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Treatment by Region, Quadratus Lumborum m. used insertion on inferior…
Treatment by Region
Lumbar
Recumbent
HVLA (DIRECT)
Type I
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
Type II
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
ME (DIRECT)
Type I
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
Type II
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
Soft Tissue
MFR
Ribs
(Secondary to Thoracic DYS)
Treat Thoracic first)
HVLA-DIRECT
[Supine]
Standing c/l to SD
•Pt top arm i/l SD
•Pt SB toward c/l SD until motion is felt @ rib
Flex + SB to engage barrier
Inhaled=inferior
•Thenar Inferior of Post Rib
(up in front, down in back):
Encourages movement superiorly
Exhaled= superior
Thenar Superior of post Rib
(Down in front, up in back):
Encourages movement Inferiorly
ME DIRECT
Inhaled
Resist Inhalation
Encourage Exhalation
F/SB encourage rib to move down in front; up in back
Stand at head of bed
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
Exhaled
PT HOLD INHALATION
Resist exhalation & encourage inhalation
Post Rib Hand Placement
Dr inferior force (except 11-12)
Ipsilateral side standing
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
Articulatory Techniques
Seated Rib Raising
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
Supine Rib Raising
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
Thoracic
ME
(seated)
Type II
T1-T4
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
Type I
T5-T12
Same use torso for mobility
POSTISOMETRIC RELEXATION
Type I
T1-T4
Monitor the apex of the curve
Repeat as Type II T1-T4
POSTISOMETRIC RELEXATION
Type II
T5-T12
Same use torso for mobility
POSTIOSMETRIC RELEXATION
Soft Tissue
HVLA
Supine
•Stand Opposite Side of Rotation/Post TP
Flexed
Thenar Eminence directly on TP and thrust
will bring segment through extension, rotation, side bending barriers
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
Extended
Thenar Eminence TP of segment below dysfunction on side of rotation
Shoulder
ME
ADDucted AC
AC Joint
Abduct shoulder
POST ISOMETRIC RELEXATION
ABducted AC
Monitor Clavicle at lateral end (medial to ac joint
Contact pt elboew and bring into 30 degree felexion
Engage barrier (adduction)
Pt will bring arm into abduction
POSTISOMETRIC RELEXATION
Interanlly rotated AC
Monitor lateral end of clavicle
Bring forarm 90 abduction and
30 degress of horixontal
enagage barrier with external rotation and
Pt will bring arm into interanl rotation
POSTISOMETTRIC RELEXATION
Externally Rotated AC
Contact lateral edge of clavicle
Arm 90 degrees abduct; 30 degrees of flexion
Internally roate arm and pt pushes externally
POSTISOMETRIC RELEXATION
Anterior SC
monitor anterior/medial aspect of clavicle
Pt drapes ipsilateral arm over Dr. shoulder
Contact posterior border of pt ispiclateral scapula
Dr Apply anterior force of scapula; Feather edge
Posterior pressure of the head of clavicle
Pt will bring shoulder posteriorly
POSTISOMETRIC Relexation
Superior SC
Supine
Pt scoots to edge of table ipsilateral
Montior clavicular head at superior
Bring arm into extension; internal rotation (clavicle moves inferiorly)
Apply inferior motion to head of clavicle
Pt brings arms toward ceiling
MFR
Follow the creep
Restricted Scala
Pt lies with restricted scpular up
Knees are flexed
Dr. contacts inferior portion/medial border
of ipisltaeral
Stablize with other hand on the clavicle
Assess for planes of motion
Find area of restriction --> direct or indirect
Spencers Tecniques (8 parts)
Eat=Extension
Fried=Flexion
Chicken=Compression
To=Traction
Add Extra= Add w/ Ext Rot
Abs= Abduction
In = Internal Rotation
Milk=Joint Pump/Milking
Stablize scapula; pt is with scapula up
Extend shoulder and assess
Elbow supierorly and assess for restriction
Abduct 90 degress and cicurmcoduction (clockwise&counterclockwise
Elbow 90 Abduction and Tract toward ceeling and circles (clockwise and counterclokwise)
Contact forearm of Dr. and apply force toward the floor; pt will bring force toward the ceeling
Abduction
Place hand at the back of back or on hip and bring elbow anteriroly
Grab pt hand on Dr. shoulder and miling (inferior fore)
Pelvis
Supine (except inferior inom shear)
HVLA (DIRECT)
Supine
Posteriorly Rotated Innominate
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
Superior Sheared Innominate
Dr. stands at foot of table
Grasp pt ipsilateral leg
Abduct 10-15 and flex hip 10-15
interanlly rotate
Traction and Thrust
Reasses
Anteriorly Rotated Innominate
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
ME
Post Roated Innominate
Hypertonic hamstrings
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
Superior Innominate Shear
QL, Rectus abdominus
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
Ant Rotated Innominate
(Hypertonicity of Rectus femoris, iliacus
ipsi adductor group)
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
Inferior Innominate Shear
PRONE
Hamstrings & Quadriceps
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
Innominate Inflare (Faber)
Hip ADDuctors & Ilopsoas
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
Innominate Outflare
Hip Abductors
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
Superior Pubic Shear
Rectus Abdominus
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
Inferior Pubic Shear
Hip extensosrs and ABductors
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 Compression
Pubic shotgun technique
Wrist/Hand
HVLA
Abducted Ulna
Adducted Ulna
Posterior Radial Head
Posterior Intercarpal
Anterior Radial Head
Stand in front of patient
Anterior Intercrpal
ME
Posterior Radial Head
Extended Wrist
Anterior Radial Head
Flexed Wrist
Abducted Ulna (humeroulnar joint)
Adducted Wrist
Adducted Ulna (humeroulnar joint)
Abducted Wrist
Sacrum
"Rotation On Axis"
ME
Unilateral Flexed Sacrum
HOLD INHALATION
-Resist flexion with anterior force
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
Unilaterally Extended Sacrum
HOLD EXHALATION
Resist extensionwith anterior force
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
Backward Sacral Torsion
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
Bilaterally Flexed Sacrum
HOLD INHALATION
-Resist flexion with anterior force
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
Forward Sacral Torsions
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
Bilaterally Extended Sacrum
HOLD EXHALATION
Resist extensionwith anterior force
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
Quadratus Lumborum m. used
insertion on inferior aspect of 12 rib--> pulls key rib into exhalation