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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

Facet Orientation
Cervical-Backward, Upward, Medial
Thoracic-Backward, Upward, Lateral
Lumbar-Backward, Upward, Medial

Table 4: Fryettes Principles

Motion

Spinal Mechanics
Table 1: Planes and Axes
Motion

Plane

Axis

Rotation

Horizontal

Vertical

Side-bending

Coronal

AP

Sagittal

Sagittal

Horizontal

Table 2: Rotation

Left Transverse
Process

Type I (Neutral)

SXRY or SYRX

Type II (Non-Neutral)

RXSX or RYSY

Right Transverse
Process

Definition-impaired or altered function of related

component of the somatic system: skeletal, arthrodial, and myofascial structures and related vascular,
lymphatic, and neural elements.
Diagnostic Criteria-Tissue Texture Abnormality,
Asymmetry, Restriction of Motion, Tenderness
(TART).

Table 5: Acute vs Chronic Dysfxn

Left

Posterior

Anterior

Acute Findings

Right

Anterior

Posterior

Vasodilatation,
Edema,
Tenderness,
Pain,
Contraction,
Skin Warm/Moist,
Muscle Spasm,
Minimal Somatovisceral changes

The point of reference for direction of rotation is a

point on the anterior and superior surface of the
body of the vertebra.

Table 3: Side-bending
Side of SB

Concave Side

Convex Side

Left

Left

Right

Right

Right

Left

Direction

Somatic Dysfunction

Side of
Rotation

Side-bending is tested by contacting the space

between two vertebral segments and pushing medially.

Chronic Findings
Vasoconstriction,
Itching & Fibrosis,
Tenderness,
Paresthesias,
Contracture,
Skin Cool/Pale,
Muscle Flaccid,
Frequent Somatovisceral Changes

Somatic dysfunction is named for the direction of

motion, this is opposite of the direction of restriction.

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

Splanchnic Nerve

T1-4

Collateral Ganglia
Cervicothoracic, middle &
superior cervical ganglia

T1-T6

Organs/Structures Innervated
Head and Neck
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
ganglion

Lower GI (small intestine, right colon,

gonads, adrenals, upper ureter)

T10-T12

Kidney

T12

Least and lumbar

splanchnic nerves

T12-L2

Least and lumbar

splanchnic nerves

Appendix (usually right)

Inferior mesenteric
ganglion

Left colon, lower ureter, bladder, uterus/

prostate, genitals

T2-T8

Arms

T11-L2

Legs

Table 7: Parasympathetic Innervation

Nerve

Nucleus

Ganglion

Organs Innervates

CN3 (Oculomotor n)

Edinger-Westphal
(accessory oculomotor)

Ciliary

Pupil

CN7 (Facial n)

Superior salivatory

Pterygopalatine...........>
OR
Submandibular...........>

Sinuses, lacrimal gland, palate

Sublingual/submandibular glands

CN9
(Glossopharyngeal n)

Inferior salivatory

Otic

Parotid gland

CN10 (Vagus)

Dorsal vagal

Superior and inferior

vagal

All structures in the head, neck,

heart, lungs, kidneys, upper ureters, entire GI tract down to the
mid-transverse colon.

S2-S4 (Pelvic
splanchnic nn)

Left colon, lower ureter, bladder,

uterus/prostate, genitals

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Nerve Roots
Table 8: Upper Extremity and Brachial Plexus Nerve Roots
Level of Exit
(Disc)

Nerve Root

Sensory

Reflex

Motor

C5 Root

C4-C5 (C4 disc)

Lateral arm

Biceps

Abduction of shoulder, elbow

flexion

C6 Root

C5-C6 (C5 disc)

Lateral forearm,
thumb, index finger

Brachioradialis

Elbow flexion, wrist extension

(most common herniation)

C7 Root

C6-C7 (C6 disc)

Middle finger

Triceps

Elbow extension, wrist flexion

C8 Root

C7-T1 (C7 disc)

Medial forearm,
ring & little finger

None

Finger flexion

T1 Root

T1-T2 (T1 disc)

Medial arm

None

Finger abduction/adduction

Table 9: Upper Extremity Major Nerves

Origin (Partial
Origin)

Nerve

Function

Injury Commonly Results in...

