Practical 1 Flashcards
(127 cards)
1
Q
Skin changes of acute SDs
A
Skin is warm, moist, red, inflamed.
2
Q
Sympathetic activty changes for acute SDs
A
Local vasodilation
3
Q
Musculature changes for Acute SDs
A
Locally increased muscle tone, muscle contraction, spasm
4
Q
Soft tissue changes for acute SDs
A
Boggy, edema, acute congestion, fluids from vascular leakage, chemical reactions on the tissues
5
Q
Visceral changes from Acute SDs
A
Minimal somato-visceral reflex effects
6
Q
Skin changes of chronic SDs
A
cool, pale
7
Q
Sympathetic activty changes for chronic SDs
A
Local vasoconstriction
8
Q
Musculature changes for Chronic SDs
A
Limited RoM, likely due to fascial contracture; feels ropy
9
Q
Soft tissue changes for chronic SDs
A
Congestion, doughy, stringy, fibrotic, thickened, exhibits increased resistance to penetration, contracted
10
Q
Visceral changes from Chronic SDs
A
Common somatovisceral reflex effects
11
Q
First Rib
A
Patient supine. Place hands on lateral portion of cervical spine palpating inferiorly towards the shoulders. As you near the base of the neck, you will feel a firm structure protruding laterally: this is the transverse processes of T1. Lateral to these will be the first rib. Alternatively, grasp trapezius and push tissue posteriorly and add pressure toward the feet.
12
Q
Clavicle
A
Stand behind seated patient and place hands on top of the shoulders, allowing fingers to drape down anteriorly. Palpate the long s-shaped bone; attaches medially to the manubrium (sternum) and laterally to the acronium of the scapula. Can be done from in front of patient as well
13
Q
Jugular Notch
A
From front of patient. In the midline, lightly palpate anterior aspect of base of the neck. Continue inferiorly until you feel a notch or groove intermediate to the two medial clavicular heads.
14
Q
Sternoclavicular Joint
A
Lateral to the jugular notch; where the medial head of the clavicle meets the sternum. Use both hands to trace clavicle towards midline until you reach the sternum
15
Q
Synchondrosis
A
1st rib with manubrium. Palpate inferior to the medial clavicular heads on the anterior aspect of the chest wall. Bilateral structure.
16
Q
Sternal Angle (Angle of Louis)
A
Palpate inferiorly from the jugular notch in the midline; you will feel a subtle shelf of bone.
17
Q
Second Costal Cartilage
A
Palpate lateral to the sternal angle to feel the cartilage of the 2nd rib.
18
Q
Costoclavicular Space
A
Space inferior to the medial third of the clavicle
19
Q
Infraclavicular Fossa
A
Deep space inferior to lateral two thirds of clavicle. More lateral than costoclavicular space
20
Q
Iliac Crest (Standing and supine)
A
Place hands on lower portion of rib cage and palpate inferiorly until you hit a bony structure. Higher in men
21
Q
Anterior Superior Iliac Spine
A
Assessed supine. With hands on top of crests of ilium, drop palms onto the anterior bony structures bilaterally. You can hook thumbs underneath and assess height differences
22
Q
Pubic Symphisis
A
Supine. Place heel of hand at umbilicus and palpate inferiorly until you feel bony structure. Once found, place index or middle finger pads of both hands on the SUPERIOR aspects. Pubic BONE is bilateral. ASK MEN TO ARRANGE THEMSELVES BEFORE PALPATING
23
Q
Inguinal Ligament
A
Runs from ASIS to pubic tubercule; feels like tight band. Start at ASIS and palpate medially and inferiorly
24
Q
Vertebral Prominens
A
Spinous process of C7. Standing behind, have the patient flex their head while looking for the most prominent midline structure at the base of the neck. To differentiate between C7 and T1 spinous processes, place your finger on the spinous process and have the patient look up: C7 will “dissappear” upon looking up.
25
Spinous Process of T1
Just below C7 spinous process. Will not disappear with extension
26
Spine of Scapula
Patient seated. Place palms on the superior/lateral aspect of the shoulders. Palpate bony shelf or "spine" traversing medially from the acromion process. Spine is at level of T3.
27
Inferior angle of scapula
"Point" of the scapula. Palpate medial border of the scapula inferiorly until you feel a tip or angle. The inferior angle of scapula is located at the level of the spinous process of the 7th vertebra; points to the 8th rib.
