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OPP > Week 15: Lab: Rib Treatment: Myofascial Release and Muscle Energy Techniques > Flashcards

Week 15: Lab: Rib Treatment: Myofascial Release and Muscle Energy Techniques Flashcards

1
Q

What are some indications of MFR?

A
  • SD in the connective tissue of the body
  • Altered fascial patterns
  • Circulatory dysfunctions
  • Lymphatic congestion
  • Respiratory impairment
  • Potentiate the effect of other techniques
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2
Q

What are some absolute contraindications of MFR?

A
  • Absence of SD
  • Lack of patient consent
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3
Q

What are some relative contraindications of MFR?

A
  • Open wounds/burns
  • Fractures
  • Recent surgery
  • Deep vein thrombosis
  • Malignancy
  • Internal organ injuries
  • Infection
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4
Q

Describe the steps of MFR of the sternum.

A
  1. Place one hand on patient’s sternum with fingers facing patient’s feet
    - Both hands can be stacked
    - Be mindful of sensitive areas
  2. Monitor inferior and superior glide, left and right rotation, and clockwise and counterclockwise motion availability for ease-binding asymmetry
  3. Either indirectly or directly meet the ease-bind barrier with a force that is gentle to moderate
  4. Hold force until release is palpated, typically 20-60 seconds
  5. Follow tissue to any additional release (creep) until it does not recur
    - Deep inhalation or other release-enhancing mechanisms may be helpful
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5
Q

What is an indication of MET (Muscle energy technique)?

A

Presence of SD in the absence of contraindications

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6
Q

What are some absolute contraindications of MET?

A
  • Any individual that is unwilling or unable to follow verbal directions
  • Dislocation (at any site of treatment)
  • Fracture (at site of treatment)
  • Lack of patient consent
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7
Q

What are some relative contraindications of MET?

A
  • Acute injury
  • Eye surgery
  • Fracture (at treatment site)
  • Low vitality patient (myocardial infarction, post-surgery)
  • Painful muscles
  • Severe osteoporosis
  • Dependent on ME physiologic principle chosen of physician
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8
Q

What are the MET basic steps?

A
  1. Position the bone, joint, or muscle to be treated at the “feather’s edge” of the restrictive barrier (point of initial resistance) in all three planes of motion
  2. Instruct the patient to contract a specific muscle in a specific direction against the physician’s unyielding counterforce for 3-5 seconds
  3. Then, instruct the patient to cease all muscle contraction/relax
  4. Slowly reposition the patient to the feather’s edge of the new restrictive barrier
  5. Repeat steps 1-4 until the best possible increase in motion is obtained (usually 3-5 repetitions)
  6. Reassess the SD
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9
Q

What rib is treated in a group of exhaled (depressed) ribs?

A

The superior rib

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10
Q

What muscle(s) attach to rib 1?

A

Anterior and middle scalenes

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11
Q

What muscle(s) attach to rib 2?

A

Posterior scalene

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12
Q

In MET of ribs 1 & 2, what does the patient’s head position do?

A

Isolates which muscle will contract

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13
Q

For an exhaled rib 1, what does the head position of the patient need to be in?

A

The patient’s head needs to be rotated 15-20 degrees away from the side of rib SD.

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14
Q

For an exhaled rib 2, what does the head position of the patient need to be in?

A

The patient’s head needs to be rotated ~30 degrees away from the side of rib SD.

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15
Q

What is the patient’s position for MET of ribs 1 & 2 in exhalation SD?

A

Supine with head rotated ~20-30 degrees from rib SD.

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16
Q

What is the physician’s position for MET of ribs 1 & 2 in exhalation SD?

A

Standing on the opposite side of the dysfunction

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17
Q

Describe the steps for MET of ribs 1 & 2 in exhalation SD.

A
  1. Place patient’s wrist from dysfunctional side onto the patient’s forehead.
  2. Reach around and grasp the posterior, superior angle of the dysfunction rib 1 or rib 2 and pull it caudad and lateral, while the other hand stabilizes patient’s wrist on forehead
  3. Ask patient to gently raise head straight up while a counterforce is applied for the physician for 3-5 sec.
    Respiratory assistance by the patient inhaling can also help
  4. After patient relaxes, increase caudad and lateral traction on the posterior rib angle to the new feather’s edge
  5. Repeat steps 3 & 4 several times until motion is improved
  6. Reevaluate rib dysfunction
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18
Q

What rib motion are ribs 3, 4, and 5 in?

