Stuff to Remember Flashcards
Superior Innominate Shear HVLA
Patient supine, feet off end of table
Physician at foot of table
Grasp pt’s tibia and fibula superior to the ankle
Internally rotate and abduct the pt’s leg
Lean back to induce axial traction
Instruct pt to inhale and exhale slowly over 2-3 cycles and gently increase traction on exhalation
Exert an axial high velocity, low amplitude thrust
Inferior Innominate Shear HVLA
Patient LR, affected side UP
Physician behind patient
Cephalad hand on PSIS, caudal hand on ASIS
Provide lateral distraction to gap the SI joint, then cephalic force
INtruct the pt to inhale and exhale slowly over 2-3 cycles and gently increase force on exhalation
Exert a cephalic force through the ASIS and PSIS contacts
Inferior Innominate Shear HVLA Alternate Technique
Patient LR, affected side UP
Phsyciain facing patient
Monitor at lumbosacral junction
Pt straights bottom leg, places foot of top leg just dial to popliteal fossa of bottom leg
Cephalic hand monitors the SI joint
Caudad forearm is placed inferior aspect of the ipsilateral ischial tuberosity
Simultaneously, push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of the SI joint is palpated
High velocity, low amplitude force is delivered with caudal forearm, parallel to the table
Anterior Innominate Rotation HVLA
Patient LR, affected side UP
Physician facing the patient
Cephalic hand between L5 & S1 spinous process
Caudad hand flexes pt’s hips and knees until L5 & S1 separates
Drop the pt’s top leg off the table
Cephalic hand moves to antecubital fossa, with forearm on shoulder
Caudad forearm is placed along the femur between the pSIS and trochanter
Simultaneously, push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of the SI joint is palpated
High velocity, low amplitude force is delivered with caudal forearm, directed down the shaft of the femur
Posterior Innominate Rotation HVLA
Pt LR with affected side UP
Physician facing pt
Cephalic hand between L5 & S1 SP
Caudad hand flexes pt’s hips and knees until L5 & S1 SP separate
Pt straightens bottom leg, and places foot of top leg just distal to the popliteal fossa of the bottom leg
Cephalic hand moves to antecubital fossa, with forearm on shoulder
Caudad forearm is placed on the PSIS and iliac crest
Simultaneously, push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of the SI joint is palpated
High velocity, low amplitude force is delivered with caudal forearm, directed towards the umbilicus
Pubic Restrictions HVLA
Pt supine, hips and knees flexed with feet flat on table
Physician standing on either side of pt
MET, alternating between Abduction of the knees with forearm between the knees, patient force toward addcution
Adduction of the knees with knees squeezed together, patient force towards abduction
With final abduction cycle, induce a high velocity, low amplitude thrust towards further abduction
MET Lumbar Type 1 (Neutral) SD, Lateral Recumbent Long Lever Technique
NUDR (Neutral dysfunction, PTP Up, Pt force Down, Recumbent)
- Pt LR, PTP Up, and doc faces pt
- Monitor at the apex of the curve with the cephalic hand
- Flex hips and knees until motion is felt under monitoring hand
- Lift pt’s ankles, SB the lumbar spine into barrier
- Pt gently pushes ankles towards the floor (Down) against doc’s counterforce for 3-5s
- Pt is asked to relax and during pot-isometric relaxation, the barrier is reengaged by pulling up on the ankles
- Repeat last 2 steps 3-5 times or until no further restrictions are met.
