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Physiological Therapeutics II
Soft Tissue & Rehabilitative Techniques
#33561


Lower Quarter Summary Table (pdf)

 

 
Stacy M. Thornhill Peterson, DC, DACRB
2.5
45.0
0
3.0

Students will study the therapeutic management of soft tissue dysfunction of the axial and appendicular skeleton.

This course expands the student's knowledge and skills for assessment and treatment of conditions of the locomotor system. Since rehabilitation of the locomotor system is fast becoming the standard of care for neuromusculoskeletal disorders, this course seeks to give the student a strong foundation in the functional restoration model of patient care. In this course, the student will perform and apply various modalities including soft tissues techniques, manipulation/mobilization techniques and exercise. A clinical context will be utilized (and, in fact, emphasized) throughout the course.

It is expected that the student have a sound understanding of biomechanics and conceptual as well as practical application from material from previous courses in manual therapeutics. This is an integrative and comprehensive course in manual therapies and active rehabilitation.
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The Institution-wide learning goals define the common ground that unites the programs within the university. They are purposefully broad so that the various colleges and schools can continue to develop their unique identities through varying ways in which the goals are met.

  1. Effective Communication
    Graduates will demonstrate effective verbal, non-verbal, and written communication skills in a wide variety of contexts, including collaborative activities.
  2. Self Directed and Lifelong Learning
    Graduates will be aware of the limits of one’s personal knowledge and experience and have an intellectual interest in scholarly and creative endeavors. Graduates will actively set appropriate learning goals, pursue them, and apply the knowledge gained.
  3. Ethical Reasoning
    Graduates will demonstrate a willingness to recognize the values of others while maintaining one’s own integrity, and act ethically and professionally in all endeavors.
  4. Individuals, Communities and Cultures
    Graduates will demonstrate awareness and sensitivity to the cultural and health practices of individuals and communities. Graduates will be able to identify appropriate health related resources.
  5. Service to the Community
    Graduates will understand and value the benefits of service to the community.
  6. Influence of Mind, Body and Spirit on Health
    Graduates will recognize the inter-relationship of the mind, body and spirit and the influence of extrinsic factors on an individual’s health.
  7. Critical Thought and Knowledge Acquisition
    Graduates will acquire, appraise and apply scientific information. Graduates will contextually organize and synthesize relevant information to address an issue or problem.
  8. Competence in one's Discipline
    Graduates will demonstrate competence of appropriate depth and scope for one's discipline.

Course Objectives
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  1. Identify key common muscle imbalances (via posture, gait and movement patterns) and suggest/demonstrate appropriate treatment procedures.
  2. Explain the basic principles of muscle energy, myofascial, Graston™ Instrument-Assisted Soft Tissue Manipulation (GISTM), mechanically-assisted STM (soft tissue manipulation), transverse friction and positional release techniques. 
  3. Demonstrate an ability to perform a soft tissue examination of the spine, pelvis and extremities (in the context of a complete exam).
  4. Employ low back/pelvis and cervicothoracic as well as upper and lower extremity soft tissue techniques to address numerous conditions that affect the locomotor system.
  5. Describe and demonstrate appropriate exercises for stability, mobility, strength, endurance and coordination for the spine, lower extremity and upper extremity.
Materials
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A. Required Text(s):
Rehabilitation of the Spine, 2nd Ed. Liebenson, Craig. Lippincott Williams & Wilkins, 2007.

 


B. Recommended Text(s):
  1. Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins, 1983. (volumes 1 & 2)
  2. Muscle Energy Techniques. 2nd edition. Chaitow, Leon. Churchill Livingstone, 2001.
  3. Soft Tissue Manipulation. Chaitow, Leon. Healing Arts Press, 1988
  4. Positional Release Therapy. D'Ambrogio, Kerry. Mosby, 1997.
  5. Manipulative Therapy in Rehabilitation of the Locomotor System, 3rd ed. Lewit, Karel. Butterworth-Heinemann, 1999.
  6. Functional soft tissue examination and treatment by manual methods, 2nd ed. Hammer, Warren. Aspen, 1998.
  7. Chiropractic Reflex Techniques. In: Foundations of Chiropractic - Subluxation. Bergmann, Thomas. Mosby, 1995.
  8. Rehabilitation of the Spine: A Practitioner's Manual. Liebenson, Craig. Williams & Wilkins, 1996 (2nd edition is scheduled to be published 1/2006)
  9. Functional Rehabilitation of Sports & Musculoskeletal Injuries. Kibler WB, et al. Rehabilitation Institute of Chicago. Aspen, 1998.

B2. Recommended Video(s)/DVD(s)

  1. Rehabilitation of the Spine, 2nd Ed. DVD. Liebenson, Craig. Lippincott Williams & Wilkins, 2007.
  2. Rehabilitation of the Spine Video Series. Liebenson, Craig. Williams & Wilkins, 1999.
  3. Soft Tissue Manipulation According to Lewit. Lewit, Karel. BH, 2000.

