Thoracic II Indirect I

Question 1

Indirect techniques used

Answer 1

. Counterstrain, indirect myofascial release, indirect balancing FPR

Question 2

Still technique

Answer 2

Combines indirect and direct methods

Question 3

Counterstrain

Answer 3

. System of diagnosis and treatment that considers dysfunction to be continuing, inappropriate strain reflex
. inhibited by applying position of mild strain in direction opposite to reflex
. Indirect technique to treat tender points assoc. w/ bone, muscle, and ligament dysfunction

Question 4

Tense and tender points

Answer 4

. Tender points that are maintained by nervous system and perpetuate after injury
. Slightly edematous areas of tissue about size of fingertip
. Found at point of muscle attachment, belly of muscle, or in dermatome of that segmental level

Question 5

Anterior tender point

Answer 5

. Depressed points

Question 6

Posterior tender point

Answer 6

Elevated point

Question 7

Interspinal and paravertebral point versus rib tender points

Answer 7

. Interspinal/paravertebral closer to midline

. Rib more lat. over rib angles

Question 8

Locations of anterior rib tender points

Answer 8

. Rib 1: costosternal junction just inf. To sternoclavicular joint
. Rib 2: mid-clavicular line
. Rib 3-10: ant. Axillary line

Question 9

Rules of counterstrain

Answer 9

. Find significant tender point:
. Find position of optimal comfort (same as position of injury):
. Fine tune

Question 10

How to find position of optimal comfort

Answer 10

continuous light contact w/ point, wrap body around point, ant points flex and post. Points extend, off midline ass sidebending and rotation

Question 11

How to find significant tender point

Answer 11

palpate for tender points assoc. w/ type I/II dysfunction, scan region for tenderness based on history

Question 12

How to fine tune counterstrain

Answer 12

. when close to position of comfort fine tune w/ small arcs (1-5 degrees) of motion
. Maintain position of comfort for 90 seconds
. Ribs held for 90 seconds
. Slowly release patient to neutral DO NOT LET THEM HELP
. Re-assess

Question 13

M99.02 CS thoracic anterior tender points AT1-AT6 patient supine dysfunction and objective

Answer 13

. Dysfunction: Ant. Thoracic tender points T1-6 midline

. Objective: dec. tenderness

Question 14

Counterstrain thoracic ant. Tender point patient and physician position

Answer 14

. Patient supine

. Physician standing on side of patient

Question 15

Counterstrain thoracic ant. Tender points procedure

Answer 15

1. Place index pad of caudad hand on tender point
2. Gently lift patient’s head and cervical spine w/ cephalad hand to introduce flexion to tender point (may need to put knee on table to introduce right amt of flexion)
3. Fine tuning if more flexion needed have patient internally rotate arms and/or place feet flat footed on table w/ knees bent, can have slight sidebending or rotation
4. Use pain scale to fine tune
5. Hold for 90 seconds
6. Return to neutral and reassess

Question 16

M99.02 CS Thoracic post. Tender points PT1-PT3 patient prone dysfunction and objective and discussion

Answer 16

. Dysfunction: post. Thoracic tender points T1-T3
. Objective: dec. tenderness
. Discussion: thoracic levels 1-5 have most sensitive points on sides of spinous processes, more extension needed the closer the point is to midline, more sidebending the farther away from midline

Question 17

Counterstrain thoracic post. Tender points patients and physician position

Answer 17

. Patient: prone w/ arms hanging over side of table

. Physician: Seated to side of table on side of tender point

Question 18

Counterstrain thoracic post. Tender points procedure

Answer 18

1. Contact tender points on side of spinous process w/ index pad of caudad hand
2. Turn patient head away from tender point supporting them w/ hand cupping chin w/ cephalad hand
3. Introduce flexion down to tender point by lifting neck post. Through chin
4. Sidebending and rotation away from point added until localization and relaxation occurs
5. Fine tuning w/ pain scale
6. Hold for 90 sec
7. Return patient to neutral position and reassess

Question 19

M99.02 MFR thoracic direct patient prone dysfunction and objective and discussion

Answer 19

. Dysfunction: restrictions of motion in fascial planes covering thoracic region
. Objective: restoring normal and symmetric motion to fascial planes
. Discussion: allows for release of large area post. And can be used as starting technique
. Can treat low, mid, and upper thoracic areas

Question 20

Myofascial release direct patient and physician position

Answer 20

. Patient prone

. Physician standing near patient’s waist

Question 21

Direct thoracic myofascial release procedure

Answer 21

1. Place hand over lower portion of thoracic musculature
2. Spread fingers apart so hands have broad base of contact, apply slight traction and motion test for fascial restriction, keep contact firm but gentle to assess direction of range of motion
3. Check cephalad-caudad, side-to-side, clockwise-counterclockwise, off at angles
4. Establish restricted direction
5. Position tissue into restrictive barrier
6. Wait for tissue release
7. If no success vary amount of downward contact pressure from hands
8. Reassess

Question 22

M99.07 CS-UE Levator scapula dysfunction, objective, and discussion

Answer 22

. Dysfunction: pain w/ motion of cervical and upper thoracic area w/ levator scapula tender point
. Objective: improve motion of upper thoracic and cervical spine
. Discussion: useful for cervical motion restriction treatment
. Traction through arm allows rotation of scapula causing levator to shorten

Question 23

Counterstrain levator scapula patient and physician position

Answer 23

. Patient prone

. Physician standing on side of tender point

Question 24

Counterstrain levator scapula procedure

Answer 24

. Physician puts index on tender point (usually on sup., med. angle of scapula)
. Patient’s head turned away from dysfunctional side
. W/ caudad hand apply traction to patient’s wrist and internally rotates patient’s arm
. Fine tune position until optimal dec. in tension and max. Decrease in tenderness
. Maintain for 90 seconds
. Return to neutral and reassess