do PR TP tx? Generally..

Answer 36

Anterior txs exhalation dysfunction Posterior txs inhalation dysfunction

Question 37

AR TP 1-2 tx involves what type of movements? AR TP 3-6?

Answer 37

F STRT F STRT

Question 38

In the J stroke HVLA tx for an inhalation dysfcn of rib 1, what contacts the first rib?

Answer 38

metacarpo-phalangeal joint (MCP joint)

Question 39

What must be done when looking for SD in the spine?

Answer 39

Look in flexion AND extension

Question 40

For the j stroke, hows the force directed?

Answer 40

Inferior then medially like a j