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147 Cards in this Set
- Front
- Back
- 3rd side (hint)
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When doing postural analysis, what are you looking at the calcaneus for?
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To see if the calcaneus is turned internal or external on one or both sides and to note any pronation or supination
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If the calcaneus is turned externally (pronation present), what are the correlations?
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Over pronation: weak tibialis anterior, do 1 leg standing test
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If you note external rotation of the lower extremity, what are the correlations?
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Overactive piriformis and adductor weakness
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If you note pelvic unleveling, what are the correlations?
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G. medius weakness, QL/TFL hypertonicity, leg length; do hip abduction and 1 leg standing tests
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If you note anterior pelvic tilt, what are the correlations?
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G. max weakness, Erector spinae and/or iliopsoas hypertonicity; do hip extension test
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If you note thoracolumbar hypertrophy, what are the correlations?
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G. max/multifidus/abdominal weakness; do hip extension, back extensor, trunk flexion tests
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How long do you do the 1 leg standing test for?
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Up to 20s eyes open then closed (but if fail w/ eyes open, don't do w/ eyes closed!)
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What qualities are you looking for in the 1 leg standing test?
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Excessive LE motion, pelvis/shoulder unleveling, overall posture
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What correlations are derived from the 1 leg standing test?
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Over pronation/mid-stance during gait; do hip abduction test
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What treatment can be given if pt fails 1 leg standing test?
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Sensory motor training and G. medius facilitation
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What qualities are you looking for in the squat strength/coordination test?
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Heel rise, knee varus/valgus, loss of lordosis/stooped position, poor balance
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What correlations are derived from the squat strength/coordination test?
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Endurance of gluteals/quads; do hip extension and back extension tests
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What advice do you give someone who fails the squat strength/coordination test?
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Maintain lordosis during lifting
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What manipulations are indicated w/ the squat strength/coordination test?
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Foot/ankle, hip, SI
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What relaxation/stretching exercises are indicated for the squat strength/coordination test?
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Hamstrings, gastroc-soleus, adductors
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What coordination/endurance exercises are indicated in the squat strength/coordination test?
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Bridging, squatting, lunging
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What qualities are you looking for in the trunk flexion or dynamic trunk flexion tests?
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Heel raise and lumbar spine hyperextension
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What correlations are derived from the trunk flexion and dynamic trunk flexion tests?
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Inhibited rectus abdominus, overactive T/L paraspinals, Iliopsoas, repeated trunk curl test, anterior pelvic tilt
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What advice do you give someone after the trunk flexion/dynamic trunk flexion tests?
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Abdominal co-contraction during lifting
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What manipulations are indicated w/ the trunk flexion/dynamic trunk flexion tests?
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Lumbar spine
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What relaxation/stretching exercises are indicated for the trunk flexion/dynamic trunk flexion tests?
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Iliopsoas and erector spinae
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What coordination/endurance exercises are indicated in the trunk flexion/dynamic trunk flexion tests?
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Pelvic tilts, dead bugs, respiration training
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What qualities are you looking for in the hip extension test?
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L-spine hyperextension, thoracolumbar muscle contraction/G. max quiet, anterior pelvic tilt, knee flexion, trunk/shoulder movement
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What correlations are derived from the hip extension test?
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Poor proximal stability, facet overload, squat/back extensor tests, toe-off during gait
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What advice do you give someone after the hip extension test?
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Proper lifting technique, rising from sitting, gait re-education
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What manipulations are indicated w/ the hip extension test?
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Hip, L/S and T/L junctions, SI, fibular head, feet
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What relaxation/stretching exercises are indicated for the hip extension test?
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Iliopsoas, rectus femoris, hamstrings, erector spinae
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What coordination/endurance exercises are indicated in the hip extension test?
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Pelvic tilts, bridges, rocker board, squats, lunges
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What qualities are you looking for in the hip abduction test?
