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SPINE > Thoracic Treatment > Flashcards

Thoracic Treatment Flashcards

1
Q

Central PA

A

Can be performed using pisiform grip or both thumbs
This technique results in extension of the upper segment on the lower due to the projection angle of the thoracic spinous processes
Pt position: Prone with arms at side
PT position: Standing to the side of the pt with low table

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2
Q

Central PA

A

Grade II: Perform a posterior to anterior oscillation before initial joint restriction is felt
Grade III: Oscillation performed to R2 and then back out of capsular tightness
Grade IV Oscillation performed between R1 and R2

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3
Q

Unilateral PA

A

Same movement as the CPA but the movement is performed on the transverse process
Remember that the transverse and spinous processes will not be in direct line in the thoracic spine

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4
Q

Accessory Rotation (THE FORK)

A

Pt position: Prone on low plinth
PT position: Standing on the same side of the plinth as the spinous process deviation if noted
1. Using a fork grip (place the index and middle fingers on transverse processes and the other palm to apply pressure over the fingers
2. Place the middle finger of the foot hand on the transverse process of the vertebra below the one to be mobilized and opposite the side of you
3. Place the index finger on the transverse process closest to you of the vertebra to be mobilized
4. Place the palm or ulnar boarder of the head hand over the two fingers and initiate oscillation

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5
Q

Accessory Rotation (THE FORK)

A

May be more comfortable reversing the use of the foot and head hands depending on the level being treated.

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6
Q

True PA

A

A true PA can be performed the same way as accessory rotation by performing the same grip type of the transverse processes of the same vertebra

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7
Q

Transverse Pressure (Grades II-IV)

A

Pt. position: prone with arms down at side
PT position: standing at the pt’s side at the level of the deviation with the table elevated
1. Place either the thumbs or finger tips at the side of the spinous process
2. Make forearms parallel to the spinous processs with elbows fixed
3. Apply lateral oscillation

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8
Q

The Pstol-(Grade IV)

A

This technique is described as if T4 is rotated to the L(spinous process to the R) and you are going with the rotation
-Mark the L transverse process of T5 and the R transverse process of T4
Pt. Position: Supine
PT position: Standing on pt’s R side

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9
Q

The Pistol

A
  1. Place a towel on foot hand and form “the pistol” by flexing digits 3-5 while extending the index and thumb
  2. Instruct the pt to clasp hands behind the neck
  3. Passively roll the pt onto the R side, placing the “pistol” over the transverse processes as marked
  4. Grasp both elbows with the head arm/hand
  5. Forward flex the pt while sidelying then roll the pt supine onto your hand
  6. Use the elbows as a lever, flex the spine to balance the pt’s upper body on your hand
  7. Shift your body weight over your L Hand
  8. Instruct the pt to take a deep breath, during exhalation, compress with your body weight to take up the slack
  9. Oscillate for a grade IV; popping often occurs, continue oscillating
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10
Q

Straight Translation

A

A PA translation can be performed in the same manner as the pistol by placing the hand contats on the transverse processes of the same vertebra
NOTE: You can place the pistol on the lower 1/2 of the segment and create an extension force of the upper half on the lower 1/2 of the segment

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11
Q

Thoracic Screw

A
  • Place the foot hand on the transverse process of the upper vertebra, utilizing a pisiform grip with fingers pointed away
  • Placed the head hand on the transverse process of the lower vertebra, again with a pisiform grip and fingers pointed toward the therapist
  • Use grade III or IV oscillations to correct the deviation
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12
Q

Thoracic Screw (Grades III-IV)

A
  • Indicated to improve thoracic rotation
  • Performed against the direction of the deviation
  • Assume you are standing with the deviation towards you
  • Pt Position: prone with arms at side
  • PT position: Standing at the side at the level of the deviation
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13
Q

Physiologic Rotation (grades III-IV) Described to the right

A

Pt. position: sitting on the end of the plinth with back towards the end of the plinth; table adjusted to be able to reach around the pt at shoulder level
—L leg is abducted with the lower leg hanging over the side of the plinth
—Arms crossed and hugging shoulders
PT position: Standing behind the pt at the end of the plinth

