FPR and Stills Inominate

Question 1

Sacral SD is due to what muscles

Answer 1

Piriformis

erector spinae

Question 2

Inominate SD is due to ____ muscles

Answer 2

• Quads (anterior rotation)
• Hamstrings (posterior rotation)
• Quad lumborum (superior shear)

Question 3

Pubic SD is due to what muscles

Answer 3

1. Rectus abdominus m
2. Adduct TP

Question 4

If one rib stops moving before the other rib during exhalation, that rib has an _______ restriction, therefore an _______ SD

Answer 4

• Exhalation restriction
• Inhalation SD

Question 5

Inhalation Rib Dysfunction: Moves into ________ position, restricted to ______ position

Answer 5

*Moves into inhalation position, restricted to exhalation position

Question 6

Inhalation Rib Dysfunction: treat what rib in a group

Answer 6

bottom

BITE

Question 7

If one rib stops moving before the other rib during inhalation, that rib has an _______ restriction, therefore an ______ SD.

Answer 7

• Inhalation restriction
• Exhalation SD

Question 8

Exhalation Rib Dysfunction: Moves into _______ position, restricted to _______ position

Answer 8

*Moves into exhalation position, restricted to inhalation position

Question 9

Exhalation SD: Treat which rib in a group?

Answer 9

Top

BITE

Question 10

Posterior or anterior palpation of the ribs identifies one that it more anterior than the others.

Answer 10

Anterior Rib Dysfunction

Question 11

Posterior palpation of the ribs identifies one more posterior than the others

Answer 11

Posterior Rib Dysfunction

Question 12

FPR Sacral Evaluation

1. Neutralize Sagittal Curve: Place pillow under patient’s lower abdomen to straighten lumbar ______ curve
2. Hand Positioning: ________ on ILAs
   
   1. Students are recommended to keep their fingers straight
3. Testing Force: Physician directs ______ force with both hands (either simultaneously or one-at-a-time)
4. Positive Test: diminished ______ motion

Answer 12

• lordosis
• thenar eminences
• cephalad
• cephalad

Question 13

FPR steps

Answer 13

• 1. Neutralize the curve
• 2. Indirect position (where the pts do like go)
• 3. Activating force for immediate release
• 4. Hold for 3-5 seconds

Question 14

• Dx Sacrum with FPR Sacral Eval (restricted only)
• Treat?

Answer 14

1. Neutralize curve: put pillow under pts abdomen
2. Put hands on ILA => push forward to head => feel which is restricted.

• • test if decrease cephalad motion.
    
    • Decrease cephalad motion on R side
      
      • Thus, pt does not like to SB L, does like to SB R
    • Decrease cephalad motion on L side
    • • Thus, pt does not like to SB R, does like to SB L

TX

Prone FPR sacal SD:

1. Neutralize curve: add a 2nd pillow under mid thigh
2. While monitoring ILA with contralateral thenar eminence (R side with L thenar em)
   
   1. Flex hip off table with knee extended until ILA moves posterior
   2. Abduct hip; IR/ER where it likes to go
3. AF: push thenar eminence toward head for 3-5 seconds
4. Neutral and reassess

Question 15

Dx: Right Piriformis TP/hypertonicity

Treat with FPR

Answer 15

Prone FPR Piriformis

1. Neutralize curve and monitor TP (
2. Indirect:
   
   1. Flex leg off table; abduct hip
3. AF: Compress through palm at knee to shorten muscle
4. Hold 3-5 seconds

Question 16

Dx: Right Gluteus Maximus TP/hypertonicity

Treat with FPR

Answer 16

1. Neutralize the curve; monitor TP (UPL4, PLPL5, HISI, PL3 glut, PL4 glut)
2. Indirect position:

• Flex hip off table
• Flex knee 90 degrees
• Doc; sit and use the knee to extend the hip until motion is felt

