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Treatment by Region, Quadratus Lumborum m. used insertion on inferior…

- - - - Pt lies recumbent on side of rotation
        2.Dr. monitors apex of curve
        
        Dr. F/E LE to find point of maxium ease
        
        Place top foot in bottom poplieat crease
        
        Grab bottom elbow; pull anteriorly to induce contralateral rotation/side bending
        6.Place cephalad forearm in axila and pectoral region; pull pt pelvis into ipsilateral rotation
        
        Once barrier is engaged: inhale/exhale
        
        Thrust onto caudal hand -->Pelvis anterioly
        
        Reasess
    - - Flexed
        
        Pt lies recumnebt on side of rotation
        
        Extend LE and Trunk
        
        Place top foot in popliteal fossa
        
        Force is anterior/superior
        
        Reases
      - Extended
        
        Pt lies recumbent on side of rotation
        
        Monitor LX-LY
        
        Flex LE until motion is felt on LY or trunk until motion is felt on LX and place foot in popliteal fossa
        
        Place cephald hand in axila; monitor with caudal hand. Use pt arm to engage rotation but don't pull anteriorly
        
        Rotate pelvis anterioly with localization
        
        Engage barrier: inhale/exhale
        
        Thrust: anterior/superior force
        
        Reasess
  - - - Pt lies recumbent sidebending side down
        
        Monitor apex of curve
        
        Flex/Extend to find ease at apex
        
        Lift both feet toward ceeling: contralateral sidebending & minimial contralateral rotation
        
        POSTIOSMETRIC RELEXATION
        
        New border; repeat and reasses
    - - Extended
        
        Pt lies recumbent rotation side down
        
        Dr. monitors LX-LY as UP/LE are flexed
        
        Push shoulder posterioly
        
        Lift both feet toward ceeling
        
        POSTIOSMETRIC RELAXATION
        New border; repeat; Reases
      - Flexed
        
        Side bending
        TREATED FIRST
        
        Pt lies recumbent rotation side down
        
        Extend LE and Trunk
        
        Push shoulder posteriorly
        
        Lift TOP Knee ONLY until motion is felt
        
        POSTISOMETRIC Relaxation
        
        New border, repeat, reasess
        
        Rotation
        TREATED SECOND
        
        Pt lies recumbent rotation side down
        
        Extend LE and Trunk
        
        Push shoulder posterioly
        
        To engage SIDEBENDING: Dr. places caudad hand/forearm on buttock (cephalic translation)
        
        Pt pushes ipsilateral shoulder anterioly into Dr. cephlad forearm to induce ipsilateral rotation through trunk
        
        POSTISOMETRIC
        
        OR Can also push buttock posteriorly against caudad hand
        
        POSTIOSMETRIC
        
        New border;repeat;reases
- - - - •Thenar Inferior of Post Rib
        (up in front, down in back):
        Encourages movement superiorly
    - - Thenar Superior of post Rib
        (Down in front, up in back):
        Encourages movement Inferiorly
  - - - 6-10
        
        Monitor lat/sup ribs
        
        Pt SB toward & F to rib
        
        Breathe Deeply and Exhale over 3-5 sec
        
        After Exhale Dr. Inf force
        
        Resist superior/inhalation motion
        
        Enage new edge increasing head/neck F&SB
        Repeat
        REASSESS
      - 11-12
        (Move posterolateral and antermedial)
        
        Monitor post/lat Ribs
        
        Reach around ipsi ASIS and apply posterior force
        WITH Ant/lat & inferior force on rib
        
        Breathe deeply and exhlae. After exhlation, pt pull ipsilateral hip anteriorly (3-5 seconds)
        
        Relax as they inhale
        
        Engage new feather edge
        
        Repeat
        
        Reasses
      - 1-5
        
        Monitor anterior/superior rib
        
        Pt F & SB toward Rib
        
        Pt breathe deeply and exhale over 3-5 seconds
        
        After exhale, Dr. provides inferior force to encourage further exhalation
        
        On inhalation Dr. ressits motion
        
        Engage new feather edge by increaseing head/neck F & SB
        
        Repeat
        
        REASSES
    - - 2
        Post Scalene
        (POST/suerioor aspect of rib 2- moves superiorly when contracted)
        
