LAB 1: Cervical Spine FPR Flashcards
1
Q
FPR for hypertonic suboccipital muscles
A
- Patient supine with head and neck off the table. Physician at head of table supporting patient’s head, monitoring hypertonic tissues with 3rd finger.
- Slightly flex head and neck forward to flatten/neutralize cervical curvature.
- Apply gentle axial compression (<1 lb of pressure) on the occiput towards feet.
- While maintaining compression, extend the head and neck and SB to the same side of the hypertonic muscles (shortening and relaxing the muscles being treated).
- Hold for 3-5 seconds waiting for tissue relaxation, return to neutral, and release compression.
- Reassess muscular tonicity.
2
Q
FPR for cervical segmental dysfunction
A
- Patient supine. Physician at head of table supporting patient’s head with one hand, monitoring articular pillars of the affected segment with index finger and thumb.
- Slightly flex head and neck forward to flatten/neutralize cervical curvature.
- Apply gentle axial compression (< 1 lb of pressure) on the occiput towards feet.
- While maintaining compression, move the segment into its ease of motion (indirect barrier of the F/E, rotational, and SB component).
- Hold for 3-5 seconds waiting for tissue relaxation, return to neutral, and release compression.
- Reassess segmental motion.
3
Q
Stills OA SD
A
- The patient is supine on the table. Physician at head of table.
- Place the pad of the index or middle finger on the side of the side-bending component in the basiocciput, using the palm to support the patient’s head. Place the other hand on top of the patient’s head.
- SB the head into its ease. Due to coupling of motion at the OA joint, slight rotation in the opposite direction will occur. Introduce F/E, depending on the diagnosis.
- Compress through the top of the head.
- While maintaining compression, take head into neutral and articulate through the restrictive barrier
- Compression is released and the head returned to neutral.
- Reassess.
4
Q
Stills AA SD
A
- Patient supine on table (or may be seated). Physician at head of table.
- Place index or middle finger on transverse process of the atlas (C1), on the side of rotation.
Rotate the head into its ease.
- Compress through the top of the head.
- While maintaining compression, take head into neutral and articulate through the restrictive barrier.
- Compression is released and the head returned to neutral.
- Reassess.
5
Q
Still’s Typical Cervical SD
A
- Patient supine on table. Physician at head of table.
- Place index or middle finger on articular pillar at level of somatic dysfunction, on the side of rotation.
- Introduce F/E, depending on the diagnosis. SB and rotate the cervical segment into its the ease.
- Compress through the top of the head.
- While maintaining compression, take head into neutral and articulate through the restrictive barrier
- Compression is released and the head returned to neutral.
- Reassess.
6
Q
BLT: OA SD
A
- Patient supine on table. Physician seated at head of table with forearms and elbows resting comfortably on table.
- Use one hand in a “pincher” grasp of the laminae on either side of the midline for C1 to stabilize and monitor the OA through the atlas.
- Place your other hand on the patient’s head to induce position of greatest BLT.
- Test respiratory phases and have the patient hold breath as long as possible in the respiratory phase (either inhalation or exhalation) that provides best BLT.
- Repeat until best motion obtained (1- 3x).
- Reassess.
7
Q
BLT: Typical Cervical SD
A
- Patient supine on table. Physician seated at head of table with forearms and elbows resting comfortably on table.
- Place palms under patient’s head, palpate articular processes with index fingers bilaterally.
- Establish point of BLT in cervical spine by inducing the position of greatest BLT through the head and neck.
- Test respiratory phases and have the patient hold breath as long as possible in the respiratory phase (either inhalation or exhalation) that provides best BLT.
- Repeat until best motion obtained (1-3x).
- Reassess.
8
Q
OA BLT
A
- With the supine patient use one hand in a “pincher” grasp of the laminae on either side of the midline for C1 to stabilize and monitor the OA through the atlas
- Place your other hand on the patient’s head to induce position of greatest BLT
- Test respiratory phases & have the pt. hold breath as long as possible in phase that provides best BLT
- Repeat until best motion obtained (1- 3x)
- Recheck
9
Q
C2-7 BLT
(C2 FSlRl)
A
- With forearms supported by the table contact bilateral articular pillars w/index fingers, respectively.
- Establish point of BLT in cervical by inducing flexion, sidebending left & rotation left through positioning the head and neck.
- Test respiratory phases & have the pt. hold breath as long as possible in phase that provides best BLT
- Repeat until best motion obtained (1-3x)
- Recheck
10
Q
What is the most important part of FPR?
A
Flatten the curve
11
Q
Supine FPR
OA F RrSl
A
- Neutralize Sagittal Curve: Monitor segment and flex spine to straighten lordotic curve at that level
- Activating Force: Add compression of <1 lb. localized to the segment
- Indirect Positioning: triplanar
- Hold for 3-5 seconds
- Return to neutral & retest TART
12
Q
Supine FPR
C2 F RrSr
A
- Neutralize Sagittal Curve: Monitor segment and flex spine to straighten lordotic curve at that level
- Activating Force: Add compression of <1 lb localized to the segment
- Indirect Positioning: triplanar indirect positioning (FRRSR)
- Hold for 3-5 seconds
- Return to neutral & retest TAR T
13
Q
AA Stills
RL stills technique
A
- The patient lies supine on the treatment table, and 4.
the physician sits or stands at the head of the table.
This may also be performed with the patient
seated. - The physician places the hands over the 5. parietotemporal regions, and the left index finger
pad palpates the left transverse process of C1. - The physician rotates the patient’s head to the left ease barrier.
- The physician introduces gentle compression through the head directed toward C1 and then with moderate acceleration begins to rotate the head toward the right restrictive barrier
- The release should occur before the restrictive barrier is engaged. If not, the physician should not carry the head and dysfunctional C1 more than a few degrees through the barrier.
- Reassess
14
Q
OA Stills
OA F SlRr
A
1, The patient is supine on the table.
- Place the sensing hand palm up under the occiput with the tip of the index finger on the occiput and the thumb on the temporal aspect of the patients head.
- Place the operating hand on the dorsum of the head.
- The head is slightly sidebent to the side of ease. Flex the head to relaxation in the suboccipital tissues.
- Introduce light compression through the dorsum of the head.
- The operating hand then moves the patient’s head from flexion through extension with slight rotation, maintaining compression.
- Compression is released and the head returned to neutral.
- Reassess for TART.
15
Q
Typical Cervical Stills technique
C4 E SrRr
A
- The patient lies supine on the treatment table.
- The physician’s right index finger pad palpates the patient’s right C4 articular process.
- The physician places the left hand over the patient’s head so that the physician can control its movement.
- The physician extends the head until C4 is engaged.
- The physician then rotates and side bends the head so that C4 is still engaged.
- The physician introduces a compression force through the head directed toward C4 and then with moderate acceleration begins to rotate and side bend the head to the left (curved arrows), simultaneously adding graduated flexion.
- The release should normally occur before the restrictive barrier is engaged. If not, the physician should not carry the head and dysfunctional C4 more than a few degrees through the barrier.
- The physician reevaluates the dysfunctional (TART) components.
