EVERY TREATMENT THERE EVER WAS Flashcards
What position does the patient have to be in for all of the cervical treatments?
Supine
Describe the cervical traction test
- One hand cradles occiput
- Other hand grasps gently below chin(avoid squeezing the chin)
- Keep head neutral or slightly flexed. Avoid extension
- Exert cephalad traction slowly and rhythmically with both hands, gradually increasing amplitudes.
- Continue until desired soft tissue or disc response or 2-5 minutes
Describe forward bending with a unilateral fulcrum
- Use one hand to flex patient’s neck in order to slide the other arm under patient’s head with hand palm down on opposite shoulder
- Keeping the neck in flexion, rotate the patient’s head toward and away from the elbow of the arm that is under the patient’s head to assess for the direction of tension.
- Rotate the patient’s head toward the direction of tension. A rhythmical pattern to the technique or a constant force is applied until tissue is softer and lengthened.
- Repeat on opposite side of cervical spinal tissue
Describe forward bending with a bilateral fulcrum
- Arms are crossed under patient’s head and hands placed palm down on patient’s shoulders
- Flex patient’s neck to induce a longitudinal stretch of the paravertebral muscles
-A rhythmical pattern or a constant force is applied until tissue is softer and lengthened.
Describe contralateral cervical traction
- Physician: At side of table opposite side being treated
- Caudad hand reaches across and contacts paravertebral muscles on side opposite of where you are standing (make sure to be lateral to spinous processes, not on them)
- Cephalad hand rests on patient’s forehead to stabilize head
- Engage tissue with ventral force and continue to apply traction moving ventrally and slightly laterally creating a perpendicular stretch
Describe cradling, with traction, supine
- Fingers placed under patient’s neck bilaterally on paraspinal muscles, just lateral to the spinous process
- Engage soft tissue with ventral and lateral force
- Apply a cephalad force to induce longitudinal traction
-Repeat above steps by repositioning hands to contact different levels of the cervical spine
Describe suboccipital release
- Finger pads placed in suboccipital region (find occipital ridge and move inferiorly until fingers fall into suboccipital region)
- Inhibition: Apply a constant inhibitory pressure for 30 seconds to 1 minute
-Kneading: pressure may be slowly and rhythmically applied until tissue texture change occur or for 2 minutes
Describe thoracic prone pressure
- Patient: Prone
- Physician: Standing at side of table opposite the side to be treated
- Place thenar and hypothenar eminence on paravertebral muscles opposite the side you are standing
- Place other hand on top of hand contacting the muscles
- Keeping your elbows straight and using your own body weight, engage soft tissues with a ventral force and move out laterally to induce a perpendicular stretch
- Repeat by repositioning hands on different levels of the thoracic spine
Describe prone pressure with counter pressure
- Patient: Prone
- Physician: Side of the table
- Place thumb and thenar eminence of caudad hand over the thoracic paravertebral muscles opposite the side you are standing
- Place hypothenar eminence of cephalad hand on paravertebral muscles on the same side you are standing
- Engage tissues with a ventral force and then move the hands in the direction in which the fingers are pointing, creating a longitudinal stretch
Describe the subscapular stretch
- Patient: Prone
- Physician: Standing at side to be treated
- Take patient’s arm, on the side being treated, and place it behind their back
- Place fingers around medial border of scapula
- Engage the tissue upward and laterally, pulling scapula away from rib cage
Describe upper thoracic shoulder block, lateral recumbent
- Patient: Lateral recumbent with side to be treated up
- Physician: Standing at side of table facing patient
- Caudad hand passes under patient’s arm and contacts paravertebral muscles
- Cephalad hand contacts anterior portion of shoulder to give counterforce. -Drape patient’s arm over your arm.
- With both hands, engage soft tissues ventrally and move out laterally to create a perpendicular stretch
Describe lower thoracic, under the shoulder, lateral recumbent
- Patient: Lateral recumbent with side to be treated up
- Physician: Standing at side of table facing patient
- Forearms contacting the axilla and iliac crest, fingers contact medial aspect of the erector spinae
- Elbows spread apart, elongating distance between the shoulder and the hip
- Engage muscle with ventral force and move out laterally to give perpendicular stretch
Describe the Paraspinal inhibitory technique
- Patient: Supine or Prone
- Physician: Standing on side being treated
- Place finger pads over the paraspinal tissues
- Apply gentle, firm pressure to engage tissue for 30-60 seconds or until release occurs
Describe lumbar prone pressure
- Patient: Prone
- Physician: Standing at side of the table opposite the side being treated -Place thenar and hypothenar eminence of one hand on patient’s lumbar paravertebral muscle on side opposite you
- Place other hand’s thenar eminence over the other hand
- Keep elbows straight and exert a gentle ventral and lateral force using your body weight to induce a perpendicular stretch
- Repeat the above steps along the lumbar spine
Describe prone presure with counter leverage
- Patient: Prone
- Physician: Stand at side of table opposite the side being treated
- Thenar eminence of cephalad hand contacts paravertebral muscles on the side opposite you
- Caudad hand gently grasps patient’s ASIS on the side opposite of you. Gently lift it towards the ceiling in order to create the counterleverage -Cephalad hand will engage tissues ventrally and move out laterally creating a perpendicular stretch
- Repeat by repositioning caudad hand along the paravertebral lumbar musculature
Describe paraspinal perpendicular stretch
- Patient: Lateral recumbent position with side to be treated up -Physician: At side of table facing patient
- Reach over patient’s back and place finger pads on the paravertebral muscles
-Engage tissues with a ventral and lateral force to create a perpendicular stretch
Modification: This stretch can also be performed by bracing the ASIS with the caudad hand and inducing a ventral stretch with the cephalad hand
DEscribe ITB Prone counter leverage
The patient lies prone and the physician stands on the left side of the patient.
