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13-09-23

1
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*#")*$"&* !+#"-*"!
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&"#0"/
ulane !acobs 2013 ulane !acobs 2013
CCCll1AL nL8vLS
SuL8llClAL CL8vlCAL LLxuS
uC8SAL Cu1AnLCuS 8AMl
1")! )&! &"-2
CCClCl1AL nL8vLS
C2 nerve rooLs
lnulCA1lCnS:
Peadache, Lenderness, loss of 8CM

MonlLor
on one
slde
18LA1MLn1
1. llnd Lender spoL.

2. osluon upper neck ln sllghL exLenslon, slde
bend Loward and roLauon away.

3. lace non-monlLorlng hand on skln over
forehead and LwlsL lL, slowly and carefully unul
spoL soens/doesn'L feel Lender.
osluon head,
Lorque skln over
forehead
A1lLn1 SulnL
ulane !acobs 2013
CCClCl1AL nL8vLS
C2 nerve rooLs
lnulCA1lCnS: Peadache, Lenderness, loss of 8CM
18LA1MLn1 vA8lA1lCn:
8alloon Lechnlque
on oLher slde
MonlLor
on one
slde
1. llnd Lender spoL.
2. use oLher hand Lo LreaL, pulllng skln lnLo a bunch" over Lhe oLher occlplLal
rldge. Co !"#$"%.
1ender spoL wlll usually soen and noL be Lender anymore.

3. Pold for aL leasL 2 mlnuLes.

4. LeL go slowly
A1lLn1 SulnL
ulane !acobs 2013
13-09-23
2
SuL8llClAL CL8vlCAL LLxuS
C3 nerve rooLs
lnulCA1lCn: loss of roLauon 8CM, headache
18LA1MLn1
1. 1urn head sllghLly Lo one slde
2. lace medlal borders of hands on skln above and below
SCM landmark

3. WalL for your skln Lo auach" Lo pauenL's skln
4. Slowly and carefully, sllde Lhe skln ln Lhe dlrecuons shown.

3. Pold for abouL 2 mlnuLes

6. LeL go slowly
An1L8lC8 18lAnCLL Cl nLCk
-()0+-("
/
-
$

/*"#&)(
&%*-1
Move skln wlLhln anLerlor
Lrlangle Loward noLch
A1lLn1 SulnL
ulane !acobs 2013
uC8SAL Cu1AnLCuS nL8vLS
uorsal raml of C3-11 nerve rooLs
lnulCA1lCn: paln, Lenderness, suness along splne
18LA1MLn1
1. lace ngers along splnous processes landmarks, walL for skln Lo suck"
2. Slowly pull skln longlLudlnally ln dlrecuons shown.
3. Cr, ll skln up Loward celllng.

4. Cr, LwlsL lL.

3. Pold for 2 mlnuLes.
6. LeL go slowly
A1lLn1 8CnL
ulane !acobs 2013
uC8SAL Cu1AnLCuS nL8vLS
uorsal raml of C3-11 nerve rooLs
lnulCA1lCn: paln, Lenderness, suness along splne
18LA1MLn1
1. lace boLh hands genLly upon Lhe back of neck ln wlde grasp. WalL for hands
Lo suck Lo skln.
2. Slowly, genLly pull skln up Loward celllng.
3. Pold for aL leasL 2 mlnuLes, longer as requlred.

4. CenLly lower Lhe skln down, and remove hands from neck.

3. Ask pauenL Lo sLand up and reassess neck movemenL and comforL level.
A1lLn1 8CnL
ulane !acobs 2013 ulane !acobs 2013
uC8SAL Cu1AnLCuS nL8vLS
3)-2
13-09-23
3
uC8SAL Cu1AnLCuS nL8vLS
uorsal raml of C3-S3 nerve rooLs
Cu1AnLCuS nL8vLS Cl
vLn18AL 8CC1 C8lCln
l8LL AnAS1CMCSlS
CvL8 1PL 8ACk
ulane !acobs 2013
uC8SAL Cu1AnLCuS nL8vLS
uorsal raml of nerve rooLs
lnulCA1lCn: LCCALlZLu 8ACk Aln Cl An? uu8A1lCn
18LA1MLn1
1. LocaLe sore spoL - monlLor lL wlLh one hand
2. uraw skln away from lL, uslng oLher hand, across mldllne
3. WalL for soenlng, Lhen hold for a few mlnuLes. 1wlsL Lhe skln sllghLly clockwlse or
counLerclockwlse lf LhaL lmproves Lhe soenlng.
4. LeL go slowly

3. Ask pauenL Lo sLand, move abouL, perform range of movemenL Lesung, Lo conrm/
consolldaLe lmprovemenL
A1lLn1 8CnL
ulane !acobs 2013
uC8SAL Cu1AnLCuS nL8vLS
uorsal raml of lumbar nerve rooLs
18LA1MLn1
1. LocaLe sore spoL - monlLor lL wlLh one hand
2. LlevaLe arm on same slde. uraw skln away from lL, uslng oLher hand
3. WalL for soenlng, Lhen hold for a few mlnuLes. WlLh monlLorlng hand, pull Lhe skln
laLerally lf LhaL lmproves Lhe soenlng.
4. LeL go slowly

3. Ask pauenL Lo sLand, move abouL, perform range of movemenL Lesung, Lo conrm/
consolldaLe lmprovemenL
A1lLn1 SulnL
lnulCA1lCn: LCCALlZLu 8ACk Aln Cl An? uu8A1lCn
ulane !acobs 2013
uC8SAL Cu1AnLCuS nL8vLS
uorsal raml of lumbar nerve rooLs
lnulCA1lCn: LCCALlZLu 8ACk Aln Cl An? uu8A1lCn
18LA1MLn1
1. LocaLe sore spoL - monlLor lL wlLh one hand

2. ull same-slde leg across mldllne wlLh oLher hand (pull from ankle, wlLh leg ln sllghL lnLernal roLauon

3. WalL for soenlng, Lhen hold for a few mlnuLes. WlLh monlLorlng hand, pull Lhe skln laLerally lf LhaL
lmproves Lhe soenlng.

