ST & MFR Labs Flashcards
1
Q
Lateral Stretch, Rhomboid Region
A
- Patient: lateral recumbent
- Physician: standing, facing patient
- Caudal hand loops beneath axilla and grasps inferior portion of medial scapular border. Cephalad hand grasps superior border of the medial scapula.
- Apply lateral traction to scapular for 1-2 seconds in repetitive, rhythmic manner
- Reassess
2
Q
Indirect MFR of Sprained Ankle
A
- Patient: supine
- Physician: at foot of the table
- Monitor fascial milieu or other individual ligaments with cephalad hand
- Use caudal hand on forefoot to introduce: inversion/eversion, plantarflexion/dorsiflexion, IR/ER. Then engage as many indirect barriers as possible and use the inherent mechanisms to release the fascia. Follow release until there is no more tissue creep
- Reassess
3
Q
ITB (Prone)
A
- Patient: Prone
- Physician: Stands on opposite side of IT band dysfunction
- Use caudad hand to grab foot or ankle, flex knee to 90°.
- Palm of cephalad hand will contact lateral thigh
- Rotate the foot and lower leg out laterally and simultaneously engaging the IT Band by compressing cephalad hand into patients IT Band, pulling posteromedialy
- Reassess
4
Q
Knee MFR
A
- Patient: Supine or seated
- Physician: Standing on same side of knee being treated
- Grasp proximal leg with both thumbs on tibial plateau between knees
- Move tibia into anterior/posterior, medial/lateral glide, and IR/ER to determine position of laxity and restriction
- Treat restrictive barrier directly or indirectly
- Reassess
5
Q
Thoracic: Subscapular Stretch
A
- 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
6
Q
C-Spine: Unilateral Forearm Fulcrum Forward Bending
A
- 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
7
Q
Plantar Fascia X MFR
A
- Patient: supine
- Physician: at foot of the table
- Cross thumbs to make an ‘X’ and place thumb pads over the area of concern at the plantar fascia. Impart an inward force that is vectored distal and lateral and continue this pressure until barrier is met, and further until release is palpated.
- Repeat with foot alternately attempting plantarflexion and dorsiflexion
- Reassess
8
Q
Thoracic: Prone Pressure
A
- 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
9
Q
Direct/Indirect Thoracolumbar MFR (Prone)
A
- Place both hands palm down on the Thoracolumbar junction B/L, fingers spread out slightly
- Engage tissues with a ventral force
- Move tissues inferiorly and superiorly, left and right, and clockwise and counterclockwise, noting in which directions there is ease of motion and restriction of motion
- Either treat the direct (into restriction) or indirect (away from restriction) barrier
- Consider utilizing REMs to enhance release
- Reassess
10
Q
Coronal/Frontal Plane
Motion Involved
Axis Involved
A
Body Divided into Anterior & Posterior Halves
Sidebending; Abduction; Adduction
Sagittal Axis (Anterior/Posterior)
11
Q
Lower Thoracic Under the Shoulder (Lateral Recumbent)
A
- Patient: Lateral recumbent with side to be treated up
- 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
12
Q
Still’s Wrist MFR
A
- Patient: seated
- Physician: standing, facing patient
- Grasp carpal bones between thenar eminences
- Test flexion/extension, ulnar/radial deviation for restriction/laxity
- Stack restrictive barriers and instruct patient to make a fist and/or spread fingers widely for 5 seconds and then relax hand
- Engage next restrictive barrier and repeat until no new restrictive barriers are encountered
- Reassess
13
Q
Knee MFR/INR
A
- Patient: Supine
- Physician: Standing on same side of knee being treated
- With Superior (Cephalad) hand, grasp distal femur to stabilize, with inferior (caudad) hand grasp tibia/fibula and use it as lever to examine for three-dimensional laxity and restriction
- Assess in full extension followed by flexion, IR/ER, Ab/Adduction
- Passively move LE to treat either Direct/indirect
- Reassess
14
Q
Upper Thoracic with Shoulder Block (Lateral Recumbent)
A
- 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
15
Q
Cervical Traction
A
- One hand cradles occiput
- Other hand grasps gently below chin
- Exert cephalad traction with both hands slowly and rhythmically while keeping head neutral or slightly flexed. Avoid extension
- Continue until desired soft tissue or disc response
- Re-evaluate
16
Q
Transverse Plane
Motion Involved
Axis Involved
A
Divides Body into Superior and Inferior Halves
Rotation; Horizontal Abduction & Adduction
Vertical (Superior/Inferior Axis)
17
Q
Thoracic Longitudinal & Lateral MFR (Lateral Recumbent)
A
- Patient: Lateral Recumbent
- Physician: Stands facing patient
- Caudad forearm contacts iliac crest, cephalad forearm contacts axilla, fingers contact medial aspect of erector spinae muscles
- Spread elbows apart while applying lateral traction on paraspinal muscles
- Have patient breath deep for activating force
- Reassess
18
Q
C-Spine: Cradling with Traction, Supine
A
- Fingers placed under patient’s neck bilaterally on paraspinal muscles, just lateral to the spinous process
- Engage soft tissue with anterior 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
19
Q
Lumbosacral MFR
A
- Patient: Prone
- Physician: Stands beside patient
- Place one hand over the inferior lumbar segment and the other hand over the superior sacral segment
- Monitor inferior and superior glide, left and right motion, and clockwise and counterclockwise motion, noting the direction of ease of motion or restriction of motion
- Treat indirect or direct barrier, Consider utilizing REMs
- Reassess
20
Q
Lumbar Prone Pressure
A
- Physician: Standing at side of the table opposite the side being treated
- Place thenar and hypothenar eminence of one hand on patient’s lumbar paravertebral muscle on side opposite you
- Place other hand’s thenar eminence over the other hand
- Keep elbows straight and exert a gentle ventral and lateral force using your body weight to induce a perpendicular stretch
- Repeat the above steps along the lumbar spine
21
Q
C-Spine: Bilateral Forearm Fulcrum Forward Bending
A
- 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.