28
Rib angle
Palpate medially along border of scapula; angle of the rib is felt as a slight ridge, more prominent if the rib has moved posteriorly. You can feel rib angles if you have the patient huge themselves and lean forward.
29
Posterior Superior Iliac Spine
Either done while patient is standing or prone. Wrap palms around the iliac crests bilaterally: thumbs should fall onto the posterior bony protruberances of PSIS, then hook your fingers underneath the surface. If it can't be found this way, you can do whole hand palpation to the superior buttocks area.
30
Sacral Sulcus
Thumbs on the PSIS. Move thumbs medially. Assess depth of sulci
31
Inferior Lateral Angle of the Sacrum
Palpate with heel of hand from PSIS until you "drop off". From here, place thumbs just superior and lateral to coccyx.
32
Ischial Tuberosity
Sit bones. ASK SPECIFIC PERMISSION. Place thumbs on posterior aspect of thighs and palpate superiorly until you feel bony prominences deep to gluteal folds. Assess which is more caudad or cephalad.
33
Tip of the acromion Process
At AC joint, the most lateral structure on top of the shoulder is the tip of the acromion
34
Acromioclavicular Joint
Place hand on clavicle and palpate laterally until it meets the acromion. Have patient perform rowing/shrugging to palpate motion
35
Greater tubercle of the Humerus
Lateral to head of humerus
36
Lesser Tubercle of the Humerus
Medial to head. Start at greater tubercule and externally rotate arm bent at elbow.
37
Intertubercular groove of the humerus
Groove in between Greater Tubercle and Lesser Tubercle. Start at greater tubercle, bend an L, externally rotate.
38
Medial Epicondyle of the distal humerus
Make patient bend elbow. Medial bone of elbow
39
Lateral epicondyle of the distal humerus
Make patient bend elbow. Lateral bone of elbow.
40
Olecranon process of proximal humerus
Bony protruberance of elbow. Midline on posterior aspect of elbow joint.
41
Radial head of proximal humerus
Flex arm at elbow. Place thumb on the anterior lateral aspect of elbow with index finger wrapped around elbow laterally on posterior aspect. Supinate/pronate to feel motion. Can also go from the lateral epicondyle of the humerus and palpate distally to find the humero-radial joint space then palpate inferiorly to find radial head
42
Greater trochanter of femur
Place open hands on sides of hips near crests and push medially. "Walk hands down" the lateral aspects of the hips until a firm bony protruberance is palpated.
43
Patella
Supine. Palpate anterior aspect of the knee. Can have patient flex thigh to feel motion.
44
Tibial tuberosity
Directly below patella in midline.
45
Fibular head
Patient supine. Flex knee to 90 degrees. Using WHOLE HAND, palpate lateral aspect of knee.
46
Medial malleolus of tibia
Bony protruberance on medial aspect of ankle
47
Lateral malleolus of fibula
Bony protruberance on lateral aspect of ankle. More distal than medial malleolus
48
Calcaneal tendon
Achillies. Do while supine.
49
Gravitational Line
Compare external auditory meatus, lateral aspect of humerus/tip of shoulder, greater trochanter, lateral condyle of knee, and slightly anterior to lateral malleolus
50
Scoliosis Screen
Evaluate standing and bending. Scoliosis named for the side of convexity.
51
Trunk range of motion
Flexion (Touch your toes) vs Extension (bend backwards, can support them); Sidebending (standing, touch your fingers to your knees).; Rotation (Seated; cross arms and rotate).
52
Hip, knee, ankle screen
Put arms out in front of you and do a squat
53
Standing flexion test
Patient is standing. Hook fingers UNDER PSIS on skin and have the patient bend forward. Test is positive on the side that moves further.
54
Seated flexion test
While SEATED. Hook fingers UNDER PSIS on skin and have the patient bend forward. Test is positive on the side that moves further.
55
Active range of motion of C-Spine
Flexion vs Extension (Down and Up). Sidebending and rotation
56
Passive range of motion
Flexion, extension, sidebending, rotation. Guarding opposite side
57
Upper extremity range of adduction screen
Give yourself a hug; test ADDUCTION
58
Upper extremity range of ABDUCTION screen
Reach above your head and down your back; tests ABDUCTION and external rotation
59
Upper extremity extension and internal rotation
Reach behind your back and up your back
60
Suboccipital Tension Release: How-To
Patient supine, physician seated at head of table. Physician places fingerpads together under the suboccipital area. Use the finger pads to direct pressure anteriorly and superiorly with a force comparable to the weight of the head.
