Lab 1: Cervical Spine FPR, Still's, and BLT

Question 1

OA: FPR

Hypertonic SUboccipital Muscles

Answer 1

1. Patient supine with head and neck off the table. Physician at head of table supporting patient’s head, monitoring hypertonic tissues with 3rd finger.
2. Slightly flex head and neck forward to flatten/neutralize cervical curvature.
3. Apply gentle axial compression (<1 lb of pressure) on the occiput towards feet.
4. While maintaining compression, extend the head and neck and SB to the same side of the hypertonic muscles (shortening and relaxing the muscles being treated).
5. Hold for 3-5 seconds waiting for tissue relaxation, return to neutral, and release compression.
6. Reassess muscular tonicity.

Question 2

Cervical FPR

Cervical Segmental Dysfunction

Answer 2

1. Patient supine. Physician at head of table supporting patient’s head with one hand, monitoring articular pillars of the affected segment with index finger and thumb.
2. Slightly flex head and neck forward to flatten/neutralize cervical curvature.
3. Apply gentle axial compression (< 1 lb of pressure) on the occiput towards feet.
4. While maintaining compression, move the segment into its ease of motion (indirect barrier of the F/E, rotational, and SB component).
5. Hold for 3-5 seconds waiting for tissue relaxation, return to neutral, and release compression.
6. Reassess segmental motion.

Question 3

OA Still’s

Answer 3

1. The patient is supine on the table. Physician at head of table.
2. Place the pad of the index or middle finger on the side of the side-bending component in the basiocciput, using the palm to support the patient’s head. Place the other hand on top of the patient’s head.
3. SB the head into its ease. Due to coupling of motion at the OA joint, slight rotation in the opposite direction will occur. Introduce F/E, depending on the diagnosis.
4. Compress through the top of the head.
5. While maintaining compression, take head into neutral and articulate through the restrictive barrier.
6. Compression is released and the head returned to neutral.
7. Reassess.

Question 4

AA Still’s

Answer 4

1. The patient is supine on the table or may be seated. Physician at head of table.
2. Place index or middle finger on transverse process of the atlas (C1), on the side of rotation.
3. Rotate the head into its ease.
4. Compress through the top of the head.
5. While maintaining compression, take head into neutral and articulate through the restrictive barrier.
6. Compression is released and the head returned to neutral.
7. Reassess.

Question 5

Typical Cervical Still’s

Answer 5

1. The patient is supine on the table. Physician at head of table.
2. Place index or middle finger on articular pillar at level of somatic dysfunction, on the side of rotation.
3. Introduce F/E, depending on the diagnosis. SB and rotate the cervical segment into its the ease.
4. Compress through the top of the head.
5. While maintaining compression, take head into neutral and articulate through the restrictive barrier.
6. Compression is released and the head returned to neutral.
7. Reassess.

Question 6

OA BLT

Answer 6

1. Patient supine on table. Physician seated at head of table with forearms and elbows resting comfortably on table.
2. Use one hand in a “pincher” grasp of the laminae on either side of the midline for C1 to stabilize and monitor the OA through the atlas.
3. Place your other hand on the patient’s head to induce position of greatest BLT.
4. Test respiratory phases and have the patient hold breath as long as possible in the respiratory phase (either inhalation or exhalation) that provides best BLT.
5. Repeat until best motion obtained (1- 3x).
6. Reassess.

Question 7

Typical Cervical BLT

Answer 7

1. Patient supine on table. Physician seated at head of table with forearms and elbows resting comfortably on table.
2. Place palms under patient’s head, palpate articular processes with index fingers bilaterally.
3. Establish point of BLT in cervical spine by inducing the position of greatest BLT through the head and neck.
4. Test respiratory phases and have the patient hold breath as long as possible in the respiratory phase (either inhalation or exhalation) that provides best BLT.
5. Repeat until best motion obtained (1- 3x).
6. Reassess.