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28 Cards in this Set
- Front
- Back
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Distortion Analysis |
Patient standing, doctor seatedP-A view, state observing S2 for lateral sway > 1/4" indicative of CAT IILateral view, state observing AC for A-P sway > 1/4" indicative of CAT INormal is sway less than 1/4", no movement (because of guarding) indicative of CAT III |
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1st Rib Palpation |
Doctor behind standing patient palpating junction of 1st rib and TVP with thumbsState bilateral mov't/tenderness >1/4" indicative of CAT IState unilateral mov't/tenderness > 1/4" indicative of CAT II usually on side of lesionNo mov't or tenderness (because of guarding) indicative of CAT III |
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Cervical Indicators |
Patient supine, doctor seated at head of tableState that Doc palpates c-spine for tenderness at spinous processes & TVPs (articular pillars)Pain @ TVP relates to lumbar spinous rotation to that sidePain @ side of spinous relates to lumbar TVP inferiority on that sideEvaluator designates tender spot, student describes relationshipNote: C1-L5, C2-L4, C3-L3, C4-L2, C5-L1, C6-T12, C7-T11L5 TVP inferiority relates to styloid process since C1 has no spinous process |
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Cervical Compaction/Cervical Stairstep, Analysis and Correction is what step |
Patient is supineCervical CompactionDoc at head of table, gently lifts patient head off table, has patient put hands on their stomachDoc tells patient to lift their legs 18-24" and notes the ease with which they can do thisDoc places palms together on either side of sagittal suture and exerts S-I pressureDoc tells patient to lift their legs 18-24" and notes the ease with which they can do thisStates: If compaction makes it easier, this is a primary cervical problem that must be cleared nowCervical StairstepDoc places palms together (thumbs form a "V") @ sagittal suture and exerts S-I/P-A pressureDoc insures patient's nose and chin remain parallel to the floor throughout the arcCorrectly identifies the 4 stepsFirst step=T1-C7, Second step=C6-C5, Third step=C4-C3, Fourth step=C2-C1State that if first step feels restrictive to check anteriors (T1-T4)Evaluator picks a level of restrictionDoc executes a figure 8 @ correct step keeping patient's nose and chin in sagittal planeDoc rechecks for restriction |
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Basic I |
Patient is supine and doc is seated at head of tableSupport patients head with palms and fingertips (fingertips lateral of EOP along nuchal line)Wait for pulses felt at fingertips to equalize (about a minute) |
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CAT III Basic Three |
Patient is supine, not on blocksDoctor is seated at head of tableDoctor's thumbs on either side of the sagittal suture at the most tender pointDoctor's fingertips on parietal bone (at least an inch above the pinna of the ear)State that the LOD is to "lift" the parietal bones laterally on inhalation for 3 respiration cycles |
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Analysis and Correction for a CAT I/III Psoas |
Patient supine, not wearing a watchDoc at head of table, feet parallel, grasps patients arms and tractions, identifies short armDoc goes to contralateral side of involved psoasInferior hand on knee of involved side psoas, moves knee laterallySuperior hand hypothenar contact on belly of psoas, not on beltInstruct patient to inhale then applies A-P pressure during exhale while bringing knee medialMaintains pressure against patient's next inhale, moves knee lateral, and repeats aboveMaintains pressure against patient's next inhale, moves knee lateral, and repeats aboveRechecks arms length |
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Analysis and Correction for a CAT II Psoas |
Patient supine, not wearing a watchDoc at head of table, feet parallel, grasps patients arms proximal to wrist, tractions, id's short armDoc goes to contralateral side of involved psoasInferior hand supports involved side iliumSuperior hand hypothenar contact on belly of contractured psoas, not on beltInstructs patient to inhale then applies pressure during exhaleMaintains pressure against patient inhale, then applies pressure again during exhaleMaintains pressure again against patient inhale, then applies pressure again during exhaleRechecks arms length |
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Anterior Iliofemoral Ligament |
Patient supine, doctor at foot of tableDoctor grasps patient proximal to ankles and internally rotates looking for restrictionDoctor goes to contralateral side of restriction and contacts 1" posterior/1" superior to trochanterPatient turns toes out as doctor lifts P-A on ligamentDoctor relaxes contact as patient turns toes inPatient turns toes out as doctor lifts P-A on ligamentDoctor relaxes contact as patient turns toes inDoc counts to 3 and patient turns toes out fast as doctor lifts P-A on ligamentRechecks legs for restrictions |
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Supine Leg Length Analysis |