4. LeL go slowly

3. Ask pauenL Lo sLand, move abouL, perform range of movemenL Lesung, Lo conrm/consolldaLe
lmprovemenL
A1lLn1 8CnL
ulane !acobs 2013
13-09-23
4
uC8SAL Cu1AnLCuS nL8vLS
uorsal raml of lumbar nerve rooLs
lnulCA1lCn: LCCALlZLu 8ACk Aln Cl An? uu8A1lCn
18LA1MLn1 vA8lA1lCn: lnul8LC1
1. Sore spoL ls locaLed, buL ls noL monlLored. 8evel block may be added for lncreased leverage

2. ull same-slde leg across mldllne wlLh oLher hand (pull from ankle, wlLh leg ln sllghL lnLernal roLauon)

3. ress ln agalnsL opposlLe hlp, slowly. Pold for a few mlnuLes.

4. LeL go slowly

3. Ask pauenL Lo sLand, move abouL, perform range of movemenL Lesung, Lo conrm/consolldaLe
lmprovemenL
A1lLn1 8CnL
ulane !acobs 2013
uC8SAL Cu1AnLCuS nL8vLS
uorsal raml of Lhoraclc nerve rooLs
18LA1MLn1
1. LocaLe sore spoL - monlLor lL wlLh one hand
2. lace arm on same slde across body and draw skln away from lL, uslng oLher hand
3. WalL for soenlng, Lhen hold for a few mlnuLes. WlLh monlLorlng hand, pull Lhe skln
laLerally lf LhaL lmproves Lhe soenlng.
4. LeL go slowly

3. Ask pauenL Lo sLand, move abouL, perform range of movemenL Lesung, Lo conrm/
consolldaLe lmprovemenL
A1lLn1 SulnL
lnulCA1lCn: LCCALlZLu 8ACk Aln Cl An? uu8A1lCn
ulane !acobs 2013
uC8SAL Cu1AnLCuS nL8vLS
uorsal raml of Lhoraclc nerve
rooLs
lnulCA1lCn: LCCALlZLu 8ACk Aln Cl An? uu8A1lCn
18LA1MLn1
1. LocaLe sore spoL - monlLor lL wlLh one hand
2. lace arm on same slde across body angllng down Loward opposlLe hlp. uraw skln away
from sore spoL, uslng oLher hand
3. WalL for soenlng, Lhen hold for a few mlnuLes. WlLh monlLorlng hand, pull Lhe skln
laLerally lf LhaL lmproves Lhe soenlng.

4. LeL go slowly
3. Ask pauenL Lo sLand, move abouL, perform range of movemenL Lesung, Lo conrm/
consolldaLe lmprovemenL
A1lLn1 SulnL
ulane !acobs 2013
uC8SAL Cu1AnLCuS nL8vLS
uorsal raml of Lhoraclc nerve
rooLs
lnulCA1lCn: ln1L8SCAuLA8 8ACk Aln
18LA1MLn1
1. auenL ls prone. LocaLe sore spoL - monlLor lL wlLh one hand
2. lace arm on same slde lnLo full elevauon. 1ake Lhe skln layer of forearm lnLo sllghL
lnLernal roLauon.
3. WalL for soenlng, Lhen hold for a few mlnuLes.
4. LeL go slowly

3. Ask pauenL Lo sLand, move abouL, perform range of movemenL Lesung, Lo conrm/
consolldaLe lmprovemenL
A1lLn1
8CnL
CAu1lCn: CLLA8 SPCuLuL8 ll8S1
13-09-23
3
ulane !acobs 2013
An1L8lC8 Cu1AnLCuS nL8vLS
4#%&*
An1L8lC8 Cu1AnLCuS nL8vLS Cl 18unk
lnulCA1lCn: oor rlb excurslon wlLh deep breaLh, Lhoraclc suness
18LA1MLn1
1. Sllde one hand behlnd back, [usL o splnous process - locaLe a Lender spoL (medlal
branch of dorsal cuLaneous nerve)
2. CLher hand, locaLe Lender spoL ln fronL, beLween rlbs, [usL o sLernum, aL correspondlng
level (medlal branch of anLerlor cuLaneous nerve)
3. ress wlLh slngle ngerup from above and below, carefully. 1hese wlll be Lender.
4. Pold for abouL 30 seconds. 1enderness wlll rapldly decrease.
3. Move Lo nexL level. 8epeaL.
6. When one slde of Lhe rlbcage ls compleLed, ask pauenL Lo sLand and check deep breaLh.
auenL wlll feel lncreased sense of space.
7. 8epeaL oLher slde.
ulane !acobs 2013
ulane !acobs 2013
LA1L8AL Cu1AnLCuS nL8vLS Cl 18unk
/+!"
LA1L8AL Cu1AnLCuS nL8vLS
13-112
lnulCA1lCn: Shoulder resLrlcuon or
perslsung paln
ASSLSSMLn1, 8LASSLSSMLn1
Ll up Lhe arm, slowly and carefully, Lake lL
up and back lnLo elevauon unul sllghL
reslsLance ls felL: 1hls represenLs Lhe llmlL
of range.
&3: uC nC1 LxCLLu 1PlS ll8S1 SMALL
8A88lL8 1C MCvLMLn1

A1lLn1
SluLL?lnC
ulane !acobs 2013
13-09-23
6
LA1L8AL Cu1AnLCuS nL8vLS
13-112
lnulCA1lCn: Shoulder resLrlcuon or
perslsung paln
ASSLSSMLn1
Ll up Lhe arm,
slowly and carefully,
Lake lL up and back
lnLo elevauon unul
sllghL reslsLance ls
felL: 1hls represenLs
Lhe llmlL of range

18LA1MLn1
1. Ask pauenL Lo resL hand on Lop of forehead,
and keep elbow up ln Lhe alr
2. lace hands genLly on slde of Lrunk. WalL unul
hands suck Lo skln.