        Turn pt head 45 degrees contralateral & hand on forehead
        
        Dr. hand on pt hand
        
        Hold inhalation & flex head/neck for 3-5 ses
        
        Relax on exhaled ; resist superior motion
        
        New edge with inferior traction
        Repeat and REASSESS
      - 3-5
        Pect Minor
        (POST-superior aspect ribs 3-5- moves superiorly)
        
        Contact pt ipsi elbow
        
        reach under ipsilateral trunk to superior/post aspect of rib
        
        Abduct pt ipsi arm until feather edge
        
        Pt hold breath inhalation while adducting toward contralateral shoulder
        
        Relax at exhale, Resits superior motion
        
        Engage new barrier
        
        Repeat & REASSES
        
        Adducting shoulder toward
        Contralateral shoulder
      - 1
        Ant Scalene
        (Post/superior aspect of rib 1-moves superiorly when contracted)
        
        Dorsum of ipsi hand on forehead
        
        Dr. hand on pt hand
        
        contact superior and psoterior portion of rib 1
        
        Hold breathe in inhalation & flex head/neck for 3-5 sec
        
        Relax on exhale; Dr. ressits superior motion
        
        New edge with inferior traction
        Repeat and REASSES
        
        Flex Head/neck
      - 6-8
        Serratus Anterior
        1.Contact pt ipsilateral forearm
        
        Reach under ipsilateral trunk and contact super/post aspect
        
        Abduct pt's ipsi arm
        
        Hold breath in inhalation while adducting shoulder toward contralteral hip. Dr. provides inferior tranction
        
        Relax at exhale; resist superior motion
        
        New border
        
        Repeat and REASSES
        
        Adducting shoulder toward
        contralateral hip
      - 9-10
        Latz Dorsi
        
        Contact Patients ipsilateral forearm or elbow
        
        Reach under ipsilateral trunk contact superior/post rib
        
        Abduct pt arm with pt's arm elbow braced on lateral thigh
        
        Hold inhalation while adducting shoulder toward ipsialteral hip
        
        Relax at exhale; ressit superior motion
        
        Enage new edge & repeat
        
        REASSES
        
        Adducting toward
        ipsilateral hip
      - 11-12
        QL
        (insertion on inferior aspect of rib 12-stretches hypertonic QL
        move into inhalation
        
        Contact and monitor posterior/medial aspect
        
        Reach around ipsiltaeral ASIS ; posterior force with
        lateral/superior force to rib
        
        Hold inhalation while pulling ispilateral hip anterioly
        
        Relax at exhale ; resist motion and POSTISOMETRIC
        
        Engage new edge
        
        Repeat and REASSESS
        
        Anterior force of
        Ipsilateral ASIS
  - - - Pt cross arms with forearms overlaping.
        Pt to lean forward resting forearms on Dr. Chest
        
        Contact ribs angles bilaterally with finger pads (start at upper ribs)
        
        Dr. stabilize using foot; apply anterolateral pressure
        
        Repeat and Reassess
    - - Patient's back @ cervicothoracic junction contact Rib angle with finger pads (lateral to costotransverse)
        2.Apply anterolateral pressure
        
        Maintain pressure unti release is palpated
        
        Repositon hands; repeat
        5 Repeat on contralateral side
        
        REASSESS
      - Balance Sympathetic Tone
- - - - Dr. stands at foot of table
        
        Grasp pt ipsiltateral leg; interanlly rotate; ABDUCT 10-15 degrees
        
        Drop patients leg off table (extending hip 10-20 degrees); Apply traction down shaft of leg
        
        Thrust
        
        Reasses
    - - Dr. stands at foot of table
        
        Grasp pt ipsilateral leg
        
        Abduct 10-15 and flex hip 10-15
        
        interanlly rotate
        
        Traction and Thrust
        
        Reasses
    - - Dr. stands at foot of table
        2.Dr. Grasps patients ipsilateral ankle; internally rotate (lock femur in acetambelum); ABDUCT leg 10-15 degrees
        
        Flex ispilateral hip 45 degrees: apply traction
        
        At exhlation Thrust
        
        Reasess
  - - - Place Dr. Hip against table/stablize pt
        
        Pt slide to edge of table and place ipsiltateral leg off table
        
        Contact the contralateral ASIS (stablize pelvis)
        
