Practical I (except CCP)

Question 1

Locate the following landmarks

1. First rib
2. Clavicle
3. Jugular notch
4. SC joint
5. Synchondrosis
6. Sternal angle
7. Second costal cartilage
8. Costoclavicular space
9. Infraclavicular fossa
10. Iliac crest
11. ASIS
12. Pubic symphysis
13. Inguinal ligament
14. Vertebral prominens
15. T1 spinous process
16. Spine of scapula
17. Vertebral border of scapula
18. Inferior angle of scapula
19. Rib angle
20. PSIS
21. Sacral sulcus
22. ILA of sacrum
23. Ischial tuberosities
24. Tip of acromion process
25. AC joint
26. Greater tubercle (of humerus)
27. Lesser tubercle (of humerus)
28. Intertubercular groove (of humerus)
29. Medial epicondyle (of distal humerus)
30. Lateral epicondyle (of distal humerus)
31. Olecranon process (of proximal ulna)
32. Radial head (of proximal radius)
33. Greater trochanter (of femur)
34. Patella
35. Tibial tuberosity
36. Fibular head
37. Medial malleolus (of tibia)
38. Medial malleolus (of fibula)
39. Calcaneal tendon / Achilles tendon

Answer 1

Point to landmark

Question 2

Evaluate your patient’s gait

Answer 2

• Length of stride/limp
• Shoulder heights
• Arm swing
• Feet orientation

Question 3

Evaluate your pts gravitational line

Answer 3

• Evaluating the pts AP spinal curve by:
  a. ) external acoustic meatus
  b. ) lateral aspect of head of humerus at tip of shoulder
  c. ) greater trochanter
  d. ) lateral condyle of knee (of femur)
  e. ) slightly anterior lateral malleolus

Question 4

Evaluate your pts side-to-side differences

Answer 4

a. ) head carriage
b. ) acromion process
c. ) inferior angle of scapula
d. ) iliac crest
e. ) PSIS
f. ) greater trochanter
g. ) feet/ankles

Question 5

Evaluate your pt for scoliosis

Answer 5

Have pt stand upright and bend forward while you are looking at their back. When bent forward, look for side of convexity

Question 6

Assess pt for trunk range of motion

Answer 6

1. Standing: flexion, extension, sidebending

2. Seated: rotation

Question 7

Quickly assess pts hip, knee and ankles

Answer 7

• Full squat with arms extended

Question 8

Assess pts cervical spine ROM-active

Answer 8

• Pt flexes, extends, sidebends and rotates

Question 9

Assess pts cervical spine ROM-passive

Answer 9

• Physician performs following actions
  a. ) flexion
  b. ) extension
  c. ) sidebending (while holding contralateral shoulder)
  d. ) rotation (while using arm / elbow on contralateral shoulder)

Question 10

Assess pts UE ROM

Answer 10

Adduction: pt gives themselves a hug
Abduction/external rotation: pt reaches above head and down to back
Extension/internal rotation: pt reaches behind and up to back

Question 11

Demonstrate: suboccipital tension release. When would this technique be utilized?

Answer 11

Utilization: tension HAs, prepare for cervical correction, assess and stretch dural attachments at C2, C3 and occiput

Treatment:

1. ) pt supine
2. ) place finger pads under sub-occipital area (at O-A junction)
3. ) provide anterior superior force comparable to weight of head, head falls into palm if treatment done correctly

Question 12

Demonstrate: posterior cervical soft tissue. When would this technique be utilized?

Answer 12

Utilization: treatment of short restrictor muscles of c-spine.

Treatment:

1. ) pt supine
2. ) place one hand on forehead, place finger pads of other hand in between spinous and articular processes
3. ) rhythmically stretch and compress soft tissue while side bending, rotating and extending cervical spine by bringing finger pads laterally and anteriorly, other hand stabilizes
4. ) perform bilaterally

Question 13

Demonstrate: cervical stretching. When would this technique be utilized?

Answer 13

Utilization: treatment of long restrictor muscles of c-spine, stretch myofascial elements of c and upper t spine, promote venous and lymphatic drainage of tissues of neck/head

Treatment:

1. ) pt supine
2. ) physician seated at top of table, arms crossed under pt’s head with hands on anterior aspect of pt’s shoulders
3. ) physician raises their arms flexing c-spine of pt until barrier reached
4. ) physician can hold pt in this position until release is felt or perform muscle energy to 4th barrier
5. ) in order to stretch barriers involving side bending and rotation, physician crosses one arm under pt’s neck and place hand of that arm on shoulder, with other hand roll head across forearm until resistance felt - then wait for release or do muscle energy

Question 14

Demonstrate: rib raising, lateral recumbent. When would this technique be utilized?

