LAB FINAL Flashcards
DISTORTION
Procedure:
shoes, off, feet on inside of thing with strings, check for AP and lateral sway
Rationale/Mechanism:
AP sway - Cat I - probably due to decreased inhibition of postural muscle tone below the level of T6
Lateral sway - Cat II - due to body’s effort to avoid sacroiliac weight-bearing on the dysfunctional side, with compensations. Hemisphericity
Antalgia - Cat III - due to avoidance of pain (taking the nerve root away from the bulging disc)
Rib Head
Procedure:
fingertips or thumbs on rib heads, have patient flex and extend neck feet together
Rationale/mechanism:
Cat 1 - movement of rib heads will be bilateral or symmetrical
Cat 2 - one side has more motion than the other because one side is anchored due to loss of stability on that side
Cat 3 - no movement of the rib heads because the entire thing is locked down.
Stress
Procedure:
Patient stands arm fossa hold - deep inhalation hold, deep exhalation hold - Cat I PSIS - hop on one leg hold, hop on other leg hold - cat 2 L5 TP - valsalvas hold Cat 3 styloid fossa.
Rationale/mechanism: testing the neurological reflexes.
Category:
Cat 1 - deep inhalation or exhalation - flexion and extension of the craniosacral mechanism
Cat 2 - hop on one leg at a time (flat footed) - the lifted leg causes greater weight in the opposite leg which could reveal SI limitations on the greater weight bearing side.
Cat 3 - valsalvas - checking for a space occupying lesion which possible could be a discogenic issue commonly seen in cat 3 patients.
Arm fossa
Procedure: four fingers same level press into sartorius or rectus abdominus. Arm straight toward ceiling, thumb toward pt head. Test. Upper fossa or lower fossa.
Rationale/mechanism:
Contact on the sartorius or rectus abdominus interferes with muscular compensation for the unstable pelvis, therefore the arm blows out.
Category: Cat 2
Cervical compaction
Procedure: check for leg length, have pt bring feet together and slowly raise them, hands to sides. Then push S-I on pt head and have them lift their feet slowly again.
Rationale/mechanism:
Harder with S-I force indicates pelvic dysfunction.
Easier with S-I force indicates possible cervical issue.
Neither better nor worse is inconclusive.
Category: 2
Heel tension
Procedure: traction on the achilles tendon. Pt prone, traction toward you and down?
Rationale/mechanism:
Achilles tendon will be tight in the presence of dural dysfunction. Palpation of decreased inhibition of posterior postural muscles below T6
Category: 1 - one more than the other
Category 2 and 3 tension is equal
Feel for resistance by dorsiflexing and plantar flexing the foot
Psoas
Procedure: pt laying on board, pull pt arms over head bring palms together see which finger is short, that’s the tight psoas. Knee up come in lat to belly button stretch out med to lat, little AP, stand on opposite side of the knee and stablize around the hip. Breathe in all the way and out all the way, push out - Cat 2 need to stabilize pelvis
Cat 3 - use leg as fulcrum push out as breath in, bring in as breathe out no need to stabilize pelvis
Rationale/mechanism:
Category:
Iliofemoral supine
Procedure: grab around the lateral malleolus and int rotate the feet to see if one is more restricted than the other.
Patient rotates foot inward then Reach behind IT band and greater trochanter and pull up as pt rotates their foot outward slowly. Can do this all the way down to the knee.
Rationale/mechanism: iliofemoral area restriction
Category: 2
UMS/LLL palpation
Procedure: upper fossa, medial knee, short leg - SI joint issue, PI ilium, ilioinguinal ligament upper fossa.
Lower fossa, lateral knee, long leg - SI joint issue - AS ilium - ilioinguinal ligament lower fossa.
Rationale/mechanism: If all the findings match either UMS or LLL, it indicates a high possibility of pelvic issue
Category: 2
Cat II Blocking
Procedure: Horizontal on UMS side iliac crest, one block diagonal (45 degrees up) on LLL side. Pt lifts pelvis to place block, pt comes back down on it. Shimmy blocks out.
Rationale/mechanism: Block until arm fossa is strong, no longer than 2 minutes
Category: 2
Stairstepping and Figure 8
Procedure: press head toward the feet. Lift head a litter to make sure that head is neutral. Continual pressure helps realign. A stuck area will either skip or stick there. Figure 8 just in that articulation within that 1 joint. Step 1 is C7-T1, step 2 is C5-6, step 3 is C3-4, step 4 is C1-2
Rationale/mechanism: this is a diagnostic and therapeutic test
Category: 2
Trapezius Fibers
Procedure: 7 reflex fibers on the traps on is on the acromion to 7 on the 1st rib. Start with 1 on the outside work in to 7.
1 = C1, T1, 2, 10
2 = C2, T3, 11, 12
3 = C3, T4/5, L1
4 = C4, T6, L2
5 = C5, T7, L3
6 = C6, T8, L4
7 = C7, T9, L5
Pump on the tip of the SP until feel change up in the C spine. Stimulate one and affect the other. Best time to do this is when already get someone stable from Cat 2
Rationale/mechanism: if done right could save someone from cat 2, feel for a change in tone and or moisture in C spine neurological response - holding parasympathetics while stimulating sympathetic fibers.
Category: 2
Cat III Blocking
Procedure: you do the work, they don’t move, you lift their body and insert blocks. Legs should even out pretty quickly but may take some time to correct.
Passive blocking for proprioception, gravity, breathing.
Minimum block for cat 3 is 10 minutes. Max is until indicators are gone or you stop seeing improvement.
Stand on long leg side, place opp block first.
45 degrees on lower side of short leg, 45 degrees on upper side other leg, facing down.
Rationale/mechanism: Using the pelvis to torque the lumbars into alignment. Indirect.
Category: 3
SOTO
Procedure: step out toe out. Pt prone, doc sits, uses whole leg, horizontally toward them then ext rotate then toe in step in
Rationale/mechanism: for piriformis when piriformis is flaccid. Do 3-5x stop when schiatica goes away. Tones the muscle so now it’s not laying on the sciatic nerve anymore
Category: 3
Cough Test and Disc Traction
Procedure: Tells you which way to traction the sacral base. Thumb over L5, fingers splayed pt takes deep breath in then coughs through entire breating cycle. Normal thumb will go up and towards head. If stuck in sacral extenstion thumb will go straight up. (SB+)Too much flexion of the sacrum will cause thumb to go towards head. (SB-). For too much extension, blocks on the crests, breathe in, hold and pull traction toward feet and floor opens back of disc. For sacral flexion, straight down S2 to the floor opens front of disc breathe out and hold.
Rationale/mechanism:
Category: 3