        Pt thigh anteriroly against force (rotates inominate anteriorly)
        
        Hold for 3-5 secs
        
        Pt relax, Repeat, Reasess
    - - Dr. stands at foot of table; contact pateints ipsilateral ankle
        
        Abduct and flex or extend until SIJ is decomprossed
        
        Interanlly rotate leg
        
        Apply traction by leaning back
        
        Pt pulls ipislateral hip upward (3-5 secvonds)
        
        POSTIOSMETRIC RELXATION
        
        Repeat and Reasses
        
        Force: Rock climbing
        Thigh up
    - - Place Dr. Hip against table and stablize pt
        
        Pt slide edge to table and place ipsilateral knee gainst shoulder
        
        Flex Pt hip (rotates inomate posteriorly)
        
        Pt push knee against Dr. shoulder while Dr. guides posterior rotation at ischial tuberosity. (Draws ischial tuberosity inferiorly): Reciprocal inhibtion of hypertonic muscles
        
        Hold for 3-5 seconds
        
        Pt relax, new barrier, repat, reasses
    - - Pt is PRONE
        
        Drop pt ipsilateral leg off table , flex their knee and place foot against Dr. thigh
        
        Dr. makes a fist and places it against ipsilateral ischiak tuberosity
        
        Pt to press left foot (kill an insect) for 3-5 seconds
        
        POSTISOMETRIC RELXATION
        
        Repeat, Reasses
    - - Dr. stands ipsilateral, ABDUCT and flex knee at 90 degrees
        
        Contact contralateral ASIS
        
        External rotation by pulling knee laterally
        
        Pt will push their knee medially (3-5 secs)
        
        POSTIOSMETRIC RELXATION
        
        Repeat and Reases
    - - Dr stands ipsilateral, flex the ipsilateral knee 90 degress leaving foot planted on table
        
        Contact pt contralateral ASIS to stablize pelvis
        
        Induce internal rotation and adduction (Dr. push the knee medially) to the edge
        
        Pt Push knee laterally (3-5)
        
        POSTISOMETRIC RELXATION
        
        Repeat and Reasses
    - - Dr. stands ipsiltateral, Pt moves to the edge of the table
        
        Ispiltareral leg hangs of the table (FLOOR off the table):
        
        Contact contralateral ASIS
        
        ABDUCT patines thing until motion is palpated at the pubic ramus
        
        Pt to lift thigh anterorly & slightly medially against force
        
        POSTISOMETRIOC RELEXATION
        
        Repeat and Reases
        
        Similar to posteriorly rotated innominate
        Except:
        
        ABDUCT until motion is felt at pubis
        
        Force is Anterior/medial
    - - Place pts ipsilateral knee against Dr. medial shoulder with pt right SIJ still on table
        
        ADDUCT pt thigh until motion is palpated at the pubic ramus
        
        Flex pt hip at barrier encouraging superior motion at the pubic bone by making fist and contact ischiabl tuberosity (superior motion)
        4.Pt to push knee inferiorly and laterally
        
        POSTISOMETRIC relexation
        
        Repeat and Reases
        
        Similar to anteriorly rotated innominate
        Except:
        
        ADDucted until motion is felt at the pubis
        
        Force is inferior/lateral
    - - Pubic shotgun technique
  - - - PRONE
        Indirect or direct. Typically, the pelvic diaphragm is inhaled-->direct engagement is needed
      - Place thumbs b/l on ischial tuberosities into ischiorectal fossa
        Roll thumbs medially
        Apply a superior, LATERAL force
        Inhale and exhale (resits on inhalation) and increase pressure on exhlation
        Return and Reasses
- - - - Place index/middle finger of left hand posterior TP of dysfunctional segment
        
        Right hand on top of pt head (rest elbow in front or on pt shoulder)
        
        Moving head to move segment into barrie in all three planes (F/E, SB/ R): Engage Barrier
        
        POSTISOMETRIC RELEXATION
        
        Repeat and Reases
    - - Same use torso for mobility
        
        POSTISOMETRIC RELEXATION
    - - Monitor the apex of the curve
        Repeat as Type II T1-T4
        POSTISOMETRIC RELEXATION
    - - Same use torso for mobility
        
