ICRFR II & III - Fascial and Soft Tissue Techniques Lab

Question 1

Treatments for the cervical spine:

Answer 1

Suboccipital tension release
Posterior Cervical soft tissue
Cervical Stretching

Question 2

Suboccipital tension release USES:

Answer 2

For tension headaches;
To prepare for cervical correction;
To assess and stretch dural attachments at C2, C3, and the occiput.

Question 3

Suboccipital tension release TREATMENT:

Answer 3

Patient supine; you at the head of table; place finger pads together and under the suboccipital area (occipito-atlantal junction); apply direct pressure anterior and superior with force comparable to the weight of the head; head falls into palm = tissue release;

Can also be applied to nuchal line when muscles are tight in that area.

Question 4

Posterior cervical soft tissue USES:

Answer 4

SHORT RESTRICTOR muscles of the cervical spine

Question 5

Posterior Cervical soft tissue TREATMENT:

Answer 5

patient supine and you at pt side with one hand on forehead just above eye brows; finger pads of other hand rhythmically stretch and compress soft tissues between the spinous and articular processes of the cervical vertebrae while sidebending, rotating, and extending the cervical spine (fingerpads laterally to anterior). Variation: if hand on head pushes and hand on neck pulls.

Question 6

Facial Patterns of CCP

Answer 6

1) head rotates better LEFT
2) head side bends better RIGHT
3) Lower thoracic cage shifts LEFT
4) Pelvis rolls better RIGHT
5) Left iliac crest HIGH
6) Lumbar lordosis INCREASED
7) Sacral Sulcus is deep on RIGHT
8) Left ILA INFERIOR–Right ILA POSTERIOR
9) Sacral fascial drag is CEPHALAD
10) Rib angles feel fuller on RIGHT of up-back
11) RIght arm is LONG (compare thumbs)
12) Left leg is LONG (compare heels pushing forward on feel)

Question 7

Cervial Stretching USES:

Answer 7

to address the long restrictor muscles of the cervical spine;
to stretch the myofascial elements of the cervical and upper thoracic regions;
to promote venous and lymphatic drainage of the tissues

Question 8

Cervical Stretching TREATMENT:

Answer 8

technique is done slowly and gently to evaluate any barriers
phys is at head of table with arms crossed under the pt’s head and hands on pt’s shoulders; phys raises crossed arms (flexing pt cervical spine) until there is a barrier to motion; when barrier reached, phys hold the pt in this position until a release is felt or utilize muscle energy by having pt press head into phys’s arms for 3 seconds;
to stretch side bending and rotation: one arm crossed under head and hand on shoulder; with the other hand phys rolls pt’s head across crossed arm’s forearm until resistance is felt - gently stretch the barrier by holding or muscle energy

Question 9

Treatments for the rib cage:

Answer 9

Rib raising - Lateral recumbent

Rib Raising - Supine

Question 10

Rib Raising - Lateral Recumbent USES:

Answer 10

To aid in respiration (asthma); to aid in circulation of patient with congestion (Pneumonia, COPD, cardiovascular, and stuctural injury); In pre- and/or post-operative care (atalectasis)

Question 11

Rib Raising - Lateral Recumbent TREATMENT:

Answer 11

ASK PT IF SHOULDER IS USEABLE; pt last on side with one hand under head and other hand on ear with elbow raised; phys holds elbow and places other hand on post rib cage/rib angles; elbow is used as a gentle counterforce while the rib cage is moved anterior and lateral and released with gentle rhythmic motion; can move hand to different regions; complete with release of tissues

Question 12

Rib Raising - Supine USES:

Answer 12

To aid in respiration (asthma); to aid in circulation of patient with congestion (Pneumonia, COPD, cardiovascular, and stuctural injury); In pre- and/or post-operative care (atalectasis)

Question 13

Rib Raising - Supine

Answer 13

Pt supine, phys stands or sits at wide with hands under rib-cage and fingers contacting the angles of the ribs; by flexing fingers in rhythmic manner, patients rib cage is raised anteriorly, then pulled laterally and then released. Release of tissues marks complete.

Question 14

Treatments for the thoracic spine

Answer 14

1) Prone Thoracic Perpendicular stretch
2) Prone Thoracic parallel stretch
3) Pectoral traction
4) clavi-pectoral stretch
5) posterior axillary traction

Question 15

Prone thoracic perpendicular stretch USES:

Answer 15

To stretch fascial restrictions within the paravertebral musculature of the thoracic spine;
To free up rib or thoracic restrictions

Question 16

Prone thoracic perpendicular stretch TREATMENT:

Answer 16

Pt prone with phys standing at side being treated. Bottom hand is the listening hand with thumb and thenar eminence in the trough area between the spinous and transverse processes over the erector spinae mass. Other hand used to apply force through the listening hand in lateral and anterior motion (into table) - rhythmic fashion. Pressure held for 3 seconds and released. Shift hands up and down.

