Meganism Practical Cards

Question 1

Dx-C3-C7 supine FRS

Answer 1

They’re in prone, your fingers are on the articular pillar, elbows out. Check in neutral and go side to side. BIAS THEN INTO A LITTLE EXTENSION.
When you translate, you’re assessing opposite side SB and rotation.

Question 2

Dx-C3-C7 supine ERS

Answer 2

They’re in prone, your fingers are on articular pillars, elbows out. Check in neutral. BIAS INTO FLEXION. Translate side to side.
If they can’t go left, they’re having a hard time going right and are stuck in left

Question 3

Dx-AA supine rotation restriction

Answer 3

Flex to 45 degrees to lock out ligamentum flavum. Put your fingers on C1 and support the head on your stomach. Without SB, rotate head.
If they can’t go left, it’s a right sided problem.

Question 4

Dx-OA supine extension restriction

Answer 4

For flexion lesions

Grab their head with fingers on posterior arch of C1. Extend them and translate left and right.

Question 5

Dx-OA supine flexion restriction

Answer 5

For extension lesions

Grab their head with fingers on posterior arch of C1. Flex then and translate left and right.

Question 6

Rx-FRS left C5,6

Answer 6

One finger extension one

Finger on RIGHT articular pillar of C6 and apply P-A force to extend. Place your hand on their head. Translate them LEFT and slightly rotate RIGHT. Tell them to try to look over their LEFT SHOULDER.

Question 7

Rx-ERS left C2,3

Answer 7

The Pinch one

Pinch- index finger in joint line and thumb on LEFT articular pillar of C2. Put your LEFT hand on their head. Use fingers to translate LEFT and rotate RIGHT.
Ask them to extend, SB and rotate LEFT against you.

Question 8

Rx-Restricted atlas rotation left

Answer 8

The hand on the face

Put your fingers on the arch of the atlas. Bring neck to 45 degrees. Rotate their head LEFT and expect to feel the arch at your LEFT finger. Place RIGHT hand on top side of their face.
Resist RIGHT rotation.

Question 9

Rx-Restricted left OA extension

Answer 9

Put LEFT finger between occiput and C1 (cervicocranial junction). Put your RIGHT hand under their chin. Extend them and translate RIGHT (LEFT SB & RIGHT rotation).
Ask them to SB RIGHT.

Question 10

Rx-Restricted right OA flexion

Answer 10

Put LEFT finger between occiput and C1 (cervicocranial junction). Put your RIGHT hand under their chin. Flex them and translate RIGHT (LEFT SB & RIGHT rotation).
Have then extend into your hand.

Question 11

Dx-T1-5 type 1 and 2 dysfunctions

Answer 11

Get scapula out-of-the-way by having them cross their arms. Upper T spine can be examined entirely while seated. Assess transverse processes. Assessed symmetry by looking above and below it. When you find asymmetry in flexion or extension and not a neutral it is a minor motion loss. Assess flexion and extension.

Question 12

Rx-ERS left T4,5

Answer 12

LEFT facet is stuck closed

The diagonal one

You stand RIGHT fingers LEFT on T4 TP and interspinous space. RIGHT hand on their head. Flex their neck and tell them to slouch. SB RIGHT and rotate RIGHT, you can use your torso.
Resist extension and LEFT SB and rotation by telling them to try to look over their LEFT shoulder.

Question 13

Rx-FRS left T2,3

Answer 13

RIGHT facet stuck open

The push with your hand one

You stand LEFT, fingers RIGHT waiting to feel RIGHT TP and provide P-A force with the palm of your hand. Swanneck LEFT hand. They’re in extension, SB RIGHT and slightly rotated RIGHT.
Instruct them to look down at their left hip.

Question 14

Rx-T1-5 neutral group dysfunction, NSrRl

Answer 14

The leg one

Find the apex/middle segment. Put up RIGHT knee (the side they side bend to) under their axilla. Swanneck RIGHT. Bring out your leg to SB them LEFT. Rotate their neck RIGHT.
Have them push into your leg and arm.

Question 15

Dx-T6-12 type 1 and 2 dysfunctions

Answer 15

Look for transverse processes. Flexion and neutral in sitting but extension is done in prone. Get cranial and caudal views!

Question 16

Rx-ERS right T8,9

Answer 16

The twist into you/ comforting one

In sitting, they put their hand on their RIGHT shoulder and so do you. Your RIGHT fingers are on interspinous space and TP. Put your axilla on their shoulder. Flexion to localize, SB LEFT, and rotate LEFT.
Tell them to extend, SB RIGHT and rotate RIGHT.

Question 17

Rx-FRS right T8,9

Answer 17

The three stepper

Teach them to weight shift
Palpate RIGHT TP and interspinous space.

1) weight shift LEFT. Put your hand on their LEFT shoulder. Bring them into LEFT rotation and ask them to rotate RIGHT.
2) weight shift RIGHT. Provide P-A force with fingers and increase LEFT SB and LEFT rotation
3) neutral weight. Provide P-A force with fist at T9 and grab their RIGHT shoulder, wrapping your arm across their chest. Tell them to flex.

Question 18

Rx-T6-12 neutral group dysfunction (NSlRr)

Answer 18

The one way weight shift

Thread the needle

They put their hand on their RIGHT shoulder and you weave. Your RIGHT thumb is localized on apex of the convexity. Weight shift LEFT. SB RIGHT rotate LEFT.
Tell them to SB LEFT and rotate RIGHT

Question 19

Dx-L1-5 type 1 and 2 dysfunction

Answer 19

L1-4 TPs
L5 articular pillars

Sacral rock to find L5.
Flexion- bend forward sitting with hands behind neck
Extension- prone in the cute position

Question 20

Rx- ERS right L4,5

Answer 20

Pt on table with RIGHT hand on LEFT shoulder. Your hand is on LEFT shoulder with axilla on them. Fingers are RIGHT on interspinous space and T4’s TP. Flex them at their torso and ask them to slouch. SB LEFT rotate LEFT.
Pt tries to lift LEFT shoulder into you.

