Lumbar, Thoracic, Ribs, Vertebra Mechanics (for CPA 3)

Question 1

In what parts of the spine are there kyphoses? Lordoses?

Answer 1

thoracic and sacral kyphoses cervical and lumbar lordoses

Question 2

How are the cervical superior facets oriented?

Answer 2

BUM backward, upward, medial

Question 3

How are the thoracic superior facets oriented?

Answer 3

BUL backward, upward, lateral

Question 4

How are the lumbar superior facets oriented?

Answer 4

BM backward, medial

Question 5

What are the 5 spinal ligaments you should know?

Answer 5

anterior longitudinal ligament posterior longitudinal ligament ligamentum flava interspinous ligaments intertransverse ligaments

Question 6

What does the posterior longitudinal ligament connect?

Answer 6

posterior aspect of the vertebral bodies

Question 7

What does the ligamentum flava connect?

Answer 7

the laminae of adjacent vertebra

Question 8

What does the iliolumbar ligament connect?

Answer 8

the transverse processes of lumbar vertebrae and the ilium

Question 9

How is excessive or restricted motion named?

Answer 9

in reference to the vertebra above in a functional vertebral unit (excess motion of L2 is motion of L2 on L3)

Question 10

When were Fryette’s principles published?

Answer 10

1918 = first 2 principles of spinal motion

Question 11

What are type one mechanics?

Answer 11

TONGO Type One Neutral Grouped vertebra Opposite sidebending and rotation

Question 12

What are type two mechanics?

Answer 12

TTOSS Type Two nOt neutral Single segment Same direction

Question 13

What is Fryette’s third principle?

Answer 13

initiating movement of a vertebral segment in any plane of motion will modify the mvnt in other planes of motion

Question 14

For which parts of the spine are Fryette’s first two principles applicable?

Answer 14

thoracic and lumbar spine only

Question 15

What spinal landmarks are at the level of the spine of the scapula?

Answer 15

T3 spinous and transverse processes

Question 16

What spinal landmarks are at the level of the inferior angle of the scapula?

Answer 16

spinous process of T7 transverse process of T8

Question 17

What spinal landmark is at the level of the iliac crest?

Answer 17

L4

Question 18

Seated Articulatory, T1-T6 (Type 2 SD)

Dx: T2 ESlRl

Answer 18

seated behind or next to pt

put thumb pad on lateral aspect of TP of level w/ SD

put pt into Flexion, Sr Rr

articulate until no restricted motion is perceived

reevaluate

Question 19

ME, seated T1-6 (type 2 SD)

Dx: T3 ERrSr

Answer 19

monitor T3 TPs using pads of thumb and index finger of one hand and middle finger pad to monitor TP of T4

other hand on pt’s head –> induce flexion - if T4 begins to move, too much flexion induced

induce sidebending and rotation to RB

MET 3-5 sec 3-5 times then recheck

Question 20

ME, seated T1-6 (type I SD

Dx: T1-3 NRlSr

Answer 20

monitors T2 TPs and TP of T3 (claw hand)

other hand on pt’s head

induce left sidebending - if T3 begins to move, too much motion was induced

induce left rotation

ME 3-5 sec 3-5 times then recheck

Question 21

For lower thoracic techniques, how do you position the patient?

Answer 21

have them put one hand on back of neck and then grasp the elbow with other hand

Question 22

How do you position yourself for type 1 lower thoracic SD?

Answer 22

make sure you stand on side opposite of pt’s hand thats on their neck

loop arm under armpit = over 1 bicep!

induce sidebending and rotation pushing away from you

Question 23

How do you position yourself while doing a lower thoracic type 2 direct technique?

Answer 23

stand on opposite side which pt has hand on back of neck

over 2 biceps –> induce sidebending and rotation pulling toward you (will be same side)

Question 24

ME, seated - Lower Thoracic SD (type 1)

Dx: T8-10 NRrSl

Answer 24

Pt seated on table w/ ipsilateral hand to the PTP behind their neck and holding elbow w/ other hand

monitor T9 TPs and TP of T10 using claw hand

hand under armpit and over 1 bicep

induce Rl and Sr by pushing away from you

ME 3-5 sec 3-5 times

Question 25

ME, seated - lower thoracic SD (type 2 SD) Dx: T7 ERrSr

Answer 25

Put pt in position w/ R hand on back of neck and grasping that elbow monitor T7 TPs and T8 TP w claw hand put arm over both biceps and induce left sidebending toward physician and left rotation ME 3-5 sec 3-5 times

Question 26

ART, seated - lower thoracic SD extension type 2 SD

Answer 26

pt sits on table w/ arms folded across chest physician stands behind/beside pt with arm over pt's shoulder and hand on opposite shoulder stabilize T10 TPs w/ thumb and index finger flex thorax into RB to level of the stabilizing hand induce ART motion until improvement

Question 27

ART, seated - lower thoracic SD flexion type 2 SD

Answer 27

pt sits w/ arms folded across chest physician sits beside pt w/ arm across chest; hand on opposite shoulder stabilize T10 TPs and use this hand as a fulcrum extend thorax and induce ART motion through RB

Question 28

Articulatory thoracic sidemending, prone

Answer 28

stand on contralateral side to PTP place caudad hand on posterior ptp, fingers facing cephalad cephalad hand insilateral w/ fingers facing caudal downward pressure to articulate spine exert longitudinal force w/ both hands to carry affected segment thru restrictive barrier reassess