The patient’s right knee is flexed to 90 degrees
The physician’s right hand grasps the patient’s right foot
or lower leg while reaching over the patient to place the left hand, palm down, over the patient’s right lateral thigh (fig.1)
The physician begins to push the patient’s foot and lower leg laterally while simultaneously compressing the right hand into the patient’s lateral thigh to engage the ITB pulling posteromedially to its restrictive barrier (fig.2)
On meeting the ITB’s restrictive barrier, the physician can maintain the tension for 10 to 20 seconds and slowly release the tension and repeat until a maximum release of the tissue is noted or perform this technique in a slow, rhythmic manner, which is repeated over a few minutes or until the tissue texture is maximally improved.
To disengage the tension on the ITB, the physician pulls the patient’s foot/lower leg back toward the midline while decreasing the pressure on the lateral thigh (fig.3)
Tissue tension is reevaluated to assess the effectiveness of the technique
Describe ITB Lateral recumbent, effleurage/petrissage
The patient lies in the right lateral recumbent position and the physician stands facing the front of the patient.
The physician’s left hand rests on the posterolateral aspect of the patient’s left iliac crest to stabilize the pelvis.
The physician makes a “fist” with the right hand and places the flat portion of the proximal phalanges over the distal, lateral thigh (fig.1).
The physician adds slight pressure into the distal ITB and begins to slide the hand toward the trochanteric.
This is repeated for 1 to 2 minutes and then the tissue tension is reevaluated to assess the effectiveness of the technique.
If preferred, the physician can alternate from the distal to proximal stroking and perform a proximal to distal stroking, ending at the distal ITB (fig.2).
Describe thoracolumbar MFR/INR, prone (direct/indirect)
Setup: patient prone, physician at side of table
Physician right hand at the right TLJ with thumb pads medial to
the longissimus thoracis and thenar eminence upon it; the left hand
is placed similarly on the left side •Internally rotate your arms at your shoulders to load the tissues
•Assess flexion/extension, rotation, & sidebending myofascial and joint-related tightness and looseness. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– leg extension, IR/ER; arm motion
•Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Describe prone regional thoracic MFR/INR
Setup: patient prone, physician at side of table
Physician right hand with thumb pads medial to the longissimus thoracis and thenar eminence upon it at T7-9; the left hand his placed similarly on the left side
•Assess each hand independently for flexion/extension, rotation, & sidebending myofascially for tightness and looseness. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– arm motion flex/extend, IR/ER,
DEscribe prone sacral base MFR/INR (direct or indirect)
Setup: patient prone, physician at side of table
Physician places one hand with pinky just superior to the lumbosacral junction, thenar & hypothenar eminence lateral to one of the sacroiliac joints and the contralateral finger pad on the lateral aspect of the other sacroiliac joint
•Assess flexion/extension, rotation, & sidebending myofascial and joint-related tightness and looseness. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– leg flex/extend, IR/ER •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Describe Cervical MFR/INR
Setup: patient is supine, physician at head of table
Physician cups the subocciput with hands (no pressure with thumbs)
•Gently, add traction to engage the hypertonic tissues
•Assess flexion/extension, rotation, & sidebending myofascial and joint-related tightness and looseness.
–Keep in mind the principle that “less is more” and adding too much motion loses localization.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– eye, tongue & UE movement •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position & Re-assess
Describe the hip region MFR/INR, standing
Setup: patient supine, physician at side of table
Physician places one hand on the proximal anterolateral aspect of the leg (over quadricep and greater trochanter) and the other posteromedially (over hamstrings
and adductors)
•Care is taken to avoid the genitalia
Assess IR/ER of hip region myofascia for tightness and looseness
.Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– knee/hip flexion/extension, AB/AD, IR/ER
•Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Describe the popliteal space MFR/INR
Setup: patient supine, physician at side of table
Physician uses finger pads to grasp the medial & lateral aspects of the hamstrings (superior) or the gastrocs (inferior) as they create the superior/inferior popliteal space
•Use a separating force to load the tissues, then assess IR/ER of area for tightness and looseness
Describe knee MFR/INR
Setup: patient supine, physician at side of table
Physician uses superior hand to grasp thigh superior to the patella & other hand inferior to patella on tibia and fibula
•Compress hands together to loose pack the joint, then assess IR/ER of area for myofascial tightness and looseness.
Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– knee flexion/extension •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position & Re-assess
Describe Ankle MFR/INR
Setup: patient supine, physician at side of table
Physician grasps the patient’s distal leg crossing the ankle joint (holding medial & lateral malleoli) with superior hand and with inferior hand grasp the forefoot
•Assess IR/ER of ankle with the malleolar hand for myofascial tightness and looseness. Then assess inversion/eversion & dorsiflexion/plantarflexion. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– dorsiflexion/plantarflexion •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position & Re-assess
Describe plantar fascia MFR/INR (direct)
Setup: patient supine, physician at the foot of table
Physician’s thumbs are crossed, making an X, with the thumb pads over the area of concern at the plantar fascia.
•The thumbs provide a separating force to load tissues appropriate to dMFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– plantarflexion/dorsiflexion •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position & Re-assess
Describe glenohumeral and scapular MFR/INR (direct and indirect)
Setup: patient prone, physician at side of table
Physician grasps the proximal humerus inferiorly near the axilla and superiorly placing thumb & 5th digit on humerus and digits 2-4 on scapula
•Assess F/E, IR/ER & AD/Abduction of the GH joint & lateral/medial, superior/inferior, & sidebending of the scapula. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– arm F/E, IR/ER, AD/ABduction •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Describe elbow MFR/INR
Setup: patient supine, physician at side of table
Physician grasps the radioulnar area near the radiohumeral joint with one hand positioned inferior to the joint and the other superior
•Assess the IR/ER for the fascia at the joint. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– dorsiflexion/plantarflexion •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Describe wrist MFR/INR
Setup: patient seated, physician facing patient
Physician a) Grasp the wrist just proximal to the wrist joint; b) Grasp distal to the wrist joint with the other hand
•Assess the IR/ER for the fascia at the joint. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– wrist flexion/extension, radial/ulnar deviation & clenching/unclenching fists
•Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Describe Still’s wrist
Physician a) Grasp the wrist anteriorly/posteriorly using your thenar and hypothenar eminences
• Assess fascial response to Flexion/Extension, Ulnar/Radial deviation at the joint. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– wrist flexion/extension, radial/ulnar deviation & clenching/unclenching fists
•Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Describe a glenohumeral joint flexion/extension SD MET
Stabilize shoulder girdle with one hand, contact elbow with the other.
Engage RB in flexion/extension based on diagnosis.
Apply principles and steps of MET to the motions of the GH joint.
Reassess.
Describe a GH Joint IR/ER SD MET
GH IR/ER SD MET
Stabilize shoulder girdle with one hand, contact wrist with the other.
Engage RB in IR/ER based on diagnosis.
Apply principles and steps of MET to the motions of the GH joint.
Reassess.
Describe a GH Joint AB/ADduction SD MET
GH AB/ADduction SD MET
Stabilize shoulder girdle with one hand, contact elbow with the other.
Engage RB in AB/ADduction based on diagnosis.
Apply principles and steps of MET to the motions of the GH joint.
Reassess
What are the 7 stages of the Spencers Technique?
Every Fine Cat Takes an an Indoor Pee
Extension
Flexion
Compression Circumduction
Traction Circumduction
ADduction and ER
ABduction
IR
Pump (traction with inferior glide)
Describe GH Articulatory Tx: Spencer’s technique part 1
Cephalad hand stabilizes shoulder girdle, caudal hand grasps elbow.
Move shoulder into extension until RB is engaged. With gentle but firm force, move a short distance through RB for 1-2 seconds and release.
Repeat rhythmically until no further progress in extension can be appreciated.
Reassess.
• MET Modification: Once RB is engaged, have patient perform flexion against physician resistance and follow rules of MET .
Describe GH Articulatory Tx: Spencer’s Technique Stage 2: Flexion
Cephalad hand stabilizes shoulder girdle, caudal hand grasps patients hand/wrist or elbow.
Move shoulder into flexion until RB is engaged. With gentle but firm force, move a short distance through RB for 1-2 seconds and return to position just inside RB.
Repeat rhythmically until no further progress in flexion can be appreciated.
Reassess.
• MET Modification: Once RB is engaged, have patient perform extension against physician resistance and follow principles of MET.
Describe GH Articulatory Tx: Spencer’s Technique Stage 3: Compression Circumduction
Cephalad hand stabilizes shoulder girdle, caudal hand grasps elbow.
