Evaluation and treatment

Question 1

Evaluation

Answer 1

1. Posture of everything
2. EFT, LPM, VCT
3. ROM: pelvic shear, forward bend, backward bend, side bend, c/s rotation, breathing, shoulder abd

Question 2

Assess superficial fascia

Answer 2

• Skin gliding: use broad contact (palm of hand) almost parallel to surface of skin, check each direction
• Specific skin gliding with 3 fingers, then finger gliding: determine exact direction of restriction

Question 3

Treat superficial fascia

Answer 3

Specific to direction and depth

• Sustained pressure
• Shortening/lengthening
• Unlocking spiral

Question 4

Bony contours of lumbar spine/pelvis

Answer 4

Sacral sulcus, coccyx, iliac crest, groove of the spine, inf border of lower ribs

Question 5

Functional excursion techniques used in FM1

Answer 5

• Thomas test position
• SLR (hamstring in diagonals)
• Prone with one leg off table (1/2 prone for quads/hip)

Question 6

How to do groove of spine with 2 hands

Answer 6

• Fingers go down groove of spine starting cranially. One pulls med->lat, other lat-> med
• Can do unilaterally and check all 4 depths
• Find a restriction that won’t let go: pass 5-6 times, then hook on.

Question 7

General techniques

Answer 7

• Use thumbs, knuckles, heel of hand, forearms, elbows

- Good for bony contours, paraspinals, elbow on piriformis

Question 8

Forward bending in sitting

Answer 8

Pt sitting upright, knees below 90, PT with hands at upper trap area, pulling back a bit and the pt slowly and segmentally folds forward. Use knuckles to make way down spine, pressing anterior/inf towards BOS.
End: pt moves back to upright position segment by segment.

Question 9

Perpendicular strumming

Answer 9

Used to eval and tx muscle play and tone.
Deform until endrange, allow it to spring back under fingers. Used weight shift to perform.
Unidirectional technique

Question 10

Perpendicular deformation

Answer 10

Used to eval and treat muscle play.

Deform muscle and down let it spring back

Question 11

Parallel mobilization

Answer 11

Used to treat muscle play.
Come in perpendicularly and hook onto area, turn body so you are parallel.
Use pronation/supination to scoop muscle off spine/other muscles. Use thumb of assisting hand to define muscle border

Question 12

Order of tx: play and tone

Answer 12

• Treat muscle play first along borders of muscle

- Then eval/tx tone

Question 13

TX of muscle tone

Answer 13

• Breathing, attempting to relax, visualization, imagery

- have pt participate in letting go

Question 14

Evaluation of rib cage

Answer 14

• Breathing pattern in sitting - look for 3D expansion
• Active SB, rotation, EFT
• Seated SB - lower, mid, and upper ribs for folding and elongation
• Sidelying: accessory and functional mobility (dysfunctional side up)

Question 15

Sidelying eval of rib cage: accessory mobility

Answer 15

• Accessory: internal/external torsion
• Scap into PE: spring ribs ant/inf for internal torsion
• Scap into AD: spring ribs post/sup for external torsion

Question 16

Sidelying eval of rib cage: functional mobility

Answer 16

• Functional: inhalation/exhalation
• Pelvis into AE: spring ribs post/inf for exhalation
• Pelvis into PD: spring ribs ant/sup for inhalation

Question 17

Rib cage treatment progression

Answer 17

1. Skin/superficial fascia
2. Bony contours ribs
3. STM: serratus, lats, inf border rib cage, obliques
4. General mobs to restricted area with breahting
5. Rib mobility: general FM with breathing, basking seal
6. Specific rib mobs: FM
7. NMR: resist inhale or exhale depending on restrictions
8. HEP: basking seal, sidelying arm circles

Question 18

Pre-test for anterior chest/rib cage

Answer 18

1. Breathing: inhalation/exhalation limitations
2. Cervical ROM
3. UE flexion
4. Supine shoulder protraction

Question 19

Treatment progression anterior chest and rib cage

Answer 19

1. Skin fascia
2. Bony contours:
   - sternum
   - Sternalis
   - sterno-costal junctions
   - resisted sternal breathing
   - clavicle
   - coricoid process
   - anterior ribs
   - lower border of rib cage (xiphoid)
   - diaphragm
3. Muscles:
   - pec major, minor
   - subscap
   - teres major/minor
   - serratus anterior
   - lats

Question 20

Evaluation of abdomen, pelvis, lower rib cage

Answer 20

• Posture
• VCT
• Thomas test
• Iliac height
• lumbar flex/ext

Question 21

Sequence of tx for abdomen, pelvis, lower rib cage

Answer 21

1. scar tissue
2. superficial fascia
3. lower border ribs with diaphragm stretch
4. Rec ab lateral borders
5. Umbilicus
6. Lateral abs (ex- contralat rot, and in- ipsilate rot obliques)
7. General abdominal contents mob
8. Iliacus
9. Psoas
10. forward bending in sitting

Question 22

Eval for c/s

Answer 22

Cervical posture and ROM, head position.

Compare and contrast bilateral structures

Question 23

Sequence for cervical/cranial tx

Answer 23

1. Cranial superficial fascia
2. Temporalis
3. Masseter
4. Posterior and submandibular bony contours
5. Medial pterygoid
6. Hyoid, larynx, thyroid and cricoid cartilage
7. longus coli
8. SCM
9. ant, mid, and post scalenes
10. A>P ant bondies with axial elong
11. Suboccipitals
12. Occipital frontalis
13. Mastoid process bony contours
14. Posterior neck soft tissues, articular pillars
15. Upper traps, levator, deep cervical fascia
16. Posterior superior serratus
17. 1st rib: AP, PA, depression
18. UE general technique

Question 24

HEP for cervical/cranium

Answer 24

Axial elong, 1st rib mob with strap

-c/s, upper thoracic rot: shift weight to opposite hip, look further into that direction