1
Q
What is the anterior chapmans point for the appendix?
A
Tip of R 12th rib
2
Q
Explain the following stills technique for cervicals: AA SD
A
- rotation only
- Place finger on transverse process of side of rotation, rotate head into ease then compress and articulate into restrictive barrier
3
Q
What is the anterior chapmans point for the pancreas?
A
7th ICS on the R
4
Q
If both thoracic TP and rib TP, which should be treated first?
A
Thoracic first!
5
Q
Explain HVLA for Typical Cervicals w/rotational emphasis
A
Place index finger behind articular pillar on side of PTP, flex pts head then slight extension to isolate motion from above and below, SB towards the FREEDOM, then rotate towards the RB
6
Q
Explain MET Lumbar type 2 seated
A
Pt seated with hand on side of dysfunction behind neck, doc on opp side, monitor apex of curve, other hand goes over both of pts arms, move pt into F/E barrier first then rotation and SB and do ME
7
Q
Explain the anterior lumbar counterstain point: AL1
A
- medial to ASIS
- Pt supine w/doc on same side w/foot on table, flex knees and hips and pull toward doc and TP (equivalent to upper body RA from the TP) -> F StRa
8
Q
Explain the kirksville crunch
A
Pt supine w/doc on side opp of PTP, pt crosses arms over chest w/arm on side of PTP on top, place thenar eminence of caudal hand on PTP, then sidebend away from doc for type 1 SD or towards the doc for type 2 SD, then on exhalation apply ant to post HVLA thrust thorugh their abdomen
9
Q
What happens during craniosacral flexion
A
- Flexion of midline bones
- Sacral base posterior (counternutation/extension)
- Decreased AP diameter of the cranium
- ER of paired bones
10
Q
What are the sympathetics to the Appendix?
A
T12
11
Q
What happens to the occiput bone during cranial flexion?
A
- basilar part and the condyles move anteriorly and superiorly, directly influencing the temporal bones and the squama moves posteriorly
- greatest lateral deviation occurs at the lateral angles
12
Q
Explain MET Type 2 SD lateral recumbent -> long restrictor technique
A
Pt lateral recumbent w/PTP down, flex hips and knees and fine tune w/F/E, put pts top foot behind bottom knee, switch monitoring hands and use cephalad hand to move pt top shoulder post while they push against you anteriorly; next pull hip anteriorly while pt pushes against you posteriorly
13
Q
Explain the following stills technique for cervicals: typical cervicals
A
- type 2 or type 2-like -> F/E and SB & R same or opp
- Place finger on articular pillar on side of rotation, SB & rotate into ease then introduce F/E ease, compress through head and articulate through restrictive barrier
14
Q
Explain Seated Knee Fulcrum
A
Pt seated w/hands clasped behind neck, doc places ipsilateral knee on PTP and passes hands through pts arms and grasps their forearms just proximal to their wrists, on exhalation gently pull pt superior and posterior to roll PTP over knee
15
Q
Explain the parasympathetic innervation of the heart
A
Preganglionic axons from the dorsal nucleus of the vagus nerve and the nucleus ambiguous synapse on the cardiac plexus
16
Q
Explain MET for U/L sacral extension
A
Pt prone, abduct and ER hip on affected side, apply ant/inf force on sacral sulcus during exhalation and resist on inhalation
17
Q
What is the posterior chapmans point for the lower SI?
A
B/w T11&12 b/l
18
Q
What happens to the temporal bones with cranial flexion?
A
- they externally rotate
- Mastoid tip moves post/medial/slightly sup
- Squamous moves ant/lat/inf
- Can treat with 5 finger temporal hold, rocking temporals, V spread or CV4
- Oblique axis from jugular surface to petrous apex -> no exact plane (oblique axis/modified coronal plane)
19
Q
What is the anterior chapmans point for the Liver?
A
5th ICS on R
20
Q
What are the sympathetics to the Lcolon/pelvis?
A
T12-L2 (least/lumbar splanchnic; inferior mesenteric ganglia)
21
Q
What is the major difference between a trigger point and a tender point?
A
a trigger point may refer pain when pressed but tender points do NOT
22
Q
Sphenobasilar synchondrosis (SBS)?