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

lateral forearm

Diminished biceps reflex

Median

(C5) C6-T1

Innervates flexors of the forearm &

hand. Sensory to the palmar surface
(including fingernails) of digits 1-3
& part of 4

Thenar eminence atrophy

Radial

C5-C8 (T1)

Innervates forearm extensors. Sensory to back of forearm, hand, digits

1-3 and part of 4

Wrist drop, diminished triceps

reflex

Ulnar

(C7) C8-T1

Innervates some flexors of the hand.

Sensory to medial hand and part of
digit 4, all of digit 5

Hypothenar eminence atrophy

Table 10: Lower Extremity Nerve Roots

Nerve Root

Level of Exit
(Disc)

Sensory

Reflex

Motor

L4 Root

L3-L4 (L3 disc)

Medial leg & foot

Patellar

Foot inversion

L5 Root

L4-L5 (L4 disc)

Dorsal surface of the

lower leg & foot

None

Dorsiflexion of the toes, foot drop

if injured

S1 Root

L5-S1 (L5 disc)

Lateral side of the

foot

Achilles

Eversion of the foot

(most common herniation)

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Table 11: Lower Extremity Major Nerves

Nerve

Origin

Function

Obturator

L2-L4

Innervates adductors, sensory to small

area of skin on medial thigh

Femoral

L2-L4

Innervates quads, sensory to medial &

middle thigh and medial lower leg

Diminished knee jerk reflex

Lateral Femoral
Cutaneous

L2-L3

Sensory to lateral thigh

Meralgia paresthetica

Posterior Femoral Cutaneous

S1-S3

Sensory to back of thigh

Sciatic

L4-S3

Innervates muscles of posterior thigh,

branches into tibial and common fibular

Tibial

L4-S3

Innervates muscles of posterior leg,

sensory to lateral posterior leg

Diminished ankle jerk reflex

Common fibular

L4-S2

Innervates anterior lower leg

Foot drop

CHAPTER 3-POSTURE AND GAIT

Table 12: Heel Lift Therapy
Type of Patient

Initial
Lift

Increase Every 2
Weeks

Less than 5mm

difference

Not
treated

N/A

Fragile Patient
(Elderly, Arthritis, Osteoporosis)

1/16 Lift

No More Than
1/16

Flexible Patient

1/8 Lift

No More Than
1/16

Injured Patient
(Where Leg
Length Was Suddenly Shortened)

Injury Commonly Results in...

Full
Amount

N/A

The total lift height should be only to of

the shortness measured by the standing x-ray.
A maximum of lift can be used inside the
shoe. Up to can be used between the
patients heel and floor. If more than is
needed, lift must be applied to the heel and
half-sole of the shoe.

CHAPTER 5-CRANIAL
Flexion:

The SBS rises.

All midline bones go into flexion.
All paired bones go into external rotation.
The respiratory phase is inhalation.
The sacral base moves posterior
(counternutation).
The skull widens laterally and shortens in its A/P
diameter.

Extension:

The SBS falls.

All midline bones go into extension.
All paired bones go into internal rotation.
The respiratory phase is exhalation.
The sacral base moves anterior (nutation).
The skull narrows laterally and increases in its A/P
diameter.

The Following Somatic Dysfunctions Occur

at the SBS:
1. Flexion (will not cycle into extension)
2. Extension (will not cycle into flexion)
3. Torsions (left and right)
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
Dysfunction

