Soft Tissue / MFR 1

Question 1

Cervical Traction, Supine

Answer 1

Patient: supine Physician: at head of table - One hand cradles occiput - Other hand grasps gently below chin - Except cephalad traction with both hands. Keep head neutral or slightly flexed. Avoid extension.

Question 2

Cervical

Forward Bending

(Unilateral fulcrum), Supine

Answer 2

Patient: supine

Physician: at head of table

• Use one hand to flex patient’s neck in order to slide the other arm under patient’s head with hand plam down on opposite shoulder
• Keeping neck in flexion, rotate the patient’s head toward and away from the elbow of the arm that is under the patient’s head looking for the direction of tension.
• Patient’s head is rotated toward the direction of tension. A rhythmical pattern to the technique or a constant force is applied until tissue is softer and lengthened.
• Repeat on opposite side of cervical spinal tissue.

Question 3

Cervical

Forward Bending

(Bilateral fulcrum), Supine

Answer 3

Patient: supine

Physician: at head of table

• Arms are crossed under patient’s head and hands placed palm down on patient’s shoulders
• Flex patient’s neck, giving a longitudinal stretch of the paravertebral muscles.
• A rhythmical pattern to the technique or a constant force is applied until tissue is softer and lengthened.

Question 4

Cervical

Contralateral Traction

Supine

Answer 4

Patient: supine

Physician: at side of table opposite side being treated

• Caudad hand reaches across and contacts paravertebral muscles on side opposite of where you are standing (make sure to be lateral to spinous processes, not on them).
• Cephalad hand rests on patient’s forehead to stabilize head.
• Engage tissue with ventral force and continue to apply traction moving ventrally and slightly laterally creating a perpendicular stretch.

Question 5

Cervical

Cradling with Traction

Supine

Answer 5

Patient: supine

Physician: at head of table

• Fingers placed under patient’s neck bilaterally on paraspinal muscles, just lateral to the spinous process
• Engage soft tissue with ventral and lateral force
• Longitudinal traction exerted by moving cephalad along the soft tissues.

Question 6

Cervical

Suboccipital Release

Answer 6

Patient: supine

Physician: at head of table

• Finger pads placed in suboccipital region (find occipital ridge and move inferiorly until fingers fall into suboccipital region)
• Apply upward pressure into tissues and hold

Question 7

Thoracic

Prone Pressure

Answer 7

Patient: prone

Physician: standing at side of table opposite the side to be treated

• Place thenar and hypothenar eminence on paravertebral muscles opposite the side you are standing
• Place other hand on top of hand contacting the muscles
• Keep your elbows straight and using your own body weight, engage soft tissues with a ventral force and move out laterally creating a perpendicular stretch

Question 8

Thoracic

Prone Pressure with Counterpressure

Answer 8

Patient: prone

Physician: side of table

• Place thenar eminence and thumb of caudal hand over the thoracic paravertebral muscles opposite the side you are standing
• Place hypothenar eminence of cephalad hand on paravertebral muscles on the same side you are standing
• Engage tissues with a ventral force and then move your hands in direction in which they are facing (thus hand facing cephalad, etc.) creating a longitudinal stretch

Question 9

Thoracic

Subscapular Stretch

Answer 9

Patient: prone

Physician: standing at side to be treated

• Take patient’s arm, on the side being treated, and place it behind their back.
• Place fingers around medial border of scapula
• Engage the tissue ventrally, then give gentle and upward traction, pulling scapula away from rib cage

Question 10

Thoracic

Upper Thoracic with Shoulder Block

Lateral Recumbent

Answer 10

Patient: lateral recumbent with side to be treated up

Physician: standing at side of the table facing patient

• Caudad hand passes under patient’s arm and contacts paravertebral muscles
• Cephalad hand contacts anterior portion of shoulder to give counterforce. Drape patient’s arm over your arm.
• With both hands, engage soft tissues ventrally and move out laterally to create a perpendicular stretch

Question 11

Thoracic

Lower Thoracic Under the Shoulder

Lateral Recumbent

Answer 11

Patient: lateral recumbent

Physician: standing at side of table facing patient

• Finger pads placed on paravertebral muscles, lateral to the spinous processes.
• Engage muscle with ventral force and move out laterally to give perpendicular stretch

Question 12

Lumbar

Prone Pressure

Answer 12

Patient: prone

Physician: standing at side of table opposite the side being treated

• Place thenar and hypothenar eminence of one hand on patient’s lumbar paravertebral muscle on side opposite you
• Engage tissue with ventral force and give force out laterally to create a perpendicular stretch

Question 13

Lumbar

Prone Pressure with Counterleverage

Answer 13

Patient: prone

Physician: standing at side of table opposite treatment side

• Thenar eminence of cephalad hand contacts paravertebral muscles on the side opposite you
• Caudad hand gently grasps patient’s ASIS on the side opposite you. Gently lift it towards the ceiling in order to create the counterleverage.
• Cephalad hand will engage tissues ventrally and move out laterally creating a perpendicular stretch

Question 14

Lumbar

Paraspinal Perpendicular Stretch

Answer 14

Patient: lateral recumbent position with side to be treated up

Physician: at side of table facing patient

• Reach over patient’s back and place finger pads on the paravertebral muscles.
• Engage tissues with a ventral force and move out laterally to create a perpendicular stretch

Question 15

Hip Myofascial Release

Answer 15

Patient: supine

Physician: stand on same side of hip being treated

• Use caudad hand to grab foot or ankle, with cephalad hand holding knee, flex hip and knee to 90*.
• Test IR/ER to determine direction of laxity and restriction.
• Indirect Tx: move hip into position of laxity (ease), apply compression or traction along femur, follow tissue release.
• Direct Tx: move hip into restriction and apply gentle force until tissue give is complete

Question 16

Superior Popliteal Space / Hamstring MFR

Answer 16

Patient: supine

Physician: stand on same side of leg being treated

• Bend knee to 90* with foot placed on table; opposite leg straight.
• Use finger pads on either side of the superior aspect of the popliteal space and introduce spreading force to load the fascia, test in multiple planes - IR/ER, clockwise/counterclockwise, superior inferior
• Engage barriers stacking either direct or indirect until tissue release occurs.