A
- SBS moves cephalad during flexion and caudad during extension
- Flexion dysfunction = sphenoid and occiput move further during flexion and less motion into extension -> inc transverse diameter
- Extension dysfunction = sphenoid and occiput move further during extension and have less motion in flexion -> long narrow head, dec transverse diameter
23
Q
Explain HVLA for Inferior Innominate Shear
A
Pt lateral recumbent w/affected side Up, docs cephalad hand on PSIS and caudad hand on ASIS, provide lateral distraction to gap SI joint then cephalad force, exert cephalad force through ASIS and PSIS contacts
24
Q
Explain SBS lateral strain
A
- 2 vertical axes; sphenoid and occiput spin in the same direction
- Named by the direction of translation of the basisphenoid
- Left lateral strain: lateral shear occurs w/the sphenoid base to the left and the occipital base to the right
25
Explain the vault contact
1. Index on greater wings of sphenoid
2. Middle finger in front of ear
3. Ring finger on mastoid process of temporal bone
4. Pinky finger on occiput
26
What are the absolute contraindications of counterstain?
- Trauma
- Severe illness in which strict positional restrictions preclude tx
- Instability of tx area -> potential to produce neuro or vascular side effects
- Vascular or neuro syndromes which might lead to compromise of these systems
- Severe degenerative spondylosis w/no motion at level where tx would take place
27
Explain the posterior rib counterstain point: PR 2-6
- sup surface of angles of ribs at medial border of scapula ~2.5in lateral to midline
- Tx = F SaRa (trunk AND head for PR 2; just trunk for 3-6) -> pt seated, doc places pts arm on side of SD on docs knee
28
Explain HVLA for AA SD
Contact lateral mass of atlas on side of SD, flex c-spine then rotate head into restrictive barrier, at the end of exhalation apply HVLA rotational thrust through a combined motion of both hand contacts
29
Explain SBS flexion
- SBS rises superiorly as the distance decreases between the inferior angle of the sphenoid and occiput decreases toward the mid position
- Basi-occiout and basi-sphenoid move superiorly
- Occipital squama moves inferiorly and posteriorly
- Greater wing moves inferiorly and anteriorly
4. **When SBS is in flexion, the ethmoid will move in the same direction as the occiput and the vomer will move in the same direction as the sphenoid -> “vowels move together and consonants move together”
30
Explain the frontal contact
1. One hand cups the occiput
| 2. Long or little finger of the other hand is on one greater wing of the sphenoid with the thumb on the opp greater wing
31
How does the occiput move in an SBS vertical strain pattern?
- Superior vertical strain = occiput is extended with rotation around its transverse axis; b/l posterior quadrants are in IR
- inferior vertical strain = occiput is flexed w/rotation around its transverse axis; b/l posterior quadrants are in ER
32
What are the anterior chapmans points for pharyngitis?
1st rib ¾ of an in laterally from sternum, where clavicle crosses the rib
33
What is the posterior chapmans point for the spleen?
B/w T7&8 on the L
34
What is the anterior chapmans point for the esophagus?
2nd ICS b/l
35
Explain the posterior pelvic counterstain point: PS5 (b/l)
- superomedial ILA b/l
- Pt prone w/doc on either side, apply post to ant pressure at location diagonally opp the TP
i. Ex. If L PS5 is tender, doc applies pressure at R sacral sulcus
36
What factors dec the rate and quality of the CRI?
1. Stress
2. Depression
3. Chronic fatigue
4. Chronic infections
37
What are the 5 characteristics of the CRI?
- Rate -> usually 10-14 cpm
- Rhythm
- Amplitude -> may diminish w/SD
- Direction -> should be longitudinal and symmetric
- Strength
38
Explain HVLA for Superior Innominate Shear
Pt supine w/feet off end of table, doc grasps pts tibia and fibula sup to ankle, IR and abduct leg, lean back to induce axial traction, increase traction on exhalation and exert axial thrust
39
Explain MET for Backward sacral torsion (R/L or L/R)
Pt lateral recumbent with axis side down, flex hip and knee of lower leg then drop top foot off table and push toward the floor while the pt pushes up against you; monitor at L5-S1 throughout
40
Explain HVLA for Posterior Innominate Rotation
Pt lateral recumbent w/dysfunctional side up, flex hips and knees, pt straightens bottom leg and places top foot on bottom knee, cephalad hand in crease of elbow, cauddad forearm placed on PSIS and iliac crest, simultaneously push shoulder posterior and roll pelvis anterior to induce axial rotation then deliver thrust w/caudad forearm towards the umbilicus
41
Explain the sympathetic innervation to the heart
Preganglionic axons from intermediolateral column of T1-5 synapse on corresponding upper thoracic sympathetic ganglia (cervical ganglia) through ascension -> postganglionic fibers form the sympathetic cardiac nerves and converge at the cardiac plexus
**Remember heart and lungs are T1-6
42
Explain the posterior pelvic counterstain point: PS1 (b/l)
- medial to inf border of PSIS b/l (sacral sulci)
- Pt prone w/doc on same side as TP, apply post to ant pressure at location diagonally opposite the TP
- Ex. Left PS1 is tender, apply pressure at R ILA
43
What is the posterior chapmans point for the stomach (peristalsis)?
