Monthly Archives: June 2016

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MET C2-C3 ERS

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Typical Cervical Vertebra (C2-C3)

Diagnosis                 

Position:  Extended, left side-bent, and left rotated (ERSleft).

Motion Restriction:  Forward bending, right rotation, and right side-bending (FRSright).

The C2 left facet won’t open.

Patient is supine on the table with the operator sitting at the head.

Operator’s left hand supports the occiput with the left thumb over the left C2-C3 zygopophysial joint.MET C2-C3 ERS left 2

 

 

MET C2-C3 ERS left 3Operator’s right hand is placed on the patient’s right frontoparietal region to control head movement.

 

Operator’s two hands roll the head and upper neck into forward bending as far as the C2-C3 interspace.MET C2-C3 ERS left 4

 

 

Operator introduces right side-bending and right rotation by right-to-left translation through the left index finger contact on the right zygopophysial joint of C2-C3, engaging MET C2-C3 ERS left 5the flexion, right side-bending, and right-rotation restriction.

 

 

Patient exerts a 3-5 second isometric contraction into backward-bending, left side-bending, or left rotation.  Following relaxation, the operator engages the new flexion, right side-bending, and right rotational barriers.  Repeat 3-5 times.

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MET C5-C6 (FRS)

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Cervical Spine Muscle Energy Technique

Typical Cervical Vertebra (C5-C6)

Diagnosis

Position:  Flexed, rotated left, and side-bent left (FRSleft)

Motion Restriction:  Extension, right rotation, and right side-bending (ERSright)

The C5 right facet won’t close.

Treatment

Patient is supine on the table with the operator sitting at the head of the table.

Operator’s finger tips of the right index and middle finger are placed on the right articular pillar of C6 to hold the segment so that C5 can be moved upon it.MET C5-C6 ERS left 2

 

 

Operator’s left hand controls the left side of the patient’s head and neck.MET C5-C6 ERS left 3

 

 

Operator’s right fingers translate the segment anteriorly introducing motion to the backward-bending barrier.MET C5-C6 FRS left 4.jpg

 

 

Operator’s left hand introduces right side-bending and rotation of the head and neck to the right by right to left translation engaging the right rotation and the right side-bending barriers.MET C5-C6 FRS left 5

 

 

Patient exerts a small isometric effort against the operator’s resisting left hand into forward bending, left side-bending, or left rotation.MET C5-C6 FRS left 6

 

 

After a 3-5 second muscular effort, the patient relaxes and the operator increases translatory movement in an anterior and right to left direction engaging the backward-bending, right side-bending, and right rotation barriers.  This process is repeated 3-5 times.

Retest.

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Occipitoatlantal (C0-C1) Condylar Glide

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Accuracy in assessing condylar glide restriction is dependent on first biasing the condyles, anteriorly or posteriorly, into the direction which is being assessed.

 Patient is supine on the table with the operator sitting at the head of the table.

Operator grasps the sides of the head with each hand and biases the condyles anteriorly by rotating the head posteriorly around an axis through the external auditory meatus while monitoring the first movement of the atlas.OASupCG2

 

 

Operator then rotates the head 30˚ to the right.OASupCG3

 

 

Operator introduces anterior translatory movement of the head asking the right condyle to glide anteriorly while sensing forOASupCG4
resistance.

 

 

Operator then rotates the head 30˚ to the left.OASupCG5

 

 

Operator introduces anterior translatory movement of the head asking the left condyle to glide anteriorly while sensing for resistance.OASupCG6

 

 

Operator grasps the sides of the head with each hand and biases the condyles posteriorly by rotating the head anteriorly around an axis through the external auditory meatus while OASupCG7monitoring the first movement of the atlas.

 

 

Operator then rotates the head 30˚ to the right.OASupCG8

 

 

 

Operator introduces posterior translatory movement of the head asking the right condyle to glide posteriorly while sensing for resistance to movement.OASupCG9

 

 

Operator then rotates the head 30˚ to the left.OASupCG10

 

 

Operator introduces posterior translatory movement of the head asking the left condyle to glide posteriorly while sensing for resistance to movement.OASupCG11

 

 

 

This tests for the forward-bending and backward-bending capacity of each condyle.  If resistance is encountered, there will be restriction of the side-bending and rotational motion coupled to opposite sides (the minor movements).  Most often, a condyle will resist posterior glide (flexion).  If this were true on the right, C0-C1 would be documented as extended and side-bent right and rotated left (ESleftRright).