        POSTIOSMETRIC RELEXATION
  - - - Pt crosses arm ovr chest, grasping shoulders with ipsilateral arm on top (same side as TP on top)
        
        Press pt elboews posteiroly and inferorly toward the ipsilateral ASIS (flexion and axial compresison)
        
        Pleace thenar emience posterior on the dysfunctional TP
        
        Place elbows on your epigastric region and flex the patient to the level of the dysfuntcion (SAME FOR FLEX/EXTENDED)
        
        Sidebend pt contralateraly
        
        Inhale/exhale localazie
        
        Thrust
        
        REASESS
- - - - Pt lies with restricted scpular up
        
        Knees are flexed
        
        Dr. contacts inferior portion/medial border
        of ipisltaeral and the thumb should contact the anterolataeral aspect of the scapula
        
        Stablize with other hand on the clavicle
        
        Assess for planes of motion
        
        Find area of restriction --> direct or indirect
- - - - Translation Emphasis
        Translate Force
        
        Stand at head of table
        
        Contact lateral aspect of articular pillars of Cx with lateral aspect of index finger on
        
        Flex pt head until motion is felt at Cx
        
        Sidebend the head and neck to the barrier from above to the level of C6. This will also induce rotation at Cx. Accenutate setup by translating Cx to the side of ease (side bend oppsoite) to engage translaton barrier
        
        Anteriorly translate articular pillars of C6 to localize
        
        If more localization is needed gently rotate head and neck to the side of ease (will lokc cervicals above Cx). Pt nose should not deviate past midline
        
        Inahle and exhale
        
        Thurst is qick translatory thrust to the ipsilateral side (opposite side bending) of the opp articular pills
      - Rotational Emphasis
        Rotate Force
        Rotate to barrier using opposite pillar
        
        Stand at the head of the table
        
        Contact posterior aspect of articular pillars of Cx with laeral aspect on index finger
        
        Flex patients neck until motion is palpated
        
        Rotate Cx to the restircted rotation. This will also induce sidebending. Pt nose should deviate past midline
        
        Anteriorly translate the articular pillars of C3 to localize
        
        If more localization is needed gently translate the head and neck to the barrier (same side bending) as it will lock cervicals above Cx
        
        Inhale and exhale
        
        Thurst, Return, Reasess (rotational thrust to barrier)
      - Translation
        SB to Barrier and Rotate to Ease
        Rotation
        SB to Ease and Rotate to Barrier
  - - - ROTATIONAL ONLY
        
        OA HVLA--> ipsi eye
        
        Place 2 MCP joint (right index finger) over the right inferior portion of pt occiput (right condyle is posterior. Hand should be perpendicular to the long axis of pt neck with hand pronated so that thumb is over patient's zygoma
        
        place left hand on the left side
        
        Apply a slight superior traction with ipsi hand to decompress OA joint
        4, Flex occiput by tucking pt chin to localize OA joint
        
        Apply slight anterior pressure with ispi hand (toward pt ipsilateral eye): COUPLES rotation and sidebending
        
        Apply further anterior translation (guide r. condyle anteriorly on c1)
        
        Inhalwe, exhale and apply corrective thrust
        Return and reases
      - AA HVLA (stand at head of table)--toward nose
        1. Placeipsilateral index finger on right articular pillar of C1.
        
        Opp hand on pt head
        
        Flex head up to 45 degress (lock out lower cervical segments)
        
        Apply slight anterior pressurewitjh ipis hand to anteriorly translate C1 on C2 and localize fore
        
        Both hands rotate head to opposite side
        
        Inhale and exhale
        Rotational thrust to the left from the right toward patients nose (AARR)
        
        Return and reases
- - - - Anterior lateral malleollus
        (posterior pressure)
        
        Contact pt ipislateral foot with caudal hand and place thenar emincne over anterior aspect of lateral malleolus
        
        Bring foot into slight pronation (draws lateral malleolus posteriorly) and stablize midfoot onto the table
        
        Engage restrctive barrier by adding posterior pressure on lateral malleolus
        
        Thrust is quick POSTEROLY directed thrust
      - Posterior lateral malleolus
        PRONE
        (anterior force)
        