Question 17

Prone thoracic parallel stretch USES:

Answer 17

To elongate fascial restrictions along their longitudinal plane thus allowing release of the tissues

Question 18

Prone thoracic parallel stretch TREATMENT:

Answer 18

Patient prone and phys at side of table opposite that being treated. Phys hands are on same side, crossed with the heels of the hands place on the belly of the hepertonic muscle with fingers of each hand parallel to each other. One hand directed cephalad and the other caudad. Gentle downward pressure applied as hands separated. Pressure for 3 seconds and released. Shifting hands up and down as needed

Question 19

Pectoral traction USES:

Answer 19

To increase the A-P diameter of the thorax.
To improve venous and lymphatic drainage of thorax
To release tension in the clavi-pectoral fascia.
To drain the anterior axillary fold edema from the upper extremity
To provide drainage from the head and neck

Question 20

Pectoral traction TREATMENT:

Answer 20

Patient supine WITH KNEES FLEXED. Phys at head of table and grasp pt anterior axillary folds with 2-4 digits, penetrating deeply to reach the pectoralis major and minor (have patient raise elbows - pray). Phys leans back and applies traction superiorly while pt inhales deeply. Hold traction while pt exhales. Several cycle of breathing and more traction

Question 21

Clavi-pectoral stretch USES:

Answer 21

To provide drainage from the head or neck.
Any illness that may cause edema to the head or neck region (tonsillitis, pharyngitis)
Anterior/rounded shoulders
TO be completed AFTER the inlet has been addressed.

Question 22

Clavi-pectoral stretch TREATMENT:

Answer 22

Patient supine with phys at head of table. Themnar eminences on anterior/superior shoulders at the level of the AC joint/humerous. Pressure into table and toward feet approx 10ib of force held for about 20 seconds.

Question 23

Posterior Axillary traction USES:

Answer 23

to increase the A-P diameter of the thorax
To improve venous and lymphatic drainage of thorax
To release tension in the clavi-pectoral fascia
To drain congestion from the posterior axillar fold, upper extremities, head and neck.

Question 24

Posterior Axillar traction TREATMENT:

Answer 24

Patient supine with KNEES BENT. Feet flat on table. Phys at head of table. Grasps pt postieror axillary fossa with 2-4 digits. (pray thing). Phys aplies stretch superiorly by leaning back while patient breathes in. Repeat several cycles

Question 25

Treatments for thoraco lumbar region:

Answer 25

1) Thoracolumbar soft tissue -prone
2) Upper mid and thoracolumbar soft tissue - Lateral recumbent
3) thoracolumbar soft tissue supine

Question 26

Thoracolumbar soft tissue - Prone USES:

Answer 26

a. To relax the paravertebral and quadratus lumborum musculature.
b. To free up the motion of ribs 11 and 12.
c. Therapeutic, as well as diagnostic, for somatic and visceral dysfunctions.
d. Special attention may be given to those areas overlying the sympathetic nerve supply to the organs the Physician wishes to affect through reflex mechanisms.

Question 27

What contributes to the stress and pathophysiology causing congestion of the venous blood and lymphatic systems of the pelvis and lumbar regions?

Answer 27

The paravertebral muscles and the quadratus lumborum (continuation of the diaphragm).

Question 28

Thoracolumbar soft tissue - Prone TREATMENT:

Answer 28

Pt in prone position and phys on opp side being treated.one hand on ASIS and other on upper back. kneading motion. COmpletion noted by softening of tissues

Question 29

Upper mid thoracolumbar soft tissue - Lateral recumbent USES:

Answer 29

a. To relax the paravertebral and quadratus lumborum musculature.
b. To free up the motion of ribs 4 through 12.
c. Therapeutic, as well as diagnostic, for somatic and visceral dysfunctions.
d. Special attention may be given to those areas overlying the sympathetic nerve supply to the organs the Physician wishes to affect through reflex mechanisms.

Question 30

Upper mid thoracolumbar soft tissue - Lateral recumbent TREATMENT:

Answer 30

Pt in lateral recumbent position. One arm folded under the head and the other elbow on table or hand holding table for stability. Pt listen hand and force hand business applied here with thumb and thenar eminence in trough area between the spinous and traverse process. Combined lateral and anterior motions stretch with rhythm. Softening of tissues and increased range of motion = complete

Question 31

Thoracolumbar soft tissue - Supine TREATMENT:

Answer 31

Pt is supine with knees flexed and feet flat on table. Phys hand hold knees and other reaches around the patient to the level of the thoracolumbar paravertebral musculature. Move knees away from phys and back while holding reach around hand and kneading fashion. Can move kneading hand around. Softening of tissues and increased range of motion.

Question 32

Thoracolumbar soft tissue - Supine USES:

Answer 32

a. To relax the paravertebral and quadratus lumborum musculature.
b. To free up the motion of ribs 11 and 12.
c. Therapeutic, as well as diagnostic, for somatic and visceral dysfunctions.
d. Special attention may be given to those areas overlying the sympathetic nerve supply to the organs the physician wishes to affect through reflex mechanisms.