61
Suboccipital Tension Release: Utilization
1. Tension headaches 2. Prepare for cervical correction 3. Assess and stretch dural attachments at C2, C3, and occiput
62
Posterior Cervical Soft Tissue: How To
Patient supine, physician on patient's die with one hand on patient's forehead just above the eyebrows. Finger pads of their other hand rhythmically stretching and compressing the soft tissues between the spinous and articular processes of the cervical vertebrae while sidebending, rotating, and extending the cervical spine. Finger pads are brought laterally and anterior. Forehead hand is stabilizing only.
63
Posterior cervical soft tissues: Utilization
Treatment of SHORT RESTRICTOR muscles of the cervical spine
64
Cervical Stretching: How To
Physician seated at head of table with their arms crossed under the pt's head and their hands placed on the anterior aspects of the patient's shoulders. Physician raises their crossed arms (flexing pt's cervical spine) until a pathological barrier of motion (ROM) is appreciated. Can either hold PT in this position until release is felt or utilize muscle energy ("Push back for 3 seconds" --> relax --> go past barrier, repeat x3). Follow this up with sidebending and rotation: one arm on patient's shoulder, other arm on neck on same side to sidebend/rotate.
65
Cervical Stretching: Utilization
1. Address LONG RESTRICTOR muscles of C-spine 2. Stretch myofascial elements of the cervical and upper thoracic regions 3. Promote venous and lymphatic drainage of the tissues
66
Rib raising: lateral recumbant: How To
ASK IF THE PT HAS ANY SHOULDER PROBLEMS. Lie on their side. Pt stands facing patient, with one arm abducted and hand placed on their head, cupping their ear. Physician holds their elbow with one hand (grounding) and places their other hand on the posterior rib cage/rib angles separating from transverse processes: go lateral to spinous process --> transverse process --> start of the angle of the rib). Ribs are moved ANTERIOR and LATERAL. Technique is done when a release of tissues is appreciated.
67
Rib raising: supine: how to
Patient is supine. Physician sits on side of patient with hands under the rib cage and fingers contacting the rib angles. By flexing the fingers in a rhythmic manner, rib cage is raised to ward the ceiling (anterior) and pulled laterally, then released. Maintain forearms on the table to utilize as a counterforce.
68
Rib raising(BOTH): Utilization
1. To aid respiration (asthma) 2. Aid circulation of patient with congestion (pneumonia, chronic obstrective lung disease, CVD) 3. Pre/post-operative care
69
Prone thoracic perpendicular stretch: How To
Patient prone, physician stands at the side of the table OPPOSITE side being treated. Put one hand (listening hand) on the patient's spine with thumb and thenar eminence in the TROUGH between spinous and transverse processes. Other hand is used to apply force through the listening hand in a combined lateral and anterior motion (into the table) to stretch and compress tissues in a rhythmic fashion. Apply to length of T-spine. Do not slide across other tissues; remain on spine. Hold on 3 seconds then release.
70
Prone thoracic perpendicular stretch: Utilization
1. Laterally stretch fascial restrictions within the paravertebral musculature of the thoracic spine 2. Free up any rib or thoracic restrictions
71
Pectoral Traction: How to
Patient is supine, with KNEES FLEXED/feet flat on the table. Physician is seated at the heat of the table. Have the patient put their hands together in otder to get better access to the space: grasp the patient's anterior axillary folds with 2-4 digits of both hands. Apply traction superiorly to stretch muscles/underlying fascia in axillary spaces (lean back to pull). Patient instructed to inhale deeply while physician takes up any remaining slack and continues to hold traction. Traction maintained while patient exhales. Repeat X3
72
Pectoral Traction: Utilization
1. Increase A-P diameter of thorax 2. Improve venous and lymphatic drainage of the thorax 3. Release tension in the clavi-pectoral fascia 4. Drain atnerior axillary fold edema from the upper extremity 5. provide drainage from the head and neck
73
Clavipectoral stretch: How to
Patient supine, physician standing at head of table. Place thenar eminances on anterior/superior shoulders at level of AC joint/humerus. Pressure through thenar eminences is directed posteriorly (into the table) and inferiorly (towards the feet) utilizing 10 lbs of force. Held for 20 seconds, then released.