B/w T6&7 on the L
44
What sutures are assoc w/tension HA's?
OM, coronal, and Asterion pain often involved in tension HA’s
45
Explain the anterior pelvic counterstain point: Psoas Major
- 2/3 distance from ASIS to midline, pressing deep
- Pt supine w/doc on same side as TP w/foot on table, markedly flex pts knees/hips and rest on docs knees, pull feet and ankles toward TP and doc
46
Name the midline/unpaired cranial bones
- sphenoid
- occiput
- ethmoid
- facial -> mandible and vomer
47
explain Seated HVLA for lower thoracics
Pt seated w/ipsilateral hand to PTP behind neck, doc goes under 1 arm and over the other for type 1 SD or over both arms for type 2 SD; put them into indirect and pull through rotational barrier on exhalation
48
Explain the significance of Sympathetic hyperactivity at the AV node
inc risk of ectopic foci and ventricular fibrillation
49
What are the anterior and posterior chapmans points for the nasals?
- Anterior = 1st costochondral junction
| - Posterior = Working backwards from the angle of the jaw and one finds tenderness on anterior part of C1
50
What is the anterior chapmans point for the small intestines?
8th-10th ICS b/l
51
What is the purpose of a CV4?
- increases amplitude of CRI
| - Used to stimulate the body’s inherent capacity to deal w/whatever dysfunction is present
52
Explain SBS extension
- SBS moves inferiorly as the distance increases between the inf angle of the sphenoid and occiput increases toward mid-position
- Basi-occiput and basi-sphenoid move inferiorly
- Occipital squama moves superiorly and anteriorly
- Greater wing moves superiorly and anteriorly
53
Explain SBS torsion
- sphenoid and occiput rotate in opposite directions around an AP axis
- Named for the superior sphenoid greater wing side; motion happens in opposite directions
- High greater wing = ant quadrant is in relative ER
- Lower greater wing = ant quadrant is in relative IR
- Right SBS torsion = right greater wing of the sphenoid superior compared to left
- Left SBS torsion = left greater wing of the sphenoid superior compared to the right
54
SNS and PNS fibers passing through the cardiac plexus are most strongly concentrated where?
in the SA and AV nodes
55
What happens to the parietal bones with cranial flexion?
- they externally rotate
- Treat IR (more common) or ER w/parietal lift
- AP axis in coronal plane
56
What is the anterior chapmans point for the stomach?
6th ICS on the left
57
explain MET Type 2 Flexed lateral recumbent -> AKA long lever technique
- “FDDR” -> Flexed dysfunction, PTP Down, pt force Down, lateral Recumbent
- Pt lateral recumbent, monitor dysfunction, pull pts arm ant/sup, engaging rotation and SB barriers then switch monitoring hands, straighten bottom leg and lift top leg up as pt pushes leg towards floor
58
Explain the anterior thoracic counterstain point: AT7-8
- 7 = lateral to midline at inf tip of xiphoid
- 8 = lateral to midline, ½ b/w xiphoid tip and umbilicus (1.5in inf to xiphoid)
- Tx = F StRa -> pt supine and manipulate head
59
Explain the becker contact
- Thumbs rest on the greater sphenoid wings; Just inf to the frontozygomatic suture
- Index fingers rest on mastoid processes
- Middle to pinky fingers rest on occiput with middle finger post to OM suture
- Palms cup occiput and post aspect of parietals
60
What is the posterior chapmans point for the esophagus?
T2 b/l
61
What is the physiological motion of the occiput?
Membranous portion of the occiput moves post/inf during fkexion and reverse during extension
62
Explain the significance of Left vagal hyperactivity at the AV node
AV blocks
63
Explain the posterior thoracic counterstain point: PT1-3 either SP or TP
E SaRa -> pt prone w/arms draped over side of table, induce tx using head
64
What factors inc the rate and quality of the CRI?