        Foot is supported by pillow or haning off the table. Stablize foot and tibia with opp hand
        
        Contact posterior portion of lateral malleolus with ipis thena eminence
        
        Engage barrier with slight anterior pressure
        
        Force is ANTERIOR though lateral malleolus
    - - Anterior Talus Option 2
        Foot slighly off the table
        
        Support posterior, medial, lateral portions of the distal tibia
        
        Webspace between 1 and 2 MCP contacts superior apect of the talus
        
        Engage barrier by dorsiflexing foot and applying posterior force. Final corrective thurst is a short thurst directed posteriorly through the restrive barrier
      - Posterior Talus Option 1
        THORUGH TIBIA
        
        Cup pt right calcaenus to stablize foot relative to ankle
        
        Opp hand is on anterior aspect of pt right distal tibia
        
        Apply posterior force through distial tibia
        
        Final force is a quick posteriorly directed thrust
        Posterior motion of tibia will result in repositoning of the talus anteriorly in the talocrual joint
      - Anterior Talus Option 1
        INFERIOR WITH DORSIFLEXION
        
        Fingers are interlaced around the dosrum of the foot so that the 5th digits contact the anterior/superior talus (thumbs will be on the sole of the foot)
        
        Dorsiflex the foot to the restrictive barrier and induce traction by leaning back. Slight inersion/eversion of ankle can localize
        
        Exert POSTERIOR force on talus through 5th digit
        4. Enage barrier (final correct force is a J motion through the physicans hypothena eminences quickly pulling the foot inferiorly while increasing doriflexion
      - Posterior Talus Option 2
        Over Talus
        
        Doc hand is wrapped around dorsum of foot with 5 digit over talus
        
        Doc lateral hand grasp the calcaneus
        
        Engage by plantarflexing the foot, applying anterior force on the calcaneus and appplying a traction inferiorly
        Final corrective force is a TRACTIONAL/DISTRACTIVE thurst while guiding the foot into plantar-flexion and anterior glide
    - - Inferior Tarsal
        
        Cross-hand
        
        hypothenar eminence contacts inferior surface of tarsal while the other hand stablizes the tarsal: CROSS HANDS
        
        Final corrective force is a quick anteior force directed into the table through the restrictive barrier of tarsal
        
        Hiss whip
        
        Thumbs pressed on the inferior portion of the dropped or inferior dysfunctional tarsal/metatarsal. The whipping motion moves the dysfunctional bone toward the dorsal surface of the foot through barrier
        Final force is a Quick SUPERIRLY DIRECTED thrust and can be repeated 3 times
  - - - Anterior lateral Malleolus
        
        Both thumbs on anterior aspect of LM and fingers wrap posteriorly around pt ankle. Foot can rest on physcians thigh
        
        Induce pronation with thigh and apply a posterior force to the lateral malleolus
        
        Pt to plantarflex into your abdomen while providng PIR
      - Posterior Lateral Malleolus
        PRONE-->encourages plantar flexion
        
        Thumbs over posterior aspect of lateeral malleolus while wrapping the fingers around the dorsum of the foot and ankle
        
        Engage feather edge by inducing supinatioon by pressing the dorsum of the foot into the table while applying a gentle ANTERIOR force to the laterall malleolus with your thumbs
    - - Anterior Talus
        
        Dorsiflexion of the foot with a POSTERIORLY DIRECTED FORCE ON TALUS is used to posterioly glide the talus t
        
        Thumbs over anterior portion of the talus, wrap fingers on posterior and lateral aspect of ankle and calcanues. Stablie foot with other hand
        
        Engage barrier by PRONATING
        Instruct pt to PLANTAR FLEX
      - Posterior Talus
        Supinate (bring it anteriorly to barrier)
        then dorsiflexion (what they like)
        
        Plantarflexion of the foot with a gentle traction to improve anterior glide
        
        Supinate the foot and instruct the pt to dorsiflex their foot while providing force
- - - - Doc places hands on either side of the base of pt neck and thumbs contact TP of T1. Anteriorly contact the SC and Ribs 1 and 2. Posteriroly thumbs should contact T1 and 2
        