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Occipitoatlantal (C0-C1) Flexion Restriction

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Patient is supine on the table with the operator sitting at the head of the table.

Operator’s hands grasp the sides of the patient’s head with the lateral aspect of the index
fingers monitoring along the posterior arch of the atlas and the rest of each hand controlling the head.

Operator forward bends the patient’s head by anterior rotation around an axis of rotation OASupFR3through the external auditory meatus while monitoring for the first movement of the atlas.

 

 

Using the hands, the operator introduces translation from right to left sensing for resistance to movement at his index fingers.  If resistance is felt, the motion restriction is OASupER4to forward bending, right side-bending, and left rotation (ESleftRright).  Something interfered with the left condyle’s ability to glide posteriorly.

 

Using the hands, the operator introduces translation from left to right sensing for resistance to movement at his index fingers.  If resistance is felt, the OASupFR5motion restriction is to forward bending, left side-bending, and right rotation (ESrightRleft).  Something interfered with the right condyle’s ability to glide posteriorly.

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Occipitoatlantal (C0-C1) Extension Restriction

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Patient is supine on the table with the operator sitting at the head of the table.

Operator’s hands grasp the sides of the patient’s head with the lateral aspect of the index fingers monitoring along the posterior arch of the atlas and the rest of each hand controlling the head.

Operator introduces backward bending to the first barrier by rolling the head posterior around an axis of rotation through the external auditory meatus.OASupER3

 

 

Using the hands, the operator introduces translation of the head from right to left, maintaining the eyes parallel to the head of the table sensing for OASupER4resistance to movement at his index fingers. If resistance is felt, motion restriction is to backward bending, right side-bending, and left rotation (C0 flexed [F], side-bent left [Sleft], and rotated [Rright].  Something interfered with the right condyle gliding forward.

Using the hands, the operator introduces translation of the head from left to right sensing for resistance to movement at his index fingers.  If resistance is OASupER5encountered, the restriction is to backward bending, left side-bending, and right rotation (FSrightRleft).  Something interfered with the left condyle gliding forward.

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Atlantoaxial (C1-C2)

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Patient is supine on the table with the operator sitting or standing at the head of the table.

Operator’s hands hold each side of the patient’s head with the index fingers monitoring the posterior arch of the atlas.  The operator flexes the patient’s head and neck to provideAASup2 restriction of the typical cervical segment rotation through ligamentous locking.  Neck flexion must be maintained throughout the procedure.

 

 

Operator’s hands introduce right rotation sensing for resistance to movement at his index fingers.  If resistance is encountered, the motion restriction is to right rotation (atlas is AASup3rotated left).

 

 

 

Operator rotates the head to the left sensing for resistance to movement at his index fingers.  If resistance is encountered the motion restriction is to left rotation (atlas is AASup4rotated right).

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Typical Cervical Segments C3-C7: ERS

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Extended, Rotated, and Side-bent Dysfunction

Patient is supine on the table with the operator sitting at the head of the table.

Operator’s index and middle fingers of each hand contact the pillar of the superior vertebra of the motion segment being tested.

Operator’s palms and thenar eminences control the patient’s head and upper cervical spine.

Operator flexes the head and neck down to the segment under examination.  ERS4

 

 

 

With the palm and thenar eminence controlling the patient’s head and upper cervical, the operator introduces translation from right to left, sensing for resistance to movement at ERS5his index fingers.  If resistance is felt, the motion restriction is to forward-bending, right side-bending, and right rotation (indicating that the segment is extended, rotated and side-bent left [ERSleft]).  Something has interfered with the capacity of the left facet to open.

With the palm and thenar eminence controlling the patient’s head and upper cervical, the operator introduces translation from left to right, sensing for resistance to movement atERS6 his index fingers.  If resistance is felt, the motion restriction is to forward-bending, left side-bending, and left rotation (indicating that the segment is extended, rotated, and side-bent right [ERSright]).  Something has interfered with the capacity of the right facet to open.