3. CenLly lengLhen Lhe skln beLween Lwo hands
unul sllghL reslsLance ls percelved. 1hen walL
for a few mlnuLes.

4. CenLly allow hands and skln under hands Lo
come back Lo neuLral. 8emove hands slowly.
3. 8eassess. Ask pauenL Lo sLand up and move
Lhelr own arm around, perform range of
mouon.
A1lLn1
SluLL?lnC
ulane !acobs 2013 ulane !acobs 2013
Su8ACLAvlCuLA8 nL8vLS
)&*"#+%# /1%'(!"#
ln1L8CCS1C88ACPlAL nL8vL
LA1L8AL Cu1AnLCuS nL8vL Cl A8M
Su8ACLAvlCuLA8 nL8vLS
C3 nerve rooLs
lnulCA1lCn: Shoulder paln
18LA1MLn1
1. lace medlal borders of hands on skln above and below
clavlcle landmark.

2. WalL for your skln Lo auach" Lo pauenL's skln
3. Slowly and carefully, sllde Lhe skln ln Lhe dlrecuons shown.
4. Pold for abouL 2 mlnuLes

3. LeL go slowly
An1L8lC8 18lAnCLL Cl nLCk
-()0+-("
/
-
$

/*"#&)(
&%*-1
Move skln wlLhln anLerlor
Lrlangle Loward noLch
A1lLn1 SulnL
ulane !acobs 2013
Su8ACLAvlCuLA8 nL8vLS
C3 nerve rooLs,
lnLercosLobrachlal nerve
lnulCA1lCn: Shoulder paln
18LA1MLn1
1. Carefully supporL pauenL's arm beLween your slde and elbow, abouL 43 degrees
exLenslon aL shoulder, abouL 60 degrees abducuon
2. lace boLh hands genLly on fronL of shoulder glrdle. lace boLh Lhumbs on Lhe skln aL
Lhe edge of Lhe large pec Lendon. WalL for hands Lo suck Lo skln.

3. Slowly and genLly draw Lhe skln down and around Lhe Lendon. Pold for Lwo mlnuLes
4. Carefully leL go.

3. Ask pauenL Lo sLand up, reassess range of movemenL and how lL feels.
A1lLn1
SluLL?lnC
ulane !acobs 2013
13-09-23
7
Su8ACLAvlCuLA8 nL8vLS
C3 nerve rooLs, laLeral
cuLaneous nerve of arm
18LA1MLn1
1. Carefully supporL pauenL's arm agalnsL your body, abouL 30 degrees behlnd Lransverse
mldllne, abouL 43 degrees abducuon.
2. LocaLe sore spoL. lace boLh hands genLly on fronL of shoulder above and below lL. WalL
for hands Lo suck Lo skln.

3. Slowly and genLly draw Lhe skln boLh dlrecuons away from lL. Pold for Lwo mlnuLes
4. Carefully leL go.

3. Ask pauenL Lo sLand up, reassess range of movemenL and how lL feels.
A1lLn1
SluLL?lnC
lnulCA1lCn: AnLerlor shoulder paln
ulane !acobs 2013
Su8ACLAvlCuLA8 nL8vLS
C3 nerve rooLs, laLeral
cuLaneous nerve of arm
18LA1MLn1
1. auenL's arm resLs ln abouL 43 degrees exLenslon, abouL 30 degrees abducuon, on a
plllow on Lop of LheraplsL's lap.
2. LocaLe sore spoL on fronL of shoulder, monlLor only. lace oLher hand behlnd shoulder.
3. ress bouom hand upward slowly and rmly agalnsL head of humerus, lllng lL up
Loward celllng sllghLly.
4. 1ender spoL wlll soen and dlsappear. Pold for abouL 2 mlnuLes.

3. Slowly remove hands. Ask pauenL Lo slL up and explore shoulder movemenL.
A1lLn1
SulnL
lnulCA1lCn: AnLerlor shoulder paln
ulane !acobs 2013
ulane !acobs 2013
+&4"#+%# /1%'(!"#
ln1L8CCS1C88ACPlAL nL8vL
AxlLLA8? nL8vL
ln1L8CCS1C88ACPlAL nL8vL
12
lnulCA1lCn: Shoulder resLrlcuon, or
perslsung paln down back of arm or
across chesL
ASSLSSMLn1
Ll up Lhe arm,
slowly and carefully,
Lake lL up and back
lnLo elevauon unul
sllghL reslsLance ls
felL: 1hls represenLs
Lhe llmlL of range

18LA1MLn1
1. lace one hand genLly over laLeral border of scapula.
lace oLher hand over enure elbow

2. CenLly buL lnexorably press Lo move Lhe scapula
medlally. Co slow. WalL for ease Lo presenL lLself.
3. CaLher Lhe skln over Lhe elbow up lnLo Lhe oLher hand.
Pold for a few mlnuLes.

2. CenLly allow hands and skln under hands Lo come back
Lo neuLral. 8emove hands slowly.

3. 8eassess. Ask pauenL Lo sLand up and move Lhelr own
arm around, perform range of mouon.
A1lLn1
SluLL?lnC
ulane !acobs 2013
13-09-23
8
AxlLLA8? nL8vL
C3,6
CuAu8lLA1L8AL
SACL
1L8
LS M
A
!C
8

1L8LS M
ln
C
8
CS1L8lC8 An1L8lC8
18LA1MLn1
1. 8rlng arm genLly up lnLo abouL 90 degrees exlon aL shoulder and elbow, and abouL 43 degrees
lnLernal roLauon aL shoulder as shown

2. use one hand Lo locaLe sore spoL aL posLerlor axllla (monlLor only): supporL forearm wlLh oLher
hand

3. use Lhe supporung hand Lo Lorque Lhe skln over Lhe forearm lnLo more lnLernal roLauon, plus ll
Lhe enure arm up sllghLly Loward celllng, unloadlng aL Lhe shoulder