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Limited ROM, hip hiking, trunk rotation, externally rotated leg, hip flexion
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What correlations are derived from the hip abduction test?
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Inhibited G. medius, overactive adductors, QL, TFL, pelvic unleveling, one leg standing
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What advice do you give someone after the hip abduction test?
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Gait re-education
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What manipulations are indicated w/ the hip abduction test?
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Hip, L/S, SI, L2-3, Feet
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What relaxation/stretching exercises are indicated for the hip abduction test?
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Piriformis, adductors, QL, TFL, Iliopsoas
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What coordination/endurance exercises are indicated in the hip abduction test?
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One leg bridge, leg abductions, lunges, rocker board
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What other factors are indicated w/ the hip abduction test?
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Leg length inequality, hyper-pronation syndrome
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What qualities are you looking for in the static back extension test?
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Shaking and loss of horizontal position
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What correlations are derived from the static back extension test?
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Endurance of multifidi, gluteals, hamstrings
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What advice do you give someone after the static back extension test?
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Lifting advice
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What manipulations are indicated w/ the static back extension test?
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Hip joint in extension, T/L, lumbar spine
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What relaxation/stretching exercises are indicated for the static back extension test?
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Iliopsoas and erector spinae
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What coordination/endurance exercises are indicated in the static back extension test?
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Quadriped cross crawl, superman
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In the postural analysis of the C/T region what are you assessing?
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Winged scapula, elevated shoulder, forward head posture, rounted shoulders (protracted scapula), internally rotated arms, SCM prominence, suboccipital/upper trapezius hypertonicity (seated to standing position)
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What correlations are present w/ winged scapula?
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Weak serratus anterior, hyperactive rhomboids; do push-up test
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What correlations are present w/ an elevated shoulder?
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Inhibition of lower traps/serratus anterior, hyperactive upper traps/levator scap; do arm abduction test
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What correlations are present w/ forward head posture?
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Inhibition of deep neck flexors, hyperactive SCM/suboccipitals; do neck flexion test, palpation
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What correlations are present w/ round shoulders (protracted scapula)?
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Weakness of middle traps, hypertonic pectorals; do arm abduction test
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What correlations are present w/ internally rotated arms?
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Weakness of middle traps, hypertonic pectorals/lat. dorsi
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What correlations are present w/ supoccipital/upper trapezius hypertonicity (seated to standing palpation?
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If greater standing, FHP may be secondary to forward drawn pelvic posture (weak G. max, short psoas, hypermobile L/S)
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What qualities are you looking for in the arm abduction test?
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Hiking of shoulder before 60 degrees abduction, primary movement in the GHJ
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What correlations are derived from the arm abduction test?
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Inhibition of lower traps/serratus anterior, hyperactive upper traps/levator scap, elevated shoulder
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What advice do you give someone after the arm abduction test?
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Proper breathing, Brugger, workstation, scapula stabilization during exercise (rows, pull downs, pec decs)
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What manipulations are indicated w/ the arm abduction test?
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AC, SC, C/T joints
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What relaxation/stretching exercises are indicated for the arm abduction test?
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Upper traps, levator scap, pectorals, subscap, lat dorsi
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What facilitation exercises are indicated w/ the arm abduction test?
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Abdominal respiration, scapula depression
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What qualities are you looking for in the neck flexion test?
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Jull modification (10s hold/sudden release), tremor, head up or down, chin jutting, difficult recovery
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What correlations are derived from the neck flexion test?
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Inhibition of deep neck flexors, hyperactive SCM/suboccipitals, palpation, FHP, FPP, rounded shoulders (protracted scapula)
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What advice do you give someone after the neck flexion test?
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Chin leading, proper breathing, Brugger, Glasses
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What manipulations are indicated w/ the neck flexion test?
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C0-C1, C/T, upper ribs
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What relaxation/stretching exercises are indicated for the neck flexion test?
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SCM's, Scalenes, suboccipitals
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What facilitation exercises are indicated w/ the neck flexion test?