Question 33

Treatment for the Innominates:

Answer 33

Ischial Tuberostiy spread

Question 34

Ischial Tuberostiy spread USES:

Answer 34

a. To release the fascia of the pelvis.
b. To treat the sacrum.
c. To separate the sacroiliac joints and allow for better motion of the sacrum between the innominates.
d. To help the sacrum to “seat” itself between the innominates (which may reduce forward sacral torsions).
e. To improve the function of the urogenital-pelvic diaphragm.
i. To decongest the pelvis and improve lower extremity drainage.
f. May be utilized as an adjunct treatment in the Osteopathic management of the following conditions: Cystitis, Proctitis, Hemorrhoids, Prostatitis, Constipation, Sacroiliac dysfunction

Question 35

Ischial Tuberostiy spread TREATMENT:

Answer 35

Pt in prone position. Phys at side of table siting beihnd the pt’s knees. Knees flexed.Find ischial tuberosities and apply lateral force. Forearms push legs outwards with lateral force and patient coughs 2-3 times.

Question 36

Treatments of the sacrum:

Answer 36

Sacral rocking

sacral inhibition

Question 37

Sacral rocking USES:

Answer 37

a. To improve sacral respiratory motion.
b. To relieve strains of the sacral fascia and related surrounding structures.
c. To enhance the Primary Respiratory Mechanism.
d. To improve the function of the urogenital pelvic diaphragm.
e. To treat constipation.

Question 38

Sacral Rocking TREATMENT:

Answer 38

Pt in prone and hands are cupped over the sacrum. Pt to breath deeply several times. Sacrum rocked anteriorly upon inhalation and reverse motion on exhalation. THis to be done after a total body treatment

Question 39

Sacral inhibition USES:

Answer 39

a. To treat diarrhea.
b. To treat dysmenorrhea.
c. Utilize cautiously in patients with spondylolisthesis or stenosis of the lumbar spine.

Question 40

Sacral inhibition TREATMENT:

Answer 40

Pt in prone position and phys hands cupped over sacrum. A static, anterior directed pressure applied over sacrum for 1-2 minutes

Question 41

Treatments for upper extremities:

Answer 41

Myofaxcial shoulder release via scapular lift

Trap pinch

Question 42

Myofaxcial shoulder release via scapular lift USES:

Answer 42

a. To release myofascial restrictions of the shoulder girdle.
b. To address rib dysfunctions.
c. Care should be taken when patient has a history of: Bursitis, Bicep tendonitis, Shoulder replacement, Rotator cuff injury, Impingement syndrome, Adhesive capsulitis

Question 43

Myofaxcial shoulder release via scapular lift TREATMENT:

Answer 43

Pt in lateral recumbent pos facing phys on side.Pt arm under head and other arm “on hip” but not holding hip to expose scapula… Phys hand grasps medial border of the scapula and other hand applies caudal pressure to shoulder to relax the musculature and induce scap winging. Pt asked to inhale and phys applies firm upward force. Repeat at least three times.

Question 44

Trap pinch USES:

Answer 44

a. To decrease congestion within the thoracic inlet.
b. To ease tension within the trapezius musculature.
c. Will assist in the treatment of headaches.

Question 45

Trap pinch TREATMENT:

Answer 45

hands are placed in a lobster claw position grasping trap. Hands may be moved medially or laterally applying gradual pressure between the thumb and other four fingers. Apply force to tense areas.

Question 46

Treatment for lower extremity:

Answer 46

Lymphatic pumping - Dorsiflexion

Question 47

Lymphatic pumping - Dorsiflexion USES:

Answer 47

a. To combat stasis, congestion, and pooling of body fluids which are the precursors to inflammation, symptoms of disease, and frank disease.
b. To encourage natural venous return and circulation in pregnant patients.
c. Good treatment for any infectious process.
d. Use caution when performing on patients with metastatic disease or patients who are recently post-operative.
e. If possible, the patient should have their axial skeleton treated to open all diaphragms prior to any lymphatic pump techniques.
f. Family members of patients can be taught to perform this technique.
g. Caution with patients:
i. Metastatic disease
ii. Recently post-operative
iii. Achilles tendonitis

Question 48

Lymphatic pumping - Dorsiflexion TREATMENT:

Answer 48

Pt supine with phys at end of table. place hands on plantar surface of patients feet , NOT TOES and rhythmically dorsiflexes the feet causing motion of the abdomen. 40-60 times per minute for approx 2 minutes twice a day.

Question 49

Treatment for head side-bending

Answer 49

suboccipital tension release

posterior cervical soft tissue

Question 50

treatment for head rotation:

Answer 50

suboccipital tension release

posterior cervical soft tissue

Question 51

treatment for pelvis rolling/iliac crest high/and increased lumbar lordosis

Answer 51

thoracolumbar soft tissue supine

Question 52

treatment for lower thoracic cage shifting

Answer 52

thoracolumbar soft tissue prone

Question 53

treatment for sacral sulcus is deep/left ILA posterior/sacral fascia is cephlad

Answer 53

ischial tuberosity spread

Question 54

treatment for rib angles feel fuller on right

Answer 54

pectoral traction
clavi-pectoral stretch
posterior axillary traction
upper mid and thoracolumbar soft tissue lateral recumbent