4. Sore spoL wlll soen and Lenderness wlll dlsappear. Pold arm ln Lhls posluon for aL leasL 2
mlnuLes.

3. Slowly brlng lL down. 8eassess sore spoL. lL should be gone. Lower arm Lo slde.

6. Ask pauenL Lo sLand up and move Lhelr own arm around, perform range of mouon.
lnulCA1lCn: aln upper arm, sore spoL behlnd axllla
A1lLn1
SulnL
ulane !acobs 2013 ulane !acobs 2013
5%/*"#+%# /1%'(!"#
AxlLLA8? nL8vL
CS1L8lC8 Su8ACLAvlCuLA8 nL8vL
AxlLLA8? nL8vL
C3,6
CuAu8lLA1L8AL
SACL
1L8
LS M
A
!C
8

1L8LS M
ln
C
8
CS1L8lC8 An1L8lC8
lnulCA1lCn: aln upper arm, sore spoL behlnd axllla
18LA1MLn1 vA8lA1lCn
1. rone lylng, arm o edge of bed, abouL 43 degrees exlon/abducuon/
elevauon from hanglng, resung on knee.

2. use one hand Lo locaLe sore spoL aL posLerlor axllla, do noL press:
supporL forearm wlLh knee and oLher hand.

3. uslng dlsLal hand, genLly grasp skln over medlal forearm, allow Lo suck,
and Lorque slowly lnLo exLernal roLauon.

4. Sore spoL wlll soen and Lenderness wlll dlsappear. Pold arm ln Lhls
posluon for aL leasL 2 mlnuLes.

3. Slowly brlng lL down. 8eassess sore spoL. lL should be gone. Lower arm
Lo slde.

6. Ask pauenL Lo sLand up and move Lhelr own arm around, perform
range of mouon.
A1lLn1
8CnL
ulane !acobs 2013
CS1L8lC8
Su8ACLAvlCuLA8
nL8vL
C3
lnulCA1lCn: alnful knoLs" Lop of shoulder
18LA1MLn1
1. auenL ls prone, arm resung on knee. LocaLe spoL.

2. CenLly grasp skln on back of arm. Aer hand ls sLuck
Lo skln, slowly and genLly drag Lhe skln around lnLo
lnLernal roLauon.
3. Sore spoL wlll soen and Lenderness wlll go away. Pold for 2 mlnuLes.
4. LeL go slowly. Sore spoL wlll sull be gone Lo palpauon.
3. Ask pauenL Lo geL up and move, perform range of mouon.
A1lLn1
8CnL
ulane !acobs 2013
13-09-23
9
CS1L8lC8
Su8ACLAvlCuLA8
nL8vL
C3
lnulCA1lCn: alnful knoLs" Lop of shoulder
18LA1MLn1
1. LocaLe Lender spoL.

2. 8rlng arm lnLo abouL 43 degrees of exLenslon and abducuon, elbow sLralghL. 8esL lL agalnsL
knee.
3. Crasp skln on forearm genLly. Carefully Lorque lL lnLo sllghL exLernal roLauon. 1enderness
wlll dlsappear. Pold for 2 mlnuLes.
4. Slowly leL go. Pave pauenL sLand up and reassess range of movemenL.
A1lLn1
8CnL
ulane !acobs 2013
CS1L8lC8
Su8ACLAvlCuLA8
nL8vL
C3
lnulCA1lCn: aln on full elevauon of arm
4. CenLly pull Lhe arm longlLudlnally, whlle lnserung Lhe eraser lnLo Lhe noLch. Pave Lhe pauenL Lake a few
slow, deep breaLhs. SLay lnslde pauenL's comforL zone. Pold for aL leasL a half mlnuLe.

3. LeL go of pauenL's nger. 8emove Lhe eraser whlle presslng down Lhe skln around Lhe noLch. Pave Lhe
pauenL sLand and recheck Lhelr range of mouon.
18LA1MLn1
1. CenLly grasp pauenL's hand by Lhe Lhlrd nger, Lhe axls of Lhe arm.

2. uL Lhe eraser end of an unsharpened pencll agalnsL Lhe
acromloclavlcular noLch aL an angle parallel Lo Lhe arm.

A1lLn1
8CnL
C8
SulnL
ulane !acobs 2013
ulane !acobs 2013
)#$
LA1L8AL Cu1AnLCuS nL8vLS
MLulAL Cu1AnLCuS nL8vLS
CS1L8lC8 Cu1AnLCuS nL8vLS
An1L8lC8 Cu1AnLCuS nL8vLS
Cu1AnLCuS nL8vLS Cl A8M
ul8LC1lCnAL 8LlL8LnCLS
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!3)(3.6
13-09-23
10
CS1L8lC8 Cu1AnLCuS nL8vLS Cl A8M
lnulCA1lCn: aln behlnd arm on movemenL, on welghL-bearlng Lhrough arm
18LA1MLn1
1. Arm hangs freely ln 90 degrees of exlon
2. llnd Lender polnL behlnd arm. lace oLher hand genLly on fronL of arm, carefully pull
skln forward ln a genLle plnch grasp
3. 1ender spoL wlll soen, Lenderness wlll dlsappear
4. Pold for 2 mlnuLes. Slowly leL go.
3. Ask pauenL Lo slL up and move arm
nC1L: 1hls same
LreaLmenL sLraLegy may
be used for polnL
Lenderness anywhere ln
upper or lower arm.
A1lLn1
8CnL
An1L8lC8 Cu1AnLCuS nL8vLS Cl A8M
lnulCA1lCn: olnL Lenderness medlal slde of elbow
18LA1MLn1
1. Arm hangs freely ln 90 degrees of exlon
2. llnd polnL Lenderness medlal slde of elbow. use oLher hand Lo perform a genLle grasp
Lechnlque, pull skln away from sore slde around Lo oLher slde.
3. 1enderness wlll decrease and polnL wlll soen. Pold for 2 mlnuLes.
4. LeL go slowly, ask pauenL Lo slL up and move elbow, reassess paln on movemenL.
nC1L: Same Lechnlque can be used for paln anywhere around elbow
A1lLn1
8CnL
Cu1AnLCuS nL8vLS Cl lC8LA8M
lnulCA1lCn: vague, lll-dened suness, ache or dlscomforL anywhere ln forearm
18LA1MLn1
1. auenL and arm can be ln any posluon, well supporLed

