Леон Чейтоу - Искусство пальпации (19).
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Леон Чейтоу - Искусство пальпации (19)
Fig. 4.26 Assessment of levator
scapula shortness involves taking the neck into full flexion and side-bending
rotation, away from the tested side, while maintaining firm shoulder pressure
on the tested side to prevent this from elevating. Discomfort reported at the
upper medial border of the scapula or the upper cervical spine suggests
shortness in this muscle, as does nature of the resistance noted during
performance of the assessment.
Fig. 5.1A Schematic
representation of cranial motion. During flexion, the occiput is thought to
move antero superior, which causes the sphenoid to rise at its synchondrosis. Simultaneous
movement occurs in the frontal, facial and nasal bones as indicated. The
extension phase of this motion involves a return to a neutral position.
Fig. 5.1 В
The flexion phase of cranial motion (inhalation phase) causes the skull, as a
whole, to widen and flatten.
Fig. 5.2 Schematic
representation of the synchrony of motion between the sacrum and the occiput.
Fig. 5.3 Palpation for the
synchrony of motion between the sacrum and the occiput.
Fig. 5.4 Palpating craniosacral
rhythmic motion via the feet.
Fig. 5.5 Smith's palpation
exercise to assess the interface between the physical and the 'energetic'
structures of the arm.
Fig. 5.6 Low back palpation. Hands under
sacrum and low back apply no pressure - contact only. Forearm resting on edge
of table acts as Becker's fulcrum. Increased pressure downwards at the fulcrum
enhances palpator's awareness of tissue status.
Fig. 5.7 Palpation of sacrum
and pelvis. Becker's fulcrum points are the right elbow on table and contacts
on anterior iliac spines with left hand/arm.
Fig. 5.8 Palpation of rib cage.
Becker's fulcrums are on the operator's crossed knees and patient's anterior
superior iliac spine (left).
Fig. 5.9 Palpation of cervical
spine. Becker's fulcrums are forearm contacts on the table.
Special Topic Fig. 6A Traction
on the sacrum (or legs) will ensure a direct pull, via the dura, on the
occiput, while traction from the occiput will ensure direct pull on the sacrum
via the dura.
Special Topic Fig. 6B
Upledger's skill training exercise for assessment of dural restrictions. This
utilises polyethylene cling film (to represent the dura) and a 'restricting'
object (to represent adhesion or restriction in the dural sheath). By standing
at the feet (or by using the sacrum) or the head, restrictions can be assessed
via gentle and highly focused traction.
Fig. 6.1 The slump test
position stretches the entire neural network from pons to feet. Note the
direction of stretch of the dura mater and nerve roots. As the leg comes from
position A to position B, the movement of the tibial nerve in relation to the
tibia and femur is indicated by arrows. No neural movement occurs behind the
knee or at levels C6, T6 or L4 ('tension' points).
Fig. 6.2 Upper limb tension
test (2). Note operator's thigh depresses shoulder as the upper arm is placed
in maximum internal rotation of the shoulder, elbow extension and forearm
pronation as hand is also pronated and extended.
Fig. 7.1 Arrows show directions
of movement, as
'ease' and 'bind' are assessed by the
'listening' hand on
the spinal tissues during functional
evaluation of spinal
segments. Movements are:
Rotation left and right
Side-bending left and right
Translation to each side
Translation forward and back
Translation up and down (traction and
Special Topic Fig. 8A Parallel
displacement of a bone involving translatoric gliding (after Kaltenborn). One
bone is moved parallel to the treatment plane until the tissues surrounding the
joint are tightened (grade II) or the tissues crossing the joint are stretched
Special Topic Fig. 8B The
direction of gliding in a joint depends upon whether the surface on which
movement is occurring is concave or convex. If concave gliding occurs it is in
the same direction as the bone movement (left) while convex gliding occurs in
the opposite direction to the movement of the bone (right).