1. Vigorous physical activity
2. Systemic fever
3. Following OMT to the craniosacral mechanism
65
Explain the posterior lumbar counterstain point: LPL5
- inferior aspect of PSIS
- Pt prone w/thigh on dysfunctional side suspended over side of table, doc on same side, flex hip and knee then add adduction and IR of hip
66
What is the SBS?
- where the basisphenoid and the basiocciput join to form a synchondrosis
- Synchondrosis = an almost immovable joint between bones bound by a layer of cartilage
67
What is the posterior chapmans point for the upper SI?
B/w T8&9 b/l
68
What is the posterior chapmans point for the pylorus?
R Rib 10 at costotransverse
69
Explain MET for B/L sacral extension
Pt prone in sphinx position, apply anterior and inferior force on base during exhalation and resist on inhalation
70
Explain a temporal pull
- Balances the tentorium cerebelli and/or the temporal bones (individually or b/l)
- Pt supine, docs right and left hands grab b/l antihelix of ears; assess motion of the temporal bones prior to technique, use pincer grip on pinnae as close to temporal bone as possible, apply traction laterally, post and sup along a vector that parallels the petrous ridge of the temporals, encourage inhalation (done by lateral pull) and take up the slack maintaining tension at the feathers edge of the restrictive barrier until a release is felt then reassess motion of temporal bones
71
Explain rocking the temporals
- Pt supine, docs points of contact are b/l or u/l 5 finger temporal hold; encourage free direction of motion first usually started w/flexion cycle
- encourage IR: thumb & index finger move superomedially while the 4th & 5th digits move inferolaterally
- encourage ER: thumb and index finger move inferolaterally while 4th & 5th digits ride along w/superomedial motion
- Simultaneous ER/IR motions are encouraged in a back and forth manner until bones achieve an asynchronous motion, then just monitor allowing physiologic motion to return
72
Explain MET i. Type 2 Extended SD Lateral Recumbent -> AKA long lever technique
- “SUEE” -> modified Sims, PTP Up, pt force Up, Extension dysfunction
- pt in modified sims w/PTP up, monitor SD, flex hips and knees and let lefs drop off table then push down on them as pt raises legs up against you
73
Explain the anterior lumbar counterstain point: AL2
- medial to AIIS (ant inf iliac spine)
- Pt supine w/doc on opp side, flex knees and hips, pull toward doc (away from TP) -> F SaRt
**This treatment requires significant rotation!**
74
What is the purpose of rocking the temporals?
This is done to relieve cranial nerve IX, X, XI entrapment/dysfunction, Eustachian tube compression, jugular vein compression, restricted temporal/occipital articulation, tinnitus
75
What are the 4 main poles of attachment for the RTM?
- Ant/Sup = crista galli
- Ant/Inf pole = clinoid processes of sphenoid
- Lateral pole = mastoid angles of parietals and petrous ridges of temporal bones
- Posterior pole = internal occipital protuberance and transverse ridges
76
What are the parasympathetics to the GI system?
- Vagus Nerve (CN X)= Upper/middle GI, liver
| - Pelvic Splanchnic (S2-4) = Lower GI
77
Explain the innervation of the cardiac plexus
- Cardiac plexus is divided into the superficial and deep cardiac plexus
- deep cardiac plexus splits into the right and left halves
- Right half supplies the right coronary plexus (R atrium and R ventricle), left coronary plexus (L atrium and L ventricle), and SA node
- The left half supplies the AV node
78
Explain the anterior thoracic counterstain point: AT9-12
- 9 = lateral to midline, ¾ distance from xiphoid tip to umbilicus (1-2cm sup to umbilicus)
- 10 = lateral to midline ¼ from umbilicus to pubic symphysis (1-2cm inf to umbilicus)
- 11 = lateral to midline, ½ b/w umbilicus and pubic symphysis (3-4cm below umbilicus)
- 12 = MAL on superoanterior surface of iliac crest (b/l)
- Tx = F StRa -> pt supine w/doc on same side as TP, flex both hips and knees all the way, fine tune w/rotation toward doc
79
Explain HVLA for Pubic Restrictions
Pt supine w/hips and knees flexed w/feet flat on table, doc on either side then do MET alternating between Abduction of knees w/forearm between knees and pt force in Adduction then ADDuction of the knees w/knees squeezed together and pt force towards Abduction -> w/final ABDuction cycle induce thrust towards further ABDuction
80
Explain the anterior thoracic counterstain point: AT1-6
- AT 1-6: 1 = midline on suprasternal notch
- 2 = midline on manubrium at sternal angle
- 3-6 = midline at level of costal cartilage related to named vertebrae