2. Crasp skln of forearm genLly wlLh boLh hands. WalL for hands Lo suck Lo skln.

3. CenLly and slowly LwlsL skln layer opposlLe dlrecuons ln large S-shape. Pold for aL leasL 2
mlnuLes. 1heraplsL wlll feel a greaL deal of mouon lnLrlnslc Lo forearm, someumes
movemenL of arm lLself. Slowly leL go.
4. Ask pauenL Lo move forearm, hand, wrlsL, and reporL.
A1lLn1
An? CSl1lCn
ulane !acobs 2013
1)&!/
ALMA8 Cu1AnLCuS nL8vLS
uC8SAL Cu1AnLCuS nL8vLS
ulCl1AL Cu1AnLCuS nL8vLS
13-09-23
11
Cu1AnLCuS nL8vLS Cl PAnuS
ulane !acobs 2013
8lCP1 lnuLx llnCL8
ul8LC1lCnAL 8LlL8LnCLS
4&/+#$7
36,28 !#+(
+#!3*/
0#$"9 !#+(
0)&1#2*/
4*$$#$7
ulane !acobs 2013
MLulAn nL8vL
18LA1MLn1
1. auenL may be ln any posluon. SupporL arm fully. LocaLe a Lender polnL anLerlor hand and
monlLor.
2. WlLh oLher hand slowly and genLly grasp skln on back of hand, and by sLages, pull lL ughL,
around enure hand. Pold for 2 mlnuLes. LeL go slowly

3. 8emove your hands, ask pauenL Lo move hand, reassess range and comforL level
A1lLn1 8CnL
A8M PAnClnC
lnulCA1lCn: Carpal Lunnel syndrome paresLhesla, paln
ulane !acobs 2013
PAnu nL8vLS
18LA1MLn1
1. auenL may be ln any posluon. SupporL arm fully.

2. Slowly and genLly grasp enure hand. 8y sLages, pull lL open. Pold for 2 mlnuLes. LeL go
slowly.
3. 8emove your hands, ask pauenL Lo move hand, reassess range and comforL level
lnulCA1lCn: Pand paln, suness
lannlng of hand
ulane !acobs 2013
13-09-23
12
PAnu nL8vLS
18LA1MLn1
1. auenL may be ln any posluon. SupporL arm fully.

2. Slowly and genLly grasp enure hand. 8y sLages, move skln genLly ln dlrecuon shown. Pold
for 2 mlnuLes. LeL go slowly.
3. 8emove your hands, ask pauenL Lo move hand, reassess range and comforL level

4. lf Lhe rsL dlrecuon doesn'L resulL ln compleLely decreased dlscomforL, Lry anoLher.

lnulCA1lCn: Pand paln, suness
ulane !acobs 2013 ulane !acobs 2013
5%/*"#+%# 5"(0+/
SuL8lC8 CLunLAL nL8vLS
MLulAL CLunLAL nL8vLS
lnlL8lC8 CLunLAL nL8vLS
SuL8lC8 CLunLAL nL8vLS
L1-3
MLulAL CLunLAL nL8vLS
S1-3
lnulCA1lCn: Aln ln 8u11CCk, Aln Cn SL8, 8LuuCLu Pl u8C
18LA1MLn1
1. Leg o slde of bed, abouL 43 degrees exlon/abducuon aL hlp, 43 degrees knee exlon, resung on
seaLed LheraplsL's knee.
2. llnd Lender polnL wlLh one hand, wlLh oLher hand, hook laLeral slde of fooL agalnsL knee, lnLo lnverslon.
3. ull heel slowly Loward you. 1ender spoL wlll soen and dlsappear.
4. Pold 2 mlnuLes, Lhen slowly leL go. Ask pauenL Lo sLand, check for lmprovemenL ln movemenL
18LA1MLn1 vA8lA1lCn: lace medlal border of fooL upon knee. ush heel away, lnLo lncreased abducuon
everslon.
A1lLn1 8CnL
SuL8lC8 CLunLAL nL8vLS
L1-3
lnulCA1lCn: aln and sore spoLs around lllac cresL
18LA1MLn1
nC1L: 1here may be several Lender spoLs wlLhln a small area. 8e pauenL
1. LocaLe Lender polnL anywhere ln low back below posLerlor rlm of pelvls, monlLor wlLh
one hand
2. lace heel oLher hand dlrecLly over posLerlor slde of LrochanLer. WalL for hand Lo suck Lo
skln
3. Cradually press skln over LrochanLer dlrecLly downward. CuLaneous nerves wlll be pulled
Lhrough Lhelr Lunnels over pelvlc rlm. 1ender spoL wlll soen and dlsappear. Pold 2
mlnuLes
4. Slowly leL go. Ask pauenL Lo sLand and reassess movemenL, dlscomforL, range.
A1lLn1 8CnL
13-09-23
13
ulane !acobs 2013
()*"#)( 5"(0+/
CLunLAL nL8vLS
18CCPAn1L8lC 8L1L
SuL8lC8 CLunLAL nL8vLS
L1-3
lnulCA1lCn: aln and sore spoLs around LrochanLer
18LA1MLn1
1. LocaLe sore spoL

2. Apply oLher hand Lo ouLslde of Lhlgh. Allow hand Lo suck Lo skln. Sllde Lhe skln dlsLally
along Lhlgh a shorL dlsLance. 8eslsLance wlll be meL. Pold Lhere and noLe soenlng,
decrease ln Lenderness wlLh monlLorlng hand.