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Abdominal respiration, deep neck flexors
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What qualities are you looking for in the push-up test (both all fours or toes)?
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Scapular winging, retraction, elevation
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What correlations are derived from the push-up test?
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Weak serratus anterior, overactive rhomboids/upper traps/levator scap
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What advice do you give someone after the push-up test?
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Avoid slumped postures
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What manipulations are indicated w/ the push-up test?
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Upper thoracic spine in extension
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What relaxation/stretching exercises are indicated for the push-up test?
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Upper traps, levator scap, pectorals
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What facilitation exercises are indicated w/ the push-up test?
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Push-up w/ plus and serratus punches
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What qualities are you looking for in the respiration test (seated, standing or supine)?
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Belly protrusion, horizontal expansion, clavicle, shoulder elevation, paradoxical
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What correlations are derived from the respiration test?
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Overactivity of the scalenes and upper traps
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What advice do you give someone after the respiration test?
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Avoid slumped postures
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What manipulations are indicated w/ the respiration test?
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Ribs 1-4 into depression
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What relaxation/stretching exercises are indicated for the respiration test?
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Upper traps, levator scap, pectorals, scalenes
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What facilitation exercises are indicated w/ the respiration test?
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Diaphragm, yoga
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Contract Relax Agonist Contract (C.R.A.C) is _______ contraction.
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isometric, for example: Hamstrings
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Eccentric Muscle Energy Procedure (M.E.P)
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Connective Tissue changes in myofascial elements (hamstrings)/ Concentric followed by eccentric /Fascial stretch
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true myofascial shortening, not just facilitation
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PFS Post facilitation stretch
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PFS maximum contraction range?
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7 – 10 seconds, for example: iliopsoas. Passive stretch Held up to 20 seconds
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Sterno-symphyseal syndrome
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Brugger's posture for relaxation while seated (edge of chair, legs Abducted and externally rotated, Rest weight on legs/feet & relaxa abdominal mm., anterior pelvic tilt, maximum lordosis by lifting sternum up. Supinate and externally rotate arms/forearms.)
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Why is Brugger's posture called Sterno-symphyseal syndrome?
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Because the sternum approximates the pubic Symphysis
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Regarding Bruegger's postural Sterno-symphyseal syndrome, first give
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Advice
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Upper crossed syndrome Is associated With increased muscular tension, and faulty _______?
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Respiration habits
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Name the muscles associated with Brugger's Sterno-symphyseal posture
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Upper fixators of the shoulder girdle/ Pectorals/ Upper extremity flexors/ Abdominals/ Hip flexors/ Adductors/ Posterior calf muscles
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Muscle tension is reversible by?
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Simply having the patient sit up straight
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With the sternum approximating the pubic symphysis, diaphragmatic inhibition results in overactivation of
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scalene and upper trapezius musculature during respiration.
Excessive shoulder girdle involvement during INHALATION. |
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Keys to Bruegger's detection?
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Upper traps
Scalenes Faulty respiration *all due to myofascial syndrome created by basically upper and lower crossed syndrome got from sitting too long |
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By learning to sit upright, one increases the lumbar _______ of the back (the Relief Position).
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lumbar lordosis
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Explain Bruegger's Relief Position for sterno-symphyseal syndrome:
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Sit at the edge of a chair.
Abduct legs slightly. Externally rotate legs slightly. Rest weight on legs/feet & relax abdominal muscles. Tilt pelvis forward & lift sternum up thus increase lumbar lordosis to its maximum. Supinate forearms. Externally rotate arms. |
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With the patient in the "Brugger relief position" previous areas of palpable tenderness should be palpated again. They should be found to be ?
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They should be found to be much softer and less tender.
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How often to incorporate Bruegger' relief position into sitting, walking, standing?
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10 seconds every 20 minutes
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Intention of Bruegger's relief coaching
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To get the patient to automatically adopt the relief position, incorporating it into sitting and standing naturally
(Craig Leibenson) |
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Muscles overactive in sedentary postures:
SHITSUGARPLuMS- it's the QL! |
Serratus
Hamstrings Iliopsoas TFL/ (iliotibial band) Soleus - Gastroc complex Upper trap Adductors Rectus femoris Pectoralis major Longissimus thoracis Masticatory muscles QL |
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Muscles overactive in sedentary postures: (15)
SHIT SUGAR PLuMS - it's the QL! |
Gastroc-soleus Complex
Hamstrings Adductors Rectus Femoris TFL/ITB Iliopsoas QL Longissmus Thoracis Pec Major Upper Trap Levator Scapulae SCM Suboccipital Mastication muscles |
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Post Isometric Relaxation steps:
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Patient positioning
“Wind-up” the muscle (taking up the slack) Engage the barrier Isometric contraction Eye movements Breathing Wait Feel the release Guide into lengthening |
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Normal Lordosis = how MEASURED?
Angle of Cervical Curve Mean: Minimum: Maximum: |
DRAW LINE ALONG ATLAS, BOTTOM OF C7, CONNECT PERPENDICULAR ANGLES. SHOULD MEASURE out a mean of ~ 40degrees, +/- 5degrees.
Cervical: 40 all others are +/- 5 |
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May lead to FACET JAMMING
Is associated with KYPHOTIC THORACIC spine |
HYPERlordosis
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Complete reversal of cervical lordosis leads to _______ deformity and may be the result of ________ instability.
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SWAN NECK
SURGICAL (secondary reversal) |
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*****RED FLAG for ligament instability in the neck
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ACUTE ANGULAR KYPHOSIS
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Cervical Gravity Line
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Plumb line measured from the apex of the dens should intersect C-7 body
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Normal
Hyperlordosis Hypolordosis Alordosis Kyphosis Kypholordosis Complete reversal of lordosis Acute angular kyphosis |
CERVICAL LORDOSIS types
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Normal
Hyperkyphosis Hypokyphosis Lordosis |
THORACIC KYPHOSIS types
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Thoracic kyphosis measurements vary according to ______ & _____
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age & gender
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Disorders that alter thoracic kyphosis
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C.O.D.S.
Compression fractures Osteoporosis Disc degeneration Scheuermann’s disease |
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Examples of HYPOkyphosis of thoracic region
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"flat back" syndrome
"SENILE" kyphosis with fractures |
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NORMAL LUMBAR lordosis measurement
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50-60 degrees
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Normal lumbosacral angle range
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26 - 57 degrees
(normal is 50-60*) |
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Hyperlordosis
Sway back Hypolordosis Antalgic hypolordosis |
Conditions of the LUMBAR LORDOSIS
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Lumbosacral angle is also called: (2)
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FERGUSON'S ANGLE
or SACRAL BASE ANGLE Normal Range: Mean: 41 degrees Minimum: 26 degrees Maximum: 57 degrees |
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LUMBOSACRAL angle (Ferguson's/Sacral base angle)
Normal Range: Mean: Minimum: Maximum: |
41 degrees is normal lumbosacral angle/Ferguson's/sacral base
26-57 degrees min-max |
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Facet Imbrication - which is least stressful on facets?
Standing Sitting on flat stool Sitting on low stool Sitting on oxford chair |
Looks like sitting on Oxford chair is best
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A disc herniation can cause ______ ______ posture.
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ACUTE ANTALGIC posture
or acute antalgic LIST |
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Describe appearance of rotated pelvis on AP lumbopelvic view
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One ilia is broad and large while other appears narrow (that's the rotated one)
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What tool can you use to compare a normal cervical spine study (flexion/neutral/extension)?
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OVERLAY TEMPLATE
*2 ways: 1. RANGE - measure range from flexion through neutral to extension using a tracing of the cervical vertebrae 2. INDIVIDUAL MOVEMENT - Trace each vertebrae and compare how much each moves individually flexion/neutral/extension |
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In the Right oblique/AP/Left oblique series, what is observed in the patient (in this particular instance)?
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OCCIPITALIZATION
(sinking of head into and past first cervicals) |
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Case Study - see it:
23 year old DC student Upper cervical clicking Auto manipulation |
showed approach of lateral mass to dens on left lateral flexion, hence the clicking
*meaning, put patient through motion for radiographs. Static poses from AP aren't always best. |
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Minimal C2-3, C3-4 hypermobility
Global hypomobility C5-6 degeneration |
case study - see it
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Case studies - see them:
21-year-old female with neck pain Kypholordosis Lumbar Lateral Bending Study Lateral Bending Study |
see case studies
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2 phases of gait
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STANCE (60%) of normal cycle
& SWING (40%) of normal cycle |
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Gait phase we spend the most time in?
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STANCE 60%
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Parts of STANCE (4)
HFMP Help! Feel My Pulse! |
Help! Feel My Pulse!
Heel strike Flat foot Mid stance Push/Toe off |
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Parts of SWING (3)
Pick up celery Swing celery Put down the celery |
Acceleration (pick up celery)
Midswing (swing the celery) Deceleration (put down the celery) |
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Why examine gait at all?
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Antalgic gaits give away a lot of information.
To determine WHICH phase and what component (limp, etc.) the problem is in. ie, Stance during heel strike foot slap - inability to dorsiflex - L5 nerve damage Plantar fascitis will also cause flat footed gait because of not wanting to heel strike. is phase and part |
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Measurable determinants:
Width of the base should be? |
1.Width of the base:
2 – 4 inches heel to heel instead of a wide stance (cerebellar, rough Sat. night, etc.) |
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Center of Gravity should oscillate no more than?
*He says this one is very important and we take it for granted |
2.Center of Gravity:
no more than 2” of vertical oscillation from the sacral base at the most Easily demonstrable |
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During stance phase, except during heel strike when knee is fully extended, the knee should or should not be flexed during all other components of stance? Why?
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The knee is flexed during all parts of stance EXCEPT heel strike.
Good knee movement is necessary. Helps maintain center of gravity (COG) and keep it from moving more than the preferred 2' oscillation. ie, meniscal problem will begin to display oscillatory motion of center of gravity. |
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LIMIT of pelvis and trunk shift LATERALLY during gait and to which side?
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4. Pelvis and trunk shift laterally: approximately 1” to weight bearing side so gluteus MEDIUS can be more efficient as you shift over
Example of excessive shift: weak gluteus medius is the lurch (pelvis also will shift anteriorly in a thrust if quads are weak - this is covered under acceleration component of swing) |
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Average length of step?
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5. Average length of step: 15"
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How many steps per min. does the average person take? (CADENCE #)
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6. Cadence:
90-120 steps/minute Shuffling gait of PARKINSON'S changes cadence. |
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By what percentage does the pelvis rotate around the hip during gait? During what phase?
(Your waddle percentage) |
7. Pelvis rotation during SWING phase: 40º around opposite hip in stance
*pelvis is rotating around stance phase foot/hip 40%. This is your percentage of 'waddle' - I just made that up. |
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In what phase do most problems result in PAIN & an ANTALGIC GAIT?
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STANCE =
*the weight bearing phase causes pain so patients try to avoid whichever component (Heel strike/Foot flat/Midstance/ Push/toe off) |
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FOOT problem that might make patient try to avoid HEEL STRIKE of Stance phase:
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HEEL SPUR
*patient may HOP to AVOID heel strike component of stance or MAY WALK ON TOES |
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KNEE problem that might make a patient try to avoid HEEL STRIKE of Stance phase:
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WEAK QUADS or FUSION in knee = UNSTABLE KNEE
that alters heel strike Normally during heel strike you would extend your knee, but if fused in flexion or weak quads won't allow extension, the heel strike is off. |
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What would cause a rough landing during FLAT FOOT component of stance?