Abduct patient’s shoulder to 90° and gently compress elbow toward glenoid fossa.
Make small clockwise circles, gradually increasing size of concentric circle for 15-30 seconds.
Reverse direction of circle and continue for 15-30 seconds.
Reassess.
Describe GH Articulatory Tx: Spencer’s Technique Stage 4: Traction Circumduction
Cephalad hand stabilizes shoulder girdle, caudal hand grasps patient’s wrist or elbow with gentle traction toward ceiling.
Abduct patient’s shoulder to 90° and add gentle traction toward ceiling.
Make small clockwise circles, gradually increasing size of concentric circle for 15-30 seconds.
Reverse direction of circle and continue for 15- 30 seconds.
Reassess.
Describe GH Articulatory Tx: Spencer’s Technique Stage 5A: Adduction and External Rotation
Cephalad hand stabilizes shoulder girdle, and have patient grasp physician’s forearm.
Slightly flex patient’s shoulder so arm may pass just in front of their body.
With caudal hand, adduct shoulder to RB. With gentle but firm force, move a short distance through RB for 1-2 seconds and release.
Repeat rhythmically until no further progress in adduction can be appreciated.
Reassess.
• MET Modification: Once RB is engaged, have patient perform abduction against physician resistance and follow principles of MET
Describe GH Articulatory Tx: Spencer’s Technique Stage 5B: Abduction
Return to starting position used in stage 5A.
With caudal hand, abduct shoulder to RB. With gentle but firm force, move a short distance through RB for 1-2 seconds and release.
Repeat rhythmically until no further progress in abduction can be appreciated.
Reassess
• MET Modification: Once RB is engaged, have patient perform adduction against physician resistance and follow principles of MET.
Describe GH Articulatory Tx: Spencer’s Technique Stage 6: Internal Rotation
Abduct patient’s shoulder 45° and IR shoulder to 90° placing dorsum of patient’s hand in the small of the back.
Reinforce anterior shoulder with cephalad hand.
With caudal hand gently pull elbow forward into IR RB. With gentle but firm force, move a short distance through RB for 1-2 seconds and release.
Repeat rhythmically until no further progress in internal rotation can be appreciated.
Reassess.
• MET Modification: Once RB is engaged, have patient perform ER against physician resistance and follow principles of MET.
GH Articulatory Tx: Spencer’s Technique Stage 7: Traction with Inferior Glide
Abduct patient’s arm and place hand on physician’s shoulder closest to patient.
Interlace fingers just distal to patient’s GH joint.
Scoop patient’s humeral head in caudal direction parallel to table to engage RB. With gentle but firm force, move a short distance through RB for 1-2 seconds and release.
Repeat rhythmically until no further progress can be appreciated.
Reassess.
• MET Modification: Once RB is engaged, have patient press hand against physician shoulder and follow principles of MET
Describe SC Joint ABduction/ADduction Dx
Patient is supine; examiner places index finger on clavicular head next to the sternum.
The patient then shrugs shoulders upwards (Abduction) and an Inferior/Caudal movement should be palpated with normal motion at the sternoclavicular joint.
Patient then lowers shoulders downward (ADduction) and a Superior/Cephalad movement should be palpated with normal motion at the sternoclavicular joint.
Top photo:
Red arrow: proximal clavicle moves inferiorly/caudad
Green arrow: distal clavicle moves superiorly/cephalad Bottom photo:
Red arrow: proximal clavicle moves superiorly/cephalad
Green arrow: distal clavicle moves inferiorly/caudad
Describe SC Joint Flexion/Extension
Patient is supine; examiner places index finger on the clavicular head next to the sternum; pt flexes shoulder to 90° and reaches for ceiling forcefully (Flexion).
A posterior movement of the clavicle should be palpated with normal motion at the sternoclavicular joint.
Patient then lowers arms back toward the table (Extension).
An anterior movement of the clavicle should be palpated with normal motion of the sternoclavicular joint.
Describe an SC Elevated/ADducted SD Articulatory Treatment
Pt lying supine with neck fully flexed by physician.
Physician places thumb over sternal end of the clavicle exerting an inferior/caudal pressure.
Pt instructed to inhale and exhale fully. During exhalation, the physician springs the clavicle inferiorly to release restriction.
Describe SC Joint—Articulatory Technique
Pt lying supine, examiner contralateral to SD.
The patient helps to gap the SC joint by
ADducting the arm ipsilateral to the SD (using their contralateral hand to aid in the motion.) The physician’s ipsilateral hand may be placed on the table under the patient’s axilla to create a fulcrum for the patient to adduct against.
- Articulatory springing is applied laterally, posteriorly, and inferiorly over medial end of clavicle using hypothenar eminence.
- Reassess.
