Thoracic I, Direct I

Question 1

Kappler’s Corollary

Answer 1

. Used to confirm flexion/extension component of type II somatic dysfunction
. Stand behind patient w/ hands over shoulders/scapular regions w/ thumbs over messed up vertebra
. Patient flexes head/neck and physicians rotates vertebra left and right
. Patient extends head and physicians rotates left and right
. Compare

Question 2

ART final corrective force is ___

Answer 2

Operator induced

Question 3

ART activating force

Answer 3

. Repetitive springing or concentric movement of joint through restrictive barrier

Question 4

MFR indirect technique

Answer 4

. Dysfunctional tissues guided along path of least resistance until free movement is achieved
. Useful for treating acute strains and sprains or highly sensitive patients

Question 5

Muscle energy

Answer 5

. Direct technique
. Form of OMT in which patient’s muscles are actively used on request from precisely controlled position in specific direction against physician counterforce
. 1st describes in 1948 by Fred Mitchell Sr.

Question 6

Muscle energy principles

Answer 6

. Patient first isometrically contracting then relaxing specific muscles for joint mobilization
. Muscles targeted short, tight, restricted muscles maintaining dysfunction
. Initial position engages restrictive barrier
. Patient provides activating force

Question 7

Guidelines for muscle energy treatment

Answer 7

. Make specific diagnosis
. Engage barrrier, HOLD
. Instruct patient to contract muscle against your holding force
. Time of contraction 3-5 sec.
. Relax 1-2 sec. 
. Engage new barrier (if no inc. in motion don’t continue to force tissue into new barrier)
. Repeat process 3-5 times
. Reassess

Question 8

Common mistakes when using muscle energy

Answer 8

. Patient contraction too forceful
. Time for relaxation ignored
. Continued treatment when muscle doesn’t response

Question 9

M99.02 ART

Answer 9

Thoracic articulation patient seated

Question 10

Thoracic articulation patient seated dysfunction, objective, and discussion

Answer 10

Dysfunction: generalized motion restriction/stiffness of single or multiple spinal segments and their articulations
Objective: improve motion restriction/stiffness of single/multiple spinal segments and their articulations
Discussion: good for older patients w/ spinal arthritis and stiffness, used segmentally or regionally, choose sidebending or rotational focus

Question 11

Thoracic articulation patient seated patient and physician position

Answer 11

. Patient seated

. Physician standing behind and to the side opposite side to treated

Question 12

Thoracic articulation patient seated procedure

Answer 12

. Contact post. Shoulder w/ your left forearm and hand, contact left spinal region w/ your right thumb/thenar
. Simultaneously sidebend and rotate successive spinal segments by applying downward force through left arm to induce left sidebending
. Work up/down spine, repetitively complete w/ restrictive segments
. Switch sides and repeat
. Reassess

Question 13

M99.02 MFR Thoracic scapulothoracic release technique dysfunction, objective, discussion

Answer 13

. Dysfunction: restricted motion of left scapula on thoracic cage
. Objective: improve scapular motion
. Discussion: used for evaluation and treatment

Question 14

Thoracic scapulothoracic release patient and physician position

Answer 14

. Patient lies on side w/ affected side up, hips and knees flexed, pillow for comfort
. Physician stands on side of table facing patient

Question 15

Thoracic scapulothoracic release procedure

Answer 15

. Drape patient’s left arm over your right shoulder
. Contact patient’s med. scapular border w/ fingertips, take 1 step back w/ back foot for stability
. Control scapula and assess full range motion
. Restrictionof motion relieved by holding against barrier w/ traction, holding in position of ease, range of motion/stretching or articulating against barrier
. Reassess

Question 16

M99.02 ME Thoracic patient seated extended dysfunction, objective, and discussion

Answer 16

Dysfunction: thoracic type II dysfunction, T8ERSr
Objective: improve ability of T8 to rotate and sidebend left and flex
Discussion: easily performed after diagnosing in seated position

Question 17

Thoracic patient seated extended muscle energy patient and physician position

Answer 17

Patient seated w/ left side closest to edge of table, arms folded across chest right over left
. Physician standing at left side of patient opposite the rotational component of dysfunction

Question 18

ME thoracic patient seated extended procedure

Answer 18

. Reach across front of patient w/ left arm to place hand on patient’s right shoulder
. Monitor spinous process of T8 and T9 w/ index and middle fingers of right hand to localize flexion as left arm/hand flex patient’s torso until restriction barrier hit
. Maintain flexion while adjusting right hand so fingers monitor T8-T9 transverse processes, using right and left hands position patient’s torso to engage in edge of left sidebending and left rotation barrier
. Patient rotates torso right as left hand applies counterforce, maintain 305 seconds, relax 1-2
. Find new barriers and repeat the 3-5 times
. Reassess

Question 19

M99.02 ME thoracic patient seated flexed dysfunction, objective, discussion

Answer 19

Dysfunction: thoracic type II dysfunction, T8FRSr
. Objective: improve T8 to rotate and sidebend left and extend
. Discussion: easily performed after diagnosing in seated position

Question 20

M99.02 ME thoracic patient seated flexed patient and physician position

Answer 20

. Patient seated at edge of table w/ left side closest to edge, arms crossed over chest right over left
. Physicians standing left side of patient opposite rotational component of dysfunction

Question 21

ME thoracic patient seated flexed procedure

Answer 21

. Left arm across patient and place on right shoulder
. Monitor T8-T9 spinous process to localize extension as your left arm induces extension until restrictive barrier felt
. Maintain extension and adjust right and left hands on torso to engage left sidebending and left rotation barriers
. Patient rotate torso to right as your left hand applies counterforce for 305 sec, relax 1-2 sec
. Find new barriers and repeat 3-5 times
. Reassess