Soft Tissue OSCE Flashcards
Cervical procedures
Traction, supine Forward bending (unilateral fulcrum), supine Forward bending (Bilateral fulcrum), supine Contralateral traction, supine Cradling w/ traction, supine Suboccipital release
Thoracic procedures
Prone pressure Prone pressure with counterpressure Subscapular stretch Upper thoracic under the shoulder, lateral recumbent paraspinal inhibitory technique
Lumbar procedures
Prone pressure Prone pressure w/ counterleverage Paraspinal perpendicular stretch
Lower extremity procedures
ITB Tension prone, counterleverage ITB Tension, lateral recumbents, effleurage/petrissage
What is parallel traction
Force directed parallel to muscle and fascial components, causing increase in length of structure
What is perpendicular traction
Force directed away from the longitudinal axis
Traction, supine
-one hand cradles occiput -other hand grasps below chin -keep head neutral or slightly flexed, avoid extension -cephalad traction slowly and rhythmically, increasing amplitude -continue 2-5 min. or soft tissue release
Forward bending (unilateral fulcrum), supine
- Use one hand to flex patient’s neck in order to slide the other arm under patient’s head with hand palm down on opposite shoulder
- Keeping the neck in flexion, rotate the patient’s head toward and away from the elbow of the arm that is under the patient’s head to assess for the direction of tension.
- Rotate the patient’s head 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
Forward bending (bilateral fulcrum), supine
- Arms are crossed under patient’s head and hands placed palm down on patient’s shoulders
- Flex patient’s neck to induce a longitudinal stretch of the paravertebral muscles
- A rhythmical pattern or a constant force is applied until tissue is softer and lengthened.
Contralateral Traction (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
Cradling with traction (supine)
- Fingers placed under patient’s neck bilaterally on paraspinal muscles, just lateral to the spinous process
- Engage soft tissue with ventral and lateral force
- Apply a cephalad force to induce longitudinal traction
- Repeat above steps by repositioning hands to contact different levels of the cervical spine
Suboccipital Release
- Finger pads placed in suboccipital region (find occipital ridge and move inferiorly until fingers fall into suboccipital region)
- Inhibition: Apply a constant inhibitory pressure for 30 seconds to 1 minute
- Kneading: pressure may be slowly and rhythmically applied until tissue texture change occur or for 2 minutes
Prone pressure
- 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
- Keeping your elbows straight and using your own body weight, engage soft tissues with a ventral force and move out laterally to induce a perpendicular stretch
- Repeat by repositioning hands on different levels of the thoracic spine
Prone pressure w/ counterpressure
- Patient: Prone -Physician: Side of the table
- Place thumb and thenar eminence of caudad 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 the hands in the direction in which the fingers are pointing, creating a longitudinal stretch
Subscapular stretch
- 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 upward and laterally, pulling scapula away from rib cage
Upper thoracic w/ shoulder block, lateral recumbent
- Patient: Lateral recumbent with side to be treated up Physician: Standing at side of 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
Paraspinal Inhibitory Technique
- Patient: Supine or Prone -Physician: Standing on side being treated
- Place finger pads over the paraspinal tissues
Apply gentle, firm pressure to engage tissue for 30-60 seconds or until release occurs
Lower thoracic under the shoulder, lateral recumbent
- Patient: Lateral recumbent with side to be treated up -Physician: Standing at side of table facing patient
- Forearms contacting the axilla and iliac crest, fingers contact medial aspect of the erector spinae
- Elbows spread apart, elongating distance between the shoulder and the hip
- Engage muscle with ventral force and move out laterally to give perpendicular stretch
Prone pressure w/ counterleverage
- Patient: Prone -Physician: Stand at side of table opposite the side being treated
- Thenar eminence of cephalad hand contacts paravertebral muscles on the side opposite you
- Caudad hand gently grasps patient’s ASIS on the side opposite of 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
- Repeat by repositioning caudad hand along the paravertebral lumbar musculature
Paraspinal perpendicular stretch
- 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 and lateral force to create a perpendicular stretch
*Modification: This stretch can also be performed by bracing the ASIS with the caudad hand and inducing a ventral stretch with the cephalad hand
ITB Prone, counterleverage
- The patient lies prone and the physician stands on the left side of the patient.
- The patient’s right knee is flexed to 90 degrees
- The physician’s right hand grasps the patient’s right foot or lower leg while reaching over the patient to place the left hand, palm down, over the patient’s right lateral thigh (fig.1)
- The physician begins to push the patient’s foot and lower leg laterally while simultaneously compressing the right hand into the patient’s lateral thigh to engage the ITB pulling posteromedially to its restrictive barrier (fig.2)
- On meeting the ITB’s restrictive barrier, the physician can maintain the tension for 10 to 20 seconds and slowly release the tension and repeat until a maximum release of the tissue is noted or perform this technique in a slow, rhythmic manner, which is repeated over a few minutes or until the tissue texture is maximally improved.
- To disengage the tension on the ITB, the physician pulls the patient’s foot/lower leg back toward the midline while decreasing the pressure on the lateral thigh (fig.3)
- Tissue tension is reevaluated to assess the effectiveness of the technique
ITB, Lateral recumbent, effleurage/petrissage
- The patient lies in the right lateral recumbent position and the physician stands facing the front of the patient.
- The physician’s left hand rests on the posterolateral aspect of the patient’s left iliac crest to stabilize the pelvis.
- The physician makes a “fist” with the right hand and places the flat portion of the proximal phalanges over the distal, lateral thigh (fig.1).
- The physician adds slight pressure into the distal ITB and begins to slide the hand toward the trochanteric.
- This is repeated for 1 to 2 minutes and then the tissue tension is reevaluated to assess the effectiveness of the technique.
- If preferred, the physician can alternate from the distal to proximal stroking and perform a proximal to distal stroking, ending at the distal ITB (fig.2).