Describe SC Elevated/ADducted (Superior Glide) SD MET
Pt lying supine, examiner on side of affected shoulder.
Doctor places one hand on the proximal clavicular head. With the other hand, grasp patient’s wrist and hold arm extended and internally rotated.
Pt is instructed to raise arm against physician’s hand toward ceiling (flexion at the shoulder) for 3-5 seconds, then relax. Joint then brought into new barrier, repeating until no new barriers reached or full ROM restored.
Patient force = black arrow; physician force = white arrow
Describe SC Horizontal Extension (Anterior Glide) SD MET
Pt lying supine, examiner on side of affected shoulder.
Place one hand on the restricted clavicle and the other hand placed behind axilla to cover the scapula. Patient holds physician’s shoulder with the hand of the affected shoulder.
Flex the clavicle toward the manubrium until movement is palpated in the SC joint by pulling scapula anteriorly.
Posterior force simultaneously applied to proximal clavicle from anterior to posterior to engage RB.
Apply the principles of MET by having patient pulling their shoulder down toward the table (red arrow).
Describe AC- Superior Clavicle ART
Pt supine with Dr on the ipsilateral side.
Physician’s finger monitoring AC joint and other fingers on superior aspect of clavicle; the other hand grasps the patient’s forearm proximal to the wrist.
Apply a traction force in a caudad direction to gap the AC joint.
—Use enough force to register a change with the monitoring hand
While maintaining the traction force, maximally flex the arm.
Reassess.
Describe AC Joint – Direct –seated ART
Grasp elbow or forearm of dysfunctional side
Grasp dysfunctional clavicle between thumb and fingers of free hand. (Thumb on
posterior/superior surface of distal clavicle) & (Not on scapula)
Apply anterior/inferior pressure with thumb on lateral (or posterior) aspect of clavicle while flexing patients elbow, extending and adducting humerus (to gap AC joint)
Doctor holds clavicle antero-inferior (with thumb). Shoulder is extended into a circulatory sweep, posterior, superior, then anteromedial while maintaining adduction and capsular tension
Recheck
Describe AC Joint IR/ER Evaluation
Atlas of Osteopathic Techniques, 3e, “Chapter 10”
Patient seated with doc standing behind the patient.
Onehandcontactsandstabilizesthe clavicular side of the joint with index finger over the AC joint, noting if patient has tenderness.
Note asymmetry of joint gap compared to opposite side.
Flex, abduct (approximately 45 degrees) to maximally engage the AC component of GH rotation.
IR and ER to assess for 90 degrees of motion in each direction.
Noterestrictionofmotionandeaseof motion.
Name dysfunction based on the direction of ease of motion (IR or ER).
Describe AC Internal Rotation SD MET
Pt Seated, physician stands behind patient.
Physician places hand on clavicle just medial to AC joint while grasping wrist with the other hand.
Add compressive force to stabilize clavicle/AC joint while flexing, abducting and ER to RB.
Apply the principles of MET by having the patient IR against physicians resistance for 3-5 seconds.
Repeat 3-5 times or until motion is fully restored.
Describe AC External Rotation SD MET
Pt Seated, physician stands behind patient.
Physician places hand on clavicle just medial to AC joint while grasping wrist with the other hand.
Add compressive force to stabilize clavicle/AC joint while flexing, abducting and IR to RB.
Apply the principles of MET by having the patient ER against physicians resistance for 3-5 seconds.
Repeat 3-5 times or until motion is fully restored.
Describe Elbow extension SD
Physician places the elbow into flexion barrier
Patient gently attempts to extend elbow for 3-5 seconds while the physician applies an isometric counterforce.
Patient is instructed to completely relax.
Repeat steps 1-3 or 3-5 times or until somatic dysfunction is alleviated.
Describe the treatment for an elbow flexion SD
Patient: seated, standing or supine, shoulder flexed to 90o, elbow extended
Physician: seated or standing
Physician places the elbow into extension barrier.
Patient gently attempts to flex elbow for 3-5seconds while the physician applies an unyieldingcounterforce.
Patient is instructed to completely relax.
Steps 1-3 are repeated 3-5 times or until somatic dysfunction is alleviated.
Describe the treatment for an elbow ADduction SD
Physician places the elbow into abduction barrier.
Patient gently attempts to adduct the elbow for 3-5 seconds while the physician applies an unyielding counterforce.
Patient is instructed to completely relax.
Steps 1-3 are repeated 3-5 times or until somatic dysfunction is alleviated.
Describe the treatment for an elbow ABduction SD
Physician places the elbow into adduction barrier.
Patient gently attempts to abduct the elbow for 3-5 seconds while the physician applies an unyielding counterforce.
Patient is instructed to completely relax.
Steps 1-3 are repeated 3-5 times or until somatic dysfunction is alleviated.
Describe the Anterior Radial head SD
- The patient is seated, and the physician stands facing the patient.
