SOT Quick Notes (Category III)

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Author:
dcmommy13
ID:
289058
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SOT Quick Notes (Category III)
Updated:
2014-11-12 23:32:23
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SOT
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  1. REFER OUT, IF....
    • 1) Treatment causes radicular SX to periphralize. 
    • 2) DTR's, dermatomes & muscle function decrease.
    • 3) Pain decreases but numbness increases &/or signs of atrophy worsening. 
    • 4) SX's of visceral or organic relationships. 
    • 5) Response to SOT treatment & SOT indicators are not congruent.
  2. Category III SX
    • 1) No rib head movement. 
    • 2) Generalized muscle ridgity. 
    • 3) Muscle guarding. 
    • 4) Antalgia. 
    • 5) Sciatica -> leg.
    • 6) L/S pain.
    • 7) Post thigh pain, lead weakness, paresthesia, atrophy. 
    • 8) Calf pain w/ palpation. 
    • 9) Pain w/ palpation of greater sciatic notch (near performs). 
    • 10) Pain moves to the spine as things start to get better.
  3. Medial disc: towards side of pain.
    *NO SIDE POSTURE!
    • Lateral disc: away from side of pain.
    • *SIDE POSTURE OK, PAIN SIDE DOWN. 
  4. Psoas Spasm: anterior antalgic position.
    Check for Piriformis Spasm also.
  5. PSOAS TECHNIQUE
    *Have pt bend leg & push into your hand to find the psoas. 
    • 1) Short arm leg side. 
    • 2) Supine w/ leg flexes... Dr on opposite side. 
    • 3) Pull knee medially. 
    • 4) If after correction the other arm goes short, correct the contralateral psoas until both sides are equal. 
    • 5) Work the psoas fibers laterally.
  6. LEG LENGTH ASSESSMENT
    • 1) Have them grab the head of the table, while apply traction. 
    • 2) Traction caudally for 30 seconds.
    • 3) Maintain traction while observing leg length discrepancy.
  7. INITIAL BLOCKING POSITION
    *Use adjusting board under the pelvis!
    • 1) Palpate the musculature in the center of the calf & gluteal region for tenderness. 
    • 2) Long leg block: under the ASIS, towards opposite hip. 
    • 3) Short leg block: obliquely under the greater trochanter, 45 degrees caudally. 
    • **Leg lengths should begin to equalize after blocks are positioned**
  8. BLOCK ANGULATION FOR PAIN CONTROL
    • If the original blocking position does NOT diminish the pain, angulate the blocks in 10 degree intervals both caudally & cephaldly. 
    • *If no position reduces the pain, try SB- or SB+ placements. 
  9. Considerations:
    • 1) After legs are even, traction the affected leg to release pressure at the disc. 
    • 2) As long as the original short leg length discrepancy does not increase it's all good. 
    • 3) THE DOCTOR LIFTS THE PELVIS TO REPOSITION THE BLOCKS, NOT THE PATIENT.
  10. SPIT
    • Spinous
    • Process pain on the side of the 
    • Inferior
    • TP
    • *Check inferior TP of L5 with Styloid process near same side C1. 
  11. TAR
    • Transverse provess pain on the side of 
    • Anterior 
    • Rotation
    • *Check superior TP & same side C1 TP. 
  12. CRANIAL BASIC
    • 1) Spread thumbs apart to open up suture, while finger tips pull the parietal bones upward.
    • 2) Repeat until all painful areas have resolved. 
    • 3) Have the patient try to lift the sciatic leg on an inhale. 
    • *If midline discopathy is present have them lift both legs. 
    • *If it is too painful, have them tighten the muscles, or think about attempting to lift the leg.
  13. Check the piriformis!
    • 1) Is it contracted &/or pain with palpation of the mm's surrounding the greater troachanter?
    • 2) Is there restriction in internal rotation of the hip? 
    • 3) Flex the leg, but not to the point of pain. 
    • 4) Press your thumb into the tissue (inferior to the acetabulum). Apply pressure to all surrounding painful areas, particularly around the greater trochanter. 
    • 5) Circle the leg while rolling the thumb over the tissue for easier access.
    • *Stand on the same side that you are working on. 

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