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- 23 yo LBP - T3-10 convex R - and leg length discrepancy - which feature should be used to
calculate the total height of the heel lift? Sacral base unleveling
- T8 level transverse process rotated L - worse in flexion =? T9 - extended and rotated L, SB L
- T7-9, transverse processes full step up - rules of 3 for thoracic spine - 1-3, level - 4-6 half step
up - 10, 11, 12 --> whole step, half step, no step
- 37 yo w neck pain after repairing ceiling fan - C6 resists translation to the R = SB R - C6 - ease
in extension - extended - type II mech - extended, SBR, rotated L - initial step w HVLA w SBing
focus? Cervical flexion, rotation R, SB L - address all restrictive barriers, but w focus on SBing
- flex neck - relieves tension on vertebral arteries - SB L into restriction
- 24 yo w upper back pain - R transverse process of T3 posterior, worse in extension - ME
positioning-->? Extend, SB L, rotate L - into restriction then isometric contraction back
toward neutral
- 23 yo w worsening ant knee pain after training for marathon - swelling w activity - pain
proximal to tibial tuberosity and slight ant knee effusion - likely abnormality of the? Patellar
tendon - patellar tendonitis - repetitive stress - ice - elevate, NSAIDS - due to accelerated and
improper training
- 45 yo female - injured back while lifting fridge - h/o PUD - Tx w? Meloxicam - NSAIDS carry
increased risk of GI bleed and renal toxicity - meloxicam preferentially inhs COX2 vs COX1 and
therefore designed to have less GI side effects - at higher doses, selectivity is lost
2 - 14 yo - abrupt ant curvature of the spine - back pain - x-ray shows Schnorl's nodes - small
protrusions of intervertebral discs into adjacent vertebral bodies - ant wedging of at least 3
adjacent vertebral bodies and endplate abnorms = ? Scheurmann's kyphosis - not corrected
,by changes in position- etiology is unknown, but typically diagnosed in adolescent boys during
their rapid growth period
- 58 yo w asthma - tightness in upper back MMs - dysfunction of thoracic vertebra near T5 -
anterior tenderpoint for anterior thoracic 5 = ? Midline of the sternum, 1 inch superior to
the xiphosternal jxn - the upper 6 points are located on the sternus and Txd w flexion of the
thoracic spine - lower points are BL on the abdomen, except for A12 and are Txd w flexion,
SBing, and rotation toward the point
- 57 yo w refractory GERD, esophageal varices and gastritis - H pylori and Barrett's esophagus (-)
- most likely additional finding on exam? C2 left, T3-6 right, T5-10 L - vagus gets input from
occiput, C1 and C2 - esoph T3-6 - stomach T5-10 on L
- 99 yo female - C4 flexed, RR, SB R - which condition would put pt at high risk for HVLA?
vertebral a atresia - 1/400,000 --> complication - vertebral a sequelae from HVLA on pts w
preexisting unilateral atresia of the vertebral a or h/o prior neck trauma has been reported to
result in locked-in syndrome, Wallenberg syndrome, aneurysm/dissection, subintimal tears,
intraluminal clots, TIA/CVA, and death - less serious, but freq comps from manipulation w
cauda equina syndrome, ruptured lumbar disc, cervical fracture/dislocation, thoracic disc
ruptures - ex vertigo
- 21 yo 1 wk post partum - lumbar tenderpoint corresponding to L4? inferior AIIS, pressing
cephalad - Tx flex hips and knees BL and induce flexion at L4 level - SBing to the R as needed -
mech of action of counterstrain (decrease tension on fiber) likely involves alpha Ia afferent and
gamma efferent relationships - passive return to neutral
- 9lb boy is delivered - likely abnormality in mother post-partum? Bilateral sacral flexion -
false (-) seated flexion test bc BL - BL deep sacral sulci
- 52 yo male - bacterial URI - suboccipital release is performed in order to? Decrease goblet
cell production - increases act of vagus, increasing parasympathetic tone --> thin copious
secretions
, - 13 yo w scoliosis - sister w similar findings - structural exam will most likely reveal?