- The physician grasps the patient’s hand on the side of dysfunction, contacting the dorsal aspect of the distal radius with the thumb.
- The physician’s other hand is palm up with the thumb resting against the anterior and medial aspect of the radial head.
- The physician pronates the patient’s forearm to the edge of the restrictive barrier. The physician instructs the patient to attempt supination while the physician applies an unyielding counterforce.
- This isometric contraction is held for 3 to 5 seconds, and then the patient is instructed to stop and relax.
- Once the patient has completely relaxed, the physician pronates the patient’s forearm to the edge of the new restrictive barrier while exaggerating the posterior rotation of the radial head with the left hand.
- Steps 5 to 7 are repeated three to five times or until there is no further improvement in the restrictive barrier.
- Range of motion of the radial head is reevaluated to determine the effectiveness of the technique.
Describe a posterior radial head SD
- The patient is seated, and the physician stands in front of and to the side of the patient’s dysfunctional arm. 2. The physician grasps the patient’s hand on the side of dysfunction (handshake position), contacting the palmar aspect of the distal radius with the index finger.
- The physician’s other hand is palm up with the thumb resting against the posterolateral aspect of the radial head.
- The physician supinates the patient’s forearm until the edge of the restriction barrier is reached at the radial head.
- The physician instructs the patient to attempt pronation while the physician applies an unyielding counterforce.
- This isometric contraction is held for 3 to 5 seconds, and then the patient is instructed to stop and relax. Once the patient has completely relaxed, the physician supinates the patient’s forearm to the new restrictive barrier while exaggerating the anterior rotation of the radial head with the other hand.
- Steps 5 to 6 are repeated three to five times or until there is no further improvement in the restrictive barrier.
- Range of motion of the radius is reevaluated to determine the effectiveness of the technique.
Describe the treatment for a radiocarpal flexion SD
- The patient is seated with the physician standing facing the patient.
- The physician extends the patient’s wrist to the edge of the restrictive barrier.
- The physician instructs the patient to flex the wrist while the physician applies an unyielding counterforce.
- This isometric contraction is maintained for 3 to 5 seconds, and then the patient is instructed to stop and relax.
- Once the patient has completely relaxed, the physician extends the patient’s wrist to the edge of the new restrictive barrier.
- Steps 3 to 5 are repeated three to five times or until motion is maximally improved at the dysfunctional wrist.
- Range of motion of the wrist is reevaluated to determine the effectiveness of the technique.
Describe a radiocarpal extension SD treatment
- The patient is seated with the physician standing facing the patient.
- The physician flexes the patient’s wrist to the edge of the restrictive barrier.
- The physician instructs the patient to extend the wrist (black arrow) while the physician applies an unyielding counterforce.
- This isometric contraction is maintained for 3 to 5 seconds, and then the patient is instructed to stop and relax.
- Once the patient has completely relaxed, the physician flexes the patient’s wrist to the edge of the new restrictive barrier.
- Steps 3 to 5 are repeated three to five times or until motion is maximally improved at the dysfunctional wrist. 7. Range of motion of the wrist is reevaluated to determine the effectiveness of the technique.
Describe a radiocarpal adduction SD treatment
- The patient is seated with the physician standing facing the patient.
- The physician abducts the patient’s wrist (radial deviation) to the edge of the restrictive barrier.
3.The physician instructs the patient to adduct the wrist while the physician applies an unyielding counterforce. 4. This isometric contraction is maintained for 3 to 5 seconds, and then the patient is instructed to stop and relax.
- Once the patient has completely relaxed, the physician abducts (radially deviates) the patient’s wrist to the edge of the new restrictive barrier.
- Steps 3 to 5 are repeated three to five times or until motion is maximally improved at the dysfunctional wrist.
- Range of motion of the wrist is reevaluated to determine the effectiveness of the technique.
Describe the treatment for a radiocarpal abduction SD
- The patient is seated with the physician standing facing the patient.
- The physician abducts the patient’s wrist (radial deviation) to the edge of the restrictive barrier.
3.The physician instructs the patient to adduct the wrist while the physician applies an unyielding counterforce. 4. This isometric contraction is maintained for 3 to 5 seconds, and then the patient is instructed to stop and relax.
- Once the patient has completely relaxed, the physician abducts (radially deviates) the patient’s wrist to the edge of the new restrictive barrier.
- Steps 3 to 5 are repeated three to five times or until motion is maximally improved at the dysfunctional wrist. 7. Range of motion of the wrist is reevaluated to determine the effectiveness of the technique.
Describe the treatment for a flexor retinacula MFR
- The patient sits on the table with the physician standing facing the patient.
- The operator interlaces the fingers of both hands applying a thenar eminence contact across the distal radius and ulnar on the dorsal side and the wrist retinaculum on the volar side.