74
Clavipectoral stretch: Utilizations
1. Provide drainage from head and neck 2. Any illness that may cause edema to the head or neck 3. Anteriro/rounded shoulders 4. Completed after inlet has been addressed
75
Posterior axillary traction: How to
Patient supine, knees flexed with feet flat on the table. With 2-4 fingers of each hand, grab posterior axillary fossas between the table and pt's body. Apply traction (lean back) while pt inhales deeply. Traction maintained as pt exhales. Repeat X3.
76
Posterior Axillary Traction: Utilization
1. Increase A-P diameter of the thorax 2. Improve venous/lymphatic drainage of thorax 3. Release tension in clavipectoral fascia 4. Drain congestion from posterior axillary fold, upper extremities, head, and neck
77
Thoracoumbar soft tissue Prone How To
Pt in prone. Physician on opposite side being treated. Inferior hand grasps ASIS on opposite side of table. Other hand placed on paraspinal muscles adjacent to lumbar spine. Hand controlling pelvis at ASIS moved FIRST to gently pull pelvis off table toward physician. AT END OF THAT MOTION, other hand gently applies pressure into paraspinal muscles through heal of that hand as pelvis is slowly returned to table. "Kneading" motion. ASIS hand stays, paraspinal hand can move along length of muscles down to sacrum and up to lower thoracic
78
Thoracoumbar soft tissue Prone Utilizations
1. Relax paravertebrals/quadratus lumborum musculature 2. Free up motion of ribs 11/12 3. Therapeutic for somatic/visceral dysfunctions 4. Special attn may be given to those areas overlying the sympathetic nerve supply to the organs the physician wishes to affect through reflex mechanisms
79
Upper, mid, and thoracolumbar soft tissue Lateral Recumbant: How to
Put them in lateral recumbat and make them stabilize. ut one hand (listening hand) on the patient's spine with thumb and thenar eminence in the TROUGH between spinous and transverse processes. Other hand is used to apply force through the listening hand in a combined lateral and anterior motion (into the table) to stretch and compress tissues in a rhythmic fashion. Apply to length of T-spine. Do not slide across other tissues; remain on spine. Hold on 3 seconds then release.
80
Upper, mid, and thoracolumbar soft tissue Lateral Recumbant: Utilization
1. Relax the paravertebral and quadratus lumborum musculature 2. Free up ribs 4-12 3. Therapeutic as well as diagnostic for SDs/VDs
81
Thoracoumbar soft tissue Supine How To
Supine, knees flex, feet flat on table. Physician stands at side of table; hand closest to pt's feet holding on to knees, other hand (closest to hand) reaches around the patient at the level of thoracolumbar paravertebral musculature. Physician moves pt's knees away from them and alternatively bringing paravertebral musculature laterally and anteriorly (kneading fashion)
82
Thoracoumbar soft tissue Supine Utilizations
1. Relax paravertebrals/quadratus lumborum musculature 2. Free up motion of ribs 11/12 3. Therapeutic for somatic/visceral dysfunctions 4. Special attn may be given to those areas overlying the sympathetic nerve supply to the organs the physician wishes to affect through reflex mechanisms
83
IT Spread: How to
Patient in prone, knees bent and together, feet spread. Physician seated and behind, with arms at the patient's knees. Using both hands, physician puts pads of their thumbs medial to patient's ischial tuberosities and applies firm, lateral pressure. Pt instructed to cough 3 times; as they do, firm pressure maintained through thumbs and forearms to spread tuberosities laterally.
