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These pages are packed full of high-yield info organized for quick review. It is intended
to help you pick up a few extra questions after you have completed a more thorough
study. DONT RELY ON THIS EXCLUSIVELY TO GET YOU THROUGH THE
BOARDS! You need to do a more extensive review to do well.

CHAPTER 1-PRINCIPLES Side-bending is tested by contacting the space

between two vertebral segments and pushing medi-
ally.
Facet Orientation
Cervical-Backward, Upward, Medial Table 4: Fryettes Principles
Thoracic-Backward, Upward, Lateral
Lumbar-Backward, Upward, Medial Motion Direction

Spinal Mechanics Type I (Neutral) SXRY or SYRX

Table 1: Planes and Axes Type II (Non-Neutral) RXSX or RYSY
Motion Plane Axis
Somatic Dysfunction
Rotation Horizontal Vertical Definition-impaired or altered function of related
component of the somatic system: skeletal, arthro-
Side-bending Coronal AP
dial, and myofascial structures and related vascular,
Sagittal Sagittal Horizontal lymphatic, and neural elements.
Diagnostic Criteria-Tissue Texture Abnormality,
Table 2: Rotation Asymmetry, Restriction of Motion, Tenderness
(TART).
Side of Left Transverse Right Transverse
Table 5: Acute vs Chronic Dysfxn
Rotation Process Process

Left Posterior Anterior Acute Findings Chronic Findings

Right Anterior Posterior Vasodilatation, Vasoconstriction,

Edema, Itching & Fibrosis,
Tenderness, Tenderness,
The point of reference for direction of rotation is a
Pain, Paresthesias,
point on the anterior and superior surface of the
Contraction, Contracture,
body of the vertebra.
Skin Warm/Moist, Skin Cool/Pale,
Table 3: Side-bending Muscle Spasm, Muscle Flaccid,
Minimal Somato- Frequent Somato-
visceral changes visceral Changes
Side of SB Concave Side Convex Side

Left Left Right Somatic dysfunction is named for the direction of

motion, this is opposite of the direction of restric-
Right Right Left
tion.

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CHAPTER 2-NEUROLOGIC
Autonomic Nervous System
Table 6: Sympathetic Innervation

Level Splanchnic Nerve Collateral Ganglia Organs/Structures Innervated

T1-4 Cervicothoracic, middle & Head and Neck

superior cervical ganglia

T1-T6 Heart and Lungs

T5-T9 Greater splanchnic nerve Celiac ganglion Upper GI (T5R gall bladder, T6R ducts,
T7R pancreas, T7L spleen)

T10-T11 Lesser splanchnic nerve Superior mesenteric Lower GI (small intestine, right colon,
ganglion gonads, adrenals, upper ureter)

T10-T12 Kidney

T12 Least and lumbar Appendix (usually right)

splanchnic nerves

T12-L2 Least and lumbar Inferior mesenteric Left colon, lower ureter, bladder, uterus/
splanchnic nerves ganglion prostate, genitals

T2-T8 Arms

T11-L2 Legs

Table 7: Parasympathetic Innervation

Nerve Nucleus Ganglion Organs Innervates

CN3 (Oculomotor n) Edinger-Westphal Ciliary Pupil

(accessory oculomotor)

CN7 (Facial n) Superior salivatory Pterygopalatine...........> Sinuses, lacrimal gland, palate

OR
Submandibular...........> Sublingual/submandibular glands

CN9 Inferior salivatory Otic Parotid gland

(Glossopharyngeal n)

CN10 (Vagus) Dorsal vagal Superior and inferior All structures in the head, neck,
vagal heart, lungs, kidneys, upper ure-
ters, entire GI tract down to the
mid-transverse colon.

S2-S4 (Pelvic Left colon, lower ureter, bladder,

splanchnic nn) uterus/prostate, genitals

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Nerve Roots
Table 8: Upper Extremity and Brachial Plexus Nerve Roots

Level of Exit
Nerve Root Sensory Reflex Motor
(Disc)

C5 Root C4-C5 (C4 disc) Lateral arm Biceps Abduction of shoulder, elbow
flexion

C6 Root C5-C6 (C5 disc) Lateral forearm, Brachioradialis Elbow flexion, wrist extension
thumb, index finger (most common herniation)