        Apply compression to engage fascia including sibson's fascia
        
        Hold 20-60 seconds until tissue creep indactes a change in tiusse tension
  - - - textSlight superiorly and medially compression force under costal margin to engage costal margin and fascia
        As pt exhales firm compression is unduced with a superomedial force vector in the direction of the uppermost dome of the diaphragm
        As the pt inhales, hold this compression (restricting full inhalation)
      - RESIT EXHLATION MANTAING DOME
  - - - Anterior Axillary Fold, Posterior Axillary, Antecubital Fossa, Carpal Tunnel Release
    - - Inguinal Ligament, Popliteal fossa, Achilies tendon
    - - TREAT
        
        Thoracic inlet
        
        Thoracic diaphrgm
        
        Lower extremitty baffles first
        
        2 compression per second
        Motion should be observed until the longitudinal fluid motion feels free of restriction
        
        Modification
        Placehands over dorsal aspect of ft
        Plantarflex pt feet and ankkles
        
        Maintain plantarflexion and begin rhytmic motion (augmenting plantarflexion)
    - - Modifcation 1
        Doc enchances the exhalation phase by slowing increasing pressure on the rib cage by following rivs posteroinferior motion as the patient exhales
        Stops motion as the patient inhales and limits inhalation by resisting antersuperior motion
        Return by gradually or slowly decreaseing posteroinferior pressure
      - Modifcation 2 (CONTRADICATED in COPD patients-- air trapping)
        
        pt turn head to side
        
        As pt begins last breathing cycle of Modifcation 1, the physcian abruptly rekease their presaure just as the patient initiates inhalation
        
        PT gasp and rapdily expand chest cavity.
- - - - Doc hand contact ipsi antecubital area with both thumbs while the remaining fingers wrap around posteriorly to contact either side of the olecranon
        
        Gently hold the pt ipsi hand/forearm in between the physcian thorax and arm (pt elbow should be slightly flexed)
        
        Doc will extend elbow and then gently glide olecranon LATERALLY while using body to ADDUCT ulna
        
        Final force is a quick LATERAL thrust
    - - Doc hand contacts pt ipsi antecubital area with both thumbs while remaining fingers are wrapped posterioly to contact either side of olecranon
        
        Gently hold pt ipsi hand/forearm between thorax and arm
        
        Doc will Extend and then gently glide olecranon MEDIALLY whichl using the body to ABDUCT ulna
        
        Final force is a MEDIAL direction
    - - Stand in front of Pt. Doc ipsi hand grasps pt hand in pronation with an underhand grip
        
        Opp hand grasp pt pxrimal forarm with the the thumb directly posterior to the radial head
        
        Starting with pt forarm pronated in a flexed postion, locate barrier. Apply anterior pressure to posterior aspect of radial head
        
        Apply thrust at radial head as pt forearm is brough into extension and supination through the barrier
    - - Doc grasp pt hand with thumbs on the dorsal aspect of the carpal.
        
        Press in a dorsal palmar direction (toward the floor)
        
        Thrust
    - - Stand in front of patient. The second and third fingers of doc opp hand are placed in patient lateral antercubital fossa, applying a posterior pressure over anterior aspect of radial head (fulcrum to thrust radial head posteriorly)
        
        Physcians ipsi hand grasps pt wrist in supination with an overhand grip. Pt forearm is then pronated until barrier is reached
        
        Pt forarem is brough into flextion maintaing pronation and fulcrum at radial head
        
        Thurst approximating distal end of forearm and humerus
        
        Return and reasses
    - - See posterior but thumbs are placed on palmar aspect of the hand
- - - - Stablize contralateral hip
        
        Bring hip into barrier by lifting leg and holding on arm or shoulder
        
        Pt drives force down into extension
    - - Abducting leg and hip
        stabalize contralateral ASIS
        Place Leg against Doc hip
        Pt ADD leg into docs hip
    - - Engage by bringing into external rotation
        
        support foot by grabbing ankle and supporting knee on lateral aspect
        
        Pt attmepts to place foot into midline
    - - Anteiror Fibular Head
        
        Posteiror medial direction
        Grab ankle and foot
        Engage barrier by placing fib head posteiror by (internal rotation)
        Pt attempts to pronate foot (what they prefer)
      - Supeior Fibular Head
    - - Externally Rotated
        