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14
Q

Physiologic Rotation

A
  1. Place your R hand on the L scapula by wrapping arm around the Pt and under the elbows.
  2. Find the mid-position of the desired level y asking the pt to forward bend at the neck and upper T-spine as you palpate the segment
    - –mid-position occurs when the spinous processes of the segment just begin to separate
  3. Placed the pisiform of the L hand over the transverse process of the upper vertebra with fingers falling over the ribr
  4. Bring rotation to the R by rotating the pt around the spinal axis; the pt’s weight should remain balanced on both buttocks
  5. Perform either a III or IV dependent upon the size of the oscillation
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15
Q

Upper Thoracic Extension (scoop technique)

A

Indications: Improve upper thoracic mobility
Pt. position: sitting with forehead on folded arms
PT position: Arms threaded through pt’s arms, fingers on transverse process of vertebra
Instructions: apply a superoanterior force through finger contact and forearms in a scooping motion

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16
Q

RIB Mobilizations

for inspiration

A

UP and OUT for inspiration
PT Position: prone on Plinth
PT position: Stand on the contralateral side to the mobilized costovertebral joint and face the opposite shoulder
–Use a pisiform grip on the costovertebral angle
=The mobilization is up and out in an anteriolateral fashion
=Can use respiration to acilitate the mobilization

17
Q

RIB Mobilization

Sidelying

A

Indications: Improve elevation mobility of rib
Pt. position: sidelying top arm elevated overhead, can use pillow to increase lateral flexion
PT Position: behind near head of patient, web space of foot hand contacting rib below level to be mobilized
Directions: Elevate UE while maintaining downward force on rib, can use respiration

18
Q

RIB mobilizations

for Expiration

A

DOWN and IN for expiration
Pt. position: Prone on plinth
PT Position: Stand on the ipsiliteral side to the mobilized costovertebral angle in question
–The mobilization Is down and in …in anteriomedial fashion
–Can use respiration to facilitate the mobilization

19
Q

Rib Mobilization Sitting

A

Indications: Improve mobility of rib into depression
Pt. position: sitting with arms across chest
PT position: Standing to the side of the patient grasp opposite shoulder and contact rib with web space
Directions: Move pt into sidebending while applying a inferomedial force through the rib, apply mobilization with respiration

20
Q

Supine Traction for the thoracic spine

A

Indications: postural gains, general mobility
Pt. position: lying supine hands behind head, belt placed at target site
PT position: Standing at head of table, belt around back or shoulders
Directions: pull backwards and upward on belt with body weight shift

21
Q

Additional Mobs

A 
SNAG=sustained natural apophyseal glide, mobilization with movement
SNAG for rotation
SNAG for flexion
SNAG for extension
Belt Traction (mulligan)
Lion Stretch
22
Q

Soft Tissue Manipulation

A
  • Prone longitudinal with base of hands with PT standing at head
  • Prone over end of table, feet on floor-longitudinal with base of hands, PT standing behind pt
  • Sidelying perpendiculars and parallels with and without side bending motion
  • Sitting-Elbows
23
Q

Mobility Exercises

A
  • Sidelying Rotation
  • Trunk rotation supine with hands behind head
  • Arm circles
  • –towel roll to increase mobilization
  • Cat/Cow-quadruped, against wall
  • Thoracic extension over towel roll
  • Quadriped active extension
24
Q

Functional Thoracic Rotation

A
  • with patient prone, locate restricted segment
  • unilateral P-A over transverse process or transverse pressure to take up the slack in the joint
  • have patient bend both knees and rotate lower legs side to side allowing the pelvis to rotate with the legs while holding against the rotation movement from below
  • –with transverse pressure, feet move toward you for direct technique; away from you to move with deviation (indirect technique)
  • –with UPA, feet move toward the opposite side from the facet or transverse process for direct technique; toward the same side for indirect or with deviation
  • You may add cervical rotation in similar directions for upper thoracic segments if the patient can tolerate it.

SPINE (20 decks)

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