C7 Root C6-C7 (C6 disc) Middle finger Triceps Elbow extension, wrist flexion

C8 Root C7-T1 (C7 disc) Medial forearm, None Finger flexion

ring & little finger

T1 Root T1-T2 (T1 disc) Medial arm None Finger abduction/adduction

Table 9: Upper Extremity Major Nerves

Origin (Partial
Nerve Function Injury Commonly Results in...
Origin)

Long Thoracic C5-C7 Innervates serratus anterior m Winging of the scapula

Axillary C5-C6 Innervates deltoid & teres minor mm Deltoid atrophy

Musculocutaneous C5-C7 Innervates arm flexors, sensory to Diminished biceps reflex

lateral forearm

Median (C5) C6-T1 Innervates flexors of the forearm & Thenar eminence atrophy
hand. Sensory to the palmar surface
(including fingernails) of digits 1-3
& part of 4

Radial C5-C8 (T1) Innervates forearm extensors. Sen- Wrist drop, diminished triceps
sory to back of forearm, hand, digits reflex
1-3 and part of 4

Ulnar (C7) C8-T1 Innervates some flexors of the hand. Hypothenar eminence atrophy
Sensory to medial hand and part of
digit 4, all of digit 5

Table 10: Lower Extremity Nerve Roots

Level of Exit
Nerve Root Sensory Reflex Motor
(Disc)

L4 Root L3-L4 (L3 disc) Medial leg & foot Patellar Foot inversion

L5 Root L4-L5 (L4 disc) Dorsal surface of the None Dorsiflexion of the toes, foot drop
lower leg & foot if injured

S1 Root L5-S1 (L5 disc) Lateral side of the Achilles Eversion of the foot
foot (most common herniation)

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Table 11: Lower Extremity Major Nerves

Nerve Origin Function Injury Commonly Results in...

Obturator L2-L4 Innervates adductors, sensory to small

area of skin on medial thigh

Femoral L2-L4 Innervates quads, sensory to medial & Diminished knee jerk reflex
middle thigh and medial lower leg

Lateral Femoral L2-L3 Sensory to lateral thigh Meralgia paresthetica

Cutaneous

Posterior Femo- S1-S3 Sensory to back of thigh

ral Cutaneous

Sciatic L4-S3 Innervates muscles of posterior thigh,

branches into tibial and common fibular

Tibial L4-S3 Innervates muscles of posterior leg, Diminished ankle jerk reflex
sensory to lateral posterior leg

Common fibular L4-S2 Innervates anterior lower leg Foot drop

CHAPTER 3-POSTURE AND GAIT CHAPTER 5-CRANIAL

Table 12: Heel Lift Therapy
Flexion:
Initial Increase Every 2 The SBS rises.
Type of Patient
Lift Weeks All midline bones go into flexion.
All paired bones go into external rotation.
Less than 5mm Not N/A The respiratory phase is inhalation.
difference treated The sacral base moves posterior
Fragile Patient 1/16 Lift No More Than (counternutation).
(Elderly, Arthri- 1/16 The skull widens laterally and shortens in its A/P
tis, Osteoporosis) diameter.

Flexible Patient 1/8 Lift No More Than Extension:

1/16
The SBS falls.
Injured Patient Full N/A All midline bones go into extension.
(Where Leg Amount All paired bones go into internal rotation.
Length Was Sud- The respiratory phase is exhalation.
denly Shortened) The sacral base moves anterior (nutation).
The skull narrows laterally and increases in its A/P
diameter.
The total lift height should be only to of
the shortness measured by the standing x-ray. The Following Somatic Dysfunctions Occur
A maximum of lift can be used inside the
at the SBS:
shoe. Up to can be used between the
patients heel and floor. If more than is 1. Flexion (will not cycle into extension)
2. Extension (will not cycle into flexion)
needed, lift must be applied to the heel and
3. Torsions (left and right)
half-sole of the shoe. 4. Sidebending rotations (left and right)
5. Vertical Strains (superior and inferior)
6. Lateral Strains (left and right)
7. SBS compression

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Table 13: Summary Chart of Bone Position

Somatic Greater Wings of the

Occiput Temporals
Dysfunction Sphenoid

Flexion Inferior, Anterior, and Inferior and Lateral External Rotation

Lateral Bilaterally
Extension Superior, Posterior,
and Medial Bilaterally
Left Superior on Left,
Torsion Inferior on Right
Right Superior on Right,
Torsion Inferior on Left
Left Sidebending Inferior on Left,
Rotation Superior on Right
Right Sidebending Inferior on Right,
Rotation Superior on Left
Bilaterally
Superior and Medial
Bilaterally
Inferior on Left,
Superior on Right
Inferior on Right,
Superior on Left
Inferior on Left,
Superior on Right
Inferior on Right,
Superior on Left
Bilaterally
Internal Rotation
Bilaterally
Left External Rotation,
Right Internal Rotation
Right External Rotation,
Left Internal Rotation
Left External Rotation,
Right Internal Rotation
Right External Rotation,
Left Internal Rotation