-paravertebral hump observed during exam is likely the result of? -paravertebral humping
that is convex right, mid to upper thoracic spine - 90% thoracic, convex on the R
-paravertebral hump observed during exam is likely the result of spinal rotation = Fryette type I
- 45 yo female - lower abd pain - taking opioids -->Tx? Mesenteric release = a lymphatic
drainage technique used to relieve tension on the root of the mesentery on the post abd wall -
used for n/v, d/c, abd pain, etc
- 25 yo female ballet dancer- pain after landing abruptly on heel - pain w plantarflexion -
confirm Dx w? Thompson test/calf squeeze test -appropriate for Achilles tendon rupture - pt
lies prone w feet hanging off table - clinician squeezes gastrocnemius belly, while watching for
plantar flexion - absence = + for rupture
- 42 yo w carpal tunnel - additional finding? C6 flexed, rotated R, SB R - compression of the
median n can be from microtrauma, arthritis, edema of pregnancy, hypothyroid myxedema -
the nerve roots of the median n = C5-T1
- 55 yo female - chronic LBP x1 yr - LE paresthesia and weakness - decreased ROM in lower
spine and hips BL - decreased sensation on the left medial leg and foot, +1 patellar reflex - MRI
showed L3-4 disc herniation w fractured L5 spinous process - most likely weakened?
dorsiflexion and inversion of the foot- L4 is the main mediator of the patellar reflex - L2 and
L3 also contribute - L4 is also the predominate innervation for tibialis anterior via the deep
peroneal - ask pt to walk on heels w feet inverted - ask pt to dorsiflex and invert against
resistance - 2 most common herniations = L4-5 and L5-S1
- 22 yo w difficulty and pain w writing - restricted ROM w supination and tenderness over radial
head =? R post radial head - pronation --> post radial head - supination --> ant - pain w
supination - restricted ant glide - usu from falling on pronated hand
- 32 yo - LBP x1wk - + standing flexion test - inf R pubic ramus, sup right PSIS = ? R ant
innominate rotation - thought to be due to tightness of the quadriceps
Latest Update
- 23 yo LBP - T3-10 convex R - and leg length discrepancy - which feature should be used to
calculate the total height of the heel lift? Sacral base unleveling
- T8 level transverse process rotated L - worse in flexion =? T9 - extended and rotated L, SB L
- T7-9, transverse processes full step up - rules of 3 for thoracic spine - 1-3, level - 4-6 half step
up - 10, 11, 12 --> whole step, half step, no step
- 37 yo w neck pain after repairing ceiling fan - C6 resists translation to the R = SB R - C6 - ease
in extension - extended - type II mech - extended, SBR, rotated L - initial step w HVLA w SBing
focus? Cervical flexion, rotation R, SB L - address all restrictive barriers, but w focus on SBing
- flex neck - relieves tension on vertebral arteries - SB L into restriction
- 24 yo w upper back pain - R transverse process of T3 posterior, worse in extension - ME
positioning-->? Extend, SB L, rotate L - into restriction then isometric contraction back
toward neutral
- 23 yo w worsening ant knee pain after training for marathon - swelling w activity - pain
proximal to tibial tuberosity and slight ant knee effusion - likely abnormality of the? Patellar
tendon - patellar tendonitis - repetitive stress - ice - elevate, NSAIDS - due to accelerated and
improper training
- 45 yo female - injured back while lifting fridge - h/o PUD - Tx w? Meloxicam - NSAIDS carry
increased risk of GI bleed and renal toxicity - meloxicam preferentially inhs COX2 vs COX1 and
therefore designed to have less GI side effects - at higher doses, selectivity is lost
2 - 14 yo - abrupt ant curvature of the spine - back pain - x-ray shows Schnorl's nodes - small
protrusions of intervertebral discs into adjacent vertebral bodies - ant wedging of at least 3
adjacent vertebral bodies and endplate abnorms = ? Scheurmann's kyphosis - not corrected
,by changes in position- etiology is unknown, but typically diagnosed in adolescent boys during
their rapid growth period
- 58 yo w asthma - tightness in upper back MMs - dysfunction of thoracic vertebra near T5 -
anterior tenderpoint for anterior thoracic 5 = ? Midline of the sternum, 1 inch superior to
the xiphosternal jxn - the upper 6 points are located on the sternus and Txd w flexion of the
thoracic spine - lower points are BL on the abdomen, except for A12 and are Txd w flexion,
SBing, and rotation toward the point
- 57 yo w refractory GERD, esophageal varices and gastritis - H pylori and Barrett's esophagus (-)
- most likely additional finding on exam? C2 left, T3-6 right, T5-10 L - vagus gets input from
occiput, C1 and C2 - esoph T3-6 - stomach T5-10 on L
- 99 yo female - C4 flexed, RR, SB R - which condition would put pt at high risk for HVLA?
