FPR + Stills for Pelvic + Rib SD

Question 1

Indication for FPR;

Answer 1

Myofascial or articular SD

Question 2

Absolute CI for FPR:

Answer 2

1. Unstable fracture affected by tx positioning
2. Manifestation of NEURO syx brought on by tx position
3. Exacerbation of potentially life-threatening symptomatology by treatment position (EKG changes, drop in O2 sat) in monitored pt

Question 3

Relative CI for FPR:

Answer 3

1. Tx not well tolerated or significant syx or signs occur during the process
2. comorbidities that place pt @ risk for fracture (severe osteoporosis, malignancy)
3. Moderate to severe joint instability
4. Spinal stenosis/nerve root impingement where positioning could exacerbate the condition

Question 4

FPR proposed mechanism

Answer 4

SD is initiated or maintained by increased activity in gamma motor neurons of muscles of particular segment

gamma motor system stimulates muscle spindles

overall result is increased tensoin in muscles (even in neutral position)

positioning muscle in neutral position results in INVERSE spindle ouput, which elimiates afferent excitatory input to the spinal cord through group1a +2 fibers (tension/hypertonicity of extrafusal muscle fiber is rect); unloading the joint, which enables rapid response to 3-plan therapeutic position (shifted neutral)

initial response is soft tissue, then articular

Question 5

FPR steps:

Answer 5

1. setup (monitor continuously and prep positioning- put affected body area in neutrla position)
2. activating force (compression, distraction, torsion)
3. positioning: indirect for greatest ease and HOLD for 3-5 secondss
4. Return and re-evaluate

Question 6

In pelvic FPR techniques, when do you apply the activating force?

Answer 6

apply AFTER positioning

Question 7

In rib FPR techniques, when do you apply the activating force?

Answer 7

apply BEFORE positioning

Question 8

Indication for Stills:

Answer 8

SD in virtually all tissues of body including: cranium, spine, sacrum, pelvis, limbs, muscles, tendons, ligaments, and viscera

efficacy is only limited by practitioners knowledge of fxnal anatomy

safe to use for pts of all ages

Question 9

Contraindications for Stills:

Answer 9

not advisable across recent wounds (surgical or otherwise) or fractures < 6 weeks old

Question 10

Steps to Stills technique:

Answer 10

1. indirect positioning
2. add force vector <5 lb compression/traction
3. articulate (move thru restrictive barrier - smooth and maintain force vector)
4. final tx position
5. release force vector
6. return pt to neutral and retest for TART

Question 11

After monitoring the rib in FPR, what should you tell the patient to do?

Answer 11

extend the spine to straighten kyphotic curve`

Question 12

In the Inh/exh rib SD seated PFR, if youre patient has an inhalation SD, where is your acivating force going? exhalation SD?

Answer 12

inhalation- superior

exhalation- inferior