84
IT Spread: Utilizations
1) Release fascia of the pelvis 2) Treat sacrum 3) Separate sacroiliac joints and allow for better motion of the sacrum between the inominates 4) Help sacrum "seat" itself between innominates 5) improve function of urogenital pelvic diaphragm 5) May be utilized as an adjunct treatment for a variety of conditions (cystitis, proctitis, hemorrhoids, prostatitis, constipation, sacroiliac dysfunction)
85
Sacral Rocking: How To
Patient in prone. Physician's hands cupped over sacrum. Patient asked to breathe several times; physician emphsizes the sacral respirator motion (Apex of sacrum rocked anterior on inhalation while base moves posterior; with exhalation, reverse is accomplished)
86
Sacral rocking: Utilization
1. Improve sacral respiratory motion 2. Relieve strains of sacral fascia 3. Enhance primary respiratory mechanism 4. Improve function of urogenital pelvic diaphragm 5. Treat constipation
87
Sacral inhibition: How to
Patient prone, physician's hands cupped on sacrum. Press anteriorlly on sacrum for 1-2 minute
88
Sacral Inhibition: Treatment
1. Diarrhea 2. Dysmenorrhea 3. USE CAUTIOUSLY WITH SPONDYLOISTHESIS OR STENOSIS OF LUMBAR SPINE
89
Myofascial Shoulder Release via Scapular Lift: How To
Pt in lateral recumbant FACING PHYSICIAN. Left arm internally rotated and forearm placed behind the back. If this causes them pain, arm may be kept along side of their body. Physician places arm closer to feet under patient's arm and grasps medial border of patient's scapula. Other hand is used to depress shoulder (with caudal force) to further wing the scapula. Patient inhales deeply while physician lifts scapula towards the ceiling. Patient exhales while physician holds scapula in this position. Repeat X3
90
Myofascial Shoulder Release via Scapular Lift: Utilization
1. Release myofascial restrictions of the shoulder girdle 2. Address rib dysfunctions. CAUTION: Care should be taken if pt has history of bicep tendonitis, shoulder replacement, rotator cuff injury, impingement syndrome, bursitis, or adhesive capsulitis
91
Trapezius Pinch: How to
Pt supine, physician seated or standing at head. Hands in "lobster claw" position grasping trapezius muscles bilaterally Hands may be moved medially or laterally along the bulk of the muscle applying gradual pressure between thumb and other four fingers. When area of restriction is met, apply a steady force until softening is appreciated.
92
Trap pinch: utilizatiosn
1) Decrease congestion within thoracic inlet 2) Ease tension within trapezius 3) Tension headaches
93
Lymphatic Pumping: How to
Pt supine, feet on the table. Physician places hands on plantar surfaces of feet NOT TOES, and rhythmically dorsiflexes feet causing motion of abdomen. 40-60 bpm
94
Lymphatic Pumping: Utilization
1) Combat stasis, congestion, pooling of body fluids which are precursors to inflammation, symptions of disease, and frank disease. 2. Encourage natural venous return/circulation in pregnant people 3) good treatment for any infectious process. CAUTION WITH PATIENTS WITH METASTATIC DISEASE, RECENTLY POST-OPERATIVE, OR WITH ACHILLES TENDONITIS
95
Foot/leg "flaring"
Head of bed. Assess angles of feet formed with table. CCP IS RIGHT FOOT MORE FLARED.
96
Leg length
Foot of bed. Dorsiflex both feet and compare which heel is higher up. CCP IS RIGHT FOOT IS HIGHER UP, SO LEFT LEG IS LONGER.
97
Leg external rotation
Evaluate external rotation of legs by pressing down on medial aspect of big toe at the M-P joint. CCP IS RIGHT LEG MORE EXTERNALLY ROTATED (Makes sense because of flaring)
98
Motion testing of Feet
Cup pts heels with palms of hands, placing thumbs along lateral aspects and lift feet to 20 degrees. Internally rotate feet. CCP: RIGHT FOOT RESISTS MOTION MORE BC EXTERNALLY ROTATED
99
Assessing respiration
Observe whether motion of respiration is coming from Diaphraghm, Ribs (Costal), or Mixed. CCP is Costal
100
Observation of pelvic girdle
Observe the angle of the pelvic girdle/waist. CCP: PELVIC GIRDLE IS ROTATED CLOCKWISE.
101
Iliac crest Heights
Assess which iliac cres is more cephalad/caudad. CCP: LEFT ILIAC CREST MORE CEPHALAD
102
ASIS height (Compare to table)
Assess which ASIS is closes to the TABLE, using whole hand. CCP: RIGHT ASIS IS CLOSER TO TABLE (makes sense as pelvic girlde is rotated clockwise)
103
Motion testing of pelvic girdle
Standing next to patient, place hands around lateral aspects of pelvis. Lift left side and roll pelvis to right. Lift right side and roll pelvis to left. CCP: Pelvis rolls more easily to the right and resists motion to the left
104
Assessing the inguinal areas
Whole hand/all finger pads (not just 2-3, can be ticklish). CCP: TISSUES MORE TAUT ON LEFT SIDE, MORE SLACK ON RIGHT.
