Final Practical (Treatments) Flashcards
Indications for transverse thoracic mobs
- pain, limitation in thoracic spine/ribs
- mechanical neck pain
- most likely to improve rotation, might help with SB flex and extension
- should use grades 1-4
Transverse Thoracic Mobs
- patient is prone
- stand on side you are trying to rotate vertebrae towards
- thumb flat to ipsilateral side of spinous process and scooped as close to lamina
- force is in lateral direction, with elbows extended
Seated Mid-Thoracic spine
- pt is seated on table and backed up to edge
- towel roll between chest and stacked elbows
- PT grapsts both elbows and positions chest obliquely against pts mid thoracic region
- take up the slack and translate pt towards you
- force vector is J scoop back and up
for thoracic and cervical pain/mobility restrictions
Prone Thoracic Closing/Extension Technique
- ptt is prine w/head turned to side to induce more rotation
- pisiform over facet jts
- superior hand skin locks to inferior point
- inferior hand skin locks to point superior
- timing for exhale and relaxation
- deliver HVLA thrust in PA direction
Indications for Prone thoracic closing
thoracic pain, limited mobility
cervical pain, limited mobility
limited rib mobility
Supine Thoracic Gapping
- pt moved to edge of table and elbows stacked, neck is flexed
- partial roll of pt towards PT so stabilization hand can be localized to segment
- skin lock is inferior pull
- roll pt back to supine and hug elbows, pt bridges until motion is felt
- HVLA thrust in direction of their upper arm
Thoracic Gapping indications
- localizing from below
- indicated for loss of thoracic spine mobility and/or neck pain
CT Junction Gapping Manip (seated)
- indicated: limited thoracic or cervical ROM and hypomobility with PA testing
- pt has hands behind head, with fingers interlaced
- PT threads arms through pt, hands go on pts hands
- pt brings elbows in and looks down, helping wtih flexion
- PT performs J stroke force
CT Junction Closing Manip
- limited rotation, extension, lateral flexion, mechanical neck pain
- opposite arm abducted and rested on PTs thigh
- PTs stabilizing arm on upper trap, forearm on side of head
- PT brings chest towards patient, to induce extension
- slight LF and rotation of pts head towards affected side
- skin lock on facet joint, HVLA thrust is medial and anterior
1st rib manipulation
- indications include elevated or hypomobile 1st rib
- pt seated on edge of table
- uninvolved shoulder is resting abd on PT thigh
- PT stabilizes pt head with hand to induce slight rotation and sidebend, stabilizes trunk with thigh
- mobilizing hand on 1st rib, thrust is medial/inferior
Local Cervical Rotation Mob
- for loss of rotation, radicular s/s contralateral to direction of rotation
- PT stands at head of pt, stabilizing hand wraps gently on chin, with forearm resting
- neck is flexed to where it is treated, mobilizing hand contacts superior facet with MCP of index finger
- graded mobs, moving head in rotations
OA flexion MET
- supine, head resting on table
- stand or sit at head of pt, rest pts head in one hand. thumb and index grasp posterior arches of C1
- other hand control pts head at forehead
- introduce slight head flexion to barrier
- instruct pt to look up/rotate, against resistance, hold for 305 s
- re-engage barrier, repeat 3-5 times
AA Rotation MET
- gently grasp pts head with both hands, and flex th pts head fully to lock lower cervical rotation
- apply passive rotation to motion restriction barrier
- instruct pt to look opposite direction, against resistance. hold for 3-5 seconds. Repeat 3-5 times
Cervical Lateral Glide Mobs
- PT places 2nd MCP of mobilizing hand lateral to facet joint
- other hand supports head and assists in frontal plane head/neck motion from above
- mobilizing hand applies medial force to facet joint
Indications for Cervical Lateral Glide Mobs
- do for limited cervical LF and rotation, or neck pain, w or w/out UE s/s
- closing ipsilateral side and opening contralateral side
- lower grade and not to end range for UE s/s
- higher grade to end range as tolerated for axial pain and associated ROM limitations
- effective for treating neck pain and cervicobrachial pain
Cervical Closing Mob/MET/Manip
- PT uses hand to do V grip, index finger blocking ipsilateral side of facet joint
- opposite hand control forehead with thumb superior to ear
- bring cervical spine into Extension, apply left to right translation with index finger, have patient resist against force
- re-engage barrier, repeat 3-5x
Cervical Opening Mob/Met/Manip
- PT uses V grip with index finger blocking facet joint, other hand control forehead with thumb to superior to ear
- bring cervical spine into flexion w/both hands until treatment level
- apply r/l or l/r translation with MCP in direction of treating shoulder, perform MEt with small isometric forces
- re-engage barrier, repeat 3-5 times
Cervical opening/closing mobs/met/manip guidelines
Mob: grades 1-4
MET: other hand gives resistance
manip: pre-manip hold
MDT for Radicular
remember that at least 10 reps may be needed for centralization. Chin tuck
start at mid range, static, patient OP
Home cervical traction
Supine, against a door
15-20°
disc: 10-15 lbs, 5-10 min, static
joint: 20-30 lbs, 15-30 min, intermittent
Deep neck Flexor exercises
Chin tuck –> increase with ball, functional task. Decrease by laying down, providing tactile cues