3. WalL for 2 mlnuLes. 1hen slowly leL go. 1he spoL should now feel normal.
4. Ask pauenL Lo sLand up and reassess range of movemenL.
nC1L: 1here may be several Lender spoLs wlLhln a small area. 8e pauenL
A1lLn1 SluLL?lnC
SuL8lC8 CLunLAL nL8vLS
L1-3
lnulCA1lCn: aln and sore spoLs around LrochanLer
18LA1MLn1 vA8lA1lCn
1. LocaLe sore spoL over LrochanLer

2. Apply oLher hand Lo ouLslde of Lhlgh a shorL dlsLance away, allow lL Lo suck Lo skln. use a
wlde grlp, skln layer only, and gaLher skln LogeLher. WlLh oLher hand draw skln away
sllghLly

3. WalL for 2 mlnuLes. 1hen slowly leL go. 1he spoL should now feel normal.
4. Ask pauenL Lo sLand up and reassess range of movemenL.
nC1L: 1here may be several Lender spoLs wlLhln a small area. 8e pauenL
A1lLn1 SluLL?lnC
ulane !acobs 2013
SuL8lC8 CLunLAL nL8vLS
L1-3
lnulCA1lCn: aln and sore spoLs around LrochanLer
18LA1MLn1
1. LocaLe sore spoL. Leavlng knees Louchlng, genLly ll fooL. Allow Lhlgh Lo drop lnLo lnLernal
roLauon
2. 8race heel agalnsL your body. 1orque enure forefooL lnLo elLher lnverslon or everslon,
whlchever way works beuer for rellevlng Lhe Lenderness and lnduclng soenlng over
LrochanLer.
3. Pold for 2 mlnuLes. LeL go slowly.
4. Ask pauenL Lo sLand, reassess movemenL, dlscomforL, range.
A1lLn1 SluLL?lnC
ulane !acobs 2013
13-09-23
14
lLlCP?CCAS18lC nL8vL
L1
lnulCA1lCn: aln around slde of pelvls, Lender spoL on laLeral pelvlc rlm
18LA1MLn1
1. 8esL pauenL's leg on Lop of your knee. auenL's legs are aL abouL 90 degrees of
exlon aL hlp and knee

2. LocaLe sore spoL, monlLor. WlLh oLher hand, pull pauenLs feeL lnLo slde bend away
from Lender slde. auenL's body, and leg on aecLed slde wlll go lnLo sllghL exLernal
roLauon. AecLed slde fooL may be crossed beneaLh oLher fooL.

3. ull on Lhe skln over bula ln caudal dlrecuon, sllghLly.

4. SpoL wlll suddenly soen and be less Lender. Pold for 2 mlnuLes.

3. Slowly leL go. 8esLore pauenL's body Lo a neuLral posluon. Ask pauenL Lo sLand and
move Lhrough range of movemenL.
A1lLn1 SulnL
ulane !acobs 2013 ulane !acobs 2013
)&*"#+%# 5"(0+/
C1PL8 lnCulnAL Cu1AnLCuS nL8vLS
LA1L8AL Cu1AnLCuS nL8vL Cl 1PlCP
lLlClnCulnAL Cu1AnLCuS nL8vL
LA1L8AL Cu1AnLCuS nL8vL Cl 1PlCP
lnulCA1lCn: aln or paresLhesla ouLslde of Lhlgh,
someumes resLrlcLed hlp movemenL
18LA1MLn1
1. auenL ls suplne wlLh legs relaxed over a bolsLer, hlps abouL 43 degrees of exlon.
2. LocaLe place where LCn1 emerges, medlal and lnferlor Lo ASlS. Someumes lL wlll feel
Lender. usually lL wlll feel hard. MonlLor wlLh one hand.
3. lace oLher hand on skln of Lhlgh, [usL dlsLal. WalL for hand Lo suck Lo skln. CenLly pull
skln layer dlsLal.
4. Lmergence place wlll soen. WalL for 2 mlnuLes.
3. LeL go slowly.
6. Ask pauenL Lo sLand up and recheck range of mouon
A1lLn1 SulnL
ulane !acobs 2013
lnulCA1lCn: aln or paresLhesla ouLslde of Lhlgh,
someumes resLrlcLed hlp movemenL
C1PL8 lnCulnAL Cu1AnLCuS nL8vLS
18LA1MLn1
1. auenL ls suplne wlLh legs relaxed over a bolsLer, hlps abouL 43 degrees of exlon.
2. LocaLe Lender spoLs along lngulnal llgamenL. 1hey wlll be abouL an lnch aparL.
3. 1reaL as for LCn1
A1lLn1 SulnL
ulane !acobs 2013
13-09-23
13
lnulCA1lCn: aln or paresLhesla ouLslde of Lhlgh,
someumes resLrlcLed hlp movemenL
lLlClnCulnAL nL8vL
18LA1MLn1
1. auenL ls suplne, legs relaxed over a bolsLer. 8rlng leg lnLo greaLer exlon, fooL resung
up on bolsLer, abouL 30 degrees of abducuon. 8esL knee agalnsL your body.
2. llnd adducLor Lendon landmark, follow lL up Lo publc ramus, nd Lhe Lender polnL Lhere
3. MonlLor Lhe Lender polnL. lace oLher hand on skln. WalL for hand Lo suck Lo skln.
Slowly and genLly draw skln up Loward knee. 1enderness wlll dlsappear. Pold for 2
mlnuLes
4. Slowly leL go. 8rlng leg lnLo neuLral. Ask pauenL Lo sLand up and move around, check
range of movemenL
A1lLn1 SulnL
ulane !acobs 2013 ulane !acobs 2013
5"(0+- 4(%%#
lnlL8lC8 CLunLAL nL8vLS
CS1L8C8 lLMC8AL Cu1AnLCuS nL8vL L8lnLAL 88AnCP
uuLnuAL nL8vL (uLLL8)
CCCC?CLAL nL8vLS
lnlL8lC8 CLunLAL nL8vLS
lnulCA1lCn: aln on slmng, paln ln pelvlc oor
18LA1MLn1
1. 8oLh knees are ralsed, comforLably supporLed over a bolsLer. Leg on slde o be LreaLed ls
exed lnLo abouL 90 degrees hlp exlon
2. Cne hand locaLes sore spoL on or medlal Lo lschlal LuberoslLy. lace oLher hand agalnsL
skln behlnd Lhlgh.
3. WalL unul skln and hand suck LogeLher. Slowly pull skln layer up Loward knee. Sore spoL
wlll soen, Lenderness wlll decrease.
4. WalL 2 mlnuLes, slowly leL go.
3. Ask pauenL Lo geL up, check for changes ln quallLy of movemenL, ablllLy Lo slL
comforLably
A1lLn1 SulnL
ulane !acobs 2013
L8lnLAL 88AnCP Cl
CS1L8lC8 lLMC8AL Cu1AnLCuS nL8vL
uuLnuAL nL8vL (uLLL8)
lnulCA1lCn: aln ln pelvlc oor ln males (felL all Lhe ume as a splkey mass" ln
recLum, worse wlLh slmng) or females (paln felL durlng sexual lnLercourse)
18LA1MLn1
1. LsLabllsh good LreaLmenL boundarles beforehand. auenL may wear Lhln underwear. auenL lles
suplne, hlps exed abouL 43 degrees, knees supporLed agalnsL each oLher, feeL aparL, legs relaxed. auenL
ls encouraged Lo breaLhe somewhaL slower and deeper Lhan usual.
2. Cne hand resLs agalnsL slde of pelvls Lo reassure, and Lo monlLor breaLhlng.
3. WlLh Lhe oLher hand locaLe lschlal LuberoslLy. Move [usL medlal Lo lL. Lnsure wrlsL ls sLralghL and arm ls
llned up parallel Lo pauenL's body
4. Slowly lnserL sLralghL ngers lnLo so ussue of pelvlc oor [usL medlal Lo lschlal LuberoslLy. Pold for
many mlnuLes. Co slowly Lhrough several sLages. LvenLually pelvlc oor wlll soen. WlLhdraw hand
slowly.
3. Ask pauenL Lo rlse and move around, slL, check for change ln dlscomforL ln slmng.
1argeL polnL for conLacL/pressure ls where
perlneal nerve surfaces, [usL medlal Lo
lschlal LuberoslLy
A1lLn1
SulnL
ulane !acobs 2013
13-09-23
16
MLulAL CLunLAL nL8vLS, CCCC?CLAL nL8vL
lnulCA1lCn: Sore Lallbone when slmng
18LA1MLn1
1. LsLabllsh good LreaLmenL boundarles. WlLh one hand, locaLe Lenderness aL up of coccyx.
Cne slde of up may be more Lender Lhan oLher slde. MalnLaln conLacL buL don'L press
hard
2. lace oLher hand aL over skln over sacrum. Allow ume for hand Lo suck Lo skln. Some
pressure agalnsL sacrum usually feels good.
3. 1wlsL Lhe skln carefully clockwlse, or counLerclockwlse, and deLermlne whlch way feels
besL Lo pauenL by asklng Lhem. 1enderness should dlsappear. Choose LhaL dlrecuon. Pold
for abouL 2 mlnuLes.
4. Slowly leL go, remove conLacL. Ask pauenL Lo geL up, move around, slL eLc., and
deLermlne lf Lhey feel more comforLable.
A1lLn1 8CnL
ulane !acobs 2013 ulane !acobs 2013
5%/*"#+%# *1+61
C81u8A1C8 nL8vL
CS1L8lC8 Cu1AnLCuS nL8vL Cl 1PlCP
lnulCA1lCn: 8esLrlcuon ln hlp
exlon, paln back of leg
18LA1MLn1
1. lace forearms and hands on skln of posLerlor leg. LeL hands
and arms suck Lo skln.
2. Slowly pull elbows aparL, drawlng skln longlLudlnally.
3. Pold for abouL 2 mlnuLes, leL go slowly.

