F1 Flashcards
Rib Tubercle Tender Points - pushing downward
Visceral
Rib Tubercles - pushing laterally
Arterial
Rib Tubercles - pushing superiorly
Neural
Rib Tubercles - pushing medially
Ligamentous
At which level is the spine of the scapula?
Rib 4, SP 3
At which level is the superior angle of the scapula?
T2
At which level is the inferior aspect of the scapula?
Rib 8, SP 7
At which level is the iliac crest?
L4
What is on the bottom of the wellness pyramid?
Symptomatic with dysfunction and inflammation
A positive scan is indicated by tenderness or rigidity?
Rigidity
What are the key segments?
C1-C3
C7-T1
T1-T2
coccyx
What does a unilateral scan most likely indicate?
A scar on the other side
ALLT1-ALLT12-MS
TP #1: located over the lateral aspect of rib tubercles 1-12.
TP #2: ALLT1-ALLT6 also have TPs over the anterior humerus from the deltoid insertion to above the supracondylar ridge
Tx: Flex, SBToward, Mild Rot Toward
Cervicothoracic posterior translation of the involved segment
Symptoms: c-t pain, medioscapular pn, kyphosis and related conditions
ALLL1-ALLS2-MS
TP: ALLL1-ALLS2 have tp locations along the medial posterior femur/hamstring mass
Tx: hooklying with feet toward tp side mildly
Hip flex, add, & IR of the involved (hamstring) side
Symptoms: lumbago, lumbar disc herniation, limited SLR/hamstring mobility
Note: Involved motion segment will be flexed with prominent sp process
PLLT1-PLLT8-MS
TP #1: over inferolateral tip of thoracic transverse processes. T1-T8 (lateral edge of paravertebral)
Inf to sup
TP #2: PLLT1-6 also have TPs over the posterolateral aspect of the humerus between deltoid insertion and Supra-condylar ridge
Tx: (prone) Shoulder ext and adduction moderately, ER
Sx: cervicalgia, medioscapular pain, shoulder ROM loss, shoulder/arm pain
PLLT9-PLLT12- MS
TPs: Inferolateral tip of thoracic transverse processes T9-T12 (lateral edge of paravertebral)
Inf to sup
Tx: supine, ipsilat knee flexed, trunk SB Toward involved segment by sliding involved side leg toward TP side, trunk rot toward the involved side via lower trunk rotation AWAY from involved side. Let thoracolumbar spine extend
PLLL1-PLLCX4-MS
TP #1: dorsal of coccyx - segments CX3 and CX4, post to ant approach
TP #2: PLLL1-PLLCX4 also have tp locations along lateral posterior femur/hamstring mass - behind ITB
Tx: supine, trunk SB Toward involved segment-slide feet toward tp side, Rot Toward involved via ant/med/sup lift of ASIS
Sx: LBP, limited flex, sciatica/limited SLR, coccyx, pain, heel pain (with PLLCX locations)
Note: Involved motion segment will be extended with a ‘sunken’ sp process
Superior Sympathetic Pre-Ganglionics
SSCT1-2-N
TP SCCT1: investing layer of deep cervical fascia (ID as taut band of fascia) 2 finger widths lateral to the medial end of the clavicle. Sup-Inf
TP SCCT2: investing layer of deep cervical fascia (ID as taut band of fascia) 3 finger widths lateral to the medial end of the clavicle. Sup-Inf
To: c/s flexion, SB Toward, Rot Away
Symptoms: Pain and neurovascular conditions related to head, neck, UEs.
Sympathetic Pre-ganglionics
SCT1-T5-N
TPs:
SCT1: inferior aspect of medial clavicle
SCT2-4: centrally over manubrium, sternum
SCT5: xiphoid, approach tp Inf-sup
Tx: horizontal abd (in 45-70 deg shoulder abd depending on tp level)
Sx: thoracic pain per level, neurovascular symptoms per thoracic level
SCT1 & SCT2: use with all head, neck c/o
SCT3: use with shoulder, lung, esophagus, UE disorders
SCT4 & SCT5: use with heart, and UE disorders
Sx: Cervicothoracic pain, headaches, arm pain, arm burning/numbness, visceral/vascular symptoms per the Sympathetic NS Impact Chart C1-T5
PGC4-C6-N and PGT2-T5-N (cardiopulmonary and Esophageal Plexus)
TPs: PGC4-6: anterior cervical tubercles, ant to post
TPs: PGT2-T5: located over the inferior aspect of the rib tubercles. Inf to Sup
Tx: Supine, marked shoulder flexion and adduction
Glide - ribcage and viscera (via arm traction) in an anterior, medial and superior direction
Symptoms: thoracic pain, anxiety/PTSD, organ dysfunction per level (e.g, tachycardia for PGT4-N, PGT5-N)
Note: you will need more superomedial traction for the cervical sympathetic and more anteromedial traction for the thoracic locations.