CHAPTER 6-CERVICAL SPINE

Table 6-14: Motion and Positional Findings for OA Tri-axial Somatic Dysfunction

Transverse Transverse If the Right

If the Left Side is
Side is Most
Somatic Restricted Process Process Most Dominant
Translation Terminology Dominant in
Dysfunction Motion Closer to the Closer to the in Restriction &
Restriction &
Mandible Mastoid Tissue Changes
Tissue Changes

(F)SLRR (E)SRRL Translates Right OR Right Left Anterior Posterior

Restricted in Left Transla- Occiput Left Occiput Right
tion During Extension

(E)SLRR (F)SRRL Translates Right OR Right Left Anterior Posterior

Restricted in Left Transla- Occiput Left Occiput Right
tion During Flexion

(F)SRRL (E)SLRR Translates Left OR Left Right Posterior Anterior

Restricted in Right Transla- Occiput Left Occiput Right
tion During Extension

(E)SRRL (F)SLRR Translates Left OR Left Right Posterior Anterior

Restricted in Right Transla- Occiput Left Occiput Right
tion During Flexion

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Table 15: Motion and Positional Findings For Typical Cervical Tri-axial Somatic Dysfunctions

May Also Posterior Side of Most

Somatic Restricted Translation
Be Written Articular Paraspinal mm.
Dysfunction Motion Terminology Tightness
as... Process

(E)RRSR or (F)SLRL Translates Left OR Translates Right Right

ERSR Restricted in Right Trans- From Right Most Prominent Most Prominent
lation During Flexion to Left During Flexion During Flexion

(E)RLSL or (F)SRRR Translates Right OR Translates Left Left

ERSL Restricted in Left Transla- From Left to Most Prominent Most Prominent
tion During Flexion Right During Flexion During Flexion

(F)SRRR or (E)RLSL Translates Left OR Translates Right Right

FSRR Restricted in Right Trans- From Right Most Prominent Most Prominent
lation During Extension to Left During Extension During Extension

(F)SLRL or (E)RRSR Translates Right OR Translates Left Left

FSRL Restricted in Left Transla- From Left to Most Prominent Most Prominent
tion During Extension Right During Extension During Extension

CHAPTER 7-UPPER EXTREMITY Table 17: Radial Head Somatic Dysfunction

Somatic Restricted Most Likely

The Seven Stages of Spencer: Dysfunction Motions Mechanism
1. Extension of the upper extremity to 90 degrees.
2. Flexion of the upper extremity to 180 degrees. Radial Head Posterior and Fall Backward on
3. Circumduction with glenohumeral joint compres- Anterior Pronation the Outstretched
sion. This tests the joint surfaces. Hand
4. Circumduction with traction. This tests the joint Radial Head Anterior and Fall Forward on
capsule. Posterior Supination the Outstretched
5. Abduction (not adduction) to 90 degrees. Hand
6. Internal rotation.
7. Pump, also called traction with caudal glide.
Table 18: Tests of the Upper Extremity
Table 16: Ulnar Somatic Dysfunction Test Purpose
Somatic Carrying Olecranon Adsons Test Compression of the Subclavian
Wrist
Dysfunction Angle Process Artery
Abducted Increased Increased Increased Allens Test Collateral Circulation of the Hand
Ulna Adduction Medial
Glide Apleys Evaluate the Range of Motion of
Scratch Test the Shoulder
Adducted Decreased Increased Increased
Ulna Abduction Lateral Apprehension Detect Chronic Shoulder
Glide (Crank) Test Dislocation

