Upper cervicals and thoracics Flashcards
Anatomic factors that affect breathing –> areas to evaluate and treat as necessary for patients with respiratory problems (8)
- Upper thoracic vertebrae
- Ribs
- Sternum
- OA
- Accessory muscles of respiration
- Anterior cervical fascia
- Thoracic diaphragm
- T10-12 and lower ribs
How does somatic dysfunction of the thoracic pump effect the viscera? (4)
- Decreases venous drainage
- Decreases arterial supply
- Decreases lymphatic drainage
- Decreases responsiveness of the respiratory mechanism to body demands (acid/base, oxygen demand, CO2 removal)
Anatomic features to consider of the thoracic diaphragm
- C3-5 (phrenic nerve)
- Upper lumbars (diaphragmatic crus)
Anatomic features to consider of the upper thoracic vertebrae
- Mechanical effects
- Sympathetically mediated viscerosomatic reflexes (T1-6)
Seated vertebral myofascial release for peds
- The child is seated with physician behind them
- The physician’s thumbs are placed on the transverse processes of the segments to be treated. The physician most often will have each thumb on a different segment. The fingers wrap around the thorax for stabilization
- Engage the area focusing on the myofascial planes surround the vertebrae by working with rotation, side bending, and flexion/extension. Then begin to work outwardly to engage the surrounding tissues of the diaphragmatic crus and the diaphragm. Remember, the focus is within the myofascial structures, not the articular
Is the seated vertebral myofascial release direct or indirect?
Direct
Seated upper thoracic and sternal MFR for peds
- Contact the sternum, upper ribs, and upper vertebrae (if possible)
- Directly engage the barrier by moving the ribs, sternum, and vertebrae in whatever way is necessary to bring myofascial release to the entire upper thoracic region
Seated rib FPR for peds
- Gently grasp both the anterior aspect of the rib, lateral to the costochondral junction, and the posterior aspect over the rib angle, as close tot eh costotransverse junction as possible
- Disengage the rib by using a pincer grasp ( a gentle anterior-posterior force)
- Once the rib is disengaged, gently rock the rib along its long axis until a release is felt
Emphysema PE presentation
General: underweight, sits leaning forward with hands supporting him on the edge of the table and dyspneic
Neck: scalenes prominent
Heart: Sounds distant, PMI not detected
Thorax: barrel-chested
Lungs: relatively CTA B/L with scattered rhonchi, deep breathing triggers cough
Biomechanical treatment model for respiratory
- Need to make diaphragm more mobil
- Need to improve the bellows function of the ribcage
- Need to address scalenes/1st rib
Respiratory/Circulatory/Lymph treatment model for respiratory
- Need better air exchange
- Avoid thoracic lymphatic pump technique
Neurological treatment model for respiratory
Viscerosomatics
Metabolic treatment model for respiratory
Breathing is hard work and many with COPD cannot breathe while eating
Behavioral treatment model for respiratory
Smoking cessation
Principles of direct MFR
Identify the restrictive barrier in multiple planes.
Engage the tissue in opposition to the pattern of dysfunction.
Load a constant force on the area of greatest restriction
Wait for the tissues to unwind or release
Principles of indirect MFR
Identify the position of free motion in all planes
Place the tissue into the position of ease and maintain this until the tissues release
MFR for the diaphragm
- Stand behind seated pt. Placing pt so that their center of gravity is close to yours will make the biomechanics of the technique easier and allow you to use your arms and torso to support the patient.
