Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

"Down and Dirty Osteopathy"

2,515 views

Published on

Dr. Richard Chmielewski, DO, FACEP, NMM/OMM gave a lecture on the ins and outs of Osteopathy and Osteopathic Medicine, including various techniques used by the Doctor on a daily basis.

Published in: Health & Medicine
  • Be the first to comment

"Down and Dirty Osteopathy"

  1. 1. Down and Dirty Osteopathy RICHARD CHMIELEWSKI, DO, FACEP, NMM/OMM THE FALCON CLINIC FOR HEALTH, WELLNESS AND RECOVERY 1 OXFORD CROSSING, SUITE #1 NEW HARTFORD, NEW YORK 13413
  2. 2. My personal journey into Osteopathic Medicine  Graduate Student in Neurophysiology at Cornell University  Osteopathic Medical Student at the College of Osteopathic Medicine and Surgery at Des Moines, Iowa  General practice/ hospitalist after graduation from Des Moines, 1976  Residency at Interboro Osteoapathic Hospital in Brooklyn, NY  Residency in Emergency Medicine – to board certification  30 years in emergency medicine  Stress/ burnout  General osteopathic medical practice in Utica area
  3. 3. Neurophysiology Studies at Cornell  Experiments on surgically exposed spinal cord of cats  Studied interneurones and how they integrate the afferent signals into the spinal cord from the periphery ( e.g. skin, muscle, and visceral organs such as the bladder, etc.)  Studied how those inputs can modify/ alter the output to the periphery or target organs ( e.g. muscle tone, activity of viscera such as the bladder)  Learned about the 4 major reflex patterns and how they interact:  Somato-somatic  Viscero-visceral  Somato-visceral  Viscero-somatic
  4. 4. I was already studying Osteopathy without even knowing it!
  5. 5. The 4 Basic Reflexes  Somato-somatic reflex - The Knee jerk or patellar reflex  Viscero-visceral reflex - The colon is full, needs to empty - defecation  Somato-visceral reflex - Pain from external injury causing BP and HR to rise  Viscero-somatic reflex - inflammation of the appendix will cause the muscles of the lower abdomen to be tense and sensitive, eventually over the appendix
  6. 6. The Reflex Arc and Interneurons
  7. 7. The Autonomic Nervous System Reflex Arcs are slightly different SOMATIC REFLEX ARC AUTONOMIC NERVOUS SYSTEM REFLEX ARC
  8. 8. THORACO-LUMBAR SYMPATHETIC GANGLIA AND THEIR RELATIONSHIP TO THE RIBS AND THE PARIETAL PLEURA
  9. 9. A LITTLE KNOWN NERVE - THE RECURRENT MENINGEAL NERVE OF LUSCHKA  The meningeal branches of the spinal nerves (also known as recurrent meningeal nerves, sinu-vertebral nerves, or recurrent nerves of Luschka) are a number of small nerves that branch from the spinal nerve near the origin of the anterior and posterior rami, but before the rami communicantes branch. They then re-enter the intervertebral foramen, and innervate the facet joints, the anulus fibrosus of the intervertebral disc, and the ligaments and periosteum of the spinal canal, carrying pain sensation. The nucleus pulposus of the intervertebral disk has no pain innervation.
  10. 10. RECURRENT MENINGEAL NERVE OF LUSCHKA
  11. 11. Sites of Innervation of the Recurrent Meningeal Nerve of Luschka  INNERVATES THE:  Ligaments within the spinal canal  The capsule of the articular facets  The vascular system of the spinal cord  A short branch terminates in the venous plexus of the spinal cord  A longer branch enters the epidural space, breaks up into smaller branches and is then distributed over the posterior surface of the vertebrae and the anterior surface of the lamina  Other filaments enter the posterior longitudinal ligament and innervate the meninges of the spinal cord  The nerve is reported to exist in all portions of the spinal column
  12. 12. Challenges today parallel those faced in the mid and late 19th century by Dr. Still  Disenchantment/ distrust of the medical profession  Overreliance on medications  Epidemic of addiction ( narcotics and alcohol, drug abuse)
  13. 13. Relevance of Osteopathy to Today’s World of Medicine – multiple crises  Need for more primary care physicians  Narcotics Overuse/ Overprescribing and Addiction  Public’s Perception of Prescribing Medications  Public’s Perception of Alternative Medicine  NIH and the CAM section
  14. 14. What is Osteopathic Intervention Good For?  To Help the Body to Function Better  It might involve improving a physiologic function (e.g. breathing, better functioning bowel movements, reduce swelling, etc.)  It might involve improving mechanical/ musculoskeletal functioning ( anywhere in the body)  Can be used to improve the body’s own ability to fight infection/ heal, e.g. specific treatment of asthma, or pneumonia/ influenza, etc.