Greater Wings of the

Sphenoid

Occiput

Temporals

Flexion

Inferior, Anterior, and

Lateral Bilaterally

Inferior and Lateral

Bilaterally

External Rotation
Bilaterally

Extension

Superior, Posterior,
and Medial Bilaterally

Superior and Medial

Bilaterally

Internal Rotation
Bilaterally

Left
Torsion

Superior on Left,
Inferior on Right

Inferior on Left,
Superior on Right

Left External Rotation,

Right Internal Rotation

Right
Torsion

Superior on Right,
Inferior on Left

Inferior on Right,
Superior on Left

Right External Rotation,

Left Internal Rotation

Left Sidebending
Rotation

Inferior on Left,
Superior on Right

Inferior on Left,
Superior on Right

Left External Rotation,

Right Internal Rotation

Right Sidebending
Rotation

Inferior on Right,
Superior on Left

Inferior on Right,
Superior on Left

Right External Rotation,

Left Internal Rotation

CHAPTER 6-CERVICAL SPINE

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

Somatic
Restricted
Dysfunction Motion

Translation Terminology

Transverse
Process
Closer to the
Mandible

Transverse
Process
Closer to the
Mastoid

If the Left Side is

Most Dominant
in Restriction &
Tissue Changes

If the Right
Side is Most
Dominant in
Restriction &
Tissue Changes

(F)SLRR

(E)SRRL

Translates Right OR
Restricted in Left Translation During Extension

Right

Left

Anterior
Occiput Left

Posterior
Occiput Right

(E)SLRR

(F)SRRL

Translates Right OR
Restricted in Left Translation During Flexion

Right

Left

Anterior
Occiput Left

Posterior
Occiput Right

(F)SRRL

(E)SLRR

Translates Left OR
Restricted in Right Translation During Extension

Left

Right

Posterior
Occiput Left

Anterior
Occiput Right

(E)SRRL

(F)SLRR

Translates Left OR
Restricted in Right Translation During Flexion

Left

Right

Posterior
Occiput Left

Anterior
Occiput Right

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

Restricted
Motion

(E)RRSR or
ERSR

(F)SLRL

(E)RLSL or
ERSL

(F)SRRR

(F)SRRR or
FSRR

(E)RLSL

(F)SLRL or
FSRL

(E)RRSR

Translation
Terminology

May Also
Be Written
as...

Posterior
Articular
Process

Side of Most
Paraspinal mm.
Tightness

Translates Left OR
Restricted in Right Translation During Flexion

Translates
From Right
to Left

Most Prominent
During Flexion

Translates Right OR
Restricted in Left Translation During Flexion

Translates
From Left to
Right

Most Prominent
During Flexion

Translates Left OR
Restricted in Right Translation During Extension

Translates
From Right
to Left

Right

Right

Most Prominent
During Extension

Most Prominent
During Extension

Translates Right OR
Restricted in Left Translation During Extension

Translates
From Left to
Right

Most Prominent
During Extension

CHAPTER 7-UPPER EXTREMITY

1. Extension of the upper extremity to 90 degrees.
2. Flexion of the upper extremity to 180 degrees.
3. Circumduction with glenohumeral joint compression. This tests the joint surfaces.
4. Circumduction with traction. This tests the joint
capsule.
5. Abduction (not adduction) to 90 degrees.
6. Internal rotation.
7. Pump, also called traction with caudal glide.

Right
Most Prominent
During Flexion

Left

Left
Most Prominent
During Flexion

Left

Left
Most Prominent
During Extension

Table 17: Radial Head Somatic Dysfunction

Somatic
Dysfunction

The Seven Stages of Spencer:

Right

Restricted
Motions

Most Likely
Mechanism

Radial Head
Anterior

Posterior and
Pronation

Fall Backward on
the Outstretched
Hand

Radial Head
Posterior

Anterior and
Supination

Fall Forward on
the Outstretched
Hand

Table 18: Tests of the Upper Extremity

Table 16: Ulnar Somatic Dysfunction
Somatic
Dysfunction
Abducted
Ulna
Adducted
Ulna

Carrying
Angle
Increased

Decreased

Wrist
Increased
Adduction
Increased
Abduction

Test

Purpose

Olecranon
Process

Adsons Test

Compression of the Subclavian

Artery

Increased
Medial
Glide

Allens Test

Collateral Circulation of the Hand

Apleys
Scratch Test

Evaluate the Range of Motion of

the Shoulder

Apprehension
(Crank) Test

Detect Chronic Shoulder

Dislocation

Drop Arm Test

Detect Tears in the Rotator Cuff

Muscles

Increased
Lateral
Glide

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Table 18: Tests of the Upper Extremity

Test

Purpose

Empty Can
Test

Detect Tears of the Supraspinatus

Tendon or Muscle

Finkelsteins
Test

DeQuervains Tenosynovitis
(Abductor Pollicis Longus &
Extensor Pollicis Brevis Tendons)

Load & Shift

Test

Shoulder Instability, Anterior or

Posterior

Phalens Test

Carpal Tunnel Syndrome

Posterior
Apprehension
Test

Posterior Shoulder Instability or

Dislocation

Speeds Test

Bicipital Tendinitis

Sulcus Sign

Inferior Shoulder Instability

Tinels Sign

Carpal Tunnel Syndrome

Yergasons
Test

Bicipital Tendinitis

CHAPTER 8 & 10-THORACIC

AND LUMBAR SPINE
Table 19: The Rule of Threes
Spinous Process
Location in
Relation to the
Vertebral Body

Transverse
Process Location
in Relation to the
Spinous Process

T1-T3

Over the Body of

the Corresponding
Vertebra

The Same
Horizontal Plane

T4-T6

Over the Intervertebral Space Below

About 1/2 Inch

Up and Lateral

T7-T9

Over the Body of

the Vertebra Below

About 1 Inch Up
and Lateral

T10-T12

Over the Body of

the Corresponding
Vertebra

The Same
Horizontal Plane

Vertebrae

Forward Bending (Flexion) Dysfunction

Positional findings:

There is a slight separation of the spinous process

from the segment below.