Patient is supine, Doc at foot of tableDoc grasps posterior aspect of patient's legs, proximal to anklesDoc brings legs to lateral edge of table and exerts pressure L-M while patient resists for 3 secsPt relaxes, Doc maintains traction and brings legs together to assess leg length at medial maleolusCorrectly identifies short leg as having the superior maleolus |
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Arm Fossa Test |
Patient supine, not on boardDoc stands on right side of patient even with their hipDoc insures patient is not wearing a watchDoc has patient extend their right arm, soft fist facing mediallyDoc does a test pull of appropriate forceDoc checks upper fossa with a flat four-finger contact while saying "hold" and pulling patient's armDoc checks lower fossa with a flat four-finger contact while saying "hold" and pulling patient's armDoc walks around the head of table in a clockwise mannerDoc does a test pull of appropriate forceDoc checks upper fossa with a flat four-finger contact while saying "hold" and pulling patient's armDoc checks lower fossa with a flat four-finger contact while saying "hold" and pulling patient's armState: If any of the fossa are not grade five (weak), this is a definitive test for CAT II |
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Block Category II Evaluator designate short leg L / R |
State definitive test to block CAT II: Arm Fossa TestState must have congruency to block: UMS or LLLAccurately describes what UMS and LLL meanPatient SupineBoard 4" above iliac crestActive blocking: patient lifts hipBlock short leg at iliac crest 90 degrees to spineBlock long leg at trochanter 45 degrees superiorlyState the goal: 4 grade five (strong) fossasState maximum blocking time: 2 minutes |
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Block Augmentation, CAT II, Basic II |
Patient supine on blocks for CAT IIStates indicated when grade five (strong) arm fossa goes weak on maximum inhalation or exhalationDoc at head of table with left hand under occiput, right hand on frontal boneDoc instructs patient to inhale, put their tongue on the roof of their mouth and dorsiflex their feetDoc instructs patient to exhale, relax their tongue, and plantarflex their feetDemonstrate correction if arm fossa goes weak on inhalationDoc will pull I-S on both the frontal and occiptal bones during exhalation and relax on inhalationDemonstrate correction if arm fossa goes weak on exhalationDoc will push S-I on both the frontal and occiptal bones during inhalation and relax on exhalation |
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CAT II, Post Block Technique, Long Leg/Short Leg |
State this is performed after blocking CAT II and patient's legs are unevenDoc goes to short leg side, superior hand under knee, inferior hand under ankleDoc flexes knee to chest from lateral to medial then extends the leg, repeats 3xDoc repeats on long leg side going from medial to lateral 3x |
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Prone Leg Length Analysis |
Patient is prone Doc at foot of the tableDoc grasps anterior aspect of patient's legs, proximal to anklesDoc brings legs to lateral edge of table and exerts pressure L-M while patient resists for 3 secsPt relaxes, Doc maintains traction and brings legs together to assess leg length at medial maleolusCorrectly identifies short leg as having the superior maleolus |
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Trap Fiber Analysis |
Patient is proneDoc is seated at head of tableCorrectly identifies area 1 in the "V"Correctly identifies area 7 just off the TVP of T1Correctly identifies area 4 and states the others are equally spaced betweenApplies increasing pressure with thumb from area 1 to area 7 looking for tender spotsIsolates the most tender spot (out of a possible 14)States which spinal areas are associated with the identified trap areaChecks each spinous associated with the tender areaCorrectly sets up on the most tender spinous (cervical figure 8, thoracic/lumbar knife edge) |
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Heel Tension |
Patient is proneDoctor is seated at foot of tableDemonstrate both hands at same time and two hands on one ankleDemonstrate squeezing achilles tendonStates heel tension is restriction or thicker/tender achilles |
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Atlas Dural Subluxation |
Patient is proneCorrectly performs prone leg checkChecks resistance to dorsiflexion of patient's feet and designates side of heel tensionDoc maintains dorsiflexion and has patient turn head to left then to the rightStates normal=slight shortening on side of head rotation, absence of reflex=atlas dural subluxationEvaluator indicates side of atlas dural subluxation and circles L or RDoc tractions long leg side while patient tractions head of table for 5 secondsDoc tractions heel tension leg while patient turns head left and right through full ROM 1xPt turns head to atlas dural subluxation side, Doc dorsiflexes both feet 10 sec on/10 sec off,3xDoc rechecks for reflex by having patient turn head left and right while holding dorsiflexion |
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Blocking CAT I Evaluator designates short leg R / L |
