HVLA Thrust Manipulations:

REGION TECHNIQUE INDICATION PROs/CONs

Need to have good knee

HIP 1. LAD 30̊/30̊/slight ER OA
joint
1. LAD manip-- 30̊/30̊/IR SIJ mechanical lock
- can bias toward EXT to correct for post rot. better for hypomobility
Ant/post rotation of
SIJ - can bias toward FLX to correct for ant rot.
innominate
SIJ not great for pt. with
2. SIJ Gapping w/mechanical lock irritated Lx
1. L4-L5 Gapping (sidelying)
- extension bias protects annulus
- Modifications if can’t
- push down on the cranial segment/up on the Hypomobility,
get wound up enough =
L/s caudal , pt. needs to be close mechanical
towel roll under side
dysfunction/facet
/positions in SB
2. L5-S1 Gapping (sidelying)
- lock into the iliac crest: line of force down femur
- Gapping separation
gentler (1st step)
1. Prone Gapping (wind up caudal/cranial segmts)
- can be used as a
2. Prone Double knife edge
Postural/mechanical progression to treat
3. Prone T/s closing modification (U/L closing)
dysfucntions of the (different
T/s t/x, shoulder options/positions)
4. Supine T/s Gapping
pain/dysfunction, c/s - can do b/l or u/l
5. Supine T/s Gapping (U/L)
pain/headaches
more focal, SB away + Rot toward
- Knife edge can be more
6. Supine Upper T/s
focal for pt. restricted in
ext
2 vs 1: distraction is
1. CT junction in sitting
more global, don’t need
- Downglide (SB toward/rot away/opposite arm up)
to lock cranially
- Gapping (SB away/rotate toward/same arm up)
C/s
- Need to be
2. Seated CT junction upglide
conservative!
(distraction of C7 on T1)
- Know red flag s/s
1st Rib:
Tx: pre-position t/s rot away Can push down and out
c/s SB away/Rot toward for costovertebral, lateral
pt. head rest in arm, manip ant/distal 1st rib hypomobility, P-A for costo-transverse
Ribs rib
Rib (general) hypomobility/pain Can accommodate for
1. Supine: same as t/s supine- instead of trigger prone vs. supine
finger, use flat hand to cup Rib preference
2. Prone: Stabilize opposite t/s,
1. Carpal Whip
Wrist - Limited Extension: palmar glide of carpal row Hypomobile wrist (NOT ON EXAM)
- Limited Flexion: dorsal glide of carpal row
Hypomobile wrist,
1. Varus thrust
Elbow decreased gross (NOT ON EXAM)
2. Radial glide manip
ROM/pronation+sup
 Additional MT Techniques:

Cervicogenic Headaches
MOVEMENT
TECHNIQUE
ASSESSING
Side Bend Rotation Test
C1/C2 - Bony locking
- Rot toward, SB away

Flexion/Rotation Test
C1/C2
- want to hold below C2 so when flex, C1/2 able to move

C0/C1 (O-A) Prone UPA on transverse process of C1 – glide onto occiput, force toward eyes

C2/C3 Prone UPA on transverse process of C2 (rotation of C2 on C3)

C1/C2 Rotate pt. head to 30̊, Prone UPA transverse process of C2

Seated – block sp w/MTP w/pincer grasp, Rot toward-SB away

C1/2 - cup C1 w/ opposite hand, rest pt. head in elbow
- distract upwards and angled toward side of dysfx.

Shoulder: Rotator Cuff Interval/Posterior Capsule

Position Technique

Rotator interval capsule, ER @0

Supine
- elbow bent, bring to ER stop, distract at elbow down line of humerus

Rotator interval capsule, hand on hip, elbow in flexion/arm slight extension

Side lying
- curvilinear force through arm toward back

Posterior capsule progression:

Supine 1. Cross body
2. flexion/for end range elevation

HIP: FAI

Position Technique

FADDIR progression:
Supine
1. posterior mobilization through femur—bringing more toward ADD and IR as pt can tolerte
Physical Assessment Prior to Manipulations:
GENERAL:

1. AROM
a. Capsular: Arthritis/ medical patho
b. Non- Capsular: mechanical (what we want!)
2. PROM (quality of motion)
a. PROM > AROM = contractile or nerve lesion
3. Passive Accessory ROM (joint play)
a. Grade 0-6
i. Grades 1-2 = mobs, Grades 2-3= manip candidates
4. Resistive Tests:
a. Strong + painful = mild mm/tendon lesion
b. Weak + painful = mm tear or serious lesion
c. Weak + painless = complete tear or N. lesion
5. Special Tests:
a. Neurodynamic
b. Repeated movements

Hip:

1. KNOW CAPSULAR PATTERN: IR > FLX > ABD

2. PROM IR/ER @0/@90
3. Painful ARC?
4. Assess for capsular tightness/pain
5. Special tests
a. FABER/FADDIR
b. Scour
c. Prone IR
d. Sign of the Buttock
e. Functional movements: squat

SIJ:

1. Clear L/S First:

a. AROM
2. SIJ Special tests
a. Supine:
i. Distraction test (supine pressing straight down B/L ASIS)
ii. Thigh thrust test (hand under sacrum/push down the line of the femur)
iii. FABER (hip vs SI…ant vs post pain)
b. Side lying
i. SI compression (straight pressure straight down)
c. Prone:
i. P-A over S2/base of sacrum
3. Hyper vs Hypomobility:
a. Hypermobility—FABER will compress it and might feel better
 i. Distraction
ii. Thigh thrust
iii. Active SLR
1. Hold together ASIS
2. Fires oblique force couple (force closure)
a. Pt. crosses arms have them obliquely rotate to you w/SLR
b. Hypomobility – FABER will make it feel worse (b/c distraction feels better)
i. Compression
ii. P-A

Lumbar:
In sidelying

- Assessing cranial to caudal – fingers in the interspinous space to see which one moves which one
doesn’t as well “piano keys”

Rib:

1. 1st rib mobility:

a. Rotation/Lateral flexion test in sitting:
i. Rotation away/SB towards
ii. Positive test = inability to SB head d/t hypomobility of the 1st rib blocking the SP of
C7
2. General/Prone:
a. Push on the rib/Differentiate between rib/t-spine
b. Pre-position rib in c/l rotation and stabilze

C/S:

1. ROM:
a. Gross ROM (all planes)
b. Chin tuck
i. For lower c/s ext and upper c/s flexion
c. Protraction
i. For lower c/s flexion and upper c/s extension
2. Vertebral Artery test
a. CN assess baseline
b. Rotate head (>30 dergrees) hold
c. Reassess CN with rotation
3. Instability tests:
a. Sharp Purser
i. Transverse ligament integrity
b. Alar Ligament test
c. Tectorial membrane (Prone flexion)
4. Joint mobility assessment
i. Quick test
ii. Cranial to caudal assessing upglide/downglide potential of each segment
iii. P-A in prone