There is a slight approximation of the spinous process to the one above.

There is usually tenderness of the supraspinous ligament.

Motion findings:

Rotation is restricted bilaterally.

Side-bending is usually restricted bilaterally.

The segment forward bends easily and is restricted

in backward bending.

Backward Bending (Extension) Dysfunction

Positional findings:

There is a slight separation of the spinous process

from the segment above.

There is a slight approximation of the spinous process to the one below.

There is usually tenderness of the supraspinous ligament.

Motion findings:

Rotation is restricted bilaterally.

Side-bending is usually restricted bilaterally.

The segment backward bends easily and is

restricted in forward bending.

Neutral Somatic Dysfunction

Positional findings (SXRY):

Approximation of the transverse processes on side

X, caused by side-bending toward side X.

Separation of the transverse processes on side Y.

Posterior transverse process on side Y, caused by

rotation to side Y.

Anterior transverse process on side X.

The spinous process may be shifted to side X.

Motion findings:
With motion testing, the segment will move in the direction of somatic dysfunction and it will be restricted in
the direction opposite of the somatic dysfunction.

Table 20: Neutral Positional Diagnosis

Sense of
Fullness and
Posterior
Transverse
Processes

Easy Normal
(EN)

(N)SLRR

Right

EN Right or ENR

(N)SRRL

Left

EN Left or ENL

Dysfunction

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Non-Neutral Somatic Dysfunction

Positional findings (R XSX):
Approximation of the transverse processes on side
X, caused by side-bending toward side X.
Separation of the transverse processes on side Y.
Posterior transverse process on side X, caused by
rotation to side X.
Anterior transverse process on side Y.
The spinous process may be shifted slightly to side
Y.
These dysfunctions are generally very painful and
may present with a significant amount of paravertebral muscle spasm.
Motion findings:
With motion testing, the segment will move in the direction of somatic dysfunction and it will be restricted in
the direction opposite of the somatic dysfunction.

Table 23: Muscles Used for Inhalation Rib

Somatic Dysfunction
Muscle

Transverse
Process
Position in
Extension

Dysfunction

Transverse
Process
Position in
Flexion

FRS Left

Posterior Left

Symmetrical

FRS Right

Posterior Right

Symmetrical

ERS Left

Symmetrical

Posterior Left

ERS Right

Symmetrical

Posterior Right

CHAPTER 9-RIBS

Rib 12 Directly

Intercostales

Forced Exhalation

CHAPTER 11-THE INNOMINATES

AND PUBES

The standing flexion test will be positive on the side

of the dysfunction in both innominate and pubic
dysfunctions..

Table 24: Innominate Dysfunction

Muscle

Acts Upon

Scalenes

Ribs 1-2

Pectoralis Minor

Ribs 3,4,5,(6)