PGT5-PGT9-N (Celiac Plexus)
TP: Inferior aspect of rib tubercles T6-T9. Inf to sup
Tx. Supine with hips/knees flexed. Slide feet mildly toward tp side
Shoulder adduction and trunk rotation away from tp side.
Glide/compress ribcage and viscera in an inferomedial direction toward t-l junction (Celiac Plexus)
Note: Adjust or ‘fine tune’ the release with trunk rotation and inferomedial compression
PGLS-N
TP: located 3cm lateral to PSIS in the upper gluteal mass (Jones HISI)
Glide for R: of bladder just proximal to ipsilateral pubic ramus in a superior and slightly lateral direction toward mid clavicle
Glide for L: use rolled towel placed under anterior aspect of pelvic floor, glide uterus/prostate superior, slightly lateral to L side.
Symptoms: lumbosacral pain, bladder urgency, prostate/uterus dysfunction, CRPS, PTSD.
Note: Will occasionally need to use a towel roll and lift through the pelvis
EPIC1-LV
TP: between occiput and medial arch of the Atlas (superior surface of the medial arch of the Atlas) Post to Ant
Tx: OA flexion, SB Away, Rot Toward tp side
Traction - moderate, maintaining cervical position
Symptoms: headaches, post-concussion syndrome, occipital pain, brain fog (cognitive impairment), central sensitization
EPIC2-T6-LV
TPs: EPI C2-6: lateral humerus (centrally) from below deltoid tuberosity to above supracondylar ridge
TP: EPIC7 - medial end of clavicle (Jones AC8)
TPs: EPIT 1-T6: centrally over manubrium and sternum at the level of the interspace
Tx: Cervical flexion to level, SB Away Rot Toward the tp side
Traction - cervical/upper thoracic as ‘finishing’ move
Symptoms: cervicalgia/inflammations, cervical radiculopathies, arm and shoulder pain
EPIT7-EPIT11-LV
TPs: under corresponding inferior rib margins, 1-2 cm medial to rib margin. Ant to Post
Tx: Supine, lumbar flexion to level of dysfunction (>flexion for EPIT6 vs EPIT10) through iliac crest
Traction in the plane of the femur
Symptoms: chronic thoracic pain/inflammation, diffuse unknown extremity pain/neurological symptoms
EPIL2-5-LV
TPs: in a row over the lateral mid femur (middle 1/3). L2 is most proximal and L5 is most distal. Lat to med onto lateral femur/ITB
Tx: lower trunk rotation away from involved side
Traction mild to moderate along axis of femur
Symptoms: LBP/inflammation, lumbar radiculopathies, lateral thigh pain
Segmental Arteries
SEGT1-SEGL5-A
TPs: inferior aspect of thoracolumbar spinous processes. Inf to sup
Side glide: corresponding rib (in thoracic) or inferior part of the motion segment/lamina (in lumbar) in a medial and superior direction to exaggerate the spinal concavity. Motion test to find ‘direction of ease’.
Note: The segment will be restricted at the involved process to superior glide (from inferior aspect of SP)
Symptoms: radiculopathies, weakness in extremities, DJD/DDD, organ dysfunction per spinal level
Posterior Intercostal Arteries
PINT T1-11-A
TP: medial tip of rib tubercles, ribs 1-12. Medial to lateral
Glide : of PINT artery, located in the rib interspace below the involved rib, in a superomedial direction
Symptoms: pain at tender point location (medioscapular)
External Iliac Artery “Psoas Major”
EIL-A
TP: posterior aspect of L2 transverse process (paraspinal mass). Med to lat with a ‘snapping’ motion
Glide: of ipsilateral EIL (above inguinal ligament) in superomedial direction towards the umbilicus.
Symptoms: LBP, psoas tightness, peripheral arterial dysfunction, hip weakness
Inferior Epigastric Artery “Psoas Minor”
IEP-A
TP: superolateral aspect of pubic ramus, deep and medial to the AIIS (psoas minor insertion). Sup to Inf
Tx: supine with hips & knees slightly flexed
Glide: Of internal epigastric A (Inf & slightly lateral to umbilicus) in an inferior and lateral direction.