C. Required Materials for Lab:
  1. PT II Manual #33561 (copies of which are in the bookstore).
  2. Shorts/loose sweat pants; sports bra or similar item.
Assignments
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  1. Reading PT II Manual #33561
  2. Reading selected chapters from Rehab of the Spine, 2nd ed.
  3. Practicing laboratory procedures
Attendance
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  1. Attendance is required, as outlined in the current NWHSU student Handbook. Attendance may be taken at any point during the sessions each week. The student is responsible for anything that transpires during each session, even if the student is not able to attend. In the event that a class session is missed, the student is responsible for obtaining information regarding schedule changes and/or other announcements that may have been made.
  2. Students with health-related condition(s), which contraindicate participation in any class activity, must notify the instructor during the first week of class or immediately following the onset of the condition(s). Students who believed that they have incurred an injury or have exacerbated a preexisting condition while in class should report to the instructor immediately.
Grading Criteria
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There will be two (2) practical examination for the course. They will be administered according to the examination schedule that the student receives for the trimester. Students will be tested on the information covered up to the date of the examination. For each of the examinations, students are responsible for reading the PT II manual and keeping up-to-date on the material covered in the previous sessions. The examination will primarily be "hands on" in nature; however, there will be an oral component as well. Students must obtain a minimum of 65% of the total points (100) at the end of the trimester course. Student handbook policy will be followed in regards to any missed test.

Guaranteed grades are as follows:

A = 90-100% of the 100 total points
B = 80-89% of the 100 total points
C = 70-79% of the 100 total points
D = 65-69% of the 100 total points
F = Failure to accrue at least 65% of total points
Course Competencies
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COGNITIVE DOMAIN


Knowledge: students will have formulated an understanding of spine and pelvis and extremity soft tissue examination/treatment.
  1. The student is responsible for finding trigger points, tender points and the soft tissue barrier phenomenon for the following muscles:

    Muscles Prone to Tightness (Lower Quarter):
    Iliopsoas
    Rectus Femoris
    Tensor Fascia Lata
    Adductors
    Erector Spinae
    Pelvic Floor
    Quadratus Lumborum
    Piriformis
    Hamstrings
    Gastrocnemius & Soleus

    Muscles Prone to Tightness (Upper Quarter):
    Suboccipitals
    Sternocleidomastoid
    Upper Trapezius
    Levator Scapulae
    Scalenes
    Pectoralis Major & Minor
    Subscapularis
    Infraspinatus
    Common Flexors (of the Elbow)
    Extensors (of the Forearm)
    Thenar/Hypothenar eminence

    In Addition,

    Other Areas
    Diaphragm/Respiratory Coordination
    Patellofemoral Articulation
    Cervical Spine Articulations
    Upper Thoracic Articulations
    Ribs 3-10 (Intercostals; Transverse Thoracis)
    Posterior Capsule (of the Shoulder)
    Acromioclavicular Ligament

  2. The student is responsible for providing definitions, variations to the techniques (i.e., respiratory assist, visual synkinesis, etc.) and indications/contraindications to any of the following techniques:

    Soft Tissue Techniques
    Post-isometric Relaxation (PIR)
    Alternative Manual Resistance Techniques (MRT)
    Mechanically-Assisted STM (Soft Tissue Manipulation)
    Ischemic Compression
    Myofascial Release Therapy (MFR)
    Graston™ Instrument-Assisted Soft Tissue Manipulation (GISTM)
    Transverse Friction Massage (TFM)
    Positional Release Therapy (PRT, AKA Strain Counterstrain)
    Neuro-reintegration Techniques

  3. The student must be able to properly perform the following procedures by the end of the course:
    1. Post-isometric relaxation for the erector spinae, iliopsoas, rectus femoris, tensor fascia lata, adductors, quadratus lumborum, piriformis, hamstrings, gastrocnemius, soleus, suboccipitals, sternocleidomastoid, upper trapezius, levator scapulae, pectoralis major/minor and scaleni, subscapularis and infraspinatus;
    2. Alternative manual resistance techniques for the piriformis, hamstrings, illiopsoas, common flexors (of the elbow), thenar/hypothenar eminence + palmar fascia and pectoralis major/minor;
    3. Graston™ Instrument-Assisted Soft Tissue Manipulation for the erector spinae, quadratus lumborum, iliolumbar ligament, gastroc-soleus, achilles tendon, plantar fascia, suboccipitals, upper trapezius and levator scapulae;
    4. Ischemic compression for the infraspinatus, upper trapezius and levator scapulae;
    5. Myofascial release therapy for the erector spinae, iliopsoas, rectus femoris, adductors, tensor fascia lata, suboccipitals, sternocleidomastoid, upper trapezius, levator scapulae, extensors (of the forearm), posterior capsule and thenar/hypothenar eminence + palmar fascia; and
    6. Transverse friction massage for the supraspinatus and infraspinatus tendons and acromioclavicular ligament;
    7. Positional release therapy for the quadratus lumborum, piriformis, sternocleodomastoid and pectoralis major/minor;
    8. Neuro-reintegration techniques for the diaphragm/respiratory coordination and general balancing of spinal & limb musculature; and
    9. Key joint mobilization techniques (& associated soft tissue release) of the pelvis (sacrum and ilia), lumbar (L1-5), craniocervical, cervical (C1-7) and upper thoracic articulations as well as anterior ribs (3-10) and patellofemoral articulation.
  4. Describe and demonstrate exercises to strengthen/facilitate the following muscles:

