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41 Cards in this Set

  • Front
  • Back
OA has mostly _ with almost no _
FLEXION/EXTENSION

SIDE BENDING
When you diagnose OA which side is posterior
The sulcus that is deeper - NOT the one that is tender
Translational and side bending components of OA are same or opposite side?
OPPOSITE
Although OA doesnt follow Fryettes principles it follows _ like mechanics
TYPE I - rotation and side bending to opposite sides
Describe HVLA for OA
1.patient supine, doc standing at patient’s head with his/her hands on both sides of the patient’s neck
2.place metacarpophalangeal (MCP) joint on the posterior occiput (remember…tender DOES NOT equal posterior)
3.side-bend patient’s head towards the direction of rotation until you feel motion at the rotated segment (do not over bend), will be a very slight amount
4.rotate the patient’s head away from the side of rotation until you feel the selected segment “lock out” (be careful not to lose the side-bending you already induced), will be a very slight amount
5.once patient is locked out, thrust towards the patient’s opposite eye with slight rotational component (some traction of the OA will also have been induced by the rotational component)
6.RECHECK
In diagnosis of OA there is only _ component
ROTATIONAL
How do you termine which way is AA rotated
You flex head and turn it each way using nose as a pointer. AA is rotated TOWARDS freedom of motion
Describe HVLA for AA
1.patient supine, doc standing at patient’s head with his/her hands on both sides of the patient’s neck
2.place metacarpophalangeal (MCP) joint on the posterior transverse process (yes, C1 has a transverse process, not articular pillars) of C1 (side vertebrae is rotated towards), make sure you don’t have your thumb on the patient’s carotid or jugular
3.side-bend patient’s head towards the direction of rotation, slightly, until you feel motion at the rotated segment (remember, C1 does not actually have side bending capability, side bending should be very minimal)
4.rotate the patient’s head away from the side of rotation until you feel C1 “lock out” (be careful not to lose the side-bending you already induced)
5.once patient is locked out, thrust in the same direction as you have induced rotation towards (rotate his/her head slightly farther than the restriction)
-you should not be thrusting so the patient’s nose ends up pointing directly to the side, but instead it should be pointing slightly more cephalad
-be sure patient’s neck muscles are relaxed before you thrust (often having him/her inhale and thrusting on the exhale helps)
6. RECHECK
Describe cervical C3-C7 HVLA
1.patient supine, doc standing at patient’s head with his/her hands on both sides of the patient’s neck
2.place metacarpophalangeal (MCP) joint on the posterior articular pillar (where the facets come together) of the rotated vertebrae (side vertebrae is rotated towards), make sure you don’t have your thumb on the patient’s carotid or jugular
3.translate the patient’s head in direction opposite from the way they are rotated, until you feel motion at the selected segment
4.side-bend patient’s head towards the direction of rotation until you feel motion at the rotated segment (do not over bend)
5.rotate the patient’s head away from the side of rotation until you feel the selected segment “lock out” (be careful not to lose the side-bending you already induced)
6.once patient is locked out, thrust in the same direction as you have induced rotation or towards the restriction, using either a rotational or side bending thrust
-be sure patient’s neck muscles are relaxed before you thrust (often having him/her inhale and thrusting on the exhale helps)
7.RECHECK
Is HVLA direct or indirect technique
DIRECT - move into and through the barrier
Quadratus Lumborum is attached to _
12th rib
Iliac crest
Vertebral column
Quadratus Lumborum functions with _
RESPIRATION
Quadratus Lumborum stabilizes _
Origin of the diaphragm
Innervation of the Quadratus Lumborum
T12-L3
Bilateral contraction of the Quadratus Lumborum causes _
EXTENSION
Unilateral contraction of the Quadratus Lumborum causes _
Extension and ipsilateral side bending
Quadratus Lumborum spasm causes _
- Low back pain
- Referred pain to hip and groin
- Exhalation 12th rib dysfunction
- Diaphragm restriction
Psoas syndrome presents how?
Initially as bilateral psoas spasm but later concentrates on one side
Key somatic dysfunction in Psoas Syndrome
Non-neutral dysfunction of L1-L2
Origin of Psoas
L1-L4 (L5)
Where does psoas extend
Over pubic ramus and under the inguinal ligament
Psoas inserts _
On lesser trochanter on the medial side of the femur
Psoas is innervated by _
L2-L3
Function of psoas
Flexes trunk on thigh, flexes lumbar spine and laterally flexes lumbar unilaterally