Patient proneBoard 4" above iliac crest (pt can help by lifting up so Doc can place the board)Sternal Roll in placePassive blocking, patient does not helpBlock short leg at trochanter 45 degrees superiorlyBlock long leg at ASIS 45 degrees inferiorlyState the goal: balance the bodyState maximum blocking time: 10 minutes |
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Analysis and Correction of Crest Sign |
Must state that this is a myogenic signPatient is prone not on blocksDoc evaluates spinal erector muscles at level of L4 and chooses major side (most tone, wider)Doc describes difference between Davis Stretch Sign (thumbs) and Davis Contractile Sign (fingers)Doc now blocks pt CAT IDoc re-evaluates the Crest sign and determines to either build up weak side or adjustDoc demonstrates building up weak crest sign if necessary (stabilizes sacrum, goads weak side)State rules for adjusting crest signAdjust major side firstNever adjust over a blockDo not pull the block to do the adjustment1st adjustment major side: Crest roll if block is at trochanter, Ischial tube toggle if block at ASIS2nd adjustment minor side: Crest roll if block is at trochanter, Ischial tube toggle if block at ASIS |
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Analysis and Correction of Dollar Sign |
Must state that this a neurogenic signPatient is prone not on blocksStates Dollar sign is located two human inches lateral and 3 human inches inferior from the PSISDoc evaluates dollar sign and chooses major side (most tone, "trampoline")Doc now blocks pt CAT IDoc re-evaluates the Dollar sign and determines to either build up weak side or adjustDoc demonstrates building up weak dollar sign if necessary (monitors major side and goads weak side)State rules for adjusting dollar signAdjust major side firstNever adjust over a blockDo not pull the block to do the adjustment1st adjustment major side: Gluteal scoop if block is at ASIS, PSIS toggle if block is at trochanter2nd adjustment minor side: Gluteal scoop if block is at ASIS, PSIS toggle if block is at trochanterNote: PSIS toggle is clockwise on the right and counter-clockwise on the left |
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Analysis and Correction of Sacral Base |
Patient is prone on blocks for CAT IDoc places thumb on L5 spinous and has patient cough forciblyStates: thumb towards ceiling=SB+, thumb towards head=SB-, both ways=SBnEvaluator pick one and circle: SB+ SB- SBnChoose correct blocking pattern for selected sacral baseSB+: \ / 45 degrees down at ASIS SCP=Sacral Apex during inhalationSB-: / \ 45 degrees up at trochanter SCP=Sacral Base during exhalationSBn: - - between ASIS and Trochanter SCP=apex during inhalation, base during exhalation |
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Vasomotor |
Patient is prone on blocks for CAT IState that this is done after assessing/correcting for Sacral BaseObserve for area changes in thoracic spine (reddening, blanching, texture, temperature, etc.)Assess these areas for most superior/tender spinousRelate that spinous to the Trap Fiber Analysis Chart Cervical component and take TVP contactExert I-S pressure on Thoracic Spinous and monitor Cervical TVP for moistureAdjust Thoracic Spinous I-S with knife hand |
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Glute Fiber Analysis |
Patient is prone not on blocksDoctor states that glute fibers relate to the lumbar spineCorrectly identify PSIS - L5, then evenly around crest L4 - L1If still tender after CAT III blocking, treat as a trigger point |
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S.O.T.O |
Patient is proneState that indicator is sciaticaState that maneuver is both diagnostic and theraputicDoc is seated at side of involvement, supports patient's leg anteriorly prox to knee and ankleDoc brings leg lateral (14", until glutes bunch, or patient tolerance)Doc externally rotates patient's leg (toes out) and holds for 10-15 secs, returns to startWait two minutes and repeatAsk patient is it: Better? Worse? Same?Correctly identifies outcome: better=piriformis problem, worse=sequestered disc, same=sublux/herniated discRepeat every two minutes if piriformis problem |
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Blocking CAT III |
Patient proneBoard 4" above iliac crestSternal roll in placePassive blocking, patient does not helpBlock short leg at trochanter 45 degrees inferiorlyBlock long leg at ASIS 45 degrees inferiorlyState the goal: Reduction of painState maximum blocking time: 30 minutes |
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CAT III Block Augmentation, Posterior Iliofemoral Ligament |
Patient properly blocked CAT IIIDoctor grasps patient proximal to ankles and internally rotates looking for restrictionDoctor goes to side of restriction, SCP is 1" superior and 1" posterior to top of trochanterIf contact is on the short leg side, i.e. over the block at the trochanter, remove itDouble thumb toggle towards the opposite obturator foramenReplace block if you had previously removed itRecheck internal rotation |
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CAT III Block Augmentation, Lumbar Vertebral Derotation |
Patient properly blocked CAT IIIPatient tractions head of tableDoctor flexes patient's knee with inferior hand on involved side toward gluteState lumbar rotation may be linked to cervical indicatorSCP is spinous process on side of rotation, LOD L - M |