MET Lumbar Type 2 Flexed SD, Lateral Recumbent Long Lever Technique
FDDR (Flexed dysfunction, PTP Down, Pt force Down, LR)
- Monitor at dysfunction with caudad hand
- Grasp pt’s arm and pull anterior/superior, engaging rotation and SB barriers
- Switch monitoring hands
- Straighten bottom leg, engaging extension barrier
- Engage SB barrier by lifting ankles
- Pt pushes down towards floor against resistance
- Relax, engage new barrier during post-isometric relaxation
- Repeat until no further restriction
MET Lumbar Type 1 (Natural) SD, Lateral Recumbent, Long Restrictor Technique
- Pt LR, PTP down, Physician facing pt
- Caudad hand or thigh to flex pt’s knees and hips while cephalic hand monitors the apex of the curve
- Fine tune F/E of hips until dysfunctional segment/curve is in neutral
- Pt’s top leg is lowered off the edge of the table, causing anterior rotation of the pelvis, until the monitoring hand detects motion
- Switch monitoring hands. Use cephalad hand to move the pt’s top shoulder posteriorly until the caudal hand detects motion
- Pt pushes top shoulder forward against doc’s resistance for 3-5s
- Relax. Doc gently moves the pt’s shoulder posteriorly, rotating T/L spine to new restrictive barrier
- Pt pulls the hip posteriorly & cephalic against doc’s resistance for 3-5s
- Relax. Doc moves the pt’s pelvis anteriorly & caudal, engaging new SB and R barriers
- Repeat until no new restrictions
MET Lumbar Type 2 SD, Lateral Recumbent, Long Restrictor Technique
- Pt LR, PTP down, Doc facing the pt
- Caudad hand or thigh flexes pt’s knees and hips while cephalic hand monitors dysfunctional segment
- Fine tune F/E until the dysfunctional segment is in neutral.
- Place pt’s top foot behind the bottom knee in popliteal fossa
- Switch monitoring hands. Use cephalad hand to move pt’s top shoulder posteriorly until the caudal hand detects motion.
- Pt pushes shoulder forward against doc’s resistance for 3-5s
- Relax. Doc moves the pt’s shoulder posteriorly, rotating T/L spine to new restrictive barrier
- Pt pulls hip posteriorly against doc’s resistance for 3-5s
- Relax. Doc moves the pt’s pelvis forward to new rotation barrier
- Repeat until no new restrictions
HVLA Supine “OB Roll”
Pt supine, fingers interlaced behind neck
Doc stands opposite PTP, monitors at segment and SBs the trunk to RB until motion is felt at dysfunctional segment
Place cephalad hand through the pt’s C/L arm and rest the dorm of hand on pt’s sternum
Caudad hand blocks linkage at pt’s ASIS on opposite side
Doc rotates pt’s trunk with cephalad hand into the rotational barrier
On exhalation, exert a rotational thrust
If you’re treating an extension sacral SD, which way do you rotate the pt’s legs?
External rotation after ABducting
If you’re treating a flexion sacral SD, which way do you rotate the pt’s legs?
Internal rotation
Forward Sacral Torsion ME
L/L or R/R
Modified Sims, axis side down, hips and knees flexed to 90 degrees. lower both legs to the floor and pt lifts up against doctor’s force
Backward Sacral Torsion ME
L/R or R/L
LR, axis side Down, F H/K to 90degrees, pull pt’s lower arm toward physician to produce posterior rotation so pt’s back gets closer to the table. drop top foot off table and have patient push that leg up against physician’s counterforce
HVLA Supine T-Spine (Kirksville Crunch)
Physician stands OPPOSITE PTP
Pt crosses arms over chest with side of PTP on top
Doc places thenar eminence of caudal hand on PTP
Pt’s elbows are position in doc’s upper abdomen
Cephland hand/forearm lift’s pt’s head and neck to localize RB (type 1 SB away from doc, Type 2 SB toward doc)
Pt inhales and exhales deeply
Upon exhalation, the examiner exerts a posterior to anterior HVLA thrust through their abdomen toward the posterior transverse process
HVLA Prone (Texas Twist)
Stand on side OPPOSITE PTP
Place hands facing opposite directions on either ride of SP depending on type of SD:
Type 1: Hand facing caudad, place hypothenar eminence on PTP, Hand facing cephalad, place thenar eminence on opposite TP
Type 2: Hand facing cephalad, place thenar eminence on PTP, Hand facing caudad, place hypothenar eminence on opposite TP
Pt inhales and exhales deeply. As patient exhales, follow their motion to further engage barrier
At the end of exhalation, a downward anterior HVLA thrust is applied with a counter balance pressure (twist) in the direction the fingers are pointing with greater force on the PTP side
AC1 Mandible
Located on the posterior surface of the ascending rams of the mandible
Tx = SARA
AC1
C1 TP midway between ramus and mastoid process
Tx = RA
AC2-6
Anterolateral aspect of the TP of affected vertebra
Tx = F SARA
AC7
Posterosuperior surface of proximal clavicle where SCM inserts
Tx = F STRA
AC8
Medial end of the clavicle at the sternal attachment of the SCM near the sternal notch
Tx = F SARA
AT1
Midline on suprasternal notch
AT2
Midline on the manubrium at the sternal angle