- The operator maintains anteroposterior compression over the wrist while the patient actively flexes and extends fingers.
- The patient repeats flexion and extension efforts several times, mobilizing flexor tendons under the flexor retinaculum while the operator’s hands maintain compression resulting in distraction.
- Reassess for effectiveness of the technique.
Describe a wrist isotonic MET treatment
Patient: Seated, standing or supine Physician: Seated or Standing
Physician crosses thumbs and contacts the tissue over the patient’s pisiform and trapezium
While the patient tries to flex the wrist, the doctorapplies pressure with both thumbs in a lateral direction.
Physician lightens force slowly to allow patient toovercome the physician’s force.
Repeat steps 2-3 until somatic dysfunction is alleviated.
Describe the metacarpophalangeal joint SD
Physician evaluates the motion at the metacarpophalangeal joint in flexion, extension, abduction, adduction, clockwise and counterclockwise circumduction.
When a restriction is felt, gentle repetitive motion is made through the restrictive barrier toward the anatomic barrier.
Continue articulation until somatic dysfunction is alleviated.
Describe the Proximal and Distal Interphalangeal Joint SD ART
Physician evaluates the motion at the proximal anddistal interphalangeal joints in flexion, extension, abduction, adduction, clockwise and counterclockwise circumduction.
When a restriction is felt, gentle repetitive motion is made through the restrictive barrier toward the anatomic barrier.
Continue articulation until somatic dysfunction is alleviated.
Descrine the gluteus hypertonicity test
Patient: lateral recumbent with affected side up.
Physician stabilizes at ipsilateral PSIS with onehand. Other hand grasps pt’s leg above ankle and flexes at hip until barrier is reached and foot is placed on physician’s thigh.
- Pt is instructed to push foot downward againstphysician’s thigh/counterforce for 3 to 5 seconds.
- Pt instructed to relax; physician repositions pt into new restrictive barrier.
- Repeat at least 3-5 times or until no new barriers are attained.
- Reassess for TART.
Describe the treatment for a Hip External rotation somatic dysfunction
Patient: Supine or prone with hip and knee flexed to 90
Physician internally rotates pt’s hip to restrictive barrier
-Pt is instructed externally rotate hip against physician’s counterforce for 3 to 5 seconds. -Pt instructed to relax; physician repositions pt into new restrictive barrier.
- Repeat at least 3-5 times or until no new barriers are attained.
- Reassess for TART.
Describe the treatment for a hip internal rotation SD
Patient: Supine or prone with hip and knee flexed to 90
Physician externally rotates pt’s hip to restrictive barrier
-Pt is instructed internally rotate hip against physician’s counterforce for 3 to 5 seconds. -Pt instructed to relax; physician repositions pt into new restrictive barrier.
- Repeat at least 3-5 times or until no new barriers are attained.
- Reassess for TART.
Describe the MET technique for a Hip Abduction SD
Fig: 19.11
Patient: Supine
Physician stabilizes contralateral LE just above the ankle with one hand. Other hand adducts other LE to test for hypertonic abductor. -Approximate the restrictive barrier
-Pt is instructed to push LE laterally againstphysician’s counterforce for 3 to 5 seconds.
-Pt instructed to relax; physician repositions pt into new restrictive barrier.
- Repeat at least 3-5 times or until no new barriers are attained.
-Reassess for TART.
Describe a Hip adduction SD
Patient: Supine with both legs straight at the hip and knee
Assessment: Physician uses one hand to abduct the leg that being tested and stabilizes just proximal to the pt’s knee using own hip. Physician places other hand on contralateral knee to stabilize the leg.
Physician abducts patient’s leg until restrictive barrier met, as described above.
-Pt is instructed to gently push the knee of affected leg into physician’s hip for 3-5 seconds.
- Pt instructed to relax; physician repositions pt into new restrictive barrier.
- Repeat at least 3-5 times or until no new barriers are attained.
-Reassess for TART.
Muscle Energy: Hypertonic Long Adductor of Lower Extremity
Patient: Supine with both legs straight at the hip and knee
Assessment: Physician uses one hand to abduct the leg that being tested and stabilizes just proximal to the pt’s knee using own hip. Physician places other hand on contralateral knee to stabilize the leg.
Physician abducts patient’s leg until restrictive barrier met, as described above.
-Pt is instructed to gently push the knee of affected leg into physician’s hip for 3-5 seconds.
- Pt instructed to relax; physician repositions pt into new restrictive barrier.
- Repeat at least 3-5 times or until no new barriers are attained.
-Reassess for TART.
Describe Muscle Energy: Hypertonic Short Adductor of Lower Extremity for a Hip adduction SD
Patient: supine with non-tested leg straight at the hip and knee.
Assessment: The tested leg is externally rotated and flexed at the thigh and knee with the foot resting against the other thigh.
