Practical

Question 1

PIR stretch

Answer 1

1. passively stretch muscle to point of tension
2. contract muscle (isometric) gently for about 10 seconds
3. relax
4. doctor feels for decrease resistance
5. gently stretch to next point of tension
6. repeat 2-5 times for 3-5 reps

Question 2

CRAC stretch

Answer 2

1. passive stretch for 10-15 seconds
2. contract isometric for 6 seconds
3. relax
4. contract agonist while stretching agonist for 10 seconds
   5 repeat as needed
   Can only be done at hip, knee, shoulder, elbow

Question 3

cervical spine flexion

Answer 3

1. purpose: to assess if they have hyperextension of the cervicals
2. instructions: have them lay face up and look toward feet
3. monitor patient
4. describe findings
5. normal: patient would have curled their neck and tucked chin in to the chest
6. correction: have them take posture breaks, have them make a “double chin” and hold for a small period of time

Question 4

quadruped rollback

Answer 4

1. purpose: to check for cervical hyperextension
2. instructions: get on all fours and sit back in your feet
3. monitor patient
4. describe findings
5. normal: patient would have rolled back onto their feet without any extension of their neck
6. correction: have them do the rollback properly, take posture breaks

Question 5

wall angel

Answer 5

1. purpose: to check for any tightness in the lats or pecs
2. instructions: stand against the wall (whole spine touching wall) with your feet about a foot away from the wall with your arms out in front of you. then squat down and lift your arms up above your head
3. monitor patient
4. describe findings
5. normal: patient could perform move without arching their back off the wall and can keep their arms against the wall
6. correction: stretching of lats and pecs

Question 6

arm elevation

Answer 6

1. purpose: screens for thoracic mobility
2. instructions: press whole spine on wall, arms down at first. then take one arm and raise it above your head as far as you can go
3. monitor patient
4. describe findings
5. normal: patient should be able to keep back against wall and be able to touch the wall with their arm above their head
6. correction: PIR stretch

Question 7

thoracic mobility screen

Answer 7

1. purpose: to screen for thoracic mobility
2. instructions: have patient lean against table or wall with hands. have patient drop only their chest as far as they can go without using arms
3. monitor patient
4. describe findings
5. normal: no lumbar extension, only extending at the thoracics
6. correction: practice the move, posture breaks

Question 8

P-A lumbar instability

Answer 8

1. purpose: determine if lumbars are unstable or subluxated
2. instructions: have patient’s torso on the table, with legs on the floor. Push against each lumbar spinous process, noting which ones are painful. then have them lift the legs up off the floor and push against each lumbar spinous process again. Note if those segments are still painful
3. monitor patient
4. describe findings
5. normal: no pain on either part
6. correction: strengthen core muscles, adjust

Question 9

hip extension

Answer 9

1. purpose: assess the activation of the glutes
2. instructions: have patient lay prone, place fingers on hamstring, glute, and paraspinals. lock knee and extend hip.
3. monitor patient
4. describe findings
5. normal: ipsilateral hamstring, ipsilateral glute, contralateral paraspinals, ipsilateral thoracolumbar paraspinal
6. correction: start off easy, have them contract glutes without paraspinals and work up from there

Question 10

hip abduction

Answer 10

1. purpose: watch for glute med activation
2. instructions: have patient lying on their side. have them lift their leg up as high as they can go
3. monitor patient
4. describe findings
5. normal: abduct and internally rotate hip. patient attempts to maintain position. watch for movement of leg from original position
6. correction: stretch hip flexors and paraspinals, strengthen glutes and abdominals

Question 11

glute activation screen

Answer 11

1. purpose: to assess activated glute
2. instructions: have patient lay prone, place fingers on hamstring, glute, and paraspinals. lock knee and extend hip.
3. monitor patient
4. describe findings
5. normal: ipsilateral hamstring, ipsilateral glute, contralateral paraspinals, ipsilateral thoracolumbar paraspinal
6. correction: start off easy, have them contract glutes without paraspinals and work up from there

Question 12

deep squat

Answer 12

1. purpose: to assess how they utilize muscles when they squat
2. instructions: have patient do a squat the way they can do it
3. monitor patient
4. describe findings
5. normal: upper body up, knees out, lumbars in a normal position
6. correction: forward translation/upper body: wall ball squat
   knees cave in: monster walk
   feet turned out: banded talus pull
   lumbars over flexed/extended: lateral band squat

Question 13

mirror image

Answer 13

1. purpose: to help with those who sit at a desk all day
2. instructions: have the patient go from a slumped position to a sitting fully up position
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct posture mistakes
6. PIR stretches for pecs

Question 14

cervical isometrics

Answer 14

1. purpose: to help with cervical extension
2. instructions: push hand into head, look for extension
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. create “double chin”

Question 15

cat/camel

Answer 15

1. purpose: to help with thoracic mobility
2. instructions: patients on all fours, have them only drop their thoracics down, then have them curl up their thoracics as far as they can go
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. sphinx

Question 16

sphinx

Answer 16

1. purpose: to help with thoracic mobility
2. instructions: patient prone, have them go up on your elbows, could have a band and externally rotate forearms
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. cat/camel

Question 17

reach, roll, lift

Answer 17

1. purpose: to see activation of lower trap, rotator cuff and lat
2. instructions: have patient on elbows and knees, palms down and upper back rounded. slide one hand forward while rotating your palm upward. pull shoulder blade toward your feet, lift arm straight up while keeping the elbow straight, slowly return to start position and repeat on other side
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. PIR of lat or lower trap

Question 18

bruegger’s posture exercise

Answer 18

1. purpose: to give the patient a “posture break”
2. sit at edge of chair, turn feet slightly out, feet slightly wider than hip width. tuck chin slightly, deep breath from abdomen, slowly exhale while rotating arms out, spreading fingers wide, lifting sternum
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. mirror image

Question 19

wall/ball squat

Answer 19

1. purpose: to correct forward translation during squats
2. place ball at lumbar spine and against wall. have them squat down while keeping the ball against them and the wall
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. strengthen glutes and hamstrings

Question 20

monster walks

Answer 20

1. purpose: to correct knees caving in during a squat.
2. place band midway between knee and hip, have them walk with the band
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. hip extension

Question 21

squat/hip hinge

Answer 21

1. purpose: to help patient do a squat properly
2. have patient do a squat with a neutral spine, knees, out, toes forward, no forward translation
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. ball squat

Question 22

front bridge

Answer 22

1. pupose: to assess core function
2. have them go from the wall, or from the floor. hands either parallel with their shoulders or parallel with their eyes, maintain neutral spine
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. curl up

Question 23

dead bug

Answer 23

1. purpose: to assess core and pelvic floor muscles
2. have them lay on their back with all 4 limbs off the floor or arms off the floor. have them either extend an arm or extend an arm and the opposite leg
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. front bridge

Question 24

side bridge

Answer 24

1. purpose: to assess core stability
2. have them get on their side on their elbow and feet
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. easier: do it from knees
   harder: have them rotate

Question 25

curl up

Answer 25

1. purpose to assess core stability
2. chin tucked, fingers under lumbar lordosis to maintain neutral spine position. bend one leg, one leg straight. curl up around axis in mid thoracics at angle of scapula
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. easier: both legs bent

Question 26

bird dog

Answer 26

1. purpose: to assess core stability
2. neutral position on all fours, brace abdomen, move one limb at a time without moving any other part of the body
3. monitor patient
4. did patient have a neutral spine during exercise?
5. correct mistakes
6. harder: move one leg and opposite arm