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In the Preface, I state that: “Pain may be described as an unpleasant sensory and emotional experience associated with actual or ____________ tissue damage.”
Does their pain have to be actual tissue damage for the brain to consider it a threat?
Many clients report pain in the ______________.
Tip: Think phantom limb pain.
If the client labels her experience as pain and reports it in a way consistent with pain caused by tissue damage,_________________.
Tip: We need to accept the brain’s interpretation of pain, not just the reported underlying pathology or injury.
Pain is always an unpleasant feeling and is conveyed to the brain by:
Tip: Think receptors, not nerves.
When asked what they considered to be the primary cause of most bodily pain and dysfunction, who said “lack of variety of movement patterns”?
Tip: Which of these legendary figures was the movement guru?
With proper treatment, each cycle is usually characterized by:
Tip: What are the therapeutic goals?
Who said “the body is always working towards order”?
The founder of chiropractic and proponent of innate body intelligence.
In the “Introduction,” I state: “For therapists working in a pain management setting, a sound ____________ is key to creating a treatment plan.”
Tip: What do we do before we begin treatment?
A technique is:
Tip: Technique is an invitation to touch.
It is important to ask yourself: “Are the tight muscles __________ or __________ contracted and why?”
Tip: What is active contraction called? Passive contraction?
In the “Technique Tips” section, I state: “The force applied should not create _____pain.”
Tip: Ask the client to tell you if they are feeling pain in other areas when you work.
Think _______when performing deep tissue myofascial work.
Tip: The goal is to improve what?
Visualize the______ and ______anatomy beneath your fingers.
Tip: How are you affecting the skeletal and nervous systems?
Work at the client’s restrictive barrier but don’t______the barrier.
Tip: Always work pain-free at the client’s tolerance level.
Effective deep tissue work requires low shoulders, locked in ________, and force coming from the ground.
Tip: Always maintain proper spinal curves when doing deep tissue work.
What is one of the primary goals of Myoskeletal Alignment?
Tip: The goal is to level the head and tail.
How is the client positioned?
Tip: This position allows for the best position for working the back
Where does the therapist make contact?
Tip: Right hand cups the anterior while the left hand restrains on the posterior hip.
How much effort should the client use when pushing their hip down to the table?
Tip: Don’t let them push too hard. It engages too many muscles.
What should be done after meeting the restrictive barrier?
Incorrect answer: try again. Tip: Follow this three step protocol on all techniques.
Which plane is the joint being mobilized in?
Tip: It’s not just sidebending, but also rotation. Rotation and sidebending couple to opposites at the O-A joint.
How is the client positioned?
Tip: You must allow the back of the head to rest in your fingertips.
Where should the finger pads contact in the beginning?
Tip: Think muscle first.
Bodywork is about
Tip: All these are correct but what movement describes them all?
The goal is for the therapist’s fingers to slowly make their way up under the transverse process of:
Tip: What upper cervical vertebra has the widest transverse processes?
This technique helps:
Tip: When you pull the TP on the right, it opens the TP on the left?
What is usually the primary problem with plantar fasciitis?
Tip: All these can contribute to plantar fasciitis, but a strong arch depends on smoothly gliding calf muscles.
How many branches compose the plantar fascia?
Tip: At the calcaneal tuberosity, one slip connects to the toes and the other down the lateral border of the foot.
When calcium is deposited on the ___________ of the calcaneus bone, instead of being absorbed into the bone matrix, it leaves a heel spur.
Tip: Bone spurs form as the plantar fascia pulls away from the calcaneal lip.
Although the spur itself is not a pain generator, the highly innervated __________
may become inflamed from pressure and friction.
Tip: It’s the stretched and injured skin of the bone that can be painful.
In the spindle-stim maneuver, the client’s knee is flexed to ___ degrees.
Tip: Keep the knee in the most stable position possible.
Which of these is NOT a goal of the pec release technique?
Tip: Pulling the shoulders back is scapular retraction which is what we’re doing here.