Answer 14

Utilization: aid respiration, aid circulation in pt with congestion, in pre-and post-opt care (atelectasis for example)

** don’t perform tx if pt has shoulder instability of pathology
Treatment:
1.) pt lateral recumbent with arm raised up and hand over ear and pt is facing physician
2.) physician holds elbow and places other hand on posterior rib cage/rib angles
3.) rib cage is moved anteriorly and laterally with gentle rhythmic motion while elbow is used as gentle counterforce - physician moves cephalad and caudad to different rib levels, treatment completed with release of tissues appreciated

Question 15

Demonstrate: rib raising, supine. When would this technique be utilized?

Answer 15

Utilization: aid respiration, aid circulation in pt with congestion, in pre-and post-opt care (atelectasis for example)

Treatment:

1. ) pt supine
2. ) physician sits or stands at side with hands under ribs cage and their fingers contacting rib angles
3. ) physician flexes fingers in rhythmic manner providing anterior and lateral force - move cephalad and caudad to different rib levels, treatment completed with release of tissues appreciated

Question 16

Demonstrate: prone thoracic perpendicular stretch. When would this technique be utilized?

Answer 16

Utilization: stretch fascial restrictions in paravertebral musculature of thoracic spine, free up any rib or thoracic restrictions

Treatment:

1. ) pt prone
2. ) physician at side of table opposite to area being treated
3. ) physician places one hand on pt’s spine with thumb and thenar eminence in area between spinous and transverse processes over erector spinae mass, other hand applies force to listening hand in anterior and lateral direction (don’t slide over tissue) - apply to entire t-spine

Question 17

Demonstrate: pectoral traction. When would this technique be utilized?

Answer 17

Utilization: increase AP diameter, improve venous / lymphatic drainage of thorax, release tension in clavi-pectoral fascia, drain anterior axillary fold edema form UE, provide drainage from head and neck

Treatment:

1. ) pt supine with **knees flexed
2. ) physician seated at head of table, grasps pt’s anterior axillary folds penetrating deeply to reach both pec major and minor (pt can bring hands together into prayer position to get tissue)
3. ) physician applies superior traction to stretch tissues, pt inhales deeply while physician takes up slack, pt exhales while physician holds traction - repeat for a few cycles at least three

Question 18

Demonstrate: clavi-pectoral stretch. When would this technique be utilized?

Answer 18

Utilization: drainage from head and neck, reduce edema to head and neck caused by illness (tonsillitis, pharyngitis), anterior/rounded shoulders **only do this treatment after inlet has been addressed

Treatment:

1. ) pt supine
2. ) physician at head of table, place thenar eminences on anterior superior shoulders at AC joint
3. ) pressure directed posteriorly and inferior with ~ 10 pounds of force, hold position for 20 seconds

Question 19

Demonstrate: posterior axillary traction. When would this technique be utilized?

Answer 19

Utilization: increase AP diameter of thorax, improve venous / lymphatic drainage of thorax, release tension in clavi-pectoral fascia, drain congestion from posterior axillary fold/UE/head/neck

Treatment:

1. ) pt supine with **knees flexed
2. ) physician seated at head of table and grasps pt’s posterior axillary fossa (pt can raise elbows to facilitate this)
3. ) apply superior traction to stretch tissue, pt inhales and physician takes up slack, pt exhales while physician maintains tension - repeat at least three cycles

Question 20

Demonstrate: thoracolumbar soft tissue, prone. When would this technique be utilized?

Answer 20

Utilization: relax paravertebral and QL musculature, free up motions of ribs 11 and 12, therapeutic and diagnostic for somatic and visceral dysfunctions

Treatment:

1. ) pt prone
2. ) physician stands on opposite side of treatment area, hands closest to pt’s feet on ASIS, other hand over paraspinal lumbar muscles
3. ) ASIS hand pulls upwards/other hand loose, at top of height paraspinal muscle hand provides downward force - kneading motion ensues - move along length of muscles down to sacral base and up to lower thoracic vertebrae, treatment completed with softening of tissues or increased ROM

Question 21

Demonstrate: upper mid and thoracolumbar soft tissue, lateral recumbent. When would this technique be utilized?