22
Q
Thoracic: Prone Pressure with Counterpressure
A
- 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
23
Q
Lumbar: Paraspinal Perpendicular Stretch (Lateral Recumbent)
A
- 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
24
Q
Head & C-Spine: Suboccipital Release
A
- 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
- Kneading: pressure slowly and rhythmically applied until tissue texture changes occur
- Inhibition: constant inhibitory pressure for 30 seconds - 1 minute
25
Superior Popliteal Space/Hamstring MFR
- Patient: Supine
- Physician: Stand on same side of leg being treated
- Bend knee to 90° with foot flat 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**
26
Hamstring Hypertonicity ME/MFR Tx
- Patient: Supine
- Physician: Standing on side to be treated
- **With knee extended and contralateral ASIS stabilized, flex patients hip until fascial barrier is met**
- Patient is then instructed to **push leg downward toward table while physician resists for 3-5 seconds.**
- **Engage the next restrictive barrier and repeat until motion is restored**
- Reassess
27
What is T.A.R.T.?
Tissue Texture Change
Asymmetry
Restriction of Motion
Tenderness
28
ITB (Lateral Recumbent)
- Patient: Lateral recumbent
- Physician: Stands facing the front of the patient
- **Stabilize patient by placing cephalad hand on the posterolateral aspect of iliac crest**
- **Make a fist with caudad hand and place the flat portion of the proximal phalanges over the distal lateral thigh**
- **Engage tissue giving a slight downward pressure into IT Band and slide fist proximally towards the greater trochanter region. Then move proximal to distal.**
- Reassess
29
Lumbar: Prone Pressure with Counterleverage
- 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
30
Seated Paraspinal Lumbar ST
- Patient: Seated
- Physician: Seated next to patient
- **Palm on medial aspect erector spinae muscle group, other hand across patient’s chest grasping contralateral shoulder**
- In repetitive fluid motion, **apply force anteriorly and laterally while depressing and translating erector spinae laterally until tissue release**
- Reassess
31
Upper Limb and Shoulder MFR
-**Patient: Prone with arm dangling from the table**
**-Physician: Seated on the side of the involved upper limb**
- Grasp the humeral head of the patient with both hands and monitor the tissues for tissue texture response to the following motions introduced through the humeral head: flexion/extension, IR/ER of the humerus, adduction/abduction of the humerus, protraction/retraction of the scapular, superior/inferior scapular motion, traction/compression
- Engage either for direct or indirect MFR. Follow the release until there is no more tissue creep
- Reassess
32
C-Spine: 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 and continue to apply traction moving anterolaterally creating a perpendicular stretch to cervical paraspinal muscles**
33
Elbow MFR
- Patient: seated or supine
- Physician: on side of the involved upper limb
- Hold the patient's hand with one hand and the proximal radius and ulna with the other hand
- Test elbow flexion/extension and forearm supination/pronation to determine directions of laxity and restriction
- Indirect: gently and slowly move the elbow to its position of laxity, apply compression or traction between your hands to facilitate laxity, and follow any tissue release until it is competed
- Direct: slowly move the elbow into its restriction and apply steady force until tissue give is competed
- Slowly return the elbow to neutral and retest motion
- Reassess
34
Prone I - Sacral Release
- **Place bottom hand over sacrum with heel over base and fingers over apex. Place other hand on top in opposite direction.**
- Engage Barriers: Sup/Inf; Rotation; Sidebending
- Treat indirect or direct barrier by stacking dysfunction, Consider utilizing REMs
- Reassess
35
Plantar Fascia (Longitudinal Stretch) MFR
- Patient: Supine
- Physician: At foot of table
- **Stabilize foot by placing hand over dorsum of foot**
- **Make a closed fist with your other hand and contact sole of patient’s foot just proximal to metatarsal heads**
- **Exert moderate pressure and move fist distal to proximal towards the calcaneus along the plantar fascia**
- Reassess
36
Hip Myofascial Release
- Patient: Supine
- Physician: Stand on same side of hip being treated
- Flex hip and knee to 90°, with caudad hand contacting the ankle and cephalad hand monitoring the knee
- 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 release is completed**
37
Sagittal Plane
Motion Involved
Axis Involved
Divides body into L and R halves
Flexion and Extension
Transverse/Horizontal Axis (R/L)
