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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.
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.
Medial disc: towards side of pain.
*NO SIDE POSTURE!
- Lateral disc: away from side of pain.
- *SIDE POSTURE OK, PAIN SIDE DOWN.
Psoas Spasm: anterior antalgic position.
Check for Piriformis Spasm also.
*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.
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.
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**
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.
- 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.
- Process pain on the side of the
- *Check inferior TP of L5 with Styloid process near same side C1.
- Transverse provess pain on the side of
- *Check superior TP & same side C1 TP.
- 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.
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.