A

Pump handle motion

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19
Q

What muscle attaches to ribs 3, 4, and 5?

A

Pectoralis minor

20
Q

For MET of ribs 3-5, what position does the arm on the dysfunctional side need to be in?

A

Shoulder/arm is abducted and externally rotated to an angle that matches the attachment of the pec minor to that specific rib.

21
Q

What is the patient position for MET of ribs 3-5?

A

Supine with arm bent over head.
Head is straight or rotated away.

22
Q

What is the physician’s position for MET of ribs 3-5?

A

Standing on either side of the patient and facing them.

23
Q

Describe the steps for MET of ribs 3-5 in exhalation SD.

A
  1. Grasp the posterior and superior border of the dysfunctional rib with your caudad hand and pull it down (into the barrier).
  2. Place your cephalad hand on the patient’s flexed elbow and move it until force s localized at the dysfunctional rib
  3. Ask patient to bring elbow toward their chest while you apply a counterforce for 3-5 seconds
    May add respiratory assistance by asking the patient to inhale
  4. After patient relaxes, increase caudad traction on posterior rib angle to new feather’s edge
  5. Repeat steps 3 & 4 several times until motion has improved
  6. Reevaluate rib dysfunction
24
Q

What rib motion are ribs 6-10 in?

A

Bucket handle motion

25
Q

What muscle is attached to ribs 6-8?

A

Serratus anterior; its the primary activating muscle

26
Q

What muscle is attached to ribs 9-10?

A

Latissimus dorsi; its the primary activating muscle

27
Q

What is the patient’s position for MET for ribs 6-10 in exhalation SD?

A

Supine with the shoulder abducted ~90 degrees, where motion/barrier is felt at the rib level.

28
Q

What is the physician’s position for doing MET on ribs 6-10 in exhalation SD?

A

Sitting or standing on the same side as the rib SD. The cephalad hand abducts the arm.

29
Q

Describe the steps for MET of ribs 6-10 in exhalation SD.

A
  1. With caudad hand, grasp the posterior/superior angle of the dysfunctional rib and exert a caudad and lateral traction (into the barrier).
  2. Cephalad hand supports abducted arm and cephalad lateral thigh is placed against the patient’s elbow.
  3. Instruct the patient to push the arm into your thigh while your thigh applies an unyielding counterforce for 3-5 sec.
    Patient may be asked to slowly inhale during the contraction to enhance the effectiveness of the technique.
  4. After patient relaxes, increase caudad and lateral traction on posterior rib angle to new feather’s edge
  5. Repeat steps 3 and 4 several times until motion has improved.
  6. Reevaluate rib dysfunction
30
Q

What rib motion are ribs 11-12 in?

A

Caliper motion

31
Q

What muscle attaches to ribs 11 and 12?

A

Quadratus lumborum

32
Q

What position is the patient in for MET of ribs 11 and 12 in exhalation SD?

A

Prone with their legs positioned 15-20 degrees to the opposite of the dysfunction (this puts tension on the quadratus lumborum).

33
Q

What position is the physician in to treat MET of ribs 11 and 12 in exhalation SD?

A

Standing on the opposite side of rib SD

34
Q

Describe the steps for MET of ribs 11 and 12 in exhalation SD.

A
  1. Place cephalad hypothenar eminence inferior to the 11th and 12th ribs and exert a gentle pressure cephalad to stabilize the rib.
  2. Caudad hands grasps the patient’s right iliac crest and gently pulls caudad
  3. Ask patient to inhale, exhale, and then inhale deeply
  4. During inhalation, instruct the patient to pull their iliac crest toward their ipsilateral shoulder as your caudad hand applies an unyielding counterforce and your cephalad hand maintains cephalad pressure on the inferior aspect of the 11th or 12th rib.
  5. Hold for 3-5 seconds, and then instruct to stop and relax
  6. Once the patient has completely relaxed, lift the ASIS further to put the rib further into the barrier
  7. Repeat steps 3-6 several times until rib motion has improved
  8. Reevaluate rib dysfunction
35
Q

What rib is treated in a group of inhaled (elevated) ribs?

