Cervical - backward, upward and medial

Thoracic - backward, upward and lateral

Lumbar - backward and medial

Types of muscle contractions:

1. Isotonic

2. Isometric

3.  Isolytic

4.  Concentric

5.  Eccentric

1.  Contraction results in approximation of origin and insertion w/o change in tension - operator's forces is less than patient's force

2.  Contraction results in increased tension w/o approximation of origin and insertion - operator force = patient force

3.  Contraction against resistance while forcing muscle to lengthen - operator force is more than patient force

4.  Contraction results in approximation of origin and insertion

5.  Lengthening of muscle during contraction due to external force

Cervical Segments / Motions

1.  OA

2. AA

3.  C2 - C4

4.  C5 - C7

1.  Flexion / extension

2.  Rotation

3.  Rotation

4.  Sidebending

Rule of 3's

1.  T1-T3

2.   T4 - T6

3.  T7 - T9

4.  T10

5. T11

6.  T12

1.  Spinous process located at level corresponding to TVP

2.  Spinous process located 1/2 segment below corresponding TVP

3.  Spinous process located one full level below corresponding TVP

4.  like 7-9

5.  like 4-6

6.  like 1-3

1 - articulates only w/ T1 and has no angle

2 - has a large tuberousity on shaft for serratus anterior

11/12 - only articulate w/ corresponding vertebrae and lack a tubercle

10 - sometimes considered atypical because it only articulates w/ T10

AKA Furguson's Angle

Formed by drawing the intersection of a horizontal line with the line of inclination of the sacrum

Normally 25-35 degrees

Grades of Spondylolysis

I

II

III

IV

I: 0-25%

II: 25 - 50%

III: 50 - 75%

IV:  75 - 100%

Cobb angle - draw a horizontal line from the vertebral bodies of the extreme ends of the curve, then draw perpendicular lines from these horizontal lines and measure the acute Cobb Angle

Mild: 5- 15 degrees

Moderate: 20 - 45 degrees

Severe: greater than 50 degrees 

Apply to side of short leg

Final lift height should be 1/2 to 3/4 of measured leg length discrepency, unless there was a recent sudden loss of length (ie hip fracture or prosthesis) - in this case, the lift should be the full amount

Fragile patient (elderly, arthritic, osteoporotic, having acute pain) - begin with a 1/16" (1.5mm) heel lift and increase by 1/16" every two weeks

Flexible patient - begin with 1/8" (3.2mm) heel lift and increase 1/8" every two weeks

Maximum of 1/4" may be applied to inside of shoe - if more than this is needed, it must go on outside of shoe

Maximum heel lift possible = 1/2"

If more height needed, ipsilateral anterior sole lift should be added to keep pelvis from rotating to opposite side

Respiratory - superior transverse axis

Inherent - craniosacral - superior transverse axis

Postural - middle transverse axis

Dynamic - ambulation - two sacral oblique axes

1.  When L5 is sidebent, a sacral oblique axis is engaged on the same side as the sidebending

2.  When L5 is rotated, the sacrum rotates the opposite way on an oblique axis

3.  The seated flexion test is found on the opposite side of the obliqe axis

Erb-Duchenne's palsy

C5 and C6 nerve roots

During child birth

Formed by intersection of two lines - the first is the longitudinal axis of the humerus - the second starts at the distal radial-ulna joint, and passes through the proximal radial-ulna joint

Normal carrying angle is 5 degrees in men

Normal carrying angle is 10-12 degrees in women

Flexion contracture of the MCP and DIP

Extension contracture of the PIP

Results from a contracture of the intrinsic muscles of the hand and often associated w/ RA

Extension contracture of the MCP and DIP

Flexion contracture of the PIP

Results from rupture of the hood of the extensor tendon at the PIP

Often associated w/ RA

dorsiflexion

eversion

abduction

Plantar flexion

inversion

adduction

Normal angle between shaft and neck = 120-135 degrees

If angle is <120 - coxa vara

If angle is >135 - coxa valga

Angle formed by intersection of a line from the ASIS through the middle of the patella, and a line from the tibial tubercle through the middle of the patella

Normal angle = 10-12 degrees

Increased Q angle = genu valgum

Decreased Q angle = genu varum

O'Donahue's Triad

(Terrible triad, Unhappy triad)

Types of ankle sprains:

1.  Type I

2.  Type II

3.  Type III

1.  anterior talofibular ligament

2.  anterior talofibular ligament + calcaneofibular ligament

3.  Anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament

CNS

CSF

Dural Membranes

Cranial Bones

Sacrum

Stress

Depression 

Chronic fatique

Chronic infections

Vigorous physical exercise

Systemic fever

Following OMT to the craniosacral mechanism

Dural Attachments

Foramen Magnum

C2

C3

S2

Flexion of the midline bones

Sacral base posterior (counternutation)

Decreased AP diameter of the cranium (but the head widens slightly)

External rotation of the paired bones

Extension of the midline bones

Sacral base anterior (nutation)

