Review: Pelvic and Rib FPR/Stills Flashcards
What are the 4 steps for FPR?
- Setup: monitor SD, while putting affected body area in neutral position
- Activating force: compression, torsion, or distraction
- Positioning: indirect position for greatest ease and hold for 3-5 sec.
- Return and re-evaluate
How to perform FPR sacral evaluation; what’s a positive test?
- Pillow under pt’s lower abs to straighten lumbar lordosis
- Thenar eminences on ILA’s
- Doc directs cephalad force w/ both hands (simultaneously or one-at-a-time)
- (+) test = diminished cephalad motion
How to tx using prone FPR for restriction of (left/right) sacral motion on ilium?
- Flex dysf. side leg off table w/ knee extended until ILA moves posteriorly
- Slight ABduction at hip w/ IR/ER to fine-tune
- Add cephalad motion at thenar eminence = activating force
How to perform prone FPR: Piriformis?
- Flex leg off table and ADduct
- Add axial compression through palm at knee to further shorten muscle = activating force
How to perform prone FPR: Gluteus Maximus?
- Flex dysf. side hip off table; knee flexed 90°; extend hip w/ knee supported on doc’s thigh until motion felt at TP
- Activating force = add torsion force by ER rotating hip thru ankle contact using the knee as a fulcrum
Hypertonic gluteus maximus and hamstrings may be associated with what type of innominate SD?
Posterior innominate rotation
The piriformis is often involved in what type of sacral SD?
Sacral torsion, creating an axis of rotation
How to perform prone FPR: Hamstrings?
- Extend hip of dysf. side, resting pt’s distal femur on doc’s thigh
- Flex knee to maximally diminished hamstring tension with IR/ER fine-tuning
- Activating force = add axial traction OR compression using your cephalad hand AND thigh
How to perform supine FPR: Quadriceps - Vastus Lateralis?
- Pt w/ pillow under their head; ask them to comfortably bend both knees
- Flex hip, rest pt’s calf on doc’s thigh; keep knee maximally extended and direct patella towards monitoring hand; add IR/ER and AB/ADduction for fine-tuning at the hip
- Activating force = add axial traction or compression using your thigh
How to perform seated FPR: costochondral TP/restriction?
- Have pt sit up tall = neutralize sagittal curve; monitor costochondral joint
- Activating force = compression thru pt’s spine/shoulders
- Rotate pt toward TP/restriction until motion is felt or TP releaases
How to perform seated FPR: Posterior Rib SD?
- Monitor rib at costotransverse jct. and instruct pt to extend spine to straighten kyphotic curve
- Activating force = add compression ≤ 1 lb. localized to segment
- Flex pt towards until rib is engaged and add rotation and SB to side of posterior rib until motion felt at costotransverse jct.
How to perform seated FPR: inhalation or exhalation rib SD?
- Grip rib posteriorly and anterolaterally; tell pt to slightly sit-up (extend) to neutralize kyphosis
- Tell pt to lean into you and turn their head AWAY and hold breath in direction of ease
- Activating force = move hands in direction of ease
How to perform supine Still’s for Superior Innominate Shear?
- Initial = ER of LE and ABduct to gap SI joint
- Compress through sole of pt’s foot to elevate hip
- Activating force = maintain compression while IR hip
- Final position = mild traction thru ankle and RB
How to perform supine Still’s for Posterior Innominate Rotation?
- Initial: flexion at hip + knee; hip ADduction while monitoring superior SI pole
- Localizing force: compress thru knee to monitoring fingers
- Activating force: maintain compression while ABducting LE, extending knee
- Final position: mild traction thru anke w/ knee extended
How to perform supine Still’s for Anterior Innominate Rotation?
- Initial: flexion of hip to about 45° and comfy knee flexion w/ hip ABduction while monitoring inferior SI pole
- Localizing: compress thru knee to monitoring fingers
- Activation: maintain compression while ADducting LE and flexing hip to monitoring fingers; and tractioning thru ankle to finish
- Final: mild traction thru ankle w/ knee extended
How to perform seated Still’s for Posterior Rib SD?
- Initial: ABduct ipsilateral arm until motion localized to dysf. rib
- Localizing: compression to the rib thru elbow
- Activating: ADduct arm across chest while maintaining compression
- Final: arm ADducted across pt’s chest
How to perform supine Still’s for Exhalation/Anterior TP Rib?
- Initial: grasp ipsilateral forearm prox. to wrist while monitoring rib
- Localizing: use traction to pull arm inferiorly until you feel motion localized to rib and tell pt to exhale
- Activating: tell pt to inhale, at same time, flex pt’s arm while maintaining traction and localization
- Final: pt’s arm flexed
How to perform supine Still’s for Inhalation/Posterior TP Rib?
- Initial: grasp ipsilateral forearm prox. to wrist and flex pt’s arm; monitor dysf. rib laterally
- Localizing: pull pt’s arm anteriorly/superiorly (traction) until you feel motion localized to rib and tell pt to inhale maximally
- Activating: tell pt to exhale and, at same time, extend pt’s arm while maintaining traction and localization
- Final: arm near neutral
Using a β2-agonist to promote smooth m. bronchodilation in a patient with asthma would go under which of the 5 models of OMT?
Neurologic