- Tx = Pt supine w/feet flat on table, doc at head of table, flex pts head
81
Explain the posterior thoracic counterstain point: PT10-12 either SP or TP
E SaRa (pelvis) or E SaRt (torso) -> pt prone w/arms draped over top of table w/pillow under chest, doc on same side and grabs opp ASIS, raising the pts hip and inducing extension of the lower Tspine
82
Explain the posterior lumbar counterstain point: PL3 Lat (gluteus medius)
- 2/3 of the way between PSIS & TFL
| - Pt prone w/doc on same side of TP, extend hip
83
Explain a V spread
- Pt supine, docs ipsilateral hand w/2nd and 3rd fingers on either rside of suture to be released, contralateral hand 180 degrees opposite, palm or 2 fingers contact head
- Spread fingers on both side of restricted suture to disengage articulation; gently apply a force with the opposing hand towards the dysfunctional suture such that a fluid flow or tide is produced toward the fingers making the V, adjust until there’s a response felt at the V spread fingers
- Reassess motion of the paired bones and at the sutures between them
84
Explain the texas twist
- Pt prone w/doc on side opp of PTP
- Type 1 SD: Place thenar eminence of cephalad hand on PTP w/fingers facing caudad then place caudad hand on ipsilateral TP w/fingers facing cephalad
- Type 2 SD: Place caudad thenar eminence on PTP w/fingers facing cephalad and place hypothenar eminence of cephalad hand on ipsilateral TP
85
What are the sympathetics to the upper gi?
T5-9 (Greater splanchnic; celiac ganglia)
86
Explain the following stills technique for thoracics: upper thoracics, seated
Move head into planes of ease, add compression then articulate through restrictive barriers
87
Explain the anterior lumbar counterstain point: AL5**
- ant aspect of pubic bone (on pubic ramus) ~1cm lateral to pubic symphysis (near pubic tubercle)**
- Pt supine w/doc on same side of TP w/foot on table, flex hips and knees, push ankles away from doc and rotate knees toward -> F SaRa
88
What is the anterior chapmans point for the GB?
6th ICS on the right
89
What are the sympathetics to the SI and R colon?
T10-11 (lesser splanchnic; superior mesenteric ganglia)
90
Explain the anterior pelvic counterstain point: Inguinal Ligament (Inlig)
- Lateral surface of the pubic bone near attachment of inguinal ligament
- Pt supine w/doc on same side as TP w/foot on table, flex hips and knees to 90 and rest on docs knee, crossing opp ankle over leg, pull ankles toward doc (IR hip on side of TP)
91
What is the anterior chapmans point for the Spleen?
7th ICS on the L
92
Explain the posterior pelvic counterstain point: High Ilium Sacroiliac (HISI)
- lateral aspect of PSIS
| - Pt prone w/doc on same side as TP, monitor TP by pressing lateral to medial, extend hip and fine tune w/Ab/AD
93
Explain the posterior pelvic counterstain point: Piriformis (**Common for boards**)
- ½ way from ILA to greater trochanter
- Pt prone w/dysfunctional side at edge of table and doc seated on same side, flex pts hip off table and Ab and ER pts knee
94
Explain a 5 finger temporal hold (can be done u/l or b/l)
- pt supine, doc places middle finger in external auditory canal and the index and thumb pinch the zygomatic arch, ring and little fingers ant and posterior of the mastoid process
- If done u/l the opp hand cradles the occipital squama medial to the occipitomastoid sutures
95
What is a Unicoronal synostosis?
- premature fusion of a single coronal suture leading to a head shape called anterior plagiocephaly
- Usually due to difficult labor and delivery of the child -> need OCMM or helmet therapy
96
Explain the posterior lumbar counterstain point: UPL5
- superomedial border of PSIS
| - Pt prone w/doc on opp side of TP, doc extends hip to TP and ER
97
Explain the anterior lumbar counterstain point: AL3-4
- AL 3 lateral to AIIS
- AL4 inf to AIIS
- Pt supine w/doc on opp side of TP w/foot on table, flex hips and knees, pull knees and ankles toward doc -> F SaRt
98
explain HVLA for Supine Knee Fulcrum for Upper and Middle Thoracics
Pt supine w/fingers clasped behind neck, position docs ipsilateral knee under PTP, pass hands through pts flexed UE’s on both sides and encircle pts rib cage w/fingers, on exhalation gently pull pts chest downward into the thigh while adding cephalad traction
99
Explain the Rays of the sun approach to direction of thrust
1. Upper cervicals thrust is towards the eyes
2. Middle cervicals thrust is straight across the neck
3. Lower cervicals thrust is directed down toward chest
100
What are the dural attachments of the cranium, vertebral column and sacrum?
foramen magnum, C2, C3, S2
101
What are the bregma and lambda?