    Muscles Prone to Weakness
    (Lower Quarter)
    Gluteus Maximus
    Gluteus Medius
    Transversus Abdominus (TA)
    Multifidus
    Vastus Medialis Oblique (VMO)
    Quads/Hamstrings

    Muscles Prone to Weakness
    (Upper Quarter)
    Serratus Anterior
    Rhomboids
    Middle & Lower Trapezius
    Deep Neck Flexors
    Rotator Cuff Muscles

     

  5. Students should be able to describe the role of lumbar/pelvis and cervicothoracic soft tissue manipulation in the overall treatment of lower and upper quarter locomotor system dysfunction and be able to apply such treatment to the following conditions:

    i. Lumbar Facet Syndrome xii. Temporomandibular Joint Dysfunction
    ii. Lumbar Disc Herniation xiii. COPD
    iii. Piriformis Syndrome xiv. DISH
    iv. Spondylolisthesis xv. Thoracic Kyphosis
    v. Sacroiliac Joint Syndrome xvi. Thoracic Outlet Syndrome
    vi. Pregnancy xvii. Intercostal Neuritis
    vii. Female/Male Health Disorders xviii. Anterior Chest Contusion
    viii. Tension/Migraine Headache xix. Pseudoangina
    ix. Cervical Radiculopathy xx. Myofascial Pain Syndrome
    x. Cervical Acceleration-Deceleration (CAD) Injury xxi. Sacroiliac / Lumbar / Thoracic/Rib/ Cervical Intersegmental Dysfunction (ISD)
    xi. Vertigo xxii. Various Upper / Lower Extremity Conditions

All of the aforementioned parameters will be measured by demonstration of knowledge based on the practical examinations that will be administered.

Conditions:
See above.

PSYCHOMOTOR DOMAIN


Application/Skills: Students will be tested with two (2) examinations that will evaluate the ability to properly perform the procedures demonstrated in lab (as listed above). Any material covered in any 1-hour or 2-hour session (including the information found in the manual) may be included in the verbal portion of the exam.

Many of the concepts of this course will be cumulative in nature, i.e., building upon information in previous courses. Students should be able to examine and treat as well as know the functional interrelatedness of the fascia, muscles, capsule, ligaments, osseous articulations and viscera.



AFFECTIVE DOMAIN


Students will demonstrate integrity, sensitivity, respect, courtesy, compassion and professionalism at all times, and will be able to apply the examination and treatment techniques learned in this course while demonstrating those same qualities.
Weekly Calendar of Learning Objectives
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Week Dates Topics/Learning objectives
Week 1 01/04-

Evaluation of Respiratory Dyssynergia & Associated In-Office Diaphragmatic Re-training, MFR, & Home Breathing Exercises

Week 2 01/11-

Evaluation of Lumbo-Pelvic Sagittal Plane, Iliopsoas Tightness, Gluteus Maximus Weakness/Inhibition, Associated Soft Tissue Techniques of Iliopsoas, Rectus Femoris & Anterior Hip as well as In-Office Gluteus Maximus Re-training
Week 3 01/18-

Rectus Femoris, Tensor Fascia Lata, Erector Spinae, Pelvic Floor & Quadratus Lumborum Evaluation & Treatment
Week 4 01/25- Short & Long Adductors Evaluation & Treatment; Review
Week 5 02/01-

Homecoming; No Classes
Week 6 02/08- Hamstrings, Gastrocnemius-Soleus & Piriformis Evaluation & Treatment; Review
Week 7 02/15-

Midterm Examinations (Practical Lab Exam - date TBA)
Week 8 02/22-

Midterm Examinations (con't)
Week 9 03/01- Soft Tissue Techniques Upper Quarter, Part I
Week 10 03/08- Soft Tissue Techniques Upper Quarter, Part II
Week 11 03/15- Soft Tissue Techniques Upper Quarter, Part III
Week 12 03/22-

Special Topics
Week 13 03/29-

Rehabilitation: Overview; Review
Week 14 04/05- Final Examinations
(Comprehensive Practical Lab Exam - date TBA)
Week 15 04/12-
 Final Examinations
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
Maintained by Northwestern College of Chiropractic
Last updated: 20 February, 2007
 

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