Muscle energy/HVLA

Question 1

ME for difficulty opening the jaw

Answer 1

1. Have patient open mouth
2. Put 2 fingers on their chin
3. Have the patient try to close their mouth

Question 2

ME for difficulty closing the jaw

Answer 2

1. Have patient close mouth
2. Physician puts fingers under the chin
3. Have them try to open their mouth

Question 3

If a patients jaw deviates to the left opening opening, which side is the dysfunction on?

Answer 3

The left (jaw deviates to the side of the dysfunction)

Question 4

ME for difficulty moving the jaw laterally

Answer 4

1. Put fingers on the affected side

2. Ask the patient to push against your fingers

Question 5

Thoracic Inlet HVLA setup up PRONE

Answer 5

1. Patient’s head is sidebent AWAY, rotated TOWARDS (this is opposite of what you do in supine HVLA)
2. 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)

Question 6

Ribs 2-5 (pump handle) inhalation somatic dysfunction ME

Answer 6

1. Patient is supine
2. Place fingers or hypothenar eminence on the superior surface of the dysfunctional rib
3. Flex the patients head and side-bend to the level of dysfunction (can put knee under patients shoulder to help)
4. Hold rib down as the patient inhales, follow it further into exhalation.

Question 7

Ribs 6-10 inhalation muscle energy

Answer 7

1. Patient is supine

Question 8

Most common somatic dysfunction in a fall forward on an outstretched hand (FOOSH)

Answer 8

Posterior radial head dysfunction (radial head WANTS to pronate)

Question 9

ME for posterior radial head

Answer 9

Since radial head wants to be posterior (pronated), move the arm into SUPINATION (radial head moves anterior)

Question 10

Helpful mnemonic for radial head dysfunctions

Answer 10

SAPP; if it’s a Supination dysfuction, radial head is Anterior. If it’s a pronation dysfunction, radial head is posterior

Question 11

ME for anterior (supinated) radial head

Answer 11

Since it wants to be anterior (supinated), move it into pronation (posterior)

Question 12

Fall backwards onto outstretched hand causes what radial head dysfunction

Answer 12

Anterior (supination) dysfunction

Question 13

HVLA for anterior (supinated)

Answer 13

1. “Shake hands” with the patient be able to move patients forearm
2. Rotate forearm into barrier (pronation/posterior)
3. Apply a posterior thrust on the radial head as you flex the elbow

Question 14

Posterior radial HVLA

Answer 14

1. “Shake hands” with patient and grab the radial head with your other hand
2. Rotate the forearm into the supination barrier
3. Apply anterior thrust on radial head as you EXTEND the elbow.

Question 15

What is the cephalad pointing hand correcting for in the Texas Twist

Answer 15

SIDEBENDING (i.e. cephalad pointing hand is always on the side of the sidebending)

Question 16

Type I ME for the lumbars

Answer 16

1. Have patient lay in lateral recumbent position with the ROTATED SIDE UP
2. Flex legs until movement is felt at segment
3. Lift up both ankles until motion is felt, then have patient push down

Question 17

Type 2 flexed ME for lumbars

Answer 17

FDR;

1. Patient is in the lateral recumbent position with the ROTATED SIDE DOWN
2. Flex knees until motion is felt at monitoring segment
3. Have patient straighten out bottom leg
4. Lift up top leg, have patient push down

Question 18

Type 2 extended ME for lumbars

Answer 18

SUE (Sims, dysfunction side UP, extension);

1. Patient is in sims position with dysfunction (rotated) side UP
2. Lift both knees until motion is felt
3. Have patient “hug the table”
4. Drop BOTH legs off the table
5. Push down on ankles while patient pushes up

Question 19

HVLA for lumbars in the lateral recumbent position

Answer 19

1. Patient is in lateral recumbent position with the rotated/dysfunctional side UP
2. Flex knees and hips until motion is felt at that segment
3. Have patient straighten out the bottom leg and put top leg in the popliteal fossa
4. Rotate upper body to face ceiling
5. Place forearm of monitoring hand on the PSIS and other hand on the shoulder
6. Thrust anteriorly on PSIS w/ exhalation

Question 20

HVLA for lumbars in the seated position

Answer 20

1. Have the patient straddle the table and stand on the side opposite of the posterior/rotated transverse process
2. Place anterior hand on the patients far shoulder with armpit resting on near shoulder
3. Place thenar eminence of your posterior hand on transverse proces
4. Sidebend and rotate into barrier
5. As patient exhales, thrust the patient towards you as your thenar eminence pushes into the transverse process

Question 21

In what position do you motion test the fibular head?

Answer 21

Patient is supine with the knee flexed to 90 degrees. Sit on foot to stabilize the leg.

Question 22

If the fibular head is anterior, name the compensatory motions in the foot

Answer 22

Dorsiflexed, externally rotated

Question 23

If the fibular head is posterior, what are the compensatory motions of the foot

Answer 23

Plantarflexed, inverted

Question 24

ME for posterior fibular head

Answer 24

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.

Question 25

ME for anterior fibular head

Answer 25

AIIP; knee flexed to 90 degrees and one hand monitoring the fibular head, internally rotate, invert, plantarflex

Question 26

Anterior fibular head HVLA

Answer 26

1. Pt is supine with knee slightly flexed (pillow under the leg) 2. Internally rotate, invert, plantarflex the foot 3. Place your fulcrum on the fibular head and thrust down towards the table as you extend the leg

Question 27

Forward sacral torsion ME

Answer 27

SUE type position; 1. Patient is in the sims position with the axis side down 2. Monitor the LSJ 3. Flex knees until motion is felt at the LSJ 4. Have the patient hug the table 5. Drop the patients legs off the table 6. Push down on the patients legs and have them push up against you

Question 28

HVLA of the sacrum

Answer 28

1. Have patient lay in lateral recumbent position with the SACRAL ROTATION SIDE UP 2. Flex patients legs to level of dysfunction 3. Have patient straighten bottom leg and put top leg into popliteal fossa of bottom leg 4. Have patient turn torso up towards ceiling. 5. Forearm of caudad arm on PSIS, other arm on shoulder of patient 6. thrust forward as patient exhales

Question 29

Sacral C technique

Answer 29

1. Patient is supine 2. Physician stands on the SAME SIDE as the deep sulcus. 3. Sidebend up and lower body away from you (hence sacral C/smiley face)