- Bregma = old ant fontanelle
| - Lambda = old post fontanelle
102
Explain the posterior lumbar counterstain point: PL 1-3 TP
- on respective TP (can be b/l)
| - Pt prone w/doc on opp side, extend hip to TP and rotate toward TP
103
Explain the anterior pelvic counterstain point: Iliacus (IL)
- lower quadrant, 1-2in medial to ASIS deep in iliac fossa
| - Pt supine w/doc on same side as TP with foot on table, flex hip and knees w/ankles crossed and frog leg
104
Explain the posterior lumbar counterstain point: PL4 Lat (gluteus medius)
- posterior margin of TFL
| - Pt prone w/doc on same side of TP, extend hip
105
What is a bicoronal synostosis?
fusion of both coronal sutures leading to a head shape called bracycephaly
106
Explain the sympathetic innervation to beta 2 receptors in the lungs
bronchodilation
107
Explain the anterior thoracic counterstain point: AL5-8T
- 5-6 = at costosternal joint at affected level
- 7-8 = on inf medial surface of costal cartilages, 1 & 2in inferolaterally from xiphoid
- Tx = F StRa -> pt seated w/doc behind pt w/leg on table under pts arm on unaffected side
108
Explain Balanced Membranous Tension (indirect)
- Use frontal occipital hold or vault hold
- SBS is held in the midpoint of dysfunction until a still point is obtained -> inability to feel CRI -> position maintained until CRI motion begins to return and is noted to be more symmetrical than before and normal motion is restored
109
Explain the posterior pelvic counterstain point: PS 2, 3, 4 (midline)
- midline sacrum between sacral spines
| - Pt prone w/doc standing on either side, apply post to ant pressure on apex (if PS2), base (if PS4), or either (if PS3)
110
What is the anterior chapmans point for stomach acidity?
5th ICS on the L
111
What are the anterior rib counterstain points?
- AR 1 & 2: 1 = inf to clavicle on rib 1 lateral to manubrium
- AR 2 = 1.5 in lateral to manubrium on rib 2 at MCL or deep in axilla
- Tx = F StRt -> pt supine w/doc at head of table inducing tx w/head
112
Explain craniotomy-sacral motion
- Nutation = during cranial extension of the SBS the sacral base moves anterior (flexion) around the transverse axis
- Exhalation = sacral flexion and cranial extension
- Counternutation = during cranial flexion of the SBS the sacral base moves posterior (extension) around a transverse axis
- Inhalation = sacral extension and cranial flexion
113
Explain the axes of midline cranial bones
bones rotate about a transverse axis in the sagittal plane
114
Explain the parasympathetics to the renal system
- Vagus Nerve (CN X) = Kidney, upper ureter
| - Pelvic Splanchnic (S2-4) = Lower ureter, bladder
115
Explain HVLA for Typical Cervicals w/sidebending emphasis
Flex, rotate towards the FREEDOM, then sidebend towards the RB, thrust in the sidebending plane towards the T1 spinous process
116
Explain MET Type 1 (neutral) lateral recumbent -> long restrictor technique
- Pt lateral recumbent w/PTP down, flex pts knees and hips while monitoring apex, fine tune w/F/E, lower pts top leg off table, switch monitoring hands and use cephalad hand to move pts top shoulder posteriorly and have pt push top shoulder anteriorly against you; next use caudad arm to pull hips anteriorly while pt pulls against you posteriorly
117
What is the anterior chapmans point for the Pylorus?
Sternum
118
Explain a parietal lift
- Pt supine, docs fingertips contact across inf aspect of parietal bones just sup to parietal-squamous sutures, thumbs interlocked above the sagittal suture -> thumbs don’t touch pt!
- Apply slight force to parietals by pulling thumbs against each other to move bones toward IR, maintain until change in quality/quantity of CRI motion then gently release forces
119
What is the posterior chapmans point for the GB?