Where should the client’s arm be placed?
Tip: This position internally rotates the scapula which has wandered off the ribcage.
Ida Rolf used to say “Put it where it belongs and make it ________”
Tip: Always ask for movement as an enhancer.
What is the therapist putting back where it belongs?
Tip: Think shoulder blade on ribcage for improved posture.
In the second technique for protracted shoulder girdle, the therapist brings the client’s arm across their body to the first _____________ restrictive barrier.
Tip: Remember, the arm is still behind the back and you’re bringing the client’s wrist toward the midline.
The goal of the mobilization is to relieve __________ pressure on the spinal cord.
Tip: In spinal stenosis, what material has collected around the cord and putting pressure on the dura mater?
In the spinal stenosis technique the primary landmark is the ___________ spine
Tip: Most stenosis causes the legs to go numb.
To begin the technique, the therapist palpates the _____ spinous process.
Tip: Always start at the bottom vertebra and work your way up the back.
The client is placed in a similar position to the “_________ roll” often performed by chiropractors.
Tip: This twisting maneuver was so- named because it often immediately corrected the painful low back.
In the spinal stenosis technique, the bottom leg is moved forward and back to mobilize all joints and soft tissues of the ____________spine.
Tip: Spinal stenosis typically occurs in the low back.
“If your back hurts, it’s your ________ fault.”
Tip: The hips must be mobile to have a stable lumbar spine.
With the knee extended, the prone client raises her leg as high as possible to test how much ____ _____ she has.
Tip: She’s engaging the hamstring muscles and stretching the hip flexors, which tells you how much she can extend her hip.
The spindle-stim maneuver is meant to kick in a _____________.
Tip: What is a myotactic reflex ark commonly called?
The spindle-stim goal is to _________ weak gluteal muscles.
Tip: Think turning on the weak muscle….what are you doing to it?
About how much time should this technique be applied per side?
Tip: You must give the spindles enough time to be activated.
Which of these is a synovial joint that should have movement?
Tip: Connects the sacrum to the coccyx.
Which of these ligaments is involved in this technique
Tip: Several ligaments must be released for this to be effective.
“If you cannot feel the ______ of the coccyx, you may have coccyx dysfunction.”
Tip: In a hooked coccyx, which segment do we want to come back toward us?
Addressing a misaligned coccyx can cause a client to become very emotional, due to the vertebra’s direct attachment to the dural membrane through the ____________.
Tip: The end is the “final terminal” for the dural membrane.
Client performs a ______________ as an enhancer to the coccyx technique.
Tip: Got to get the pelvis moving back and forth as you hold the coccyx.
The goal is to restore capsular flexibility and joint play to facets stuck ________.
Tip: As the neck flexes forward, the C7 vertebra moves forward on T1 and often gets stuck there.
In medical terms, the dowager’s hump is called _______________.
Tip: Kyphosis is a normal thoracic curve, so what is it called when the kyphotic curve is exaggerated?
The therapist’s forearm hooks the fascia at _____ and glides down the lamina groove to help close the facet joints.
Tip: What is the bottom cervical vertebra?
When the client raises their head out of the cradle, we are asking their facets to ________.
Tip: Spinal extension asks the superior vertebra to glide down on its inferior neighbor and do what?
One of the primary goals for today’s manual therapist is restoration and maintenance of ________________.
Tip: We have spinal curve to absorb shock.
The goal of this technique is to release the fibrotic ___________ hip capsule.
Tip: If they’re lying prone and you extend the client’s leg, are you stretching the back or the front?
To begin the technique, the client’s knee is flexed to _______ .
Tip: It is important to flex the knee enough to place it in your armpit.
The bracing hand should be placed __________ the ischial tuberosity.
Tip: To stretch the anterior capsule, you can’t have the brace hand on the butt; it must be on the femur to isolate the stretch to the anterior capsule.
The therapist is mainly focusing on ___________ of the hip.
