Competency 4 Flashcards
4a. Perform assessment of myofascial tissues for ease and restriction of motion and determine
direct and indirect barriers.
Places hands on the thoracolumbar paraspinal tissues and moves superficial and deep
fascial layers with hands in multi‐planes.
Applies forces to describe the assessment for direction of ease within the tissue and the
bind within the soft tissues.
States the assessment of the tissues principle can be applied to any soft tissue.
Describes correctly that ease of motion in direction of named dysfunction and the bind
would be in direction of restrictive barrier.
Correctly associates ease of motion with indirect soft tissue barrier and techniques
Correctly associates bind of motion with direct soft tissue barrier and techniques.
States the treatment forces applied are more deeply directed into the soft tissue and these
forces are directed in a rhythmic alternating fashion
Defines Parallel Traction as a force directed parallel to muscle and fascial components,
causing overall increase in length of the structure
Defines Perpendicular Traction as a force applied to soft tissue and is directed away from
the longitudinal axis causing relaxation of tissue.
4b. Perform the Supine Traction cervical spine soft tissue treatment
Patient appropriately placed in supine position with doc at head of table
One hand cradles patient’s occiput
Other hand grasps gently the patient’s chin
Student provides a cephalad traction with both hands (keep head neutral or slightly flexed.
Avoid extension)
Describes forces are maintained until relaxation of elongation of the tissues are palpated.
4c. Perform the Forward Bending (Unilateral Fulcrum), supine, cervical spine soft tissue treatment
Patient supine with student seated at head of table
Student uses one hand to flex patient’s neck in order to slide the other arm under patient’s
head with hand palm down on opposite shoulder
Student provides a force to place neck in flexion,
Student repositions free hand to rotate the patient’s head toward elbow of arm that’s
under patient’s head
Provide a rhythmical pattern to the technique and/or a constant force until tissue softer and
lengthened.
Repeats for the opposite side of cervical spine tissues.
4d. Perform the Forward Bending (Bilateral fulcrum), supine, cervical spine soft tissue treatment
Patient supine with student seated at head of table
Student arms are crossed under patient’s head and hands placed palm down on patient’s
shoulders
Student provides a force to place neck in flexion
Student states he/she is providing a longitudinal stretch of the paravertebral tissues.
Provide a rhythmical pattern to the technique and/or a constant force until tissue softer and
lengthened.
4e. Perform the Contralateral Traction, supine, cervical spine soft tissue treatment
Doctor at side of table facing patient’s head and neck opposite the side being treated
Caudad hand reaches across and contacts paravertebral muscles on side opposite of where
you are standing (make sure to be lateral to spinous processes, not on them)
Cephalad hand rests on patient forehead to stabilize head
Provides a ventral and slightly lateral force with caudad hand while the cephalad hand
simultaneously applies a rotatory force to the head and neck toward the side being treated
States the combined forces create a perpendicular stretch to the cervical paraspinal tissues.
Forces are provided in a rhythmical manner as the student works up and down the cervical
spine paraspinal tissues.
This is repeated for the opposite side
4f. Perform the Cradling with Traction, Supine, cervical spine soft tissue treatment
Patient supine with student seated at head of table.
Student contacts the cervical spine paraspinal muscles bilaterally , just lateral to the spinous
process
Student provides a ventral and lateral force to the tissues bilaterally to provide a
perpendicular stretch.
Student provides a longitudinal traction by moving cephalad along the soft tissues
States the goal is relaxation of the cervical spine tissues.
4g. Perform the Suboccipital Release, Supine, cervical spine soft tissue treatment
Patient is supine with student seated at head of table.
Student places finger pads in the suboccipital region.
Student provides an upward pressure into tissuesslightly extend the OA joint and tissues
The student maintains the steady force.
States they are palpating for a release of the tension and the head will extend slightly over
their fingers
4h. Perform the Prone Pressure thoracic spine soft tissue treatment.
Patient is in a prone position
Physician is standing at side of table opposite the side to be treated
Student places the thenar and hypothenar eminence of one hand on thoracic paravertebral
muscles opposite the side he/she is standing
Student places their other hand on top of the hand contacting the paraspinal thoracic tissue
Keeping the elbows straight and using their own body weight, the student provides an
anterior and lateral force creating a perpendicular stretch.