- Place finger pads under the anterior costal margin and contact the diaphragm
- Assess where the greatest area of restriction is. The restriction may be in the mediastinum or the lumbar spine
- Expand your anatomical awareness and try to think in 3 dimensions
- Use the patient’s torso to place them into the barrier (direct) or position of ease (indirect)
- Use MFR principles to resolve the somatic dysfunction
Still Technique basic principles
- Place the dysfunctional tissues into their position of ease
- Add a force vector (usually compression) through the dysfunctional tissues
- Move the tissues through the restrictive barrier
Works better to correct the saggital plane last
Still Technique for inhaled first rib
- Brace opposite hand on the table with the elbow locked in extension
- Hand on affected side is placed on the anterior chest
- Place medial hand on rib head to monitor it. The forearm becomes a fulcrum as the technique progresses
- Lateral hand applies a compressive vector force from the elbow to the rib head to decrease tension on the joint capsule.
- Lift the elbow cephalad while maintaining the compressive force throughout the arc. –> This mimics the “up in front” position of the inhaled rib.
- Continue moving the elbow cephalad and then posteriorly while maintaining the compressive force.
- As you move the elbow posteriorly and inferiorly, the rib head is now pushed through the physiologic barrier.
- You may feel it “clunk” back into place. Recheck to ascertain resolution of the somatic dysfunction
Still Technique for the exhaled first rib
- Place medial hand on rib head to monitor it. The forearm becomes a fulcrum as the technique progresses
- Lateral hand applies a compressive vector force from the elbow to the rib head to decrease tension on the joint capsule.
- Lift the elbow cephalad while maintaining the compressive force throughout the arc. –> This mimics the “up in back” position of the exhaled rib.
- Continue lifting the elbow cephalad and swing it anteriorly while maintaining the compressive force throughout the arc.
- As you move the elbow superiorly and anteriorly, the rib head is now pushed through the physiologic barrier
- You may feel it “clunk” back into place. Recheck to ascertain resolution of the somatic dysfunction
Still Technique for Thoracic and Lumbar Vertebral SD (seated)
- For lower Ts and Ls, place your hand on one of the pt’s shoulders and your opposite axilla on the other shoulder. Compress form both shoulders to the level of the SD.
- If there are multiple SDs, treat the worst one first. Place it in the position of ease and then quickly check the other SDs. If they are not apparent, don’t treat them. They are compensatory SDs.
Still Technique for Ribs
- Ribs held in inhalation are more anterior and move more freely anteriorly
- Rotation of the thorax anteriorly to the opposite side of the affected rib should put the tissues into ease
- Hold the posterior portion of the rib to move it anteriorly
- Rotate the ipsilateral shoulder anteriorly to the opposite side
- Add compression with your hand on the shoulder (and your axilla on the other shoulder)
- Return the ipsilateral shoulder posteriorly
What position do inhaled ribs move?
Anterior
What position do exhaled ribs move?
Posterior
How do ribs attach to the vertebral segments?
At the same level and above.
EX: rib 3 attaches at rib T2 and T3
How do ribs 1-5 move?
pump handle motion
How do ribs 6-10 move?
bucket handle motion
How do ribs 11-12 move?
caliper motion
Where are anterior tenderpoints found on the ribs?
Found along the mid clavicular line, or along the mid axillary line
What somatic dysfunction are anterior rib tenderpoints associated with?
Exhaled SD
Treatment of anterior rib tenderpoint
- Knee contralateral of TP
- Flexion and sidebending towards the tenderpoint (more flexion with anterior points and more side bending with lateral points
- Rotation is usually towards the tender point
- Hold for 120 seconds
Where are posterior tenderpoints found?
Found along the posterior rib angles
What somatic dysfunction are posterior rib tenderpoints associated with?
Inhaled SD
Treatment of posterior rib tenderpoints
- Knee ipsilateral to TP
- Slight extension, side bending away to elevate the posterior part of the rib
- Rotation usually away from the rib tender point
- Hold for 120 seconds
Muscle energy for inhaled caliper ribs
- Caudad hand over ASIS
- Cephalad hand over posterior lateral aspect of ribs 11 or 12
- Anterior lateral vector
Muscle energy for exhaled caliper ribs
- Caudad hand over ASIS
- Cephalad hand over posterior medial ribs 11 or 12
- Anterior vector