B/w T6&7 on the R
120
Explain MET Lumbar type 1 (neutral) seated
Pt seated w/hand on side of PTP behind neck, Doc behind pt on opp side of PTP, monitor apex of curve, place other hand under one of pts arms and over the other, flex torso, then engage rotation and SB barriers and do ME
121
Explain the posterior lumbar counterstain point:PL1-5 (midline)
- midline, on respective spinous process
| - Pt prone w/doc on same side as TP, extend hip to TP
122
What are the anterior chapmans points for the middle ear?
- Anterior = Superior clavicle ~2-3cm lateral to SC junction
- Posterior = Base of occiput at OA joint
123
Explain a frontal lift
- Pt supine, doc interlaces fingers above frontal bone, placing hypothenar eminences on corresponding lateral angles of frontal bone, w/heels of hand in front of coronal suture
- During extension/IR, interlaced fingers exert constant pressure against eachother resulting in medial pressure against the frontal eminences via the hypothenar eminences ; raise frontal bone anteriorly either u/l or b/l as appropriate to dx -> follow motion into ER, wait for release of tension and gently release
124
Explain MET for U/L sacral flexion
Pt prone, abduct and IR the hip on affected side, apply ant/sup force on ILA during inhalation and resist during exhalation
125
Explain the axes of paired cranial bones
rotate about an AP axis w/IR/ER rotation in the coronal plane
126
Explain the posterior thoracic counterstain point: PT4-6 either SP or TP
E SaRt -> pt prone w/arms draped over top of table, induce tx using head
127
Explain HVLA for Anterior Innominate Rotation
Pt lateral recumbent w/dysfunctional side up, flex pts hips and knees, drop top leg off table, place cephalad hand in crease of elbow and caudad forearm along femur between PSIS and trochanter then simultaneously push shoulder posterior and roll pelvis anterior, force delivered w/caudad forearm down the shaft of the femur**
128
Explain the anatomy of the trigeminal nerve
“Standing Room Only”
- Superior orbital fissure = transmits V1 (ophthalmic N) and CN III, IV, VI
- Foramen Rotundum = transmits V2 (maxillary n)
- Foramen Ovale = Transmits V3 (mandibular n)
**Sensory impulses from the forehead, orbit, anterior and middle fossae of the skull and upper surface of the tentorium are all transmitted by the trigeminal nerve, notably V1 and V2
129
What is the posterior chapmans point for the Liver?
B/w T5&6 on the R
130
explain MET Type 1 (neutral) lateral recumbent -> long lever technique
- “NUDR” -> Neutral dysfunction, PTP Up, pt force Down, Recumbent
- pt lateral recumbent w/PTP up, monitor apex and flex hips and knees then lift pts ankles and have pt push ankles down
131
Explain the following stills technique for cervicals: OA SD
- type 1 like -> F/E but R & SB are opp
- SB into ease (slight rotation in opp direction occurs on its own) then F/E into ease, compress through top of head and articulate into restrictive barrier
132
Explain the posterior thoracic counterstain point: PT7-9 either SP or TP
E SaRt -> pt prone w/arms draped over top of table w/a pillow under their chest, induce tx using their head
133
What components is the PRM comprised of
CNS + CSF + Dural membranes + cranial bones + sacrum = PRM
134
Explain the following stills technique for thoracics: lower thoracics seated (T6 and below)
Docs arm on post shoulders, move into planes of ease, add compression through shoulders and articulate through restrictive barriers
135
Explain the posterior pelvic counterstain point: High Ilium Flare Out (HIFO)
- lateral aspect of ILA, assoc w/coccygeus muscle
- Pt prone w/doc on opp side of pt, extend leg on side of dysfunction enough to clear other leg, induce marked adduction and ER by pulling leg towards doc
136
What happens during craniosacral extension
1. Extension of midline bones
2. Sacral base anterior (nutation/flexion)
3. Increased AP diameter of cranium
4. IR of paired bones
137
When SBS is in flexion, how does the ethmoid will move in and vomer move in relation to the occiput and sphenoid?
When SBS is in flexion, the ethmoid will move in the same direction as the occiput and the vomer will move in the same direction as the sphenoid
**“vowels move together and consonants move together”
138
Explain SBS vertical strain
- 2 transverse axes
- Named by the direction of the basisphenoid; direction is the same for both bones
- Superior vertical strain = when the sphenoid is in flexion -> basisphenoid is superior
- Inferior vertical strain = when the sphenoid is in extension -> basisphenoid is inferior
139
Explain the parasympathetic innervation of the lungs
- Cholinergic innervation of M3 receptors in the lungs -> bronchoconstriction, mucus secretion, bronchial vasodilation
- Irritation of pulmonary branches of the vagus nerve produce strong inhibitory reflexes on the heart -> Decreased heart rate and vascular tone
140
Explain HVLA for OA SD
Contact posterior occiput post to mastoid process on side of PTP, place into direct position and add localizing cephalad directed traction, at the end of exhalation apply thrust
141
What is the posterior chapmans point for the pancreas?
B/w T7&8 on the right
142
Explain the sympathetics to the renal system
- GU tract = T10-L2
- Ureter – upper/lower = T10-11/T12-L2
- Bladder = T12-L2
143
What is the physiological motion of the sphenoid?
Greater wings move ant/inf during flexion and reverse during extension
144
What happens to the frontal bones with cranial flexion?
- During flexion, it externally rotates (low sloping forehead) -> Treat w/frontal lift
- Dual AP axis in coronal plane and sup/inf axis in horizontal plane
145
Explain the significance of right vagal hyperactivity at SA node
sinus bradyarrhythmias
146
Explain SBS side bending rotation
- one AP axis (rotation) and 2 vertical axes (sidebending); sphenoid and occiput spin in opposite directions about the 2 vertical axes and in the same direction about the 1 AP axis
- Named for the convex side (flexed side)
147
What are the axes of motion of the sacrum?
- ST (respiratory) axis: Transverse axis about which the sacrum moves during the respiratory cycle and inherently due to PRM in OCMM
- MT (postural) axis: Functional transverse axis of nutation and counternutation in the standing position, passing though ant aspect of S2
- IT (pelvic/ilial) axis: Functional transverse axis at the level of S3 through the inf auricular surface and represents the axis for movement of the ilia on the sacrum
148
What is the posterior chapmans point for the middle SI?
B/w T9&10 b/l
149
Explain the anterior pelvic counterstain point: Low ilium (LI)
- lateral aspect of superior ramus where psoas muscle crosses pelvic rim
- Pt supine w/doc on same side as TP, flex hip and knee to 90, ER hip, fine tune w/AD/AB (only one leg for this tx!)
150
What is the posterior chapmans point for stomach acidity?
B/w T5&6 on the L
151
What is the sutherland fulcrum?
- functional name given to the straight sinus as the origin of the 3 sickle-shaped agents of the falx cerebri and the tentorium cerebelli
- Suspended = moves but remains in the RTM
- Automatic = moves w/motion of the CRI
- Shifting = straight sinus moves up and down
152
Explian the innervation of the thoracic duct
The thoracic duct is functionally under sympathetic control, thus hypersympathetic tone may decrease lymphatic flow
153
Explain the posterior rib counterstain point: PR1
- post margin of rib head beneath margin of trapezius
- Tx = E SRT -> extend head and rotate toward then use SB to fine tune in either direction; Pt supine or seated w/doc standing behind or to side, if seated doc may use pts arm over his knee to fine tune SB
**This treats a depressed rib, inhalation restriction
154
Explain the nerve distribution of the head
- Anterior 2/3 = trigeminal nerve
- Posterior 1/3 = lesser occipital (C1-3), recurrent branches of IX & X
- Sympathetics = T1-4
155
How does IR and ER of the temporal bone affect the eustachian tubes?
- Internal rotation can close Eustachian tubes -> high pitched tinnitus -> Occurs w/SBS extension
- External rotation -> low roaring sound or tinnitus -> occurs w/SBS flexion
156
List the 4 phases of counterstain
- relaxation
- reset of spindle fibers and nociceptors -> NOT golgi tendon organs, that's ME
- washout -> takes 10-15 sec to begin and peaks at ~1min
- slow return to neutral -> rapid return can cause reactivation of spindle activity
157
Name the paired cranial bones
- parietal
- frontal
- temporal
158
What are the anterior and posterior chapmans points for otitis media?
- Anterior = Superior aspect of clavicle just lateral to 1st rib
- Posterior = Lateral edge of C1 posteriorly
159
What are the anterior chapmans points for sinusitis?
3.5in lateral to sternum on superior aspect of 2nd rib
160
What are the 5 components of the PRM?
- Inherent mobility of the brain and SC**
- Fluctuation of CSF
- Mobility of intracranial and intraspinal membranes -> fascial mobility and continuity significantly impacts the PRM**
- Articulatory mobility of the cranial bones
- Involuntary mobility of the sacrum between the ilia
161
Explain the significance of sympathetic hyperactivity at the SA node
inc risk of SVT
COM: OS IV
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