The forces are repeated in a rhythmical manner
States the goal is to palpate relaxation in the thoracic paraspinal tissues
4i. Perform the Prone Pressure with counter pressure thoracic spine soft tissue treatment
Patient placed in prone position.
Student is standing at side of the table opposite the side to be treated.
Student places thenar eminence and thumb of caudad hand over the thoracic paravertebral
muscles opposite the side you are standing
Student places hypothenar eminence of cephalad hand on paravertebral muscles on the
same side you are standing
Engage tissues with a ventral force and then move your hands in direction in which the
fingers are pointing (thus fingerspointing cephalad will move cephalad, etc) creating a
longitudinal stretch
Demonstrates a rhythmical manner of force application until tissues are relaxed
4j. Perform the Subscapular Stretch thoracic spine soft tissue treatment.
Patient placed in prone position
Student is standing at side of thoracic spine to be treated.
Student places patient’s ipsilateral hand in behind their back.
Student places fingers of both hands around medial border of patient’s scapula.
Student provides a force to engage the tissue then give gentle and anterolateraltraction,
pulling scapula away from rib cage
Force is maintained until tissues soften and relax
4k. Perform the Upper Thoracic with Shoulder Block, Lateral Recumbent, thoracic spine soft tissue
treatment.
Patient is placed in a lateral recumbent position with side to be treated up
Student is standing at side of table facing patient
Student passes caudad hand under ipsilateral patient’s arm and contacts the upper thoracic
paravertebral muscles.
Student’s cephalad hand contacts anterior portion of ipsilateral shoulder (Drape patient’s
ipsilateral arm over students cephalad forearm).
With cephalad arm a posterior counterforce is provided with simultaneous force from the
caudal hand, ventrally and laterally to create a perpendicular stretch to engage soft tissues.
Forces are provided in a rhythmical manner until tissues are softened and relaxed
Repeat procedure for the opposite side
4l. Perform the Lower Thoracic under the shoulder, Lateral Recumbent, thoracic spine soft tissue
treatment.
Patient is placed in a lateral recumbent position with side to be treated up
Student is standing at side of table facing patient
Student contacts lower thoracic paravertebral muscles, lateral to the spinous processes
with finger pads of both hands.
Student engages tissues with anterior andlateral force to provide a perpendicular stretch
Forces are provided in a rhythmical manner until tissues are softened and relaxed
Repeat procedure for the opposite side
4m. Perform the Prone Pressure lumbar spine soft tissue treatment.
Patient is in a prone position
Physician is standing at side of table opposite the side to be treated
Student places the thenar and hypothenar eminence of one hand on lumbar paravertebral
muscles opposite the side he/she is standing
Student places their other hand on top of the hand contacting the paraspinal lumbar tissue
Keeping the elbows straight and using their own body weight, the student provides an
anterior and lateral force creating a perpendicular stretch.
The forces are repeated in a rhythmical manner
States the goal is to palpate relaxation in the thoracic paraspinal tissues
4n. Perform the Prone Pressure with counterleverage lumbar spine soft tissue treatment
Patient prone
□ Physician standing on the opposite side of the table from the dysfunctional tissue.
□ Cephalad hand contacts paravertebral muscles with thenar/hypothenar eminence
□ Caudad hand contacts ASIS opposite side from doctor
□ Doctor gently lifts ASIS posteriorly (up)
□ Simultaneously applies an anterolateral pressure to the paravertebral muscles creating a
perpendicular stretch
□ Continues in a rhythmical manner noting release of tension of tissue
Patient is brought back to a neutral position and reassessed
4o. Perform the Lateral Recumbent Position lumbar spine soft tissue treatment.
Patient is placed in a lateral recumbent position with side to be treated up
Student is standing at side of table facing patient
Student contacts lumbar paravertebral muscles, lateral to the spinous processes with finger
pads of both hands.
Student engages tissues with anterior andlateral force to provide a perpendicular stretch
Forces are provided in a rhythmical manner until tissues are softened and relaxed
Repeat procedure for the opposite side
