Final Practical (Treatments)

Question 1

Indications for transverse thoracic mobs

Answer 1

• 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

Question 2

Transverse Thoracic Mobs

Answer 2

• 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

Question 3

Seated Mid-Thoracic spine

Answer 3

• 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

Question 4

Prone Thoracic Closing/Extension Technique

Answer 4

• 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

Question 5

Indications for Prone thoracic closing

Answer 5

thoracic pain, limited mobility
cervical pain, limited mobility
limited rib mobility

Question 6

Supine Thoracic Gapping

Answer 6

• 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

Question 7

Thoracic Gapping indications

Answer 7

• localizing from below
• indicated for loss of thoracic spine mobility and/or neck pain

Question 8

CT Junction Gapping Manip (seated)

Answer 8

• 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

Question 9

CT Junction Closing Manip

Answer 9

• 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

Question 10

1st rib manipulation

Answer 10

• 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

Question 11

Local Cervical Rotation Mob

Answer 11

• 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

Question 12

OA flexion MET

Answer 12

• 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

Question 13

AA Rotation MET

Answer 13

• 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

Question 14

Cervical Lateral Glide Mobs

Answer 14

• 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

Question 15

Indications for Cervical Lateral Glide Mobs

Answer 15

• 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

Question 16

Cervical Closing Mob/MET/Manip

Answer 16

• 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

Question 17

Cervical Opening Mob/Met/Manip

Answer 17

• 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

Question 18

Cervical opening/closing mobs/met/manip guidelines

Answer 18

Mob: grades 1-4
MET: other hand gives resistance
manip: pre-manip hold

Question 19

MDT for Radicular

Answer 19

remember that at least 10 reps may be needed for centralization. Chin tuck

start at mid range, static, patient OP

Question 20

Home cervical traction

Answer 20

Supine, against a door
15-20°
disc: 10-15 lbs, 5-10 min, static
joint: 20-30 lbs, 15-30 min, intermittent

Question 21

Deep neck Flexor exercises

Answer 21

Chin tuck –> increase with ball, functional task. Decrease by laying down, providing tactile cues