Tip: To stretch the front side, you must take the hip into what?
The client should easily have about ___ degrees of hip extension off the table.
Tip: Don’t expect too much hip capsule stretch.
These techniques are performed with the client ___________.
Tip: This is the best way to access the upper traps and levator scapula.
In the upper trap elbow technique, the therapist’s elbow should glide the tissue ________ to _________.
Tip: In those with upper crossed syndrome, the tissue needs to come to the midline to help support the spine. Flat backs, just the opposite.
In the pec stretches, the client’s hand is placed _____________.
Tip: The client’s elbow should be pointing toward the ceiling.
In the Lat release, the client’s arm is placed __________ .
Tip: To stretch the lateral side of the body, the hand needs to grab the top of the therapy table.
In the Wall Angel retraining exercise, the client should have ________ point(s) of contact against the wall.
Tip: Make sure they maintain all points of contact during this test.
In the Floor Angel retraining exercise, maximal extension should be held for ________ seconds.
Incorrect answer: try again. Tip: Three points of contact held for how many seconds?
The adductor magnus may be a hamstring because it is partially enclosed in a fascial bag with ___________.
Tip: Both these muscles are innervated by the sciatic nerve.
While internally rotating the femur, the therapist’s palm braces the hamstrings and rolls the tissue ___________.
Tip: When you pull the ankle towards you, it internally rotates the femur causing your bracing hand to push the tissue toward the midline.
When the therapist reaches across and externally rotates the femur, his palm resists and rolls the tissue ______ .
Tip: When you pull the ankle toward you, it externally rotates the contralateral femur, causing your bracing hand to push the tissue away from the midline.
In the pin and stretch technique, the therapist pins the hamstrings with constant pressure moving in a ___________ direction.
ip: You’re pushing the tissue toward the head to separate the muscle from its fascial bag.
The goal of the pin and stretch technique is to pin the fascial bag and ask the muscle to move __________ in its own bag.
Tip: Pin the fascia and move the muscle up-and-down inside.
The spindle-stim maneuver is used because lower shoulder stabilizers are often ________.
Tip: More powerful muscles on the front often neurologically inhibit the rhomboids and lower traps.
These muscles are often overpowered by tight ___________.
Tip: Major and minor muscles of the front line.
In the spindle-stim technique which direction should the tissue be moved?
Tip: Do the lower shoulder stabilizers and posterior rotator cuff muscle fibers only run in a single direction?
When assessing, the prone client raises their arm as high as possible to check for scapular _____________.
Tip: Bringing the scapulae together is called what?
For this spindle-stim technique, the client’s arm is placed ___________.
Tip: Some fibers are on the stretch with the arms overhead and some with arms in a handcuff position….try both positions.
This SI joint technique mobilizes the sacrum using the ___________ as a lever.
Tip: Just like the hip capsule stretch.
Therapist’s thumbs spring sacral base and ___________ along an oblique angle.
Tip: The oblique angle of sacrum runs from one sacral base to the contralateral ILA.
If resistance is felt while springing the ILA on one side, it indicates a restriction at the sacral base on the _________.
Tip: Remember, you’re springing along an oblique axis so think contralateral.
As the therapist brings the femur into abduction and internal rotation, it stretches the ______________.
Tip: Visualize the SI joint ligaments being stretched with this maneuver.
If ilium is posterior, therapist places a flat palm on the high _______ and repeats the maneuver.
Tip: To flatten out the high side, press on the posterior pelvis.
The goal of the first O-A technique is to increase head-on-neck ___________.
Tip: In a forward head posture, the head cocks back into extension on the atlas so you want to bring it back into what?
The inability of the occiput to flex on atlas is thought to be a common cause of chronic ________ pain.
Tip: Squashing the neurovascular structures at the posterior occipitoatlantal membrane can cause headaches and referred pain in the neck.
Patterns that start at the O-A or TMJ and compensate further down are called ____________ syndromes.
Tip: If they start at the head and go down they are what?