Drop Arm Test Detect Tears in the Rotator Cuff

Muscles

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Table 18: Tests of the Upper Extremity Forward Bending (Flexion) Dysfunction
Positional findings:
Test Purpose There is a slight separation of the spinous process
from the segment below.
Empty Can Detect Tears of the Supraspinatus
There is a slight approximation of the spinous pro-
Test Tendon or Muscle
cess to the one above.
Finkelsteins DeQuervains Tenosynovitis There is usually tenderness of the supraspinous lig-
Test (Abductor Pollicis Longus & ament.
Extensor Pollicis Brevis Tendons) Motion findings:
Rotation is restricted bilaterally.
Load & Shift Shoulder Instability, Anterior or Side-bending is usually restricted bilaterally.
Test Posterior The segment forward bends easily and is restricted
in backward bending.
Phalens Test Carpal Tunnel Syndrome

Posterior Posterior Shoulder Instability or Backward Bending (Extension) Dysfunction

Apprehension Dislocation Positional findings:
Test There is a slight separation of the spinous process
from the segment above.
Speeds Test Bicipital Tendinitis
There is a slight approximation of the spinous pro-
Sulcus Sign Inferior Shoulder Instability cess to the one below.
There is usually tenderness of the supraspinous lig-
Tinels Sign Carpal Tunnel Syndrome ament.
Motion findings:
Yergasons Bicipital Tendinitis
Rotation is restricted bilaterally.
Test
Side-bending is usually restricted bilaterally.
The segment backward bends easily and is
CHAPTER 8 & 10-THORACIC restricted in forward bending.
AND LUMBAR SPINE
Neutral Somatic Dysfunction
Positional findings (SXRY):
Approximation of the transverse processes on side
Table 19: The Rule of Threes X, caused by side-bending toward side X.
Separation of the transverse processes on side Y.
Spinous Process Transverse
Posterior transverse process on side Y, caused by
Location in Process Location
Vertebrae rotation to side Y.
Relation to the in Relation to the
Anterior transverse process on side X.
Vertebral Body Spinous Process
The spinous process may be shifted to side X.
Motion findings:
T1-T3 Over the Body of The Same
With motion testing, the segment will move in the direc-
the Corresponding Horizontal Plane
tion of somatic dysfunction and it will be restricted in
Vertebra
the direction opposite of the somatic dysfunction.
T4-T6 Over the Interverte- About 1/2 Inch
bral Space Below Up and Lateral Table 20: Neutral Positional Diagnosis
T7-T9 Over the Body of About 1 Inch Up Sense of
the Vertebra Below and Lateral Fullness and
Easy Normal
T10-T12 Over the Body of The Same Dysfunction Posterior
(EN)
the Corresponding Horizontal Plane Transverse
Vertebra Processes

(N)SLRR Right EN Right or ENR

(N)SRRL Left EN Left or ENL

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Non-Neutral Somatic Dysfunction Table 23: Muscles Used for Inhalation Rib
Positional findings (R XSX): Somatic Dysfunction
Approximation of the transverse processes on side
X, caused by side-bending toward side X. Muscle Acts Upon
Separation of the transverse processes on side Y.
Posterior transverse process on side X, caused by Quadratus Lumborum Rib 12 Directly
rotation to side X.
Intercostales Forced Exhalation
Anterior transverse process on side Y.
The spinous process may be shifted slightly to side
Y. CHAPTER 11-THE INNOMINATES
These dysfunctions are generally very painful and AND PUBES
may present with a significant amount of paraverte-
bral muscle spasm. The standing flexion test will be positive on the side
Motion findings: of the dysfunction in both innominate and pubic
With motion testing, the segment will move in the direc- dysfunctions..
tion of somatic dysfunction and it will be restricted in
the direction opposite of the somatic dysfunction. Table 24: Innominate Dysfunction

Dysfunction Findings
Table 21: Non-Neutral Positional Diagnosis
Anterior Rotation ASIS inferior, PSIS superior
Transverse Transverse Posterior Rotation ASIS superior, PSIS inferior
Process Process
Dysfunction
Position in Position in Superior Shear ASIS superior, PSIS superior
Extension Flexion
Inferior Shear ASIS inferior, PSIS inferior
FRS Left Posterior Left Symmetrical
Innominate Inflare ASIS closer to the umbilicus
FRS Right Posterior Right Symmetrical
Innominate ASIS further from the
ERS Left Symmetrical Posterior Left Outflare umbilicus

ERS Right Symmetrical Posterior Right

CHAPTER 9-RIBS Table 25: Pubic Dysfunction

Dysfunction Findings

Table 22: Muscles Used for Exhalation Rib Superior Shear Pubic tubercle superior
Somatic Dysfunction Inferior Shear Pubic tubercle inferior
Muscle Acts Upon Pubic Adduction Distance between the
pubic tubercles is
Scalenes Ribs 1-2 decreased