4. Ask pauenL Lo sLand up, recheck movemenL, quallLy of range.
CS1L8lC8 Cu1AnLCuS
nL8vL Cl 1PlCP
A1lLn1 8CnL
ulane !acobs 2013
C81u8A1C8 nL8vL
lnulCA1lCn: 8esLrlcuon ln hlp
abducuon
18LA1MLn1
1. lace forearms on skln of posLerlor leg. lace boLh hands around medlal slde of leg, above
knee. LeL hands and arms suck Lo skln.
2. Slowly pull elbows aparL, drawlng skln longlLudlnally, and aL Lhe same ume, ll Lhe skln
above knee lnLo medlal roLauon around Lhe leg.

3. Pold for abouL 2 mlnuLes, leL go slowly.
4. Ask pauenL Lo sLand up, recheck movemenL, quallLy of range.
A1lLn1 8CnL
13-09-23
17
ulane !acobs 2013
5%/*"#+%# 2&""
Su8AL nL8vL
SAPLnCuS nL8vL
SAPLnCuS nL8vL
lnulCA1lCn: knee paln/dlsablllLy, severe polnL
Lenderness aL medlal knee
18LA1MLn1
1. lace forearms on skln of posLerlor leg. LocaLe Lender polnL wlLh one nger, monlLor only.
lace boLh hands around medlal slde of leg, above and below knee. LeL hands and arms
suck Lo skln.

2. Slowly pull elbows aparL, drawlng skln longlLudlnally away from knee crease and aL Lhe
same ume, ll Lhe skln above knee lnLo medlal roLauon around Lhe leg.

3. Pold for abouL 2 mlnuLes, leL go slowly.

4. Ask pauenL Lo sLand up, recheck movemenL, quallLy of range.
ulane !acobs 2013
A1lLn1 8CnL
lnulCA1lCn: aln
behlnd knee, or
down back of lower
leg
Su8AL nL8vL
18LA1MLn1
1. auenL suplne. LocaLe Lender spoL. 8rlng leg o slde of bed. Plp ls aL
abouL 30 degrees abducuon, knee abouL 43 degrees exlon. 8esL Lhe
ankle on your knee.

2. lace oLher hand on skln over laLeral slde and Lop of ankle.

3. Slowly press ankle sllghLly medlally. Sllde skln lnLo medlal roLauon around
ankle. 1op of ubla wlll be held sull by edge of bed. SpoL wlll soen and
feel non-Lender.

