Evaluation and treatment Flashcards
Evaluation
- Posture of everything
- EFT, LPM, VCT
- ROM: pelvic shear, forward bend, backward bend, side bend, c/s rotation, breathing, shoulder abd
Assess superficial fascia
- 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
Treat superficial fascia
Specific to direction and depth
- Sustained pressure
- Shortening/lengthening
- Unlocking spiral
Bony contours of lumbar spine/pelvis
Sacral sulcus, coccyx, iliac crest, groove of the spine, inf border of lower ribs
Functional excursion techniques used in FM1
- Thomas test position
- SLR (hamstring in diagonals)
- Prone with one leg off table (1/2 prone for quads/hip)
How to do groove of spine with 2 hands
- 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.
General techniques
- Use thumbs, knuckles, heel of hand, forearms, elbows
- Good for bony contours, paraspinals, elbow on piriformis
Forward bending in sitting
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.
Perpendicular strumming
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
Perpendicular deformation
Used to eval and treat muscle play.
Deform muscle and down let it spring back
Parallel mobilization
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
Order of tx: play and tone
- Treat muscle play first along borders of muscle
- Then eval/tx tone
TX of muscle tone
- Breathing, attempting to relax, visualization, imagery
- have pt participate in letting go
Evaluation of rib cage
- 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)
Sidelying eval of rib cage: accessory mobility
- Accessory: internal/external torsion
- Scap into PE: spring ribs ant/inf for internal torsion
- Scap into AD: spring ribs post/sup for external torsion
Sidelying eval of rib cage: functional mobility
- Functional: inhalation/exhalation
- Pelvis into AE: spring ribs post/inf for exhalation
- Pelvis into PD: spring ribs ant/sup for inhalation
Rib cage treatment progression
- Skin/superficial fascia
- Bony contours ribs
- STM: serratus, lats, inf border rib cage, obliques
- General mobs to restricted area with breahting
- Rib mobility: general FM with breathing, basking seal
- Specific rib mobs: FM
- NMR: resist inhale or exhale depending on restrictions
- HEP: basking seal, sidelying arm circles
Pre-test for anterior chest/rib cage
- Breathing: inhalation/exhalation limitations
- Cervical ROM
- UE flexion
- Supine shoulder protraction
Treatment progression anterior chest and rib cage
- Skin fascia
- Bony contours:
- sternum
- Sternalis
- sterno-costal junctions
- resisted sternal breathing
- clavicle
- coricoid process
- anterior ribs
- lower border of rib cage (xiphoid)
- diaphragm - Muscles:
- pec major, minor
- subscap
- teres major/minor
- serratus anterior
- lats
Evaluation of abdomen, pelvis, lower rib cage
- Posture
- VCT
- Thomas test
- Iliac height
- lumbar flex/ext
Sequence of tx for abdomen, pelvis, lower rib cage
- scar tissue
- superficial fascia
- lower border ribs with diaphragm stretch
- Rec ab lateral borders
- Umbilicus
- Lateral abs (ex- contralat rot, and in- ipsilate rot obliques)
- General abdominal contents mob
- Iliacus
- Psoas
- forward bending in sitting
Eval for c/s
Cervical posture and ROM, head position.
Compare and contrast bilateral structures
Sequence for cervical/cranial tx
- Cranial superficial fascia
- Temporalis
- Masseter
- Posterior and submandibular bony contours
- Medial pterygoid
- Hyoid, larynx, thyroid and cricoid cartilage
- longus coli
- SCM
- ant, mid, and post scalenes
- A>P ant bondies with axial elong
- Suboccipitals
- Occipital frontalis
- Mastoid process bony contours
- Posterior neck soft tissues, articular pillars
- Upper traps, levator, deep cervical fascia
- Posterior superior serratus
- 1st rib: AP, PA, depression
- UE general technique
HEP for cervical/cranium
Axial elong, 1st rib mob with strap
-c/s, upper thoracic rot: shift weight to opposite hip, look further into that direction