Serratus Anterior

Ribs 6,7,8,9,10

Latissimus Dorsi

Ribs 9,10,11,12

Quadratus Lumborum

Rib 12 Indirectly

Intercostales

Forced Inhalation

Findings

Anterior Rotation

ASIS inferior, PSIS superior

Posterior Rotation

ASIS superior, PSIS inferior

Superior Shear

ASIS superior, PSIS superior

Inferior Shear

ASIS inferior, PSIS inferior

Innominate Inflare

ASIS closer to the umbilicus

Innominate
Outflare

ASIS further from the

umbilicus

Table 25: Pubic Dysfunction

Dysfunction

Table 22: Muscles Used for Exhalation Rib

Somatic Dysfunction

Acts Upon

Quadratus Lumborum

Dysfunction

Table 21: Non-Neutral Positional Diagnosis

Findings

Superior Shear

Pubic tubercle superior

Inferior Shear

Pubic tubercle inferior

Pubic Adduction

Distance between the

pubic tubercles is
decreased

Pubic Abduction

Distance between the

pubic tubercles is
increased

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CHAPTER 12-THE SACRUM

Table 26: Sacral Somatic Dysfunction
Dysfunction

Seated Flexion
Test

Spring
Test

Sphinx Test

Sacral Base
Findings

ILA Findings

L on LOA

Positive right

Negative

More
symmetrical

Right anterior

Left posterior &

inferior

R on ROA

Positive left

Negative

More
symmetrical

Left anterior

Right posterior
& inferior

R on LOA

Positive right

Positive

Less
symmetrical

Right posterior

Left anterior &

superior

L on ROA

Positive left

Positive

Less
symmetrical

Left posterior

Right anterior &

superior

Sacral Base
Anterior

Positive bilaterally
(may appear negative)

Negative

N/A

Anterior
bilaterally

Posterior bilaterally & even

Sacral Base
Posterior

Positive bilaterally
(may appear negative)

Positive

N/A

Posterior
bilaterally

Anterior bilaterally & even

Left Sacral Margin

Posterior

Left posterior

Left posterior &

even

Right Sacral
Margin Posterior

Right posterior

Right posterior
& even

Left Unilateral
Sacral Flexion

Positive left

Negative

More
symmetrical

Left anterior

Left posterior &

markedly
inferior

Right Unilateral
Sacral Flexion

Positive right

Negative

More
symmetrical

Right anterior

Right posterior
& markedly
inferior

Left Unilateral
Sacral Extension

Positive left

Positive

Less
symmetrical

Left posterior

Left anterior &

probably
superior

Right Unilateral
Sacral Extension

Positive right

Positive

Less
symmetrical

Right posterior

Right anterior &

probably
superior

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CHAPTER 13-THE LOWER

EXTREMITY
Somatic Dysfunction of the Hip Joint
The major motions (with the knee extended) and their
approximate ranges are:
Flexion- 80 to 90 degrees.
Extension- 25 to 35 degrees.
Abduction- 45 to 55 degrees.
Adduction- 25 to 35 degrees.
Internal rotation- 30 to 40 degrees.
External rotation- 40 to 50 degrees.
The ranges will be different if the knee is bent. Somatic
dysfunction may also occur in the minor motions of the
hip joint. Those motions are:
Anterior glide- occurs with external rotation.
Posterior glide- occurs with internal rotation.

Table 27: Tests of the Lower Extremity

Test

Somatic Dysfunctions of the Fibular Head

Fibular head anterior.
Fibular head posterior.
Fibular head posterior dysfunction may cause compression of the common fibular (peroneal) nerve.

Upper Motor Neuron

Dysfunction

Barlows Test

Hip Stability

Erichsens Test

Sacroiliac Pathology

Galeazzis (Allis) Test

Congenital Hip Dislocation Ages 3-18 mos.

Homans Sign

Deep Vein
Thrombophlebitis

Lachmans Test

Anterior Cruciate
Ligament

Ludloffs Sign

Traumatic Separation of
the Lesser Trochanter of
the Femur

McMurrays Test

Meniscal Tears

Obers Test

Iliotibial Band/Fascia
Lata Dysfunction

Ortolanis Test

Congenital Hip Dislocation in a Newborn

Patricks (FABER or
FABERE) Test

Hip Joint Pathology

Posterior Drawer Test

Posterior Cruciate
Ligament

Thomas Test

Contraction of the
Iliopsoas Muscle

Thompsons Test

Ruptured Achilles
Tendon

Trendelenburg Test

Gluteus Medius Muscle

(Superior Gluteal Nerve)

Table 27: Tests of the Lower Extremity

Test

Purpose

Purpose

Babinskis

Somatic Dysfunction of the Knee Joint

Dysfunction may occur in the major motions of flexion
and extension, or in any of the minor motions listed
below:
Medial and lateral glide.
Anterior and posterior glide.
Internal rotation with anteromedial glide.
External rotation with posterolateral glide.

10

Anterior Drawer Test

Anterior Cruciate
Ligament

Valgus Stress Test

Medial (Tibial)
Collateral Ligament

Anterior Drawer Test of

the Ankle

Anterior Talofibular and

Calcaneofibular Lig.

Varus Stress Test

Lateral (Fibular)
Collateral Ligament

Apleys Compression
Test

Knee Meniscal Injury

Apleys Distraction Test

Knee Ligamentous
Injury

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