When the therapist flexes and sidebends the head, he is testing movement of the ____________.
Tip: We’re still talking about how the occiput is moving on atlas.
As the suboccipital space narrows, ______________ structures may become compressed.
Tip: Nerves and arteries underlie the posterior occipitoatlantal membrane.
The goal of this technique is to release the ______________ restriction of atlas on axis.
Tip: Most of the movement of atlas on axis is along a transverse plane.
Bringing the client into extreme neck flexion locks the _________ cervical vertebrae.
Tip: The typical cervical vertebrae run from C2-3 to C7-T1.
During the Atlas-Axis technique, the head should be brought into ____ degrees of neck flexion.
Tip: Halfway to 90 degrees is usually enough to lock the typical cervical vertebrae so you can test atlas on axis rotation.
Which of the following is not a typical cervical vertebra?
Tip: Recall the upper cervical complex is different from the typical cervicals.
Once ____ degrees of atlas-axis rotation (in each direction) is achieved, the technique is successfully completed.
Tip: The atlas-axis should rotate a total of 90 degrees with the neck flexed to 45 degrees.
These techniques are performed with the client __________.
Tip: Start in this face-up position.
In this ankle technique, therapist’s hands form a web with _______and _______securing the client’s medial and lateral malleoli.
Tip: Think soft web.
When the therapist applies traction, the webbed fingers and thumbs decompress the ______________ joint(s).
Tip: Think ankle joints not hip.
Valgus knee is often associated with ____________ of the foot
Tip: As the arch drops, the knee moves medially.
When mobilizing the knee, pain and/or ______ laxity should be noted.
Tip: What soft tissues help restrain joint motion?
DonTigny’s routine attempts to address an __________rotated ilium to relieve SI joint pain.
Tip: When the ASIS drops on one side it goes forward and down.
The therapist distracts the client’s femoroacetabular joint to_________ rotate the ilium.
Tip: Pulling on the leg causes the ASIS to move backwards.
The therapist compacts the client’s femoroacetabular joint to _________ rotate the ilium.
Tip: Pushing the femur into the acetabulum, causes the ASIS to go forward.
With both client’s knees flexed and feet flat on the table, therapist lifts and drags both knees medially and __________.
Tip: Think down toward the feet and in to the midline to release a fixated SI joint.
The client is asked to _______ the ilium using quadratus lumborum.
Tip: What action at the hip does the QL do?
Neck flexion firing order should be:
Tip: The longus capitis and colli must fire first to cock the head on the neck.
Therapist observes movement of the chin during the first _____ inches of neck flexion.
Tip: Watch the chin in the very beginning of this maneuver.
If the chin ___________ or stays level, there is a substitution pattern in neck flexion.
Tip: You want to see the chin tuck immediately tuck toward the chest in this test.
The SCM release technique is performed with the client _______.
Tip: Remember to ask the client to sidebend and hold their head up so you can get correct finger placement.
The client controls the SCM release by the amount of __________ they feel is tolerable
Tip: Ask them to hold the head up and look towards the table.
The scalene release technique is performed with the client _____________.
Tip: Work from the lateral side of the neck.
The therapist’s soft finger pads should come underneath the _________ border of SCM.
Tip: Got to get those flat fingers on the most lateral side of the neck and slide medially.
While rotating the client’s head and neck from neutral to extension, the fingers “scrub” the ___________ tubercles.
Tip: Where do the anterior scalenes attach in the neck?
The therapist looks for scalene fibrosis along the anterior tubercles of ___ to ___.
Tip: The anterior scalenes do not attach to the top or bottom vertebrae of the neck.
If thickness or knots are palpated, client deeply inhales or tucks (and releases) as therapist holds _____________.
Tip: Keep your fingers soft but firm.
A hiatal hernia occurs when the stomach is pulled through the hole in the __________.
Tip: What is the major muscle of breathing?
The therapist should palpate the client’s __________ process.
