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OPP Review - Not an extensive review.

Just stuff that I thought was important to look over before the
written test. Take it or leave it.

Vertebral unit – 2 vertebrae and everything between them

Vertebral segment – 1 vertebra

Superior Facets of Vertebra

- Cervical
o Coronal plane
o BUM – backward, upward, medial
- Thoracic
o Coronal Plane
o BUL – backward, upward, lateral
- Lumbar
o Sagittal plane
o BUM – backward, upward, medial

Vertebral Somatic Dysfunction – Fryette’s principles

Principle I – In neutral, groups of vertebrae are side bent and rotated in opposite direction

o Usually pain is not unbearable


o Chronic condition

Principle II – when flexed or extended, the coupled motions of side bending and rotation in a
single unit occur in same direction

o Associated with acute pain

Principle III – motion of a vertebral segment in any plane of motion will modify the movement of
that segment in other planes (generally reducing it)

Rule of 3’s (for thoracic vertebrae only)

- 1,2,3,(12) – SP in same plane as TP


- 4,5,6, (11) – SP ½ way between its TP and TP of one below
- 7,8,9, (10) – SP one level below its TP

Tibiofemoral motion

- Knee flexion – internal rotation; short leg


- Knee extension – external rotation; long leg

Fibular head
- Anterior glide – posterior movement of distal fibula and ext. rotation of the ankle
- Posterior glide – anterior movement of distal fibula and int. rotation of the ankle

Tibiotalar joint

- People with inflexible joint are 5x more at risk for sprains


o Usually plantar flexion (anterior talus)

Navicular

- External rotation = inversion

Cuboid

- Internal rotation = eversion


o Usually the cause of an inversion ankle sprain

Lumbar Muscle Energy

- Lateral Recumbent
- Type I
o Posterior TP up
- Type II
o Posterior TP down

Innominate Motion

- Physiologic (normal when in motion)


o Rotation and flare
- Non-physiologic (caused by some trauma)
o Innominate shear and pubic shear
- Innominate Shear
o Superior shear – both ASIS and PSIS superior
o Inferior shear – both ASIS and PSIS inferior
o Determine which side by flexion test
- Pubic Rami Shear
o Superior – superior pubic tubercle and tender inguinal ligament
o Inferior – inferior pubic tubercle and tender inguinal ligament
- Pubic Compression
o Standing flexion test +/-
o ASIS and PSIS equal
o Tender pubic rami and tender pubic symphysis
- Innominate Rotations
o Anterior rotation
 Inferior ASIS, superior PSIS
o Posterior Rotation
 Superior ASIS, inferior PSIS
- Innominate Flares
o Outflare
 Lateral ASIS, medial PSIS
o Inflare
 Medial ASIS, lateral PSIS

HIPLSIT (order we treat dysfunction)

- Hip
- Innominate Shears
- Pubic
- Lumbar
- Sacroiliac
- Innominate Rotations
- Thoracic

Lumbar HVLA

- Posterior TP down
- Lateral recumbent
- Localize to joint space below

Pubic Muscle Energy (types of ME used; he always likes to ask this)

- Superior Innominate Shear


o Respiratory cooperation
- Inferior innominate Shear
o Post-isometric and respiratory cooperation
- Superior Pubic Shear
o Joint mobilization using muscle force
- Inferior Pubic Shear
o Post-isometric
- Pubic Symphysis Reset
o Joint mobilization using muscle force
- Anterior Innominate Rotation
o Post- isometric
- Posterior Innominate Rotation
o Joint mobilization using muscle force
- Outflared Innominate
o Post-isometric
- Inflared Innominate
o Post-isometric

Sacral Muscle Energy

- Remember Fred Mitchell came up with this stuff


- 3 tests
o Seated flexion
o Spring test
o Backwards bending
- 2 landmarks
o Sacral sulcus
o ILA
- 2 problems
o Sacral shears
o Sacral torsions
- 3 horizontal axes on sacrum
o All on S2 (top, middle, bottom)
- Shears
o Non-physiologic
o Involves slippage of the sacrum around the backward C-shaped SI joint
o Occurs around middle axis
o True SI joint problem
- Torsions
o Physiologic
o L5/S1 joint problem
o Occurs around oblique axis
o Imbalance in the muscles that affect sacral motion in relation to L5 motion
- * L5 rotates to same side as deep sulcus *
- Respiratory Motion
o Inhalation
 Curves flatten; sacrum conternutates
o Exhalation
 Sacrum nutates

HVLA Review

- Long lever and short lever


- Goal is to move 1/8 inch
- For thoracic somatic dysfunction
o Flexion
 Isolate to segment below
 Force is 90⁰ posterior
o Extension
 Isolate to segment below
 Force is directed 45⁰ cephalad and posterior

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