3. AF: apply torsion by ER hip at ankle
4. Hold 3-5 sec

Question 17

Dx: Right Medial Hamstring Hypertonicity SD

Treat with FPR

Answer 17

Prone FPR Hamstring

1. NEutralze saggital curve ; monitor TP or hypertonicity
2. Indirect:
   
   1. Extend hip and rest anterior distal femur on docs thigh
   2. Flex knee to decrease hamstring hypertonicity and fine tune (IR/ER hip and tibiofemooral joint)
3. AF: Traction or compression using hand on TP

Question 18

Dx: Left Vastus Lateralis Hypertonicity SD

Treat FPR

Answer 18

Supine FPR: Quadriceps

1. Neutral position: put pillow under HEAD, make pt bend knees and monitor TP/hypertonicity
2. Indirect:
   
   1. Flex hip and rest calf on docs thigh with knee extended
   2. Direct patella to monitoring han
   3. Fine tune hip: IR/ER/abduct/adduct
3. AF
   
   1. Axial traction/compression using Dr. thigh

Question 19

Dx: Left costochondral TP/restriction

Treat w FPR

Answer 19

Seated FPR: Costochondral Somatic Dysfunction

***When treating ribs; AF first => position; when treating all else; position => AF.

1. Neutralize curve: have pt sit straight up to extend and straighten thoracic kyphotic cruve and monitor joint
2. AF: compress through spine and shoulders
3. Indirect position
   
   1. Rotate towards until motion felt
4. Hold 3-5 seconds

Question 20

Dx: Posterior Rib

Treat w FPR

Answer 20

Seated FPR Posterior Rib SD

1. Neutralize curve and monitor TP
2. AF: Compress <1lb through shoulders
3. Indirect position
   
   1. Flex pt until rib is engaged
   2. R/SB to the same side (R rib => RRSBR)
4. Hold

Question 21

Dx: Left Rib 9 Exhalation Dysfn.

Treat with FPR

Answer 21

Seated FPR: INH/EX Rib S.D.

1. Neutralize pt
   
   1. sit on side of pt and grab rib posterior and anterolaterally
   2. Tell pt to sit straight up
2. Indirect
   
   1. Tell pt to lean into you and turn head away (disart costotrans junction)
   2. Hold breath
3. AF: Add localizing/activating force where rib likes to go

Question 22

What 3 things to focus on for Stills?

Answer 22

• 1. Put in ease of motion (indirect)
• 2. Compress
• 3. Take into RB (direct)

Question 23

Superior Innominate Shear Stills Technique

Answer 23

Superior Innominate Shear Stills Technique

1. Indirect (initial position)
   
   1. Pt is supine
   2. Abduct and ER LE to gap SI joint (w leg raised slightly off table)
2. Compress from sole => inominate
3. Direct (final position)
   
   1. Maintain compressing while IR hip => apply traction at ankle

Question 24

Inferior Innominate Shear Stills Technique

Answer 24

Inferior Innominate Shear Stills

1. Indirect (initial position)
   
   1. Pt is supine
   2. Flex hip and knee
   3. Adduct hip while monitoring upper pole of SI joint
2. Compress from knee => upper pole of SI joint
3. Direct (final position)
   
   1. Maintain compressing while abducting hip and extending knee => add traction

Question 25

Anterior Innominate Rotation Stills

Answer 25

• Initial Positioning:
  
  • Patient supine.
  • Flex hip 45 degrees and flex knee;
  • Abduct hip & monitor inferior pole of SI joint.
• Add Force Vector:
  
  • Compress through knee => inferior pole of SI joint.
• Articulation:
  
  • Adduct LE and flex hip.
• Final Positioning: LE adducted, knee extended.
• Release Force Vector: May apply traction through ankle.
• Return to neutral & retest

Question 26

Supine Still Technique: Posterior Rib
Dx: Right Posterior R4

Answer 26

Question 27

Stills: Exhalation/Anterior TP Rib

Answer 27

Question 28

Still Inhalation/Poster TP Rib

Answer 28