Pectoralis Minor Ribs 3,4,5,(6) Pubic Abduction Distance between the

Serratus Anterior
Latissimus Dorsi
Quadratus Lumborum
Intercostales
pubic tubercles is
Ribs 6,7,8,9,10 increased
Ribs 9,10,11,12
Rib 12 Indirectly
Forced Inhalation

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CHAPTER 12-THE SACRUM

Table 26: Sacral Somatic Dysfunction

Seated Flexion Spring Sacral Base

Dysfunction Sphinx Test ILA Findings
Test Test Findings

L on LOA Positive right Negative More Right anterior Left posterior &
symmetrical inferior

R on ROA Positive left Negative More Left anterior Right posterior

symmetrical & inferior

R on LOA Positive right Positive Less Right posterior Left anterior &
symmetrical superior

L on ROA Positive left Positive Less Left posterior Right anterior &
symmetrical superior

Sacral Base Positive bilaterally Negative N/A Anterior Posterior bilat-

Anterior (may appear nega- bilaterally erally & even
tive)

Sacral Base Positive bilaterally Positive N/A Posterior Anterior bilater-

Posterior (may appear nega- bilaterally ally & even
tive)

Left Sacral Margin Left posterior Left posterior &

Posterior even

Right Sacral Right posterior Right posterior

Margin Posterior & even

Left Unilateral Positive left Negative More Left anterior Left posterior &
Sacral Flexion symmetrical markedly
inferior

Right Unilateral Positive right Negative More Right anterior Right posterior
Sacral Flexion symmetrical & markedly
inferior

Left Unilateral Positive left Positive Less Left posterior Left anterior &
Sacral Extension symmetrical probably
superior

Right Unilateral Positive right Positive Less Right posterior Right anterior &
Sacral Extension symmetrical probably
superior

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CHAPTER 13-THE LOWER Table 27: Tests of the Lower Extremity

EXTREMITY
Test Purpose
Somatic Dysfunction of the Hip Joint Babinskis Upper Motor Neuron
The major motions (with the knee extended) and their Dysfunction
approximate ranges are:
Flexion- 80 to 90 degrees. Barlows Test Hip Stability
Extension- 25 to 35 degrees.
Erichsens Test Sacroiliac Pathology
Abduction- 45 to 55 degrees.
Adduction- 25 to 35 degrees. Galeazzis (Allis) Test Congenital Hip Disloca-
Internal rotation- 30 to 40 degrees. tion Ages 3-18 mos.
External rotation- 40 to 50 degrees.
The ranges will be different if the knee is bent. Somatic Homans Sign Deep Vein
dysfunction may also occur in the minor motions of the Thrombophlebitis
hip joint. Those motions are:
Lachmans Test Anterior Cruciate
Anterior glide- occurs with external rotation.
Ligament
Posterior glide- occurs with internal rotation.
Ludloffs Sign Traumatic Separation of
Somatic Dysfunction of the Knee Joint the Lesser Trochanter of
Dysfunction may occur in the major motions of flexion the Femur
and extension, or in any of the minor motions listed McMurrays Test Meniscal Tears
below:
Medial and lateral glide. Obers Test Iliotibial Band/Fascia
Anterior and posterior glide. Lata Dysfunction
Internal rotation with anteromedial glide.
External rotation with posterolateral glide. Ortolanis Test Congenital Hip Disloca-
tion in a Newborn
Somatic Dysfunctions of the Fibular Head Patricks (FABER or Hip Joint Pathology
Fibular head anterior. FABERE) Test
Fibular head posterior.
Posterior Drawer Test Posterior Cruciate
Fibular head posterior dysfunction may cause compres-
Ligament
sion of the common fibular (peroneal) nerve.
Thomas Test Contraction of the
Iliopsoas Muscle

Thompsons Test Ruptured Achilles

Table 27: Tests of the Lower Extremity Tendon

Trendelenburg Test Gluteus Medius Muscle

Test Purpose (Superior Gluteal Nerve)
Anterior Drawer Test Anterior Cruciate Valgus Stress Test Medial (Tibial)
Ligament Collateral Ligament
Anterior Drawer Test of Anterior Talofibular and Varus Stress Test Lateral (Fibular)
the Ankle Calcaneofibular Lig. Collateral Ligament
Apleys Compression Knee Meniscal Injury
Test

Apleys Distraction Test Knee Ligamentous

Injury

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