A

The inferior rib

36
Q

What is the patient’s position for MET with respiratory assist for an inhalation SD of ribs 1 and 2?

A

Supine

37
Q

What is the physician’s position for MET with respiratory assist for an inhalation SD of ribs 1 and 2?

A

Sitting or standing at the head of the bed

38
Q

Describe the steps for MET with respiratory assist for inhalation SD of ribs 1 and 2.

A
  1. Place ipsilateral thumb over the anteromedial aspect of the dysfunctional rib 1
  2. Contralateral hand rotates head 30-45 degrees to edge of restrictive barrier
  3. Ask patient to lift head against contralateral hand
  4. With ipsilateral thumb, encourage exhalation motion and resist inhalation movement of rib
  5. Isometric contraction is held for 3-5 seconds, then patient relaxes head
  6. Once relaxed, minimally extend patient’s head to new restrictive barrier
  7. Repeat steps 3-5, resisting inhalation and following exhalation several times until rib motion is improved
  8. Reevaluate rib dysfunction
39
Q

What is the patient’s position for MET with respiratory assist for inhalation SD of ribs 2-5?

A

Supine

40
Q

What is the physician’s position for MET with respiratory assist for inhalation SD of ribs 2-5?

A

Standing at the head of the bed and place flexed knee underneath the patient’s upper thoracic region at the level and side of the dysfunctional rib

41
Q

Describe the steps of MET with respiratory assist for inhalation SD of ribs 2-5.

A
  1. Flex (and sidebend) patient’s upper body to the side of the rib dysfunction until tension is taken off the dysfunctional rib
  2. Place thumb/finger webspace in the intercostal space above the dysfunctional rib on its superior surface
  3. Push inferiorly on the rib shaft in anterior axillary line, while the patient inhales and exhales deeply
  4. During exhalation, push the rib more inferiorly while you flex and sidebend the neck and thorax a little farther and resist inhalation motion during inhalation
  5. Repeat steps 3 and 4, resisting inhalation and following exhalation several times until rib motion has improved
  6. Reevaluate rib dysfunction
42
Q

What is the patient’s position for MET with respiratory assist for inhalation SD of ribs 6-10?

A

Supine

43
Q

What is the physician’s position for MET with respiratory assist for inhalation SD of ribs 6-10?

A

Standing at the head of the table and on the same side as the dysfunction.

44
Q

Describe the steps for MET with respiratory assist for inhalation SD of ribs 6-10.

A
  1. Sidebend (and flex) patient’s upper body to the side of the dysfunction until tension is taken off the dysfunctional rib.
  2. Place thumb/finger webspace in the intercostal space above the dysfunctional rib on its superior surface
  3. Push inferiorly on the rib shaft in mid-axillary line, while the patient inhales and exhales deeply
  4. During exhalation, push the rib more inferiorly while you flex and sidebend the neck and thorax a little farther and during inhalation, resist the inhalation motion
  5. Repeat steps 3 and 4, resisting inhalation and following exhalation several times until rib motion is improved
  6. Reevaluate rib dysfunction
45
Q

What is the patient’s position for MET with respiratory assist for inhalation SD of ribs 11-12?

A

Prone

46
Q

What is the physician’s position for MET with respiratory assist for inhalation SD of ribs 11-12?

A

Stand on opposite side of table than rib dysfunction

47
Q

Describe the steps of MET with respiratory assist for inhalation SD of ribs 11-12.

A
  1. Move patient’s legs 15-20 degrees on opposite side of table than rib dysfunction, taking tension off the quadratus lumborum
  2. Place cephalad hypothenar eminance medial and inferior to angle of dysfunctional rib
  3. Caudad hand stabilizes and slightly lifts patient’s ASIS
  4. Exert a gentle, sustained lateral and cephalad traction on the dysfunctional rib as patient inhales and exhales deeply.
    - During exhalation, exaggerate rib exhalation with more cephalad and lateral traction
    - Resist inferior rib motion during inhalation
  5. Repeat step 4, resisting inhalation and following exhalation several times until rib motion imrpoves
  6. Reevaluate rib dysfunction

OPP (27 decks)

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