Final Practical M1`T1

Question 1

When do you use Myofascial release?

Answer 1

When you’re doing a musculoskeletal screening and you want to stretch and release soft tissue or joint components

Question 2

What are the varieties that we can do myofascial release in lumbosacral region?

Answer 2

We can either do direct or indirect, or supine/prone

Question 3

What are steps of MFR in supine lumbosacral?

Answer 3

1. Lie patient supine, and I will sit level with knee
2. Patient’s knees and hips are flexed at 45 degrees
3. Use my cephalad hand to pull the knees toward me and lift their hips so I can place my the pads of my finger tips at base of sacrum and palm at the apex.
4. I use my forearm over ASIS to initiate left and right truncal rotation
5. After finding ease and bind you can apply gentle to moderate force either directly or indirectly for 20 to 60 seconds

Question 4

What are steps of MFR in prone lumbosacral?

Answer 4

1. One hand over inferior lumbar (L4-L5) and other over superior (L1-L2)
2. Move hands with fascial pressure up, down, clockwise, counterclockwise, left, right
3. Determine ease or bind and either apply 20-60 seconds directly or indirectly
4. Ask the doc if they want you to “creep”

Question 5

What is the purpose of soft tissue techniques and some contradictions?

Answer 5

You use soft tissue by doing various lateral, linear, deep pressure, and/or separation of muscle origin to see how to tissue responds based on palpation. Use for example when wanting to reduce muscle hypertonicity. Important contradictions are fractures, if patient is elderly you don’t want to really put them in prone and do pressure, or infection.

Question 6

What’s unilateral prone pressure?

Answer 6

A type of soft tissue technique

Question 7

What are steps of unilateral prone pressure?

Answer 7

1. Patient is prone with head facing me or in hole, while I stand at OPPOSITE side of treatment.
2. Place thumb and thenar eminence on medial part of patients paravertebral musculature
3. Thenar eminence of other hand on thumb of bottom
4. Keep elbows straight with body weight.
5. Hold for seconds and slowly release; do 3-5 times

Question 8

What is two handed prone traction?

Answer 8

Soft tissue technique

Question 9

What are steps of two handed prone traction?

Answer 9

1. patient prone and physician stands at level of pelvis
2. cephalad hand is placed over the base of the patient’s sacrum with fingers towards coccyx with the other going the other way.
3. Using thenar eminence of hand physician will separate them without pushing on spinous processes.

Question 10

What is prone pressure counter lever?

Answer 10

type of soft tissue technique

Question 11

What are steps of prone pressure with counterlever?

Answer 11

1. physician stands at OPPOSITE side of treatment.
2. Place cephalad hand on medial paravertebral, and caudad hand hooking under ASIS, and gently lift it to the ceiling.
3. physician places gentle kneading force

Question 12

What is unilateral pressure lateral recumbent

Answer 12

soft tissue

Question 13

What are steps of unilateral pressure lateral recumbent?

Answer 13

1. patient’s knees and hips are flexed and patient places infrapatellar part on my quad
2. pads of fingers on medial aspect of paravertebral medial.
3. use gentle kneading force toward you using knees as leverage, OR you can place a hand on ASIS for leverage

Question 14

When do you use lumbar counterstrain?

Answer 14

when a patient has a strained muscle, myofascial tissue trauma. Purpose is to place injured tissue at rest to reset gamma motor neurons & spindle afferent neurons

Question 15

What’s indication and steps of AL1 region?

Answer 15

1. Patient comes in with pain of throrcolumnar or abdominal wall pain
2. Patient lays supine and I will put my hand on medial, superior ASIS and label that tender point as a 10.
3. Lift leg on table and place patients knees over my thigh in flexed position at L2
4. Since AL1 is STRAw , I pull the knee toward me so that the patients torso is rotated away, and the knees toward me so that they are side bent toward.
5. Entire time keep finger on medial superior ASIS
6. Reassess and fine tune until patient is 0.

Question 16

What are steps of AL2-AL4?

Answer 16

All are similar it is just different where you label tender point.
AL2: patietn comes in with lateral hip pain. The tender point is medial inferior AIIS
1. Patient is supine and i am on OPPOSITE side of tender point.
2. Place knee on table, place patient’s over at level of L3, and pull knees and ankles toward me.
3. Reassess fine tune until a 0.

AL3: patient comes in with groin pain place tender point at lateral inferior AIIS, and lift their knees to level of L4.
AL4: patient comes in with laterla hip and/or groin pain. Place tender point inferior AIIS, and bring knees to level of L5.

Question 17

What are steps of AL5?

Answer 17

Patient comes in with lower sacral pain.
1. Label tender point at anterior, superior pubic ramus
2. Place knee on table and patient’s hips flexed to level of S1
3. Pull knees in and ankles slightly away.

Question 18

Posterior Lumbar spinous and transverse counterstrain

Answer 18

For spinous process, patient comes in lower inferolateral deviated spinous proces pain. For transverse they come in for postlateral aspect of transverse process.
1. Lay patient in prone place finger on tender point either spinous or transverse and label it a 10.
2. Lift patients leg, adduct it and and external rotate.
3, Alternatively,, physician can grasps ASIS and gently lift toward side of counterstrain point.

Question 19

Quadratus Lumborum

Answer 19

Patient comes in with lower rib 12, and pelvic pain.
1. Label superior aspect of iliac crest as a 10 as patient is prone.
2. side bend trunk toward side of counterstrain by extending, abducting, and eternally rotating the patient’s hip

Question 20

UPL5 (upper pole L5)

Answer 20

Patient comes in with lower back or pelvic pain
1. Label superior medial PSIS as a 10, adduct patients leg

Question 21

when do you use and not use HVLA?

Answer 21

use in general to restore motion to a previously mobile articulation that exhibits restriction in intersegmental range of motion. Don’t use in surgical fusion, joint instability, severe osteoporosis

Question 22

What are steps in type 1 lateral recumbent HVLA?

Answer 22

lay patient on side they LIKE to rotate to.
1. drop leg over the table and rest caudad arm on table while cephalic loops through top arm
2. monitor L5 and S1
3. Hiya

Question 23

What are steps in seated HVLA short lever type 2?

Answer 23

1.you are going to take patient into bind, so stand on side of the bind (direct)
2. do macarena on side of ease
3. since it’s type 2 loop hand under axilla while placing thenar eminence on paravertebral muscles at L2

Question 24

What are steps in seated HVLA long lever type 2?

Answer 24

do same as short lever just place thenar eminnece or palm at base of interspace of L2 L3 instead of paravertebral

Question 25

When do you use muscle energy?

Answer 25

use when there’s somatic dysfunction with myofascial origin to reduce hypertonicity, restricted joints (direct)

Question 26

Steps in muscle energy techniques

Answer 26

Same as HVLA where you take patient into their bind, except instead of hiya you hold while they resist for 3 seconds, you do 3-5 times. Also for type two pulling together, tuck their top foot into antecubital fossa.

Question 27

What are the tender points for posterior lumbar counterstrain?

Answer 27

For PL1-5 if it’s spinous the inferolateral part of the deviated spinous process and is it’s transverse the inferolateral portion of the dysfunctional transverse process

Question 28

What are tender points for Quadratus lumborum?

Answer 28

superior aspect of iliac crest

Question 29

How do you do posterior lumbar region exam?

Answer 29

stand on opposite side of dysfunction, place finger on tender point and lift leg up on same side. In alternate, you are going to lift the hip on opposite side your standing.