Increased AP diameter of the cranium

Internal rotation of the paired bones

During flexion, the sphenoid appears to be flexing forward

During extension, the sphenoid appears to be extending backward

Describe where you would find dysfunctions or what they could case based on the following descriptions:

1. vagal somatic dysfuntions

2. Occipital / condylar dysfunction

1. AO, AA and/or C2 (and S2-S4)

2. Compression of CN XII can result in poor suckling of the newborn; dysfunctions of CN IX and CN X at the jugular foramen can also cause suckling dysfunction in the newborn

Viscerosomatics:

1. Head and neck

2. Heart

3. Respiratory system

4. Esophagus

5. GI (before ligament of Treitz - divides duodenum and jejunum)

6. GI (between ligament of treitz and spleninc fexure - divides transverse and descending colon)

7. GI (after splenic flexure)

8 . Appendix

9. Kidneys

10. Adrenal medulla

11. Upper ureters

12. Lower ureters

13. bladder

14. gonads

15. Uterus and cervix

16. Erectile tissue of penis / clitoris

17. Prostate

18. Arms

19. Legs

1. T1 - T4

2. T1 - T5

3. T2 - T7

4. T2 - T8

5. T5 - T9

6. T10 - T11

7. T12 - L2

8. T12

9. T10 -T11

10. T10

11. T10 - T11

12. T12 - L1

13. T11 - L2

14. T10 - T11

15. T10 - L2

16. T11 - L2

17. T12 - L2

18. T2 - T8

19. T11 - L2

Anteriorly at the tip of the right 12th rib

Posteriorly at the TVP of the T11 verterbra

Anteriorly 2" superior and 1" lateral to the umbilicus

Posteriorly between the spinous process and TVP's of T11 and T12

Anteriorly 1" superior and 1" later the umbilicus

Posteriorly between the spinous and TVP's of T12 and L1

Trigger points may refer pain when pressed

Tenderpoints DO NOT refer pain beyond the location compressed

1. Palpate restriction

2. Apply compression (indirect) or traction (direct)

3. Add twisting or transverse forces

4. Use enhancers

5. Await release

Common: OA left, Cervicothoracic right, thoracolumbar left, lumbosacral right

Uncommon: AO right, Cervicothoracic left, thoracolumbar right, lumbosacral left

Right - right upper extremety, right hemicranium, heart and lobes of the lung (EXCEPT left upper lobe)

Left - Remainder of the body

Location / treatment positions for the following tenderpoints:

1. Anterior cervical

2. Posterior cervical

3. Inion

4. Anterior thoracic

5. Posterior thoracic

6. Anterior ribs

7. Posterior ribs

8. Anterior Lumbar

9. Posterior Lumbr

1. slightly anterior to or on most lateral aspect of lateral masses - SARA

2. Tip or lateral sides of spinous process - extend, SARA

3. At inion or just below - marked flexion

4. T1-T6 - midline of sternum; T7-T12 - in rectus muscle on inch lateral to midline on R or L - flex thorax and small amount of SARA

5. Either side of spinous process or TVP's - extend, SARA

6. Rib 1 - just below medial end of clavicle; Rib 2 - 6-8cm lateral to sternum on rib 2; Ribs 3-6 mid-axillary line on corresponding rib?? Rib 1 and 2 - flex and sidebend and rotate towards; Ribs 3-6 sidebend and rotate towards w/ slight flexion

7. Angle of corresponding rib - minimal flexion and SARA

8. L1 - medial to ASIS; L2-L4 on ASIS; L5 - one cm latteral to pubic symphysis on superior ramus // patient supine w/ knees and hips flexed and markedly rotated away

9. on either side of the spinous or TVP; L3 and L4 may be found on iliac crest; L5 may be found on the PSIS

1. patient in neutral position - physician straightens the AP curve of spine (decreasing kyphosis or lordosis)

2. physician applies facilitating force (compression, torsion or both)

3. The physician then shortens the muscle to be treated

4. Position is held for 3-4 seconds

5. physician releases the position and reevaluates the dysfunction

post-surgical patients

ICU patients

Use reciprocal inhibition instead

Treatment:

1. Inhalation rib

2. Exhalation rib

1. rib is held up - have pt exhale fully and hold lowest rib in the group inferior as pt inhales

2. rib is stuck down - have pt inhale fully and as they exhale, hold the highest rib in the group superior

osteoporosis

osteomyelitis (including Pott's disease)

fractures in the area of thrust

bone metastases

Rheumatoid arthritis

Downs syndrome

Acute whiplash

pregnancy

post-surgical conditions

herniated nucleus pulposus

patients on anticoagulation therapy or hemophiliacs should be treated with great caution to prevent bleeding

Vertebral artery ischemia (positive Wallenburg's test)

Stage I: Extension

Stage II:  flexion

Stage III: circumduction w/ compression

Stage IV: Circumduction with traction

Stage V: Abduction

Stage VI: Internal rotation

Stage VII: Joint pump

General pathology of the hip joint

arthritic changes in the hit or sacroiliac joint