  15. 15. Osteopathy vs. Osteopathic Medicine  Definition of Osteopathy – from Dr. A.T. Still  The Rule of the Artery Reigns Supreme  The object of the physician is to find health, anyone can find disease.
  16. 16. Definition of Osteopathic Medicine - from the Littlejohn brothers and into the 20th Century  Osteopathic medicine:  A complete system of medical care with a philosophy that combines the needs of the patient with the current practice of medicine, surgery and obstetrics, and emphasizes the interrelationships between structure and function, and an appreciation of the body's ability to heal itself.
  17. 17. Philosophy and Practice  Osteopathy is , first and foremost, a philosophy  Developed and founded in the late 19th century by Dr. Andrew Taylor Still Dr. Andrew Taylor Still Founder, Osteopathy 1828-1917
  18. 18. The Four Components of the Osteopathic Philosophy  The body is a unit, and the person represents a combination of body, mind and spirit.  The body is capable of self-regulation, self-healing and health maintenance.  Structure and function are reciprocally interrelated.  Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.
  19. 19. It’s All About Circulation Arterial – Venous-Lymphatic Cerebrospinal Fluid Circulation Axoplasmic Flow in Neurons
  20. 20. The Autonomic Nervous System And How Circulation Throughout the Body is Integrated and Controlled by the Nervous System
  21. 21. Dermatomes – the body is a wiring diagram
  22. 22. Cause and Effect Logic - linear Individual (a) (b) ( c ) Result
  23. 23. Holistic Logic – non-linear  ( c )  Result  (a)  Individual  (b)
  24. 24. Osteopathic Manipulative Treatment - OMT  Osteopathy is a Holistic Philosophy  It uses the 4 principles of Osteopathic Medicine as the basis of treatment
  25. 25. Osteopathic Manipulation as an Important Tool The musculoskeletal system ( muscles, bones and fascia) make up 70% of the human body weight Osteopathic Manipulative Treatment ( OMT) is a significant modality to affect the body, assisting it in it’s OWN healing process “Manipulation is central to, not synonymous with Osteopathy” Anthony Chila, DO
  26. 26. Fascia  Fascia is a specialized system of the body that has an appearance similar to a spider's web or a sweater.  Fascia is very densely woven, covering and interpenetrating every muscle, bone, nerve, artery and vein, as well as, all of our internal organs including the heart, lungs, brain and spinal cord.  It is not just a system of separate coverings. It is actually one continuous structure that exists from head to toe without interruption. In this way you can begin to see that each part of the entire body is connected to every other part by the fascia, like the yarn in a sweater.
  27. 27. Some Images of Fascia
  28. 28. The Application of Principles of Osteopathy in Clinical Practice  The Barrier Concept – restrictions of motion  T.A.R.T.  Somatic Dysfunction  Principles of Motion  Direct and Indirect Techniques
  29. 29.  “Barrier” defines the limit of motion.  The Barrier Concept describes motion in a joint or in tissue in one plane.  A neutral point exists along with barriers.  The presence of a somatic dysfunction will alter normal barriers and produce a pathologic neutral point. The Barrier Concept
  30. 30. The Barrier Concept
  31. 31. The Barrier Concept
  32. 32. T.A.R.T.  Tissue Texture Changes  Asymmetry  Restriction of motion  Tenderness
  33. 33. Somatic Dysfunction  Def: “impaired or altered function of related components of the somatic (body  framework) system: skeletal, arthrodial, and myofascial structures, and related  vascular, lymphatic, and neural elements”  Glossary of Osteopathic Terminology, 2001
  34. 34. Diagram of a Somatic Dysfuncton Related: Skeletal Arthrodial (joint) Myofascial Related Elements Vascular Lymphatic Neural
  35. 35. Principles of Motion  H.H. Fryette, D.O. (a CCOM graduate )  First described the principles of physiologic spinal motion in the 1920’s.  These are the principles that we use today to describe typical spinal motion--both segmental and groups of segments.  The TWO principles he described are Principles I and II. REF: Presentation on theme: "Osteopathic Medicine Osteopathic Medicine John M Lavelle, D.O. John M Lavelle, D.O. Spine Physiatrist. - http://slideplayer.com/slide/4311457/
  36. 36. Freyette’s Principle I  When the spine is in neutral (absence of marked flexion or extension), and sidebending is introduced, a group (3 or more) of vertebrae rotate into the produced convexity.  Maximum rotation occurs at the APEX.  Rotation and sidebending occur to OPPOSITE sides.