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FOOT SLAP/DROP (weak or paralyzed dorsiflexors cannot control elongation)
*DORSIFLEXORS permit the foot to perform a smooth ECCENTRIC contraction and intentionally PLACE the foot on the ground instead of slapping it. |
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During what component of stance is the weight borne equally over all aspects of the foot? __________.
In this component, name a couple of things that might make a patient want to avoid full foot contact with the ground: |
MID STANCE is full foot contact.
This is when we see a lot of problems and the gluteus medius and maximus lurches appear. Unstable knee gaits Pain from arthritis Calluses over metatarsal heads (inflammation of metatarsal phalangeal joints above a collapsed transverse arch) Corns on dorsum of toes |
Treatment for metatarsalgia is orthotics and other connective tissue procedures.
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During MIDSTANCE of stance phase, how do the quads help the knee?
What would happen if a patient's quads were weak? |
During MIDSTANCE, the quads hold the knee stable when the knee is BENT.
Weak quads mean an unstable knee, bent or straight! |
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In MIDSTANCE component of stance phase, what two pathological motions might you see?
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Gluteus MEDIUS lurch (ABduction). If gluteus medius is weak then much shifting over leg occurs.
~Susan Sarandon's milk with that shake Gluteus MAXIMUS lurch (EXtension) Not as common. Most important during TOE OFF according to tape but answer is midstance ~Frankenstein or an ice skater? |
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During PUSH/TOE OFF component of stance phase, if I'm not pushing off with my great toe, what might be the problem(s)?
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HALLUX RIGIDUS -smash the 1st metatarsal joint to stop someone
METATARSALGIA (callosities with dropped transverse arch) Corns on the 4th & 5th toes - evident by shoe CREASE - indicates that I push off with LATERAL side of forefoot instead of toe If the knee isn't happy, there is no Push/toe off, either |
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Why are there FEWER problems DURING SWING phase?
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NON-WEIGHT BEARING
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Name the parts of SWING phase again:
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Acceleration
Midswing Deceleraton (pick up the celery, swing it, put it down) |
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What might be a problem with the patient's FOOT during ACCELERATION phase of swing?
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DORSIFLEXORS again!
Trying to get GROUND CLEARANCE. So they start to raise whole leg up. |
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During ACCELERATION component of swing phase, a person needs to FLEX THE KNEE by ___% MAX
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65% MAX knee flexion during acceleration component of swing
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What is a potential HIP problem during ACCELERATION component of swing?
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EXAGGERATED HIP THRUST FORWARD (look out for this person if they are only wearing a trench coat!)
**has WEAK QUADS if exaggerated hip thrust during acceleration because they are literally having to throw their leg forward. Could also be, according to tape, weak FLEXORS of hip. |
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In stance phase, this is called foot drop. In MIDSWING of swing phase, lack of dorsiflexor strength would give a patient ________ gait.
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STEPPAGE
*lack of dorsiflexion in ANKLES causes TOE to SCRAPE, leading to steppage gait. |
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During DECELERATION of swing phase, what group of muscles is necessary for a controlled, smooth heel strike in the next phase?
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HAMSTRINGS
Eccentric hamstring contraction allows for a smooth touchdown during heel strike. No shock absorption. Heel pain, thickening of heel pad. *WEAK HAMS CAUSE HARSH HEEL STRIKE, heel pad thickening, knee HYPEREXTENSION (back knee gait) |
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also called military neck
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ALORDOSIS
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represents a significant deviation off George's line, and is a red flag. Do not adjust this cervical condition.
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acute angular kyphosis showing a step-off deformity
could be mets, trauma (whiplash), blow to head. Has potential to be serious. |
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Cervical gravity line from dens should fall through:
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C7
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severe head carriage
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Ankylosing spondylitis
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top of T1 to bottom of T12
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khyphotic curve
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