vertebral a atresia - 1/400,000 --> complication - vertebral a sequelae from HVLA on pts w
preexisting unilateral atresia of the vertebral a or h/o prior neck trauma has been reported to
result in locked-in syndrome, Wallenberg syndrome, aneurysm/dissection, subintimal tears,
intraluminal clots, TIA/CVA, and death - less serious, but freq comps from manipulation w
cauda equina syndrome, ruptured lumbar disc, cervical fracture/dislocation, thoracic disc
ruptures - ex vertigo
- 21 yo 1 wk post partum - lumbar tenderpoint corresponding to L4? inferior AIIS, pressing
cephalad - Tx flex hips and knees BL and induce flexion at L4 level - SBing to the R as needed -
mech of action of counterstrain (decrease tension on fiber) likely involves alpha Ia afferent and
gamma efferent relationships - passive return to neutral
- 9lb boy is delivered - likely abnormality in mother post-partum? Bilateral sacral flexion -
false (-) seated flexion test bc BL - BL deep sacral sulci
- 52 yo male - bacterial URI - suboccipital release is performed in order to? Decrease goblet
cell production - increases act of vagus, increasing parasympathetic tone --> thin copious
secretions
, - 13 yo w scoliosis - sister w similar findings - structural exam will most likely reveal?
-paravertebral hump observed during exam is likely the result of? -paravertebral humping
that is convex right, mid to upper thoracic spine - 90% thoracic, convex on the R
-paravertebral hump observed during exam is likely the result of spinal rotation = Fryette type I
- 45 yo female - lower abd pain - taking opioids -->Tx? Mesenteric release = a lymphatic
drainage technique used to relieve tension on the root of the mesentery on the post abd wall -
used for n/v, d/c, abd pain, etc
- 25 yo female ballet dancer- pain after landing abruptly on heel - pain w plantarflexion -
confirm Dx w? Thompson test/calf squeeze test -appropriate for Achilles tendon rupture - pt
lies prone w feet hanging off table - clinician squeezes gastrocnemius belly, while watching for
plantar flexion - absence = + for rupture
- 42 yo w carpal tunnel - additional finding? C6 flexed, rotated R, SB R - compression of the
median n can be from microtrauma, arthritis, edema of pregnancy, hypothyroid myxedema -
the nerve roots of the median n = C5-T1
- 55 yo female - chronic LBP x1 yr - LE paresthesia and weakness - decreased ROM in lower
spine and hips BL - decreased sensation on the left medial leg and foot, +1 patellar reflex - MRI
showed L3-4 disc herniation w fractured L5 spinous process - most likely weakened?
dorsiflexion and inversion of the foot- L4 is the main mediator of the patellar reflex - L2 and
L3 also contribute - L4 is also the predominate innervation for tibialis anterior via the deep
peroneal - ask pt to walk on heels w feet inverted - ask pt to dorsiflex and invert against
resistance - 2 most common herniations = L4-5 and L5-S1
- 22 yo w difficulty and pain w writing - restricted ROM w supination and tenderness over radial
head =? R post radial head - pronation --> post radial head - supination --> ant - pain w
supination - restricted ant glide - usu from falling on pronated hand
- 32 yo - LBP x1wk - + standing flexion test - inf R pubic ramus, sup right PSIS = ? R ant
innominate rotation - thought to be due to tightness of the quadriceps