4. Pold for 2 mlnuLes. LeL go slowly. 8rlng leg up lnLo neuLral, on Lop of bed.

3. Ask pauenL Lo sLand up and move around, reassess range of movemenL.
A1lLn1
SulnL
ulane !acobs 2013
)&*"#+%# 2&""
An1L8lC8 Cu1AnLCuS nL8vLS
SAPLnCuS nL8vL
13-09-23
18
lnulCA1lCn: knee paln/
dlsablllLy, severe polnL
Lenderness aL medlal knee
18LA1MLn1
1. LocaLe Lender polnL medlal knee. MonlLor only.
2. WlLh oLher hand, draw skln over fronL of knee Loward laLeral slde of knee, uslng paLella as
a fulcrum. roceed slowly.

3. AL some polnL, Lenderness wlll decrease and soen
4. Pold aL leasL 2 mlnuLes. Slowly leL go.

3. Ask pauenL Lo sLand and reevaluaLe movemenL, range, dlscomforL level.
A1lLn1 SulnL
SAPLnCuS nL8vL, An1L8lC8,
lnl8AA1LLLA8 88AnCP
ulane !acobs 2013
An1L8lC8 Cu1AnLCuS nL8vLS Cl knLL
lnulCA1lCn: 1enderness over
fronL of knee when kneellng,
paLellar paln
18LA1MLn1
1. lace boLh hands on fronL of legs. CaLher as much skln as
posslble, genLly up Loward Lhe celllng.
2. Pold for 2 or more mlnuLes.
3. LeL go slowly.

4. 8eassess for Lenderness, movemenL, range of mouon.
A1lLn1 SulnL
ulane !acobs 2013
An1L8lC8 Cu1AnLCuS nL8vLS Cl knLL
lnulCA1lCn: 1enderness over fronL of knee when kneellng,
paLellar paln
18LA1MLn1
1. LocaLe a dlsuncL Lender polnL, anywhere.

2. lace oLher hand on Lhe skln on Lhe opposlLe slde. CaLher Lhe
skln Loward LhaL slde. Pold for 2 or more mlnuLes.
3. LeL go slowly.

4. 8eassess for Lenderness, movemenL, range of mouon.
A1lLn1 SulnL
ulane !acobs 2013 ulane !acobs 2013
(%."# ("6
Su8AL nL8vL
SAPLnCuS nL8vL
SuL8llClAL L8CnLAL
13-09-23
19
Cu1AnLCuS nL8vLS Cl LCWL8 LLC
ulane !acobs 2013
ul8LC1lCnAL 8LlL8LnCLS
ulane !acobs 2013
Su8AL nL8vL
ASSLSSMLn1
1. 1oes are supporLed by Lhe bed. CenLly grasp skln over boLh heels.
2. WalL for hands Lo suck Lo skln. Slowly pull skln layer dlsLally. Cne slde wlll llkely sllde easler
Lhan Lhe oLher.

3. 1reaL slde LhaL slldes less easlly.
4. 8eassess ln same manner posL LreaLmenL.

A1lLn1 8CnL
lnulCA1lCn:
Cld ankle spralns,
decreased 8CM aL ankle
ulane !acobs 2013
Su8AL nL8vL
lnulCA1lCn: aln behlnd knee, or down back of lower leg
18LA1MLn1
1. auenL prone. LocaLe Lender spoL.

2. lace oLher hand on skln over medlal slde of leg [usL below
knee.
3. CaLher skln lnLo hand. SpoL wlll soen and feel non-Lender.

4. Pold for 2 mlnuLes.

3. LeL go slowly.
A1lLn1 8CnL
ulane !acobs 2013
13-09-23
20
Su8AL nL8vL
18LA1MLn1
1. 1oes are supporLed by Lhe bed. llnd sore spoL on back of leg.
CenLly grasp skln over heel.

2. WalL for hand Lo suck Lo skln over heel. Slowly pull skln layer
around heel. Peel wlll move wlLh lLs ughLly adhered skln.

3. 1wlsL slowly, by sLages. Pold aL leasL 2 mlnuLes. LeL go slowly

4. 8eassess.

A1lLn1 8CnL
lnulCA1lCn: Cld ankle spralns,
decreased 8CM aL ankle
ASSLSSMLn1
A1lLn1
8CnL
ulane !acobs 2013 ulane !acobs 2013
4%%*
CALCAnLAL nL8vL
CS1L8lC8 1l8lAL nL8vL
Su8AL nL8vL
LAn1A8 nL8vL
ul8LC1lCnAL 8LlL8LnCLS
ulane !acobs 2013
L8CnLAL nL8vL
lnulCA1lCn: aln, Lenderness
ln crease of anLerlor ankle
18LA1MLn1
1. auenL ls slmng on edge of LreaLmenL Lable. 1heraplsL slLs on low sLool.
AecLed fooL slLs on LheraplsL's knee. CLher fooL ls supporLed by a sLool.
2. llnd Lender polnL wlLh one hand. WlLh knee, bend pauenL's fooL lnLo as
much dorslexlon as posslble. 1ender polnL wlll reduce, buL wlll noL
compleLely resolve.
3. lace oLher hand rmly around heel. Carefully LwlsL heel elLher
clockwlse or counLerclockwlse, whlchever dlrecuon seems Lo work besL
for LhaL lndlvldual.
4. Pold 2 mlnuLes. Slowly leL go. 8rlng pauenL's fooL genLly ouL of
dorslexlon. Pave pauenL sLand, reassess range, comforL level
nC1L: 8ranch of
peroneal nerve
LargeLed ln Lhls
LreaLmenL ls
deeper, behlnd
exLensor
reunaculum.
ulane !acobs 2013
13-09-23
21
LAn1A8 nL8vL
lnulCA1lCn: aln bouom of fooL or heel
18LA1MLn1:
1. Moblllze mulu-dlrecuonally.
2. Co slowly, hold for long perlods of ume. lncrease
Lorque force as/when sysLem permlLs.
ulane !acobs 2013