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21 Cards in this Set

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What is are articulatory techniques?
A direct technique (restrictive barrier is engaged); low velocity, moderate to high amplitude or moderate to long lever technique. Example supine rib raising and Spencer techniques.
What is the normal range of motion for the thoracic spine?
Flexion: 20-45 degrees
Extension: 25-45 degrees
Side Bending: 20-40 degrees
Rotation: 35-50 degrees
What is the normal range of motion for the lumbar spine?
Flexion 40-60 degrees
Extension 20-35 degrees
Side Bending 15-20 degrees
Rotation 7-15 degrees
What does "end feel" refer to?
The tissue texture changes that occur as you approach the restricted area of a joint during a range of motion test. The quality is felt: slow change in resistance or abrupt change.
What is a long lever?
Use of one part of the body at a greater distance from the fulcrum to induce specific motion at a joint while resisting that motion (through stabilization) at the level below or above.
What is a short lever?
Use a hand to induce motion on an anatomical structure at a short distance from the fulcrum, inducing specific motion at a joint.
What is a long lever, short lever technique?
Use one part of the body as a long lever, while inducing the same (or opposite) motion with a short lever near the joint to be mobilized.
What is articulating activation for?
Articulating activation can be designed and applied to resolve either a simple problem with a single restrictive barrier or a complex problem with multiple joint and tissue restrictive barriers. This type of technique is particularly useful where the application of low, gentle, controlled movements is indicated. Respiratory cooperation and active muscle contraction can be added to enhance motion.
What is breathing used for in articulating activaton?
This intrinsic force augments the stretching, mobilizing forces applied by the physician.
How is HVLA different from articulating activation?
HVLA would use a low amplitude impulse through the barrier whereas articulating activation moves the barrier by a stretching, springing force.
What is the goal of articulating activation treatment?
The goal of a regional treatment is a smooth symmetrical range of movement in all the planes of motion available within the articulation(s).
What are some indications for articulatory techniques?
Restriction of joint motion
Myofascial shortening
Bilateral or unilateral SD in a region or at a segmental level
Preparation for HVLA specific thrust
What are some contraindications for articulatory techniques?
Advanced bone-wasting diseases
Fractures
Acute local inflammatory condition
Acute localized infection
Neurologic signs elicited during pretest or treatment (means that you must stop your treatment by this method)
How do you diagnose patients in order to use articulatory techniques?
Active Range of Motion F/E/S/R
Passive Range of Motion F/E/S/R
What would be the goal for treating an extended somatic dysfunction of vertebra?
To increase flexion; joint is "stuck" in extension (does not move in flexion, moves easiest in extension).
How would you treat vertebra with an extended somatic dysfunction?
Seated ART for extension somatic dysfunction.
Stand behind the seated patient with your axilla on one shoulder, and your hand on the other. The patient’s hands grasp your arm.
Simultaneously, stabilize the spinous process of the inferior vertebra of the dysfunctional segment with inferior pressure.
Use your arm and hand to flex the spine to its barrier (long lever).
Hold briefly and then back off slightly. Repeat gently, “springing the barrier” until motion is more normal.
Move your stabilizing hand one segment lower and repeat until the involved area is treated.
This may also be done regionally as you stabilize a region of the spine and then flex.
What would be the goal for treating a flexed somatic dysfunction of vertebra?
To increase extension joint is "stuck" in flexion (does not move in extension, moves easiest in flexion).
How would you treat vertebra with a flexed somatic dysfunction?
Seated ART for flexion somatic dysfunction.
Stand aside the seated patient. Have the patient cross the arms in front. Place your anterior arm under the patient’s arms.
Use your other hand as a fulcrum over a lumbar spinous process, stabilizing that vertebra.
Using your anterior arm, lift the patient’s arms up to introduce extension to the joint space above your fulcrum (long lever).
Accentuate extension with your thenar eminence, applying an anterior transilatory force at each lumbar segment (short lever).
Hold briefly and then back off slightly. Repeat, gently “springing the barrier” until motion is normalized.
Move your stabilizing hand one segment lower and repeat the process until the entire involved area is treated.
Discontinue or modify by using less force and amplitude if the patient has difficulty tolerating the procedure.
This can also be done regionally.
How would you treat side bent right somatic dysfunction?
Seated ART for side bent right somatic dysfunction.
Objective- increase left side bending.
Stand behind the seated patient on the side of the convexity. The patient has their arms folded across their chest.
Place your axilla on one shoulder, and your hand on the other, or under the axilla, grasping the lateral chest wall.
Place your thenar eminence or fingers of your sensing/stabilizing hand at the region to be treated, on your (ipsilateral) side of the spinous process.
Induce side bending toward you using trunk as long lever arm, pressing down with your axilla and up with your hand until you feel side bending at your stabilizing fingers.
Use your sensing hand’s thenar eminence or fingers at the spinous processes as a short lever to accentuate side bending.
Hold briefly and then back off slightly. Repeat gently, “springing the barrier” until motion is improved.
Move your stabilizing hand one segment lower and repeat until the entire involved area is treated.
If side bent left, do the same on the opposite sides.
How would you treat rotated left somatic dysfunction?
Seated ART for rotation left somatic dysfunction.
Objective – increase right rotation.
Stand behind the seated patient on the side opposite the posterior transverse process. Put your arm across the patient so that your axilla is on one shoulder, and your hand on the other.
The patient’s hands grasp your arm.
Place your other hand just to the contralateral side of the spinous process(es) (The side of the posterior transverse process). Use a short lever, lateral force to induce rotation.
Further induce rotation with your long lever hand and axilla and accentuate it with your stabilizing/sensing fingers.
Hold briefly at the end range (barrier) and then back off slightly.
Repeat, gently “springing the barrier” until motion is normalized.
Move your stabilizing hand and repeat until the entire involved area is treated.
If done segmentally: stabilize the spinous process of the inferior vertebra of the dysfunctional segment with the thumb and forefinger. Resist the rotation you are inducing with the other arm to gap the joint above the one that you are stabilizing.
Using BLT, how do you treat somatic dysfunction of the thoracic spines?
Start with the patient in the prone position. Stand or sit directly in front of affected vertebra.
Contact spinous process of segment below dysfunction with thumb and middle finger to stabilize it- hold this vertebrae firmly.
Contact spinous process of dysfunctional vertebrae with thumb and middle finger in order to move it into BLT.
- Do this by moving vertebrae into rotation (turn spinous process to right and left) and add flexion or extension (push spinous process up or down) or keep neutral in sagittal plane.
- Approximating the vertebrae will induce flexion, distracting them will induce extension.
- You do not need to add side bending- remember the principles of spinal motion.
- Direction of movement should be in the same direction of the somatic dysfunction(indirect technique).
- Do not take to “barrier”- find a point where you palpate disengagement or a sense of floating of the vertebrae.
Hold until release.
- Release may be warmth, sense of vertebrae moving / pushing your fingers, increased motion with respiration.
Retest.