L/S Anatomy
List the layers of Erector spinae (lateral to medial)
Iliocostalis, Longissimus, Spinalis
What are the two upper C/S ligaments that provide stability & what are the associated special tests?
-The Alar and the cruciate ligament
-Sharp purser & Alar ligament Test
What categorizes a compressive versus tensile profile in the C/S?
Compressive:
- EXT, Ipsilateral SB, Ipsilateral ROT
Tension:
- FLEX, C/L SB, C/L ROT
What is the force progression of retraction in sitting?
1. Retraction
2. Retraction with self OP
3. Retraction with PT OP
4. Mobilization in seated or supine
What is the main function of the external and internal oblique?
- Compression of the abdomen
- Flexes and rotates the trunk
What are the main actions of the splenius capitis and splenius cervicis?
U/L: SB & ROT
B/L: EXT
You are performing a UQS and find a sensory loss in the C7 dermatome. Is that enough to determine that the patient has neural involvement?
No! A sensory deficit in one dermatome alone is not enough. A pattern of findings in the dermatomes, myotomes, and DTRs is needed to suggest neural involvement.
Explain the steps of a FLEX ROT Test and what the (+) findings are
Step 1: Passively and FULLY flex the neck in supine
Step 2: ROT head to both sides
(+) Findings:
- <32 degrees of motion, >10 degree difference (R vs. L), Reproduction of familiar pain, or recreation of headache
Which plane are the lower lumbar facets vs. the upper lumbar facets in?
Lower lumbar: between the sagittal and frontal plane
Upper lumbar: sagittal
What is the origin and insertion of the SCM and how would you stretch it?
Origin: Mastoid process & superior nuchal line
Insertion: Sternal Head - manubrium of sternum & Clavicular head - clavicle
Stretch: Retract, SB away, ROT towards
A Physical therapist wants to stretch the Upper Trap and decides to put the patient in FLEX, SB away, and ROT away. Which muscle could the PT be stretching, and how would you correct it to target the Upper Trap?
- The Physical Therapist was stretching the levator scapulae
--> Will also accept splenius
- In order to stretch the Upper Trap, the patient should FLEX, SB away, and ROT towards
Explain how to perform a Lateral Pressure? What motion does it promote?
Step 1: Find a spinous level
Step 2: Take up the skin slack to where the finger rests on the articular pillar
Step 3: Apply lateral pressure
Motion: Lateral Bending
How many segments do the semispinalis, multifidus, and rotatores span? Which muscle is thickest in the lumbar region?
- Semispinalis: 4-6 segments
- Rotatores: 1-2 segments
- Multifidus: 2-4 segments
Multifidus will be the thickest in the lumbar region
What makes up the suboccipital triangle, and what are the contents of the Suboccipital Triangle?
Triangle: Rectus capitis posterior major, obliquus capitis superior, and obliquus capitis inferior
Contents: Posterior arch of C1, vertebral artery, and the suboccipital nerve
A patient walks into the clinic complaining of dizziness and imbalance, raising your suspicion of a vestibular disorder. List two tests for each that help differentiate between a central and a peripheral vestibular disorder.
- Central: smooth pursuit, saccades, convergence, VOR cancellation, cover/cross cover, and optokinetic
-Peripheral: Head thrust, head shaking, dynamic visual acuity
What manual therapy techniques can be utilized for a high irritability tension profile with R-sided symptoms? (list at least 2)
AKA symptoms reproduced with FLEX, L SB, and L ROT
- Thoracic manipulation
- Closing techniques: R downglide, L upglide, R lateral pressure, R rotation
- Soft tissue technique
What are the four muscles that make up the pelvic floor?
Obturator internus, piriformis, coccygeus, and levator ani
The trapezius is divided into the upper, middle, and lower trapezius. One of these portions consists of ascending muscle fibers. What is the insertion of this portion?
Lower Trap: spine of the scapula
What differentiates a positive finding in a head thrust versus a head shake test?
Head Shaking: points away from involved side
Head Thrust: points towards involved side
List the components of the UQS:
- Cervical ROM
- Special Tests: Compression, Distraction, Spurlings
- Joint Scan: Shoulder: FLEX & Elbow: Extreme FLEX/EXT w/pronation and supination
- Deep tendon reflex
- Myotome and dermatomes
-Neural Tension/ ULTT