› How do you stretch obliquus capitis superior?

› How do you stabilize obliquus capitis superior?

› How do you mobilize obliquus capitis superior?

› Stretch: Flexion, lateral flexion & some rotation

› Stabilize:  C1 TVP

› Mobilize:  occiput

Positional release for obliquus capitis superior

› Where do you palpate

› What is the most favourable position?

› Palpate:  C1 TVPs BL

› Position:  side bending and extension

› How do you stretch obliquus capitis inferior?

› How do you stabilize obliquus capitis inferior?

› How do you mobilize obliquus capitis inferior?

› Stretch:contralaterally rotate

› Stabilize:  C2 TVPs (fingers around C2 and MCPs stabilize occiput to move C1)

› Mobilize:  C1 contralaterally

Positional release for obliquus capitis inferior

› Where do you palpate

› What is the most favourable position?

› Palpate:  Hold C2 BL

› Position: passive ipsilateral rotation, extension and lateral flexion

*ask "do you still feel the tendernes?"*

Bilateral stretch

Stabilize:C2 (major) & C1 (minor)

› flex the head

Unilateral stretch

Contralat. lat flex., ispsilat. rot & glide posteriorly

What is the positional release for rectus capitis posterior major/minor?

› What do you palpate?

› What position must you put this muscle for a release?
› How long do you hold?

› Palpate: tender spot

› Position RCPM^+&- in passive extension to fully shorten and relieve tender spot

› Hold: 30-90 seconds, then slowly return to neutral

*positional release: know how to shorten the m to release (think like m approximation)*

Is flexion rotation test done in AF or PR?

› Name the steps for this test

flexion rotation test is done in PR

› Fully flex cervical spine (to put mm on slack and enable head to rotate)

› Rotate head

› Note : amt of range (how far), end feel (bony, tissue stretch, capsular), pain (tissue stretched/compressed/root of pain)

› What are the attachments of Obliquus Capitis Inferior?

› What actions does Obliquus Capitis Inferior perform?

Attachments

Inf: C2 SP

Sup: C1 TVP

Action

Ispilateral rotation

What can be limited with Obliquus Capitis Inferior?

What will be your assessment finding?

Can limit: contralateral rotation of upper cervicals, limited with tissue stretch end-feel

(also assessment finding)

Attachments

Inf: C1 TVPs

Sup: Occiput (lateral to RCPM)

Actions

UL: ispilateral lateral flexion

BL: extension of upper cervicals

Can limit: U-C forward flexion

                U-C contralateral lateral flexion

Assessment finding: limited U-C flexion in AF and PR (tissue stretch end-feel)

*observe: U-C extension*

Attachments

Inf: posterior arch of C1

Sup: medial portion of inferior nuchal line

Action

Head extension

Can limit: Head flexion (of U-C)

Assessment findings:  AF & PR limited U-C flexion

*assess mvmts through the ear*

*PR can determine types of end-feel (rule out m from jt capsule)*

*AF limits UC flexion with tissue stretch end-feel*

Attachments

Inf: C2 SP

Sup: lateral portion of inferior nuchal line

Actions

BL: head extension

UL: ispilateral rotation

Can limit: head flexion (U-C) and small limitation on contralateral rotation

Assessment findings:  limited flexion (AF & PR)

*PR: stabilize at C2*

Medial: Rectus capitis posterior major

Inf: Obliquus capitis inferior

Sup: Obliquus capitis superior

Base: Vertebral artery

Roof: Semispinalis capitis

Floor: Atlanto-occipital membrane

Obliquus capitis inferior limits contralateral rotation of the head

*OCI ipsilaterally rotates the head*

rectus capitis posterior minor

rectus capitis posterior major

obliquus capitis superior

What are sensitive structures at:

› CO-C1?

› Under semispinalis capitis?

› CO-C1: vertebral artery

› Under semispinalis capitis: greater occipital nerve

Flexion

10-15^o

*pivot through ear (2 fingers width of chest)*

Extension

120^o

*pivot through ear (front of neck is vertical)*

Lateral flexion

5-10^o

*pivot through nose (ear 1/2 away from SH)*

Rotation

40-45^o

*palpate C2, side of chin even with front of SH*

At C1-C2

*not much at CO-C1*

Myofascial restrictions (mechanical pain)

Nerve irritation (great occipital n)

Muscular trigger point (suboccipital, lev scap NOT SCALENE)

Joint referral (C1-C3)

Which cervical muscle does NOT refer pain in upper cervicals?

Flexion: occiput slides posterior

*occiput = convex*

*processes around atlas = concave*

Moving bone convex = slide in opposite direction to its roll and resultant angular swing

*slide is osteokinematic*

Moving bone concave = slide in same direction as its roll/swing

*slide is osteokinematic*

Roll is arthrokinematic

*happens at the joint*

Joint needs to be ovoid

*ovoid: joint with concave and convex surfaces*

Roll on its own = compression on one side of the joint and separation on the other

*if it only roll and does not slide, eventually it will separate (need to slide to draw back)*

Slide

Helps minimizing compression and separation of a joint

› reduce abnormal stress

› allows normal ROM

*roll is arthrokinematic (within a joint)*

Roll

Rotary movement

› New points on one surface meet new points on opposing surface

*roll & slide occur with arthrokinematic movements*

Slide

Translation movement

› Same point on one surface contacts a new point on the opposing surface

*roll & slide occur with arthrokinematic movements*

Contralat. side bending occuring with upper cervical rotation

or

Upward rot. of scapula and rotation of clavicle with shoulder abduction is an example of...
or
External rotation of tibia in full knee extension

Are accessory movements voluntary or involuntary? What are the relevance to accessory movements?

Accessory movements are involuntary

› They are necessary for normal ROM

› Include component motions and joint play

What are physiological movements?

Are physiological movements performed voluntary or involuntary?

›Physiological movements are any movements performed under your control, under the three cardinal planes (frontal, sagittal, coronal)

 › Physiological movements are VOLUNTARY