        Posterior and lateral
        Fine tune
        
        engage barrier by internally rotating
        2, Have pt externally rotate foot
      - Internally Rotated
        
        Anteriror and Meidal
        Fine tune
        
        1 engage barrier by externally rotate
        
        Interally rotate
    - - PRONE
        
        Being pt into barrier by flexing ft at knee and placing doc hand under knee
        
        Stabalize with ischial taberosity to prevent pelvis motion
        
        Engage barrier by bringing into exntension and then have pt flex hip
    - - Engage barrier by slight extnesion and adduction
        Pt drives force outwards into ABD
    - - Engage barrier by bringing into internal rotation
        
        Support by grabing ankle and knee
        
        Pt attempts to bring leg medially
  - - - Anterior Fibular Head
        
        Place pillow under pt right knee and upper calf
        
        Thenar eminence of hand is placed over anterior portion of the opposite fibular head
        
        Contact ipsilateral ankle at lateral malleolus with thumb while fingers wrap anteriroly over foot and medial ankle
        
        Engage barrier by internally rpotating ipsilateral ankley and moving lateral malleolus anteroly with the thumb and applying anterior to posterior force with thenar eminence
        
        Inhale exhale and thrust
        
        Final corrective force is a quick, POSTERIOR and MEDIALLY directed thrust through the fibular head
      - Posterior Fibular Head
        
        Flex pt hip and knee so that foot is off the table
        
        Place cephalad hand pronated in pt popliteal fossa posterior to fibular head . The hand placement will create a fulcrum around which will move head anteriorly
        
        With caudal hand externally rotate ankely and move the lateral malleolus posteriorly
        
        Final corrective forse is a quick flexing of the knee with cuuadal hand agaisnt fulcrum
- - - - ABDUCT ipsilateral leg to 15 degrees
        
        Interanlly rotate patients ipsilateral leg
        
        Monitor ipsilateral ILA and induce anterosuperior
        
        Inhale maximmaly and hold for 3-5 seconds while Dr. anterosuperior force on ipsilateral ILA
        
        Exhale while Dr. resists ILA motion
        
        Repeat
        
        Reasess
    - - Abduct ipsilateral lef to 15 degrees
        
        Externally rotate pt ipsilateral leg
        
        Pt into sphinx postion (sacrum flexes) while applying anterioinferior force on sacaral base
        
        Can monitor Joint or apply counterforce on ipsilateral ASIS
        
        Inhale while Dr. resist extension
        
        Repeat, Reases
    - - Pt lies with axis down
        
        Pull ipsilateral arm anterior and inferior (inducing right rotation/left SB of L5 until it rotates right
        
        Monitor Right sacral base: extend pt hips
        
        Keave patients bttom leg extended, drop upper leg off table. STABALIZE trunk with Dr. cephalad forearm
        
        Contact Right knee and have patient contract toward the ceilling
        
        Releax, New border, Reaeass
    - - Pt sits on table with feet touching ground. ADDuct and interanlly rotate both legs by instructing patient to sit with their feet apart and knees together
        
        Flex pts trunk forward (sacral base into extension): monitor sacral base
        
        Contact bilateral ILA with heel of hand; induce anterior motion of sacal until posterior motion is felt bilateral
        
        Move cephalad hand to back and instruct pt to inahle maximally and HOLD WHILE sitting up against force for 3-5 secs
        
        Exhale and Relax
        
        Repeat and Reasess
        
        Low Yield
    - - Pt with axis up
        
        Rotate trunk toward ceiling (until L5 begins to rotate left)
        
        Flex Pt's thighs and pelvis until motion is felt on dysfunctional base (contralateral)
        
        Introduce SB by lifting patients ankles toward ceeling
        
        POSTISOMETRIC RELEXATION
        
        Relax; engage new border; Repeat; REASSESS
    - - Pt sits on table with feet touching ground. ABDUCT/Externally Rotate Pt sit with feet together and knees apart
        
        Pt cross arms and extend their lumbar spine by arching their back. Dr. monitors sacrum and plsces other hand around pt
        
        Induce anterior motion
        
        Pt exhale maxially and HOLD while flexing forward against Dr. force
        
        Inahle and relax while Dr. resist sacral extension
        
        Repeat and Reasess