-For diagnosis, the physician places cephalad hand on the pt’s opposite hip and caudad hand medial to the pt’s knee of the tested leg.
Physician abducts patient’s leg until restrictive barrier met, as described above.
-Pt is instructed to gently push the knee of affected leg into physician’s hand for 3-5 seconds.
- Pt instructed to relax; physician repositions pt into new restrictive barrier.
- Repeat at least 3-5 times or until no new barriers are attained.
-Reassess for TART.
Describe the MET/ART for the extended Tibiofemoral SD
MET/ART
– Patient: Prone
– Physician: Standing on dysfunctional side
Flex knee to restrictive barrier
Place hand proximal to ankle of ipsilateral LE
Instruct patient to extend knee as counterforce, maintaining isometric contraction for 3-5 seconds
Upon relaxation, wait 1-2 seconds and flex to new restrictive barrier
Repeat 3-5 times or until motion is restored
DEscribe flexed tibiofemoral SD
MET/ART
– Patient: Supine with pillow under lower leg – Physician: Standing on dysfunctional side
Extend knee to restrictive barrier Place caudad hand under patient’s calcaneus and cephalad hand over patella
Instruct patient to flex knee as counterforce, maintaining isometric contraction for 3-5 seconds
Upon relaxation, wait 1-2 seconds and extend to new restrictive barrier
Repeat 3-5 times or until motion is restored
Describe the MET/ART for an AB/ADduction tibiofemoral SD
Patient: Supine, flex hip/knee to 90°
Physician: Standing at end of table on dysfunctional side,
facing towards head of table
- Grasp tibial plateau in both hands and hold distal LE between forearm and rib cage
– Modification: Can place patient’s leg on physician’s thigh
Engage the restrictive barrier (RB) and have the patient apply equal counterforce against the physician, maintaining an isometric contraction for 3-5 seconds
Allow patient to relax for 1-2 seconds for appropriate post isometric relaxation, then move leg to next restrictive barrier
Repeat 3-5 times or when motion is restored
Describe the MET/ART for a posterior fibular head SD
Patient: Supine or seated, hip and knee flexed to 90°
Physician: Standing on dysfunctional side, facing
patient
Cephalad hand holds fibular head between thumb and index finger or with the 1st MCP joint
Caudad hand grasp foot and engage restrictive barrier by moving the foot into Pronation (Dorsiflexion+Eversion+Abduction)
Have patient move foot medially against resistance for 3-5 seconds while providing anterior glide on fibular head
Repeat 3-5 times or when motion is restored
Describe the treatment for a distal fibula anterior ART
Patient supine. Physician stands at the foot of the table.
Stabilize patient’s foot, wrapping fingers around calcaneus, and engage dorsiflexion passive barrier.
Thumb of lateral hand contacts the anterior aspect of the distal fibula with other thumb on top.
Engage the restrictive barrier and use articulatory technique until motion improves.
Reassess TART.
Describe a distal fibular posterior ART treatment
Patient prone. Physician stands at the foot of the table.
Stabilize patient’s foot, wrapping fingers around calcaneus and engage plantarflexion PB.
Thumb of lateral hand contacts the posterior aspect of the distal fibula with other thumb on top.
Engage the RB and use articulatory technique until motion improves.
Reassess TART.
Describe dorsiflexed talus MET
Stabilize patient’s ankle with one hand at the level of the malleoli.
Place the other hand over the dorsum on the patient’s foot.
Bring the patient’s foot into the plantar flexion restriction barrier (RB).
Patient is instructed to bring their foot into dorsiflexion against isometric resistance for 3-5 sec, then relax.
Engage the new barrier & repeat Step 4 until no new RBs are met.
Reassess TART.
Describe the plantarflexed talus MET treatment
Stabilize patient’s ankle with one hand at the level of the malleoli.
Engage the restrictive barrier by contacting the sole of the patient’s forefoot and dorsiflexing the foot.
Patient is instructed to push through their forefoot into isometric resistance for 3-5sec, then relax.
Engage the new barrier & repeat Step 3 until no new RBs are met.
Reassess TART.
Describe an articulatory treatment with traction
Grasp patient’s heel with one hand and grasp the talus & dorsum of the foot with the other.
Maintain traction on calcaneus and articulate inversion and eversion with a “figure 8” maneuver until no new RBs are met or quality of ROM normalizes.
Reassess TART.
Describe a plantar glide SD MET
Grasp patient’s foot with both hands on dorsum of foot, lifting the foot off the table, and dorsiflex to engage PB.
Adjust inversion & eversion, dorsiflexion & plantarflexion to engage RBs.
Cross thumbs on plantar surface with one pad on cuboid & other on navicular with a separating force.
Instruct patient to “Push your foot into my thumbs” & maintain a counterforce for 3-5 seconds. Repeat MET until no new barriers are met.
Reassess TART.
