Muscle energy/HVLA Flashcards
ME for difficulty opening the jaw
- Have patient open mouth
- Put 2 fingers on their chin
- Have the patient try to close their mouth
ME for difficulty closing the jaw
- Have patient close mouth
- Physician puts fingers under the chin
- Have them try to open their mouth
If a patients jaw deviates to the left opening opening, which side is the dysfunction on?
The left (jaw deviates to the side of the dysfunction)
ME for difficulty moving the jaw laterally
- Put fingers on the affected side
2. Ask the patient to push against your fingers
Thoracic Inlet HVLA setup up PRONE
- Patient’s head is sidebent AWAY, rotated TOWARDS (this is opposite of what you do in supine HVLA)
- One hand on the patients head with the other hand cross over top on the side of the higher rib (hypothenar eminence on higher rib)
Ribs 2-5 (pump handle) inhalation somatic dysfunction ME
- Patient is supine
- Place fingers or hypothenar eminence on the superior surface of the dysfunctional rib
- Flex the patients head and side-bend to the level of dysfunction (can put knee under patients shoulder to help)
- Hold rib down as the patient inhales, follow it further into exhalation.
Ribs 6-10 inhalation muscle energy
- Patient is supine
Most common somatic dysfunction in a fall forward on an outstretched hand (FOOSH)
Posterior radial head dysfunction (radial head WANTS to pronate)
ME for posterior radial head
Since radial head wants to be posterior (pronated), move the arm into SUPINATION (radial head moves anterior)
Helpful mnemonic for radial head dysfunctions
SAPP; if it’s a Supination dysfuction, radial head is Anterior. If it’s a pronation dysfunction, radial head is posterior
ME for anterior (supinated) radial head
Since it wants to be anterior (supinated), move it into pronation (posterior)
Fall backwards onto outstretched hand causes what radial head dysfunction
Anterior (supination) dysfunction
HVLA for anterior (supinated)
- “Shake hands” with the patient be able to move patients forearm
- Rotate forearm into barrier (pronation/posterior)
- Apply a posterior thrust on the radial head as you flex the elbow
Posterior radial HVLA
- “Shake hands” with patient and grab the radial head with your other hand
- Rotate the forearm into the supination barrier
- Apply anterior thrust on radial head as you EXTEND the elbow.
What is the cephalad pointing hand correcting for in the Texas Twist
SIDEBENDING (i.e. cephalad pointing hand is always on the side of the sidebending)
Type I ME for the lumbars
- Have patient lay in lateral recumbent position with the ROTATED SIDE UP
- Flex legs until movement is felt at segment
- Lift up both ankles until motion is felt, then have patient push down
Type 2 flexed ME for lumbars
FDR;
- Patient is in the lateral recumbent position with the ROTATED SIDE DOWN
- Flex knees until motion is felt at monitoring segment
- Have patient straighten out bottom leg
- Lift up top leg, have patient push down
Type 2 extended ME for lumbars
SUE (Sims, dysfunction side UP, extension);
- Patient is in sims position with dysfunction (rotated) side UP
- Lift both knees until motion is felt
- Have patient “hug the table”
- Drop BOTH legs off the table
- Push down on ankles while patient pushes up
HVLA for lumbars in the lateral recumbent position
- Patient is in lateral recumbent position with the rotated/dysfunctional side UP
- Flex knees and hips until motion is felt at that segment
- Have patient straighten out the bottom leg and put top leg in the popliteal fossa
- Rotate upper body to face ceiling
- Place forearm of monitoring hand on the PSIS and other hand on the shoulder
- Thrust anteriorly on PSIS w/ exhalation
HVLA for lumbars in the seated position
- Have the patient straddle the table and stand on the side opposite of the posterior/rotated transverse process
- Place anterior hand on the patients far shoulder with armpit resting on near shoulder
- Place thenar eminence of your posterior hand on transverse proces
- Sidebend and rotate into barrier
- As patient exhales, thrust the patient towards you as your thenar eminence pushes into the transverse process
In what position do you motion test the fibular head?
Patient is supine with the knee flexed to 90 degrees. Sit on foot to stabilize the leg.
If the fibular head is anterior, name the compensatory motions in the foot
Dorsiflexed, externally rotated
If the fibular head is posterior, what are the compensatory motions of the foot
Plantarflexed, inverted
ME for posterior fibular head
PEED; If Posterior, place foot into external rotated, eversion, dorsiflexion
Also, make sure to flex knee to 90 degrees and monitor the fibular head
Remember, in a posterior fibular head the foot wants to be plantarflexed, inverted, internally rotated. You reverse this and bring the foot into the barrier.
ME for anterior fibular head
AIIP; knee flexed to 90 degrees and one hand monitoring the fibular head, internally rotate, invert, plantarflex
Anterior fibular head HVLA
- Pt is supine with knee slightly flexed (pillow under the leg)
- Internally rotate, invert, plantarflex the foot
- Place your fulcrum on the fibular head and thrust down towards the table as you extend the leg
Forward sacral torsion ME
SUE type position;
- Patient is in the sims position with the axis side down
- Monitor the LSJ
- Flex knees until motion is felt at the LSJ
- Have the patient hug the table
- Drop the patients legs off the table
- Push down on the patients legs and have them push up against you
HVLA of the sacrum
- Have patient lay in lateral recumbent position with the SACRAL ROTATION SIDE UP
- Flex patients legs to level of dysfunction
- Have patient straighten bottom leg and put top leg into popliteal fossa of bottom leg
- Have patient turn torso up towards ceiling.
- Forearm of caudad arm on PSIS, other arm on shoulder of patient
- thrust forward as patient exhales
Sacral C technique
- Patient is supine
- Physician stands on the SAME SIDE as the deep sulcus.
- Sidebend up and lower body away from you (hence sacral C/smiley face)