Answer 21

Utilization: relax paravertebral and QL musculature, free up motions of ribs 4-12, therapeutic and diagnostic for somatic and visceral dysfunctions

Treatment:

1. ) pt lateral recumbent with knees flexed (use upper arm to stabilize on table)
2. ) physician at pt’s back, one hand’s thenar eminence and thumb in area between spinous process and transverse process over erector spine mass, other hand over hand applies lateral and anterior motion to stretch and compress tissue rhythmically - apply to entire length of thoracic and lumbar spine (don’t slide across tissue), treatment completed with softening of tissue or increased ROM

Question 22

Demonstrate: thoracolumbar soft tissue, supine. When would this technique be utilized?

Answer 22

Utilization: relax paravertebral and QL musculature, free up motions of ribs 11 and 12, therapeutic and diagnostic for somatic and visceral dysfunctions

Treatment:

1. ) pt supine with **knees flexed
2. ) physician stands at side of table with one hand on knees, other hand reaches over pt to level of thoracolumbar paravertebral musculature
3. ) While moving pt’s knees away from physician, paravertebral musculature is brought anteriorly and laterally in a kneading fashion - may be applied to entire length of lumbar and lower half of thoracic spine - completion of treatment noted by softening of tissue or increased ROM

Question 23

Demonstrate: IT spread. When would this technique be utilized?

Answer 23

Utilization: release fascia of pelvis, treat sacrum, separate SI joints and allow for better motion, improve function of urogenital-pelvic diaphragm

Treatment:

1. ) pt prone with knees bent
2. ) physician seated at bottom of pt with arms between legs and thumbs on medial aspect of ITs applying lateral pressure
3. ) pt instructed to cough three times while lateral pressure applied to ITs and forearms of physician spreaded

Question 24

Demonstrate: sacral rocking. When would this technique be utilized?

Answer 24

Utilization: improve sacral respiratory motion, relieve strains of sacral fascia and related surrounding structures, enhance primary respiratory mechanism, improve function of urogenital pelvic diaphragm, tx of constipation

Treatment:

1. ) pt is prone
2. ) physicians hands cupped over sacrum
3. ) pt asked to breath deeply several times, physician augments sacral respiratory motion by rocking sacrum towards feet on inhalation and towards head on exhalation - apply treatment for 1-2 minutes

Question 25

Demonstrate: sacral inhibition. When would this technique be utilized?

Answer 25

Utilization: tx of diarrhea, dysmennorhea

**be cautious with using this treatment in pt’s with spondylolisthesis or stenosis of lumbar spine
Treatment:
1.) pt is prone
2.) physician hands cupped over sacrum
3.) static, anteriorly-direct pressure applied to sacrum for 1-2 minutes

Question 26

Demonstrate: myofascial shoulder release via scapular lift. When would this technique be utilized?

Answer 26

Utilization: release myofascial restrictions of shoulder girdle, address rib dysfunctions

**be cautious with pt’s with hx of bursitis, bicep tendonitis, shoulder replacement, rotator cuff injury, impingement syndrome, adhesive capsulitis
Treatment:
a.) pt lateral recumbent facing physician with left arm internally rotated and forearm placed behind back
b.) physician places hand under pt’s arm and grasps medial border of scapula, other hand is used to depress shoulder with caudal force
c.) pt inhales deeply while physician lifts scapula, while pt exhales physician maintains traction - repeat 3 times

Question 27

Demonstrate: trapezius pinch. When would this technique be utilized?

Answer 27

Utilization: decrease congestion within thoracic inlet, ease tension within trapezius musculature, assist in treatment of HAs

Treatment:

a. ) pt supine
b. ) physician places hands in lobster claw grasping trapezius bilaterally - apply pressure between thumb and four fingers as moving across muscle - apply steady force until softening appreciated

Question 28

Demonstrate: lymphatic pumping, dorsiflexion. When would this technique be utilized?

Answer 28

Utilization: combat stasis congestion and pooling of body fluids, encourage natural venous return and circulation in pregnant pts, good treatment for any infectious process

** caution with pt’s with hx of metastatic disease, recently post-operative, Achilles tendonitis
Treatment:
1.) pt supine
2.) physician places hands on the plantar surfaces of feet and rhythmically dorsiflexes feet causing motion of abdomen - flex 40-60 times per minute for approximately 2 minutes, twice per day