Question 29

ART, seated - lower thoracic sidebending SD

Answer 29

Doc stands or sits behind and beside pt who is seated w/ arms folded across the chest thenar eminence at TP of dysfunctional vertebra on ipsilateral side to doc doc induces sidebending force by pressing downward w/ axilla while also pressing medially w/ thenar eminence hold 1-2 sec, then return to neutral repeat rhythmically until motion is improved

Question 30

ART, seated - lower thoracic rotation SD

Answer 30

doc stands or sits behind and beside pt who has arms folded across chest doc has arm over pt's shoulder w/ hand on opposite shoulder thenar eminence at TP of dysfunctional vertebra on contralateral side to doc induce rotation by pulling shoulder anterior and pressing anteriorly w/ thenar eminence hold 1-2 sec then return to neutral; repeat until motion improved

Question 31

MET/ART lumbar seated treatment (type 1 SD) Dx L1-3 NRrSl

Answer 31

Pt sits w/ ipsilateral hand to PTP clasped behind neck and holding elbow w/ other hand physician places hand over one bicep (standing on side contralateral to PTP) monitor L2 TPs and TP of L3 rotate pt left and sidebend right do MET or ART

Question 32

MET/ART lumbar seated treatment (type 2 SD) Dx L2 ERrSr

Answer 32

pt's hand ipsilateral to PTP on back of neck physician stands contralateral to PTP physician monitors L2 TPs and TP of L3 rotate left and sidebend left (too far if motion felt at L3) MET or ART

Question 33

Seated Lumbar ART sidebending SD

Answer 33

Pt seated w/ hands across chest physician with arm across chest and 1 hand on contralateral shoulder thenar eminence at TP of dysfunctional vertebra on ipsilateral side of operator induce sidebending by pressing downward w/ axilla while pressing laterally w/ thenar eminence

Question 34

Seated lumbar ART rotation somatic dysfunction

Answer 34

Operator stands on contralateral side to PTP (if rotated right, stand on left side) hand on opposite shoulder and thenar eminence on TP of dysfunctional vertebra contralateral to operator induce rotation ART

Question 35

Lumbar long lever/sidebending ME treatment (type 1 SD) Dx: L3-5 N RrSl

Answer 35

mnemonic: NUDR Neutral dysfunction, ptp Up, pt force Down, lateral Recumbent pt right lateral recumbent (right side up), induce R sidebending by lifting ankles and monitoring at apex of curve w/ cephalad hand should be facing pt --\> they will pull down MET

Question 36

Lumbar ART sidebending, lateral recumbent sidebending dysfunction

Answer 36

put side of somatic dysfunction facing table (so you can sidebend pt opposite way) face pt and stabilize the superior (dysfunctional) vertebra while pulling up bent ankles to induce sidebending ART

Question 37

Lumbar long lever/sidebending ME treatment (type 2 SD) Dx: ERrSr

Answer 37

SUUE modified Sims. ptp Up. pt force Up. Extension sd. pt lateral recumbent w/ right side up and pt's torso rotated to to the table facing pt w cephalad hand monitoring dysfunction flex hips and knees, engaging flexion barrier drop pt's legs off table and push down ankles to engage sidebending barrier pt will raise ankles up against operator's counter-resistance

Question 38

Lumbar long lever/sidebending ME treatment (type 2 SD) Flexed Dx: L4 FRlSl

Answer 38

mnemonic: FDDR Flexed dysfunction, ptp Down, pt force Down, lateral Recumbent pt LR w/ disfunctional side (left) on table torso rotated back right; monitor at dysfunction w/ caudal hand straighten bottom leg, engaging extension barrier engage SD by lifting top ankle --\> instruct pt to pull toward floor w/ ankle = MET

Question 39

Lumbar long restrictor/rotation MET (type 1 SD) Dx: L3-5 N RrSl

Answer 39

Pt lateral recumment w/ ptp down caudal hand or thigh flexes pt's knees and hips; top leg lowered off edge of table --\> left rotation put caudal hand now to monitor dysfunctional segment use cephalad hand to move pt's top shoulder posteriorly option 1: pt pushes top shoulder forward against resistance option 2: pt pulls hip posteriorly and cephalad against resistance

Question 40

Lumbar long restrictor/rotation MET (type 2 SD) extended Dx: L4 ERrSr Tx: L4 FRlSl

Answer 40

Pt lateral recumbent, PTP down; physician facing pt caudal hand or thigh flexes pt's knees and hips and monitor w/ cephalad hand; flex top hip until motion is felt to flex put pt's top foot behind bottom knee switch monitoring hands. use cephalad hand to move pt's top shoulder posteriorly until caudal hand detects rotation Option 1: pt pushes top shoulder forward agianst resistance option 2: pt pulls hip posteriorly and cephalad against doc's resistance

Question 41

Lumbar Long Restrictor/Rotation MET (type 2 SD) Flexed Dx: L4 FRrSr Tx: L4 ERlSl

Answer 41

pt lateral recumbent, PTP down. Dr facing the pt caudal hand or thigh flexes pt's knees and hips while cephalad hand monitors segment. flex hip until motion is felt at inferior segment switch monitoring hands. Use cephalad hand to move shoulder posteriorly until caudal hand detects motion. Extend torso to feel motion at finger and thumb option 1: pt pushes shoulder against resistance option 2: pt pulls hip posteriorly and cephalad against resistance