muscle that responds by becoming hypertonic, shortened, and sometimes spastic
Dr. Greenman's definition of a dynamic or phasic muscle
Muscle that responds to dysfunction by inhibition, hypotonicity, and weakness
Describe the pain distribution of a hypertonic iliopsoas
lower-mid back and anterior thigh pain
Describe the pain distribution of piriformis hypertonicity
PSIS and greater trochanter pain
Describe the pain distribution of Gluteus hypertonicity
Pain in the butt
Common segmental and ligamentous dysfunctions involved in LBP
-L5 -SI joint (sacral torsions) -short leg -stretch of iliolumbar ligament -myofascial injury
What are the main motions of the lumbar spine?
Flexion and Extension
Describe the common segmental dysfunctions associated with psoas spasm
L1 and L2 rotated to same side as spasm
What is the purpose of the straight leg raise exam?
Assess for radicular pain, indicating nerve root irritation
How are the motor nerve roots graded.
0-5, 5 being the expected response 0-no tone 1-tone w/o movement 2-movement w/o gravity 3-movement against gravity, not against resistance 4-slightly diminished strength against resistance 5-full strength
Muscle isolated for L1,2 motor nerve root
Muscle isolated for L3 motor nerve root
muscle isolated for L4 motor nerve root
Muscle isolated for L5 motor nerve root
Extensor hallucis longus
Muscle isolated for S1 motor nerve root
The patellar reflex test the ___ deep tendon reflex.
The Achilles reflex tests the ___ deep tendon reflex.
What is the grade of the expected DTR?
2 out of 4
What is a grade 4 DTR?
hyperactive response with clonus
Describe the setup and purpose of the Patrick's Test.
FABERE at the hip Assesses hip arthritis with pain in SIJ and anterior groin
Describe the setup and purpose of the Thomas Test?
Patient supine, hugs knees (flattens lordosis) extends one leg. Gapping under knee or back may signify tight hip flexors (psoas).
In the "lumbar on side" treatment, the HVLA thrust is meant to increase what direction of motion?
Describe the Still Technique for a Flexed Lumbar Segment.
Patient supine, physician flexes and adducts hip on same side of segmental rotation, compression vector from knee to affected segment, abduct knee w/compression, extend knee and hip to neutral.
Explain the differences in Still Treatment of and extended lumbar in comparison to flexed.
Start with hip abducted and adduct during treatment.
To what muscles do the anterior lumbar tenderpoints correlate?
One of Still's students credited with documentation of Still's techniques
Who is Dr. Van Buskirk?
Van Buskirk found Dr. Hazard's descriptions of Still Technique
What are the major components of the Still Technique?
-moderate to low velocity -audible release not necessary -compression of ~5 lbs. maintained throughout treatment -direct force over segment is unnecessary
Still Technique is applicable to every articulation of the body except _______.
What is the general starting position of Still Technique?
What is the force vector in Still Technique?
direction and amount of compression toward the affected segment
True or False? Fryette's motion type does not have to be considered in FPR or Still Technique.
False, it is not considered in FPR but is of importance in Still Technique
Still Technique contraindications
-advanced bone wasting disease -fractures -radiculopathy -patient objection -facet syndrome/arthritis
Who developed FPR?
Dr. Stanley Schiowitz
True or False? FPR is an indirect technique used to normalize hypertonic muscles.
What is the physiological mechanism of FPR?
reset gamma loop/decrease gamma gain
decreased load via compression unloads spindle and decreases 1a fibers discharge
Is a posterior rib exhaled or inhaled?
For Still Technique Anterior Rib, what is the starting position, articulation, final position and vector direction?
start with arm (affected side) abducted and flexed @ shoulder articulation is adduction and extension @ shoulder final position is slightly abducted and extended vector is from elbow to rib head
For Still Technique Anterior innominate, what is the initial position, articulation and vector direction?
Flex hip 45-60 degrees, find soft-packing of SIJ Flex hip completely and adduct then extend the hip Vector is from knee to lower pole of SIJ
For Still Technique Posterior Innominate, what is the starting position, the articulation and the vector direction?
Hip flexed completely and adducted Abduct and extend hip Compress through the upper pole of the SIJ
For Still Technique Superior shear, what is the starting position? articulation?
Externally rotate leg from ankle, compress to SIJ Internally rotate the leg and add traction
What are the order in which the following should be treated and why? iliosacral, lumbar, sacral
lumbar, sacroiliac, sacral treatment of the first two may alleviate sacral dysfunctions
Diagnose the sacroiliac joints: +R standing flexion test +L seated flexion test Posterior right ILA
standing flexion test not used for sacral motion on ilium
For Still Technique Diagonal SI, what is the starting position, the articulation, and the direction of the vector?
Pt. supine, both hips and knees flexed to ~90 degrees, sidebend away from diagnosis direction (toward superior pole of restricted axis) Move legs across midline and extend Vector is from knees toward sacrum
Diagnose the iliosacral joint for Still Technique: +R seated flexion test posterior right ILA
For Still Technique Unilateral SI, what is the starting position, articulation, and vector direction?
Pt. supine, opposite hip flexed, abducted, internally rotated (using ankle as lever) Adduct and externally rotate, then extend hip and knee Vector is from knee toward sacrum
What x-ray view is used to examine scoliosis, unlevel sacral base, and functional short leg?
What x-ray view is used to examine the lumbar lordosis and Degenerative Joint Diseases (DDD, Facet Syndrome)?
What x-ray view is best to assess spondylolysthesis grades?
L-S Jctn Spot View
What x-ray view is best to assess spondylosis and spinal stenosis (central and foraminal)?
Why does an ankle sprain have a greater affect on the whole body's proprioceptive capacity than a proximal injury?
Due to the distal nature, the body has to correct and compensate at every joint proximal to the ankle.
What are the 4 sensory fiber types and their levels of myelination?
I - heavy II - medium III - light IV - non-myelinated
Do slow twitch fibers function in postural or phasic activity?
Postural Fast twitch participate more in phasic or dynamic activity.
Increased tension on the intrafusal muscle fiber of a flexor causes ______ _____ neurons (afferent spindle fibers) to increase AP propagation leading to an increased stimulation of ______ ______ neurons to the flexor and _______ (increased/decreased) contraction.
gamma motor alpha motor increased
Via reciprocal inhibition, explain the 3 effects of contraction of a left triceps.
inhibited left biceps inhibited right triceps enhanced right biceps
What are the 4 stages of proprioceptive balance assessment?
1. one legged standing, arms down, eyes open 2. cross arms 3. arms down, eyes closed 4. cross arms each for 30 seconds
Who advocated short foot proprioceptive training? And what is it?
Janda, short foot is elevation of the medial arch without curling of the toes.
What is lower quarter syndrome?
-Weak gluteus maximus and short hip flexors -Weak abdominals and short lumbar erector spinae -Weak gluteus medius/minimus and short TFL/QL -Anterior pelvic tilt and increased lumbar lordosis -Hypermobility of low lumbars and short piriformis -Inability to sit up from supine and dysfunctional forward bending
What are the 4 tests for lower quarter dysfunction/syndrome?