Tip: What is the finger-like structure in the medial ribcage?
The therapist’s ______ and _____ fingers should slowly sink into the soft tissue space between the xiphoid and costal ribcage on the client’s left side only.
Tip: Keep the fingers extended during this maneuver.
In the second technique, the therapist should hook the abdominal fascia with their ____________.
Tip: Use the soft part of the hand for this release.
Diastasis Recti is a tearing of the __________
Tip: What is the ligament that binds the rectus abdominis muscles together?
Before anything else, the therapist’s fingers should work______ the scar
Incorrect answer: try again. Tip: Think of freeing adhesions under the matted scar tissue.
With a ______ the therapist should rotate and check where the scar does not want to go.
Tip: Think soft surface release.
If a restriction is felt, the therapist’s hand holds at the adhesive barrier and the client is asked to __________.
Tip: A good enhancer for this technique should come from the hips.
As the tissue releases, the therapist’s hand __________ the release to the new barrier until full movement is restored in all directions.
Tip: This is an indirect technique once the restrictive barriers reached.
The goal of this routine is to decompress the __________ from the temporalis bone.
Tip: Think temporomandibular joint (TMJ).
This protocol helps with jaw ____________.
Tip: What is the jaw doing when it’s crammed back into the eminence of the temporalis bone?
These problems are often associated with __________ head posture.
Tip: Think upper crossed posture.
The client is asked to slowly open and close the mouth to help the therapist release the temporalis and masseter muscles above and below the ___________ arch
Tip: Think cheekbones.
During the history intake, make sure the client has had no jaw surgeries or
Tip: Never perform this technique until you are sure the client is completely free of all possible contraindications.
What is the most operated on disc in the body?
Tip: Think bending and twisting low back pain.
In the sacral base decompression technique, therapist drops his body weight into his hand with a soft but firm pressure, moving the sacrum ____________.
Tip: The goal is to decompress the sacrum off L5 so which direction would you go to do this?
Joints live for ___________.
Tip: Recall the importance of joint play.
During the sacral roll, do not drop onto the ________, stay on the sacroiliac ligaments and bone.
Tip: The butt muscles are typically weak already….think Lower Crossed Syndrome.
If the _________________ are extremely tender, there is probable SI joint dysfunction
Tip: What tissue bind the pelvis and SI joint together?
The goal of these techniques is to reduce excessive __________ curve.
Tip: Think hunch back.
The therapist initially applies ____ pounds of slow, sustained pressure.
Tip: The pressure is applied very slowly at the person’s tolerance level.
Therapist adds an additional ____ pounds of pressure to spring the ribcage.
Tip: Gently spring the ribs with very little pressure to check for joint play.
With excessive kyphosis, the therapist should move the tissue _________ to _________.
Tip: The erectors move laterally allowing the t-spine to curve so move them back where they belong.
If the therapist encounters a flat spot, they should move the tissue_______ to _________.
Tip: Recall Ida Rolf’s suggestions to open a space for the spine to come back to.
Physiologically, active movement assists the healing _______ tissue to align itself along normal stress lines.
Tip: What type of tissue fibroses in a frozen shoulder?
Musculotendinous structures return to their resting length within _________ following active isolated stretching
Tip: Neurologically, the tissue will reset its muscle length fairly quickly.
When evaluating the sternoclavicular joint, the ________ heads of the clavicle must drop down during shoulder elevation.
Tip: Where do the sternoclavicular joints attach to the sternum?
There are _____ motions of the sternoclavicular joint that become dysfunctional.
Tip: This is a simple joint compared to other in the shoulder girdle.
There are _____ motions of the acromioclavicular joint that become dysfunctional.
Tip: We know this joint has internal and external rotational fixations. What other movement does it have?
When the arm abducts, at _____ degrees the clavicle should start rolling.
Tip: Raise your arm to your side and palpate your clavicle.
The sternoclavicular joint provides the only firm attachment for the __________ to the axial skeleton.
