FPR and Stills Inominate Flashcards
Sacral SD is due to what muscles
Piriformis
erector spinae
Inominate SD is due to ____ muscles
- Quads (anterior rotation)
- Hamstrings (posterior rotation)
- Quad lumborum (superior shear)
Pubic SD is due to what muscles
- Rectus abdominus m
- Adduct TP
If one rib stops moving before the other rib during exhalation, that rib has an _______ restriction, therefore an _______ SD
- Exhalation restriction
- Inhalation SD
Inhalation Rib Dysfunction: Moves into ________ position, restricted to ______ position
*Moves into inhalation position, restricted to exhalation position
Inhalation Rib Dysfunction: treat what rib in a group
bottom
BITE
If one rib stops moving before the other rib during inhalation, that rib has an _______ restriction, therefore an ______ SD.
- Inhalation restriction
- Exhalation SD
Exhalation Rib Dysfunction: Moves into _______ position, restricted to _______ position
*Moves into exhalation position, restricted to inhalation position
Exhalation SD: Treat which rib in a group?
Top
BITE
Posterior or anterior palpation of the ribs identifies one that it more anterior than the others.
Anterior Rib Dysfunction
Posterior palpation of the ribs identifies one more posterior than the others
Posterior Rib Dysfunction
FPR Sacral Evaluation
- Neutralize Sagittal Curve: Place pillow under patient’s lower abdomen to straighten lumbar ______ curve
-
Hand Positioning: ________ on ILAs
- Students are recommended to keep their fingers straight
- Testing Force: Physician directs ______ force with both hands (either simultaneously or one-at-a-time)
- Positive Test: diminished ______ motion
- lordosis
- thenar eminences
- cephalad
- cephalad
FPR steps
- Neutralize the curve
- Indirect position (where the pts do like go)
- Activating force for immediate release
- Hold for 3-5 seconds
- Dx Sacrum with FPR Sacral Eval (restricted only)
- Treat?
- Neutralize curve: put pillow under pts abdomen
- 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
- Decrease cephalad motion on R side
- test if decrease cephalad motion.
TX
Prone FPR sacal SD:
- Neutralize curve: add a 2nd pillow under mid thigh
- While monitoring ILA with contralateral thenar eminence (R side with L thenar em)
- Flex hip off table with knee extended until ILA moves posterior
- Abduct hip; IR/ER where it likes to go
- AF: push thenar eminence toward head for 3-5 seconds
- Neutral and reassess
Dx: Right Piriformis TP/hypertonicity
Treat with FPR
Prone FPR Piriformis
- Neutralize curve and monitor TP (
- Indirect:
- Flex leg off table; abduct hip
- AF: Compress through palm at knee to shorten muscle
- Hold 3-5 seconds
Dx: Right Gluteus Maximus TP/hypertonicity
Treat with FPR
- Neutralize the curve; monitor TP (UPL4, PLPL5, HISI, PL3 glut, PL4 glut)
- Indirect position:
- Flex hip off table
- Flex knee 90 degrees
- Doc; sit and use the knee to extend the hip until motion is felt
- AF: apply torsion by ER hip at ankle
- Hold 3-5 sec
Dx: Right Medial Hamstring Hypertonicity SD
Treat with FPR
Prone FPR Hamstring
- NEutralze saggital curve ; monitor TP or hypertonicity
- Indirect:
- Extend hip and rest anterior distal femur on docs thigh
- Flex knee to decrease hamstring hypertonicity and fine tune (IR/ER hip and tibiofemooral joint)
- AF: Traction or compression using hand on TP
Dx: Left Vastus Lateralis Hypertonicity SD
Treat FPR
Supine FPR: Quadriceps
- Neutral position: put pillow under HEAD, make pt bend knees and monitor TP/hypertonicity
- Indirect:
- Flex hip and rest calf on docs thigh with knee extended
- Direct patella to monitoring han
- Fine tune hip: IR/ER/abduct/adduct
- AF
- Axial traction/compression using Dr. thigh
Dx: Left costochondral TP/restriction
Treat w FPR
Seated FPR: Costochondral Somatic Dysfunction
***When treating ribs; AF first => position; when treating all else; position => AF.
- Neutralize curve: have pt sit straight up to extend and straighten thoracic kyphotic cruve and monitor joint
- AF: compress through spine and shoulders
-
Indirect position
- Rotate towards until motion felt
- Hold 3-5 seconds
Dx: Posterior Rib
Treat w FPR
Seated FPR Posterior Rib SD
- Neutralize curve and monitor TP
- AF: Compress <1lb through shoulders
-
Indirect position
- Flex pt until rib is engaged
- R/SB to the same side (R rib => RRSBR)
- Hold
Dx: Left Rib 9 Exhalation Dysfn.
Treat with FPR
Seated FPR: INH/EX Rib S.D.
- Neutralize pt
- sit on side of pt and grab rib posterior and anterolaterally
- Tell pt to sit straight up
- Indirect
- Tell pt to lean into you and turn head away (disart costotrans junction)
- Hold breath
- AF: Add localizing/activating force where rib likes to go
What 3 things to focus on for Stills?
- Put in ease of motion (indirect)
- Compress
- Take into RB (direct)
Superior Innominate Shear Stills Technique
Superior Innominate Shear Stills Technique
-
Indirect (initial position)
- Pt is supine
- Abduct and ER LE to gap SI joint (w leg raised slightly off table)
- Compress from sole => inominate
-
Direct (final position)
- Maintain compressing while IR hip => apply traction at ankle
Inferior Innominate Shear Stills Technique
Inferior Innominate Shear Stills
- Indirect (initial position)
- Pt is supine
- Flex hip and knee
- Adduct hip while monitoring upper pole of SI joint
- Compress from knee => upper pole of SI joint
- Direct (final position)
- Maintain compressing while abducting hip and extending knee => add traction
Anterior Innominate Rotation Stills
- 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
Supine Still Technique: Posterior Rib
Dx: Right Posterior R4
Stills: Exhalation/Anterior TP Rib
Still Inhalation/Poster TP Rib