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Typical Cervical Segments C3-C7: FRS

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Flexed, Rotated, and Side-bent Dysfunction

Patient is supine on the table with the operator sitting at the head of the table.

Operator’s index and middle fingers of each hand contact the pillar of the superior vertebra of the motion segment being tested. FRS2

 

 

 

Operator’s palms and thenar eminences control the patient’s head and upper cervical spine.  FRS3

 

 

 

Operator backward-bends the head and neck down to the segment under examination. FRS4

 

 

 

With the palm and thenar eminence controlling the patient’s head and upper cervical, the FRS5operator introduces translation from right to left, sensing for resistance to movement at his index fingers.  If resistance is felt, the motion restriction is to backward-bending, right side-bending, and right rotation (indicating that the segment is flexed, rotated and side-bent left [FRSleft]).  Something has interfered with the capacity of the left facet to close.

With the palm and thenar eminence controlling the patient’s head and upper cervical, the FRS6operator introduces translation from left to right, sensing for resistance to movement at his index fingers.  If resistance is felt, the motion restriction is to backward-bending, left side-bending, and left rotation (indicating that the segment is flexed, rotated, and side-bent right [FRSright]).  Something has interfered with the capacity of the right facet to close.

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Cervical Spine Dx/Tx: Supine

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A.  In the absence of dysfunction, side-bending of the typical cervical spine to the right allows the right facet to close and the left facet to open. Side-bending to the left allows the left facet to close and the right facet to open.

In determining if a facet can close, one would bias the paired facets into extension by translating the vertebral segment anteriorly.  From there, translating that segment from right to left tests the right side’s ability to close, while translating from left to right tests the left side’s ability to close. 

In determining if a facet can open, one would bias the paired facets into flexion by translating the vertebral segment posteriorly.  From there, translating that segment from right to left tests the left side’s ability to open, while translating that segment from left to right tests the right side’s ability to open.

B.  In the absence of dysfunction, side-bending the occiput to the right (right to left translation) onto the superior articular facet of C1 causes the right condyle to glide anteriorly (extend) on C1 and the left condyle to glide posteriorly (flex) on C1. 

In determining if the condyles can symmetrically glide anterior or extend, one would bias the occiput into extension by translating the condyles anteriorly on the superior articular facets of C1 (backward bending).  From there, side-bending the occiput to the right further tests the right side’s ability to extend.  Side-bending the occiput to the left (left to right translation) further test the left side’s ability to extend.

In determining if the condyles can symmetrically glide posterior or flex, one would bias the occiput into flexion by translating the condyles posteriorly on the superior articular facets of C1 (forward bending).  From there, side-bending the occiput to the right further tests the left side’s ability to flex; side-bending to the left further tests the right side’s ability to flex.

C.  The articular structures of C0-C1 are unique.  Relative to the anterior/posterior (sagittal plane), the anterior aspect of the articulating surface sits 30˚ medial to the posterior aspect of the articular surface.  Turning the occiput and C1 (atlas) to the right 30˚ places the right C0-C1 articular surface parallel to the A/P (anterior/posterior) plane.  Turning the occiput and C1 to the left 30˚ places the left articular surface parallel to the A/P plane.

atlas

 

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Sitting Dx: Occipitoatlantal (C0-C1)

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Patient sits on the table.

Operator stands behind with the thumb and index finger of the right hand grasping the posterior arch of the atlas and the left hand on top of the head to introduce movement.

Operator’s left hand introduces backward-bending, left side-bending, and right OAS3rotation of the head sensing for prominent fullness under the right thumb indicating posterior rotation of the atlas on the left.

 

Operator’s left hand introduces backward-bending, right side-bending, OAS4and left rotation of the head and monitors for prominence of the right posterior arch of the atlas under the right index finger, indicative of right rotation of the atlas.

 

Operator introduces forward-bending, right side-bending, and left OAS5rotation with the left hand while monitoring for prominence of the right posterior arch of the atlas under the right index finger, indicating atlas right rotation.

 

Operator introduces forward-bending, left side-bending, and right OAS6rotation of the head with the left hand while monitoring for prominence of the left posterior arch of the atlas under the right thumb, indicating left rotation of the atlas.