  37. 37. Freyette’s Principle II  When flexion or extension is sufficient to localize forces to a single segment (non-neutral position), rotation and sidebending occur to the SAME side.  The segment rotates into the produced concavity.  Single segment (Type II) mechanics. E.g., rotation and sidebending both to the right
  38. 38. Utilizing Direct and Indirect Techniques and the Barrier Concept  Direct technique engages the restrictive (pathologic) barrier.  Indirect technique moves toward pathologic neutral.
  39. 39. Names of some of the major OMT techniques  HVLA - high velocity low amplitude  LVMA – low velocity medium amplitude  MET – muscle energy technique  CT – counterstrain technique  Cranial – cranial technique ( OCF, osteopathy in the cranial field  LAST – ligamentous articular strain technique  Lymphatic Pump Techniques  BLT – balanced ligamentous tension  MR – myofascial release
  40. 40. HVLA Technique  High-velocity-low-amplitude techniques* (also called thrust or mobilization with impulse) – involves a quick thrust over a short distance to restore joint play or a desirable gap between articulating surfaces that permits free translational or gliding motion in addition to the usual angular motion.  Contraindicated in patients with Down syndrome due to instability of the atlantoaxial joint which may stem from ligamentous laxity,  And in pathologic bone conditions such as fracture, history of a pathologic fracture, osteomyelitis, osteoporosis, and severe cases of rheumatoid arthritis  Contraindicated in patients with vascular disease such as aneurysms, or disease of the carotid arteries or vertebral arteries. People taking ciprofloxacin or anticoagulants  or who have local metastases should not receive HVLA.[ https://en.wikipedia.org/wiki/Osteopathic_manipulative_medicine http://escholarship.org/uc/item/31547932#page-1
  41. 41. Cavitation in HVLA  Sometimes an Audible Pop is Heard during HVLA – Cavitation  The sound often heard during an HVLA manipulation is called cavitation. The pop is caused by a release of gas when the joint is pushed a short distance past its passive range of motion of the joint. The mechanism is similar to cracking ones knuckles.  Some clinicians and patients consider an audible pop necessary for the treatment to be successful, although there is no scientific physiological data from studies with large patient populations to confirm this belief.
  42. 42. LVMA Technique  Low Velocity Medium Amplitude Technique – similar to HVLA but involves a slower thrust or movement over a greater distance to restore joint play or a desirable gap between articulating surfaces that permits free translational or gliding motion in addition to the usual angular motion.  There is usually no cavitation sound produced with this procedure
  43. 43. MET Technique  Muscle energy techniques* – patient directs muscle energy from a precise position in a direction against counterforce applied by the physician, thereby creating isometric contraction that results in joint mobilization and lengthening of contracted muscles.
  44. 44. Counterstrain Technique  Counterstrain techniques – the patient is moved passively away from the restricted motion towards the position of greatest comfort (usually a position where the muscle is at its shortest length), where the position is held for 90 seconds and the joint is slowly and passively returned to the neutral position.
  45. 45. Osteopathy in the Cranial Field (OCF)  “Cranial” – based on the supposition that (barely perceptible) oscillatory motions of the cranial bones and sacrum exist, the amplitude and rate are thought to provide information about the patient’s health and to be influenced by the application of gentle pressure over specific areas of the cranium and sacrum.
  46. 46. Ligamentous Articular Strain ( LAST)  LIGAMENTOUS ARTICULAR STRAIN TECHIQUE  Similar to balanced ligamentous strain techniques, but may use a lot more force, EVEN UP TO 40 LB OF PRESSURE  THERE ARE THREE COMPONENTS TO THIS TECHNIQUE:  DISENGAGEMENT - this can be with either compression into the affected joint, or traction away from the affected joint. The physician then uses palpation to bring the tissue to a neutral point.  EXAGGERATION – after disengagement, the joint or tissue is taken into the direction of the injury. By approaching the dysfunction with exaggeration of its relative freedom, a balance point is determined.  BALANCE POINT – establishing the balance point leads to the resolution of the somatic dysfunction. The key to successful treatment is this delicate balance of all the ligaments.