Shortens and externally rotates the leg
When considering psoas syndrome as diagnosis you must first rule out organic causes - name them
- Femoral bursitis and arthritis of the hip
- Iliac or femoral phlebitis
- Retroperitoneal lymphadenopathy
- Diverticulitis of the colon
- Cancer of sigmoid or descending colon
- Renal or urethral dysfunction (calculi)
- Prostatitis, salpingitis, appendicitis
How do you usually get psoas syndrome

Explain physiologically
Sitting in a soft chair or slumped in hard chair OR bending over at waist for a long period of time - then patient returns to neutral suddenly

When person is in flexed position, intrafusal muscle fibers of spindle tighten to better monitor relaxed fibers of the psoas muscle. Rapid return to neutral produces confusion of spindles and spinal cord - CAUSE SPASM OF PSOAS
Describe findings in Left Psoas Spasm
At first both are involved causing flattening of the lumbar spine (forward bending). Then one usually becomes more prominent

- L1 or L2 will rotate left and sidebend left - then the rest of the spine will side bend left

- Other vertebrae act according to type I

L1 or L2 = KEY LESION
If spastic psoas carries through to the sacrum, left side bending induces _
Non-neutral sacral response
In LEFT SPASM OF PSOAS

_ oblique axis is engaged

_ rotation of sacrum

_ sulcus is shallow

_ prominent ILA
LEFT axis

RIGHT rotation

RIGHT

RIGHT
Where does pelvic side shift occur in psoas dysfunction
TO OPPOSITE SIDE
In psoas spasm you can get sciatic nerve irritation on which side
OPPOSITE (same side of piriformis spasm)
What is the pain location in psoas spasm
Gluteal muscular and posterior thigh pain that doesnt go past the knee (OPPOSITE SIDE)
Describe pain development in psoas syndrome
First there is pain when patients sits especially straight and also vague pain in lumbar and lumbo-sacral area.Soon key lesion pain leaves and moves down and over to OPPOSITE SI JOINT. Now patient is bent forward and to the same side but there is not much pain. Same side leg is short and EXTERNALLY ROTATED
Piriformis on the opposite side is involved so pain includes gluteal area on the opposite side, then sciatic irritation occurs, pain develops down the posterior thigh
Describe treatment for psoas syndrome
Depends on acuteness and stage - remember to rule out and treat any organic cause - use counterstrain on iliopsoas point - patient supine with knees flexed
- Ice
- HVLA if not acute
- Must cool down acute muscle - DO NOT STRETCH
How would weak psoas present in a patient
Allows excessive backward bending of lumbar spine because of strong back muscles - Increased lordosis, protruding abdomen
Define piriformis syndrome
Peripheral neuritis of sciatic nerve caused by the abnormality of the piriformis muscle
Origin of piriformis
Anterolateral border of the sacrum at SI joint capsule

Anterior portion of sacrotuberous ligament
Insertion of piriformis
Superomedial aspect of greater trochanter of femur
Describe path of sciatic nerve
Passes through greater sciatic foramen, under piriformis and on posterior thigh
Name causes of irritation of sciatic nerve
- Piriformis muscle spasm
- Piriformis contracture
- Local trauma to buttocks
- Repeated mechanical stressors (running)
- Sacral base unleveling
- Pelvic instability
- Excessive local pressure
- Anatomic variation
- Local inflammation
Irritation of sciatic nerve is easily confused with _
Herniated disk or facet joint pathology