Question 21

Rx-FRS left L3,4

Answer 21

The three stepper

Teach weight shifts.

You’re behind and RIGHT of seated pt. Palpate LEFT L3 TP and interspinous space. Place RIGHT hand on RIGHT shoulder.

1) weight shift RIGHT (SB LEFT)and rotate RIGHT. Tell them to rotate LEFT.
2) weight shift LEFT. Give them P-A force, SB LEFT and rotate RIGHT, and tell them to rotate LEFT.
3) neutral weight. Provide P-A with fist at L4 with your LEFT arm across their RIGHT shoulder and tell them to flex.

Question 22

Rx-FRS left L4,5

Answer 22

The extension one

Pt lays with bad side up (RIGHT). Find L4,5, reach under them to extend. Extend shoulders. Extend legs. RIGHT rotate shoulders. RIGHT hand palpates L4,5.
LEFT hand abducts legs/ swanneck hips.
Ask them to push to the ceiling or try to sit.

Question 23

Rx-L1-5 neutral group dysfunction (NSrRl)

Answer 23

Pt puts LEFT hand on RIGHT shoulder. Your LEFT hand on RIGHT shoulder. RIGHT thumb palpates apex. LEFT SB and RIGHT rotation.
Keep pt neutral
Ask them to SB RIGHT.

Question 24

Dx-Sitting flexion test/ ILA exam in flexion

Answer 24

1) Patient is seated. Get to level of PSIS. Have patient put their hands behind their neck with elbows in front and curl down. Look for symmetry. Pathological side will go first and further.
2) move on to ILAs and do it again.

Question 25

Dx-Prone ILA exam

Answer 25

Find ILAs and assess symmetry in neutral and spring. Drop onto inferior aspect and assess symmetry.

If ILAs are asymmetrical and inferior is level, it could be a forward or backward torsion
if both are asymmetrical it could be a unilateral dysfunction because it is sheared off the axis

Question 26

Dx-Prone sacral base exam

Answer 26

Get on sacral base and palpate. Palpate articular pillars of L5 and spring. If sacral base is tender it could be the long dorsal sacral ligament.

Question 27

Dx-Prone prop ILA and base exam

Answer 27

Patient in prone. Put your fingers on bases and thumbs on ILA’s. Have them take a deep breath and assess movement. Have them go into prone prop and reassess.

Question 28

Dx-Lumbar spring test

Answer 28

Performed to assess lumbosacral relationship. Spring on lumbar spine.
+ unilateral extension dysfunction and counter nutation/ BST

Question 29

Rx-Left unilateral sacral flexion

Answer 29

INternal rotation INspiration

Facing their head abduct RIGHT left 15 degrees and internally rotate. Palpate LEFT ILA with pisiform at 45 degrees and twist hand toward head. Push with hand. Use other hand to push down on LEFT sacral base. Instruct them to breathe. Push them more with extension.

Question 30

Rx-Right unilateral sacral extension

Answer 30

EXtension EXternal rotation EXhalation

Face their feet, abduct RIGHT leg 15 degrees and externally rotate. Palpate RIGHT sacral base at 45 degrees and twist toward their feet. GET THEM INTO PRONE PROP. Put your hand under RIGHT ASIS. Breathe, exhale, push ASIS into your hand and push onto RIGHT sacral base.

Question 31

Rx-L/L FST

Answer 31

Start them in prone. Have them flexed knees and you palpate RIGHT sacral base. Contact their ASIS And twist them to Sims position with dysfunctional side up. Rest their knees on your thigh. Palpate there RIGHT sacral base and facilitate counter nutation.
Grab their feet and ask them to try to bring them up. Increased hip flexion and drop the each time.

Question 32

Rx- R/L BST

Answer 32

RIGHT Side up towards healing. Extend lumbar spine to localize with LEFT hand on base, use right hand to extend upper spine.
Use lawnmower pull to rotate.
Palpate base with RIGHT hand and bend their knees and let the top leg rest in the lower’s popliteal fossa.
Tell them to try to lift it toward the ceiling with you pushing down.

Question 33

Dx-Standing forward flexion

Answer 33

Tests for SI dysfunction

• pt stands with PT standing behind pt
• PT contacts PSISs with thumbs
• pt asked to segmentally flex forward and bring hands to the floor
• PT monitors each PSIS for symmetry

POSITIVE if one goes first or further

could be tight QL bringing one side up first, tight HS holding other side down, etc

PT must be eye level with the PSISs

Question 34

Dx-One legged stork test

Answer 34

Upper pole

Tests for SI dysfunction

• pt standing with PT standing behind pt
• PT contacts the median sacral crest of S2 with 1 thumb and the PSIS with the other
• pt asked to flex the hip past 90deg
• PT monitors PSIS for lateral/caudal migration

POSITIVE if PSIS moves cranially or no movement

Lower pole

Tests for SI dysfunction

• pt standing with PT standing behind pt
• PT contacts the sacral apex at the hiatus with one thumb and the post/inf aspect of the ilium with the other
• pt asked to flex the hip past 90deg
• PT monitors the Iliad movement for ant/inf/lat migration

POSITIVE if there is a lack of movement