  47. 47. Lymphatic Pump Techniques  Lymphatic pump techniques  designed to promote circulation of the lymphatic fluids by physical measures such as pectoral traction, postural drainage, effleurage, thoracic expansion, and rhythmic passive dorsiflexion of the feet in an attempt to enhance lymphatic return either by influencing negative intrathoracic pressure or mechanically assisting return of lymph from the lower extremities.
  48. 48. Balanced Ligamentous Tension  BLT or balanced ligamentous tension techniques – USE A VERY LIGHT TOUCH, POSSIBLY 1-3 LB AT MOST  The technique was reportedly invented by A.T. Still  It was later described by his students Rebbecca Lippincott and William Garner Sutherland, who greatly expanded it  The general prescription is to disengage and exaggerate the diagnosed somatic dysfunction. This is the indirect component. The practitioner then waits for a change in the palpatory quality of the structure being treated, i.e., a change in skin tension, temperature, or muscle tension. This is followed by a balancing stage in which the practitioner slowly brings the joint into the diagnosed dysfunction (the direct component).
  49. 49. Myofascial Release Techniques  Myofascial release techniques  Similar to deep massage, the goal is to stretch muscles and fascia to reduce tension by applying a constant force traction to the long axis of the muscles until muscle release occurs
  50. 50. EVALUATION/ TREATMENT FLOW FOR OMT BY PHYSICIAN  History/ Physical exam  Review of any pertinent imaging studies/ lab studies  Discussion with the patient on treatment  Structural Exam  Treatment either during structural exam or afterwards  Advice to the patient ( prescription for medications, application of topical crèmes or gels, application of heat/ cold packs, use of TENS units, use of brace (on the neck, back, extremities, etc.)  Exercise or stretching prescription with demonstration for the patient  Handing out printed instructions or step by step details of an exercise, etc.
  51. 51. OMT TECHNIQUES BY AREA HEAD NECK RIBS LOW BACK SACRUM AND PELVIS EXTREMITIES
  52. 52. HEAD 1. Suboccipital Release 2. Venous Sinus Drainage Technique 3. CV4 Technique ( cerebral ventricle 4)
  53. 53. SUBOCCIPITAL RELEASE
  54. 54. VENOUS SINUS DRAINAGE TECHNIQUE The technique involves gentle rhythmic pressure/ release starting at 1, the INION, and then to the 2. TRANVERSE SINUSES of the occiput 3. Spreading of the OCCIPITAL SINUS, then to spreading of the 4. SUPERIOR SAGITAL SINUS , then to spreading the 5. METOPIC SUTURE area
  55. 55. ANATOMY FOR THE VENOUS SINUS DRAINAGE TECHNIQUE
  56. 56. CEREBRAL VENTRICLE 4 TECHNIQUE or CV 4 TECHNIQUE
  57. 57. NECK – TECHNIQUES FOR TREATMENT OF CERVICAL DYSFUNCTIONS1. HVLA - Controversial. Many Osteopathic Medical Schools no longer teach HVLA of the cervical spine. Has caused tears/ rupture of the vertebral artery, resulting in some cases of stroke 2. FPR – Facilitated Positional Release 3. BLT – Balanced Ligamentous Technique 4. MET – Muscle Energy Techniques
  58. 58. FPR – Facilitated Positional Release 1. The Spurling test is conducted first to assure that the person does not have a herniated cervical disc. 2. It is not necessary to know if the dysfunction is in flexion or extension, only to which side the vertebra is rotated 3. One palpates for the rotated transverse process 4. While one hand/ thumb or finger monitors the area of dysfunction, the other hand is placed on top of the head 5. A firm pressure is applied , with the vector of pressure directed at the area of dysfunction 6. The neck is flexed and rotated to the level of the dysfunction 7. The position is held for a short period of time ( classically 3-5 seconds) 8. With pressure maintained, the head and neck are rotated back to the midline and then placed into neutral 9. Only then is pressure released from the top of the head
  59. 59. Spurling Test for Herniated Cervical Disc
  60. 60. FPR Technique modiification The FPR ( facilitated positional release) can also be done with distraction, or separation at the level of dysfunction with the patient supine, instead of sitting.
  61. 61. BLT – Balanced Ligamentous Tension  The general prescription is to disengage and exaggerate the diagnosed somatic dysfunction. This is the indirect component. The practitioner then waits for a change in the palpatory quality of the structure being treated, i.e., a change in skin tension, temperature, or muscle tension. This is followed by a balancing stage in which the practitioner slowly brings the joint into the diagnosed dysfunction (the direct component).  Disengage, Exaggerate, Guide the joint into and through its barrier of dysