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Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 Page 1 Analysis and Correction of Locomotor Dysfunction as It Applies to Autonomic Nervous System Dysregulation Lab Lino Cedros ATC, MT, CAMTC Neal O’Neal PT Test leg for loss of femur internal rotation – Mechanical or Chapman’s Obturator internus Piriformis Quadratus Laborum Illiopsoas Test groin glands for pelvic congestion GG-The lowest 2/5ths of the Sartorius muscle and its tendinous attachment on the tibia and just above the inner condyle of the femur. Chapmans drainage - Rectum and Hemorrhoids R-Lesser trochanter of the femur downward. H-Just medial and above the tuber ischii. Indicates congestion of the glands draining the rectal walls and tissues – in the rectum just below the sigmoid flexure Deep rotatory movement Reach from back for femoral points Drainage area-At angles of 7th and 8 rids on left side is a very sensitive reflex about 3 inches from the spine. Indicates a variant of rectum and colon close to the sigmoid flexure. Deep pressure between 5-6 sacral nerves for tight anal sphincter. Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 1 Test heel sign Test Hypogastic plexus Midline Sided Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 2 Test foot shake Test great toe movement on first cuneiform Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 3 Test muscles of the foot related to fluid drive Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 4 Test talus for glide- Fred Mitchell Jr test. Test fibula for glide Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 5 Test posterior lateral knee Check pubes/correct Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 6 Muscles to treat for venous pump Soleus / Medial head of the gastrocnemius Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 7 Vastus lateralis. Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 8 Flexor Hallicus longus Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 9 Iliopsoas Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 10 Superior Thoracic inlet With deep breathing check for asymmetry of end range Find presence of rotation, Drive the bus Check manubrium/sternum Diaphragm Side glide with tension to see if there is a difference hands on abdomen pointing toward Zyphoid Deep breath / look for motion restriction. Breathing: in men and children, is abdominal respiration. But in women the breathing is thoracic respiration. Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 11 Pelvic floor With deep inhalation look for marked tension on the side of dysfunction Coordinating the diaphragm to the pelvic floor Patient supine/Knees flexed Operators hand on pelvic floor Inhale less/exhale more Have the patient take a deep breath/ as they inhale increase the pressure With the next deep breathe /hold the pressure and release with exhalation Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 12 Abdominal Tension Just below the attachment of the inguinal (Poupart’s) ligament along the upper edge of the body and ramus of the pubic bone to a point near the symphysis. Dr Ada – anterior medial and inferior to ASIS bilaterally Contraction of the inguinal ring Orchitis- Epididymitis Deep firm rotatory movement Leucorrhea Most often used for pelvic drainage by Chapman but not Owens Inner condyle of the femur and upwards from 3-6 inches on the posterior aspect. Thigh and groin glands, ovaries are also involved Rotatory movement Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 13 P.T.A.S. (Pelvic-Thyroid-Adrenal-Syndrome) Broad ligament Anterior On the outer aspect of the femur to 2” above knee Posterior Between PSIS and L-5 The Broad Ligament This is a fold of peritoneum with mesothelium on its anterior and posterior surfaces. It extends from the sides of the uterus to the lateral walls and floor of the pelvis. The broad ligament holds the uterus in its normal position. The 2 layers of the broad ligament are continuous with each other at a free edge. This is directed anteriorly and superiorly to surround the uterine tube. Laterally, the broad ligament is prolonged superiorly over the ovarian vessels as the suspensory ligament of the ovary. Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 14 The ovarian ligament lies posterosuperiorly and the round ligament of the uterus lies anteroinferiorly within the broad ligament. The broad ligament contains extraperitoneal tissue (connective tissue and smooth muscle) called parametrium. It gives attachment to the ovary through the mesovarium. The mesosalpinx is a mesentery supporting the uterine tube. The Broad Ligament Venous Drainage of the Uterus The uterine veins enter the broad ligaments with the uterine arteries. They form a uterine venous plexus on each side of the cervix and its tributaries drain into the internal iliac vein. The uterine venous plexus is connected with the superior rectal vein, forming a portal-systemic anastomosis. Lymphatic Drainage of the Uterus The lymph vessels of the uterus follow three main routes: 1. Most lymph vessels from the fundus pass with the ovarian vessels to the aortic lymph nodes, but some lymph vessels pass to the external iliac lymph nodes or run along the round ligament of the uterus to the superficial inguinal lymph nodes. 2. Lymph vessels from the body pass through the broad ligament to the external iliac lymph nodes. 3. Lymph vessels from the cervix pass to the internal iliac and sacral lymph nodes. Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 15 UTERUS TREATMENT OF THE UTERUS SUPINE: For the treatment of the uterus in the supine position, start with the patient resting comfortable on the table. 1. Knees bent to 45º or with a pillow beneath the knees. 2. Practitioner sitting or standing beside the table facing patient’s feet. 3. Starting with the hands on the abdomen supra-pubically, allow the fingers to sink into the tissue just above the symphasis to that the bladder can be felt. 4. Glide the fingers superiorly until they can be directed behind the urinary bladder and into the tissue between the bladder and the uterus. With a rolling motion of the fingers, lift the uterus toward the head and hold the tissue until a relaxation is felt. 5. Repeat the procedure until the tissue in the area felt relaxed and does not resist your hands beyond normal tension. Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 16 ALTERNATE SUPINE TREATMENT 1. For this technique, you will need an adjustable table or some form of pillows or other supporting device. 2. The end of the table is raised to approximately 45º so that an angle is formed with the rest of the table. 3. The patient is placed so that their knees are over the end of the table and their head and back lying on the flat portion of the table. 4. This position will allow the patient’s uterus to “float “ away from the bladder to a slight extent thereby increasing your ability to relax the tissues in the area. 5. The treatment procedures are as outlined above. NOTES: Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 17 Uterus/Prostate Anterior Anterior medial aspect of the obturator foramen Posterior Between PSIS and spine of L-5 Innervation of the Uterus The nerves of the uterus arise from the inferior hypogastric plexus, largely from the anterior and intermediate part known as the uterovaginal plexus. This lies in the broad ligament on each side of the cervix. Parasympathetic fibres are from the pelvic splanchnic nerves (S2-4), and sympathetic fibres are from the above plexus. The nerves to the cervix form a plexus in which are located small paracervical ganglia. One of these are large and is called the uterine cervical ganglion. The autonomic fibres of the uterovaginal plexus are mainly vasomotor. Most the afferent fibres ascend through the inferior hypogastric plexus and enter the spinal cord via T10-12 and L1 spinal nerves Ursa Education Institute for Manual Therapy 1221 S Street, Sacramento, CA 95811 http://www.ursa.education/ Page 18 The Prostate This is the largest accessory gland of the male reproductive system. The prostate (prostate gland) is partly glandular and partly fibromuscular. It is about the size of a walnut and surrounds the prostatic urethra. It is enveloped in a thin, dense fibrous capsule (true capsule), which is enclosed within a loose sheath derived from the pelvic fascia called the prostatic sheath (false capsule). It is continuous inferiorly with the superior fascia of the urogenital diaphragm. Posteriorly, the prostatic sheath is part of the rectovesical septum. This separates the bladder, seminal vesicles, and prostate from the rectum. The prostatic venous plexus lies between the fibrous capsule and the prostatic sheath. The prostate has a base, apex, and 4 surfaces (posterior, anterior, and 2 inferolateral surfaces Arterial Supply of the Prostate The arteries are derived mainly from the inferior vesical and middle rectal arteries.
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