Tip: This is where the clavicle attached to the sternum.
Because the SC functions as a ________ joint, it can allow for clavicular motion in horizontal abduction/adduction and elevation/depression.
Tip: The SC joint doesn’t have full range of motion like the glenohumeral or restricted hinge-type movement like the elbow.
The SC joint always moves in the opposite direction as the _________.
Tip: The SC joint moves down during shoulder shrugging as the scapula moves up.
Thoracic outlet syndrome, rotator cuff tears, and frozen shoulders sometimes originate with _____ joint fixations.
Tip: Think how restricted movement of the clavicle may affect the brachial plexus or rotator cuff.
The goal is to treat the AC joint in _______ planes
Tip: Think internal and external rotation and abduction restrictions at the acromioclavicular joint.
While treating internal rotation, the therapist’s left hand braces the medial AC joint and monitors joint movement with his ________.
Tip: You must stabilize the shoulder and gently palpate for movement.
What are the most common restrictions at the AC joint?
Tip: Remember you must assess and treat in all cardinal planes.
While treating external rotation, the key is to maintain the arm in ____ degrees of horizontal adduction so the glenohumeral does not come into play.
Tip: Bring the arm toward the midline to isolate to the AC joint.
AC joint restrictions typically limit end-range elevation and cross-body ____________.
Tip: What is the term used when you bring the body part toward the midline?
Monkeys have flat backs causing them to not have a ________gait.
Tip: Humans are the only mammals to have this type of gait.
With lumbar hypolordosis (flat back), the therapist should move the tissue from ________ to _______.
Tip: Hypolordosis is another word for flat back so you want to move erector muscles which way to support the spine?
__________ used to say, “dig a hole to allow the spine a place to come back to.”
Tip: Think structural integration.
When warming up the tissue, the therapist should evaluate for __________
Tip: Remember to assess for different variables.
The lumbar facet opening techniques are done with the client __________.
Tip: This position allows you to flex the lumbar spine.
When the therapist asks the client to flex their knees, this causes the _______facets to open.
Tip: We‘re treating the low back folks.
The key is isolating to the dysfunctional segment and dragging the inferior vertebra _____ as the hip is hyper-flexed.
Tip: In this technique we’re pulling inferiorly on the sacrum and vertebra to encourage the joint above to open.
The client will assume a _______ position to assess for a lumbar joint that is not closing
Incorrect answer: try again. Tip: We need lumbar extension to treat vertebrae that won’t close.
If nothing is felt during the maneuver, try moving the thumbs closer to the _________________.
Incorrect answer: try again. Tip: What bony structure do you feel when palpating the midline of the spine?
A structural or fixed scoliosis __________.
Tip: If the curve gets better in any movement, it is not a fixed scoliosis.
On the convex side of the curve, where there is a prominent ribcage and scapula, the therapist should move the tissue __________ to __________.
Tip: Got to move the erectors that have spread laterally back toward the midline.
On the concave side of the curve, where the hypertonic tissues are bowing the spine, the therapist should move the tissue from __________ to __________.
Tip: Got to get those erector (bow-strings) out away from the spine.
During the seated correction, the therapist should rotate the client’s torso in the _________ direction of the scoliotic curve.
Tip: Right thoracic scoliosis should be left rotated.
With the client supine, the therapist should try to create length in the __________ fascia.
Tip: Think oblique crossing pattern through the abdominal wall.
During the cross-arm technique, what muscle(s) are we stretching?
Tip: Think deep cervicothoracic extensors…that’s what we’re stretching…the deepest layer.
With the head sidebent and rotated to the same side, the therapist is primarily stretching ___________.
Tip: Rotation and sidebending to the same side stretch these muscles.
With the head sidebent to one side and rotated to opposite side, the therapist is able to stretch ______________.
Tip: This is the best technique for stretching both these muscles at the same time.
During the trunk stretch, the therapist and client grasp each other’s __________.
Tip: This long-axis stretch requires a good grip.