MSK: Lab 3

Question 1

Which side are you gapping for Chicago role?

Answer 1

The side your hand is on the ASIS

Question 2

What should you always do before joint play to make sure its really a joint issue?

Answer 2

MMT - make sure there’s not a muscle limiting movement

Question 3

MET Lumbar gapping technique

Answer 3

Same set up as manip but both knees are flexed when locking bottom

log roll pt tpwards you and provide compression with bodyweight

pt is asked to gently untwist while PT maintains position then relax

reengage barrier and repeat as motion improves (rotate them further)

Question 4

How to figure out which MET to do? (open or closing? which side)?

Answer 4

ROM assessment: what was limited/painful - flexion or ext?

flex = opening restriction
ext = closing restriction

Which SB direction was limited? then pick the closing or opening side

Question 5

Pt presents with dec flexion, dec right side bending and dec rotation AROM and hypomobility w joint play at L2-L3. How can you treat?

Answer 5

L opening restriction at L2-L3, facet dysfxn

MET for opening restriction
Manipulation
etc

Question 6

MET opening restriction technique

Answer 6

opening the downside, so have pt lay on the side thats restricted

lock top and bottom

lift ankles, have pt push down isometrically

release and lift higher

repeat as motions improves

Question 7

MET closing restriction

Answer 7

treating “up” side so have pt lie on unaffected side

lock top and bottom

only lift one lower leg (leave the other straight on the table)

have pt push down isometrically, then relax and PT moves them further in range

Question 8

Mobility dosing vs NM dosing vs nerve glide dosing

Answer 8

mobility - 15-20
NM - low, 5 or to fatigue
nerve - 15-20 (nerve mobility)

Question 9

You just put your pt in the stabilization category. What exercises do you give them?

Answer 9

start with NM control - make sure they can activate the right msucles

progress those exercises and work up to strengthening

ex: if they can tolerate flexion, have them start with hooklying TA, then dead bug progression (drooping legs then legs and arms) or if they do better with ext start with sidelying multifidus exercises and then prone plank progression

more adv: farmers walks, RDLs

Question 10

What kind of tx might you do if the patient has bilateral deficits/symptoms vs unilateral?

Answer 10

bilateral - PA mobilization

uni - sidelying manip or gapping

Question 11

How would this pt be treated/move through the TBC categories?

Pt presents w/ radiating pain into R posterior foot, a L lateral shift w/ dec extension, dec R SB and rot AROM and normal joint play.

Answer 11

1. treat lateral shift
2. now placed in flexion direction-specific category, try to centralize pain
3. once symptoms are centralized (no more radiating pain), he is not hypomobile so he goes to stabilization

Question 12

Pt presents with severe radiating pain into L posterior ankle/foot that peripheralizes w all lumbar AROM, lumbar AROM dec in all directions, empty end-feel throughout L spine during joint play assessment

Answer 12

traction

Question 13

Pt presents w dec ext, dec L SB and rot AROM and hypomobility w joint play at L3-L4

Answer 13

L closing restriction, they’re hypomobile (MT) bucket so do opening restriction gapping