Spinal mobilisations

Question 1

What are the 3 Genics and what structures fall under each one?

Answer 1

Arthrogenic
- Cartilage
- Ligament
- Joint
- Bone

Myogenic
- Muscle
- Tendon
- Fascia

Neurogenic:
- Nerves

Question 2

What Is the Arthrogenic protocol?

Answer 2

1. Observation
2. Touch
3. Active movements + overpressures
4. Combined movements
5. Vascular tests (Cx and upper Tx)
6. Passive movements (PROM & PPIVMS)
7. Palpation (soft tissue & bony)
8. Accessory movements (PAIVMS)
9. Clear joints above and below
10. Functional movements

Question 3

What are the main nerves for the practical?

Answer 3

• Tibial
• Peroneal
• Femoral
• Sciatic
• Median
• Ulna
• Radial

Question 4

What are the Neurological tests?

Answer 4

• Nerve palpation
• Deep tendon reflexes (reflex hammer)
• Upper motor reflexes (assessing the integrity of the CNS)
• Myotomes (A group of muscles supplied by 1 ventral nerve root)
• Dermatomes (An area of skin supplied by a single dorsal nerve root)
• Neurodynamics (The ease of which a peripheral nerve moves through our soft tissues)

Question 5

What are the Noteable Dermatomes?

Answer 5

• T2: medial upper arm, chest, and mid scapula
• T1: Medial forearm
• C8: Medial wrist, little and ring fingers
• C7: Middle finger (longest finger)
• C6: Lateral forearm, thumb, index finger
• C5: Deltoid, Upper lateral arm
• C4: Shoulders, clavicle, upper scapua
• S2: Posterior thigh, posterior knee, Achilles
• S1: Heel, sole of foot, little toe
• L5: Lateral upper and lower leg, dorsum of foot, big toe
• L4: Medial lower leg
• L3: Anterior and medial knee
• L2: Anterior thigh
• L1: Anterior pelvis

Question 6

What are the kind of dermatome assessments?

Answer 6

• Blunt and sharp
• Vibration
• Cotton wool (light touch)
• Temperature

Question 7

What is the Myotome assessment?

Answer 7

• Describe the procedure to the patient
• Ask the patient to lie supine (Lx/Sx) or SOEOB (Cx/Tx)
• Apply gentle isometric resistance to each myotome (build up to maximum)
• Compare unaffected to affected side. True and / or perceived loss of strength
• Grade each myotome using the Oxford scale (0-5) or % rating
• Adapt this process if pain limits accurate testing

Question 8

What are the notable movements of each spinal vertebra?

Answer 8

Upper limb (Cx -Tx):

C1/2 Cervical flexion and extension
C3 Cervical lateral rotation
C4 Shoulder girdle elevation (“shrugs”)
C5 Shoulder abduction
C6 Elbow flexion
C7 Elbow extension
C8 Finger Flexion (“grip”) and thumb extension (“thumbs up”)
T1 Finger adduction

Lower Limb (Lx):
L2 Hip flexion
L3 Knee extension
L4 Ankle dorsiflexion
L5 Big toe extension, Hip abduction
S1 Ankle plantar flexion
S2 Knee flexion

Question 9

How would you test someones CX proprioception?

Answer 9

• One method to test it could be the laser on the head (did it in class)
• Gaze test – thumb Infront of face
• Postural stability – stand on one leg, stand on a tight rope, bend down with one leg
• Progress them by closing there eyes

Question 10

What are the 4 grades of spinal mobilisation and hhow long do you apply these?

Answer 10

Grade 1 - small movement, to not cause any pain or muscle spasm
Grade 2 - To the point of pain
Grade 3 - from pain to resistance
Grade 4 - small movement at the point of resistance

Question 11

What grades of Spinal Mobilisation do you use in correlation of SINSS levels?

Answer 11

High SINSS - Grade 1-2
Medium SINSS - Grade 2-3
Low SINS - Grade 3-4

Question 12

What are the accessory mobilisation (PAIVMS) techniques?

Answer 12

Posterior anterior central vertebral pressures
Transverse Pressures
Posterior anterior unilateral vertebral pressures

Question 13

What are the physiological mobilisation (PPIVMS) techniques?

Answer 13

Flexion
Lateral flexion
Rotation

Question 14

What are the checkpoints for certain points in the spine?

Answer 14

C2 - under occiput
C6 - disappears in neck extension
C7 - most prominent
T7 - Inferior angle of scapula
T12 - Last rib attachment
L4 - Iliac crest
S2 - in line with dimples of lower back