105
Assessing ASIS heights (compare to each other)
Place thumbs beneath each ASIS and compare the two sides. CCP: RIGHT SIDE MORE INFERIOR AND MEDIAL/LEFT SIDE MORE SUPERIOR AND LATERAL
106
Assessing pubic symphysis
Assess SUPERIOR aspect of symphysis. CCP: MORE CEPHALAD ON LEFT SIDE
107
Inominate compression test
Place palms on ASIS; apply gentle pressure down into table. CCP: RIGHT SIDE YIELDS, LEFT SIDE OFFERS RESISTANCE. ERGO, LEFT SIDE RESTRICTED
108
Fascial drag of ASIS
Place palms on ASIS with fingers on crests and evaluate fascial drag vertically with each hand in opposite directions. CCP: FASCIA GIVES FREELY CAUDAD ON RIGHT, CEPHALAD ON RIGHT.
109
Inominate findings in CCP
Left iliac crest is more cephalad, right more caudad. Pubic symphisis is sheared superiorly on the left, sheared inferiorly on the right. Iliac compression resists on right, yields on left. Fascia moves freely cephalad on left and caudad on right. ERGO ANTERIOR ROTATION OF RIGHT INOMINATE, POSTERIOR ROTATION OF LEFT INOMINATE.
110
Observation of lumbar spine
Observe the normal lordotic curve of the spine
111
Palpation of lumbar spine
Note height, extend of curve, and apex of curve
112
Motion testing of lumbar spine
Place fingertips underneath spinous processes of lumbar vertebrae. Lift spine away from table. Compare normal lumbar vertebrae to the lumbosacral junction. CCP: MOTION OF LUMBOSACRAL JUNCTION IS INHIBITED
113
Observation of upper thorax
CCP: Upper thorax is rotated clockwise. Lower thorax is rotated counter clockwise. Lower ribs appear anterior on the left.
114
Costal margins observations
CCP: Lower portion of thorax flares to the left
115
Palpation of thorax
Place hands on lower lateral aspect of thorax. CCP: CONTOUR IS NEITHER TAPERED NOR SYMMETRICAL.
116
Motion testing of costal margins
Place hands on costal margins and compress into table. CCP: LEFT SIDE MORE RESISTANT TO MOTION
117
Motion testing: lateral motion of thorax
Place hands on side of lower lateral aspects of thorax. Move rib cage laterally and see which side is more resistant to motion. CCP: LOWER THORAX MOVES MORE EASILY TO THE LEFT AND RESISTS MOVEMENT TO THE RIGHT
118
Assessing first rib
CCP: First rib anterior on the left, posterior on the right. First rib elevated on left.
119
Diagnosis of T1
T1 is rotated and sidebent to right
120
Palpation of infraclavicular area
Palpate contours and compare the two sides. CCP: Concave on the right, convex on the left.
121
Motion testing of first ribs
Press on synchondrosis formed by 1st ri and mandubrium. CCP: SPRINGS ON RIGHT, RIGID ON LEFT. MAY BE TENDER ON LEFT
122
Palpating sternal angle
Place hand on sternum with fingers pointing towards the jugular notch and palm of sternal body. CCP: Axis of sternum deviated to right; Sternal angle is flattened.
123
Motion testing sternal angle
Hand on midline of sternum, fingers just below jugular notch. Move hand left and right to assess tissue dragging. CCP: TISSUES MOVE EASILY TO LEFT, RESIST MOTION TO RIGHT.
124
Assessing arm length
Have patient flex shoulders up and see which arm falls closer to table. CCP: LEFT ARM APPEARS HIGHER THAN RIGHT ARM. Observe angle that arms form with table. CCP: ANGLE ON LEFT SIDE APPEARS LARGER THAN RIGHT SIDE. Grasp arms of pt and bring thumbs together to measure arm lengths. CCP: LEFT ARM SHORTER. Compare tensions. CCP: LEFT TENSION GREATER
125
Head sidebending observation
CCP: HEAD TURNED TO LEFT AND SIDEBENT TO RIGHT
126
Assessing sacrum
CCP: Right sulcus is deep. LEFT ILA IS POSTERIOR AND INFERIOR.
127
Motion testing Sacrum
CCP: Fascial drag is cephalad. No sacral tender points. Sphinx test negative (no motion when going up on negative). Diagnosis: LEFT ON LEFT FORWARD SACRAL TORSION***