Special Topic Fig. 8C This
figure illustrates the 'convex-concave rule' in which a mobile bone moves on a
fixed structure. In the left hand example the joint surface is concave (as
would be the case in the tibia, ulna or a phalangeal joint). If the mobile bone
was restricted in an upward direction (striped arrow) the direction in which a
gliding mobilisation would be made during treatment would also be in an upward
direction (as indicated by the two large arrows).
In the right hand example there is a mobile
bone associated with a convex surface (as in the head of the humerus, the femur
or the talus). If this were restricted in an upward direction (striped arrow)
the direction in which a gliding mobilisation would be made in treatment would
be in a downward direction (large arrows).
Special Topic Fig. 8D Schematic
representation of a range of motion indicating normal restriction barriers
(anatomical and physiological) as well as a pathological barrier and a position
of maximal ease. The quality of the 'end-feel' of each of these positions will
Fig. 8.1 Standing flexion test
for iliosacral dysfunction. The restricted side is the one on which the thumb
moves during flexion.
F'iff. 9.3 Operate/ adopts
apos/fro/7 offering a birds-eye view of ASIS prominences on which
rest the thumbs.
Fig. 8.4A The ASISs are level
and there is no rotational dysfunction involving the iliosacral joints.
Fig. 8.4B The right ASIS is
higher than the left ASIS. If a thumb 'travelled' on the right side during the
standing flexion test this would represent a posterior right iliosacral
rotation dysfunction. If a thumb 'travelled' on the left side during the test
this would represent an anterior left iliosacral rotation dysfunction.
Fig. 8.4C The ASISs are
equidistant from the umbilicus and the midline, and there is no iliosacral
Fig. 8.4D The ASIS on the right
is closer to the umbilicus/midline which indicates that either there is a right
side iliosacral inflare (if the right thumb moved during the standing flexion
test), or there is a left side iliosacral outflare (if the left thumb moved
during the standing flexion test).
Fig. 8.5 Palpation of
retrofiexion (extension) of the thoracic spine.
Fig. 8.6 Palpation of gapping
of spinous processes during flexion.
Fig. 8.7 The patient is
side-bent (towards the right in this instance) over the palpating thumb which
assesses the nature of the 'end-feel'. A sense of unusual 'bind' might
indicate a restriction.
Fig. 8.8 Assessment ('shrug
test') for restriction in clavicular mobility.
Fig. 8.9 Assessment ('prayer
test') for restricted horizontal flexion of the sternoclavicular joint.
Special Topic Fig. 9A Distal
phalanx position held as vertical to the palpated surface as possible, as
described by Abrams, for percussion ('orthopercussion') assessment.
Special Topic Fig. 9B A finger
which is to be used as a pleximeter should have the distal phalanx slightly
raised (upper finger) and not resting along its length on the palpated surface
(lower finger) [after Abrams]. The arrow represents the ideal point which
should be struck for optimal percussion efficiency.
Fig. 9.1 Palpation of the liver
(after Barral and Mercier) in which frontal, saggital and transverse planes of
motion are sequentially assessed.
Special Topic Fig. 10A Location
of pulses (right hand only illustrated) for assessment in Traditional Chinese
Special Topic Fig. 10B Taking
the pulse in TCM. One finger at a time would apply suitable degrees of pressure
to make an assessment, superficially or at depth.
Fig. 10.1 Bring hands as close
together as you can without the palms touching each other. Then bring hands
apart about 5 cm. Return hands siowiy
to original position. Repeat, and on each
repetition separate the palms by an
additional 5 cm, until they are finally 20 cm apart.
Fig. 10.2 When the hands are about 20 cm apart, slowly bring them together. Every 5 cm, test the field between your hands for a sense of
bounciness or elasticity.
Fig. 10.3 Map of 'energy (or
chakra) fields' of spinal region.
Fig. 11.1 Illustration of
Ford's cross restriction areas.
Fig. 11.2 The hand positions
which would be used in Ford's treatment of horizontal 'cross-restrictions' -
(A) pelvic, (B) diaphragmatic, (C) thoracic outlet and (D) base of skull. By
'projecting' his sense of touch he palpates for 'depth, direction and duration'
in order to treat these dysfunctions.