Symptoms: lumbosacral pain, Cervicothoracic pain/kyphosis, iliac “up-slip” dysfunction, abdominal weakness
Superficial External Pudendal Artery
EPUD-A
TP: lateral surface of pubic bone just inferior to the inguinal lig attachment (Jones ING)
Glide: of external pudendal artery (Just inferior to inguinal lig) in a superolateral direction
Symptoms: SI pain, LBP, groin (rarely this)
Biotensegrity ‘stack’ of the IEP-A
Common Carotid Arteries
CC-A
TP: Inferior aspect of second rib 3-4 cm from stereo-costal join. Inf to sup
Tx: cervical flexion, SB Toward and Rot Away mildly
Glide: of Common Carotid Artery (located lateral to trachea, medial to SCM at C5-6 level) in an inferior direction
Note: modify with marked cervical flexion and rotation Away for pts >50 yrs
Symptoms: Cervicothoracic pain, light-headedness esp upon arising
Subclavian Arteries
SUBC-A
TP: inferior aspect of 3rd rib, 3-4 cm lateral to sterno-costal it. Inf to Sup
Tx: glide shoulder girdle and Axillary artery in a superior then medial direction under pec minor muscle
Symptoms: UE pain/numbness, shoulder pain, Cervicothoracic pain
Popliteal Artery
POP-A
TP: In belly of popliteus muscle (opposite tib tub). Jones POP. Use med-lat snapping motion to ID
Glide: lower aspect of popliteal artery (located 3-5cm distal to tp in center of calf) in a superior direction
Symptoms: knee pain (loss of extension), PAD, LBP, hip pain, hyperextension
Sibson’s Fascia (Pleural Dome)
SIB-V
TP #1: anterior tip of transverse process of C7
TP #2: superior aspect of tubercle of 1st rib
Tx: cervical rotation Away, mild to moderate
Compression: of upper lung and 1st rib in a superior, posterior and medial direction
Symptoms: Cervicothoracic pain, possible neurovascular irritation
SIB - UT pain
PDP - Levator pain
PP - Rhomboid pain
Anterior Pleura
AP-V
TP: over anterior aspect of 3rd rib, 7cm lateral to the third sternocostal joint
Tx: supine, IR of upper aspect of rib cage (roll anterior and medial)
Symptoms: thoracic pain, shoulder dysfunction/capsulitis, loss of tidal volume (lung)
Pleural Dome Posterior
Posterior Pleural Locations
PDP-V and PP-V
TPs: located over superior aspect of 2nd and 4th rib tubercles B. Sup to Inf
Tx; seated/supine with arm adducted across chest
Glide: of ipsilateral lung (R2 level for PDP, R4 level for PP) in a posterior, superior and slightly lateral direction via pressure through forearm
Symptoms: medioscapular pain at location of tp, decreased tidal volume (lung), shoulder dysfunction/capsulitis
SIB - UT pain
PDP - Levator pain
PP - Rhomboid pain
Lateral Pleura
LP-V
TP: Inferior aspect of 6th rib, medial to anterior Axillary line (on a vertical line that is just medial to the coracoid process)
Tx: Supine, PT’s hand over distal 1/3 of sternum
Glide: of sternum in a superolateral direction towards the ipsilateral shoulder
Symptoms: mid-thoracic pain, shoulder dysfunction/capsulitis, decreased tidal volume (lung)
Triangular LIgament of Liver, Right
TL-V (R)
TP: Bilaterally over superior aspect of 6th rib, medial to the anterior Axillary line (located on a vertical line that is just medial to the coracoid process)
Tx: Supine, PT hand over lower ribcage overlying the liver
Glide: of lower rib cage and liver directly toward the tp
Symptoms: mid-thoracic pain, kyphosis, shoulder dysfunction, poor tidal volume (lung)
Triangular Ligament of Liver, Left
TL-V (L)
TP: inferior aspect of 6th rib medial to the anterior Axillary line (in a vertical line that is just medial to the coracoid process), bilateral
Tx: supine, PT hand over right lower ribcage overlying the liver
Glide: of lower rib cage and liver directly toward the tp
Symptoms: mid-thoracic pain, shoulder dysfunction, kyphosis, poor tidal volume (lung)
Median/Medial Umbilical Ligament
MUL-V
TP: medial, superior aspect of pubic bone, Just lateral to symphysis pubis. Can be found bilaterally
Tx: supine with hips & knees flexed
Glide: PT palm overlying umbilicus, glide anterior abdominal wall in an inferior, lateral then posterior direction (towards sacrum ) using your finger tips
Symptoms: sacral pain, bladder dysfunction, limited SLR/sciatica
Cecum, Medial
CECM-V
TP #1: superomedial aspect of right PSIS, in SI joint, on a small tubercle
TP #2: posterior aspect of the right medial femoral condyle
Tx: supine with right hip flexed, foot resting on table, adduction of R hip mildly (move knee medially)
Glide: of Cecum (medial and slightly below or above ASIS) in a posterior, inferior and slightly lateral direction
Symptoms: SI dysfunction Right side, limited SLR/sciatica, medial knee pain right side, digestive dysfunction
Note: motion test cecum for restriction prior to starting glide
If you can’t gap the SI joint, then it’s ADDucted
Piriformis syndrome = mesentery, visceral
Sigmoid Colon
SIG-V
TP #1: located over the superomedial aspect of the left PSIS on a small tubercle
TP #2: posterior aspect of left medial femoral condyle
Tx: supine with left hip flexed, foot resting on table, hip adduction mildly by moving left knee medially
Glide: of inferior most aspect of Sigmoid Colon in a posterior, inferior and slightly lateral direction.
Note: motion test Sigmoid Colon prior to fascial glide
Symptoms: SI dysfunction left side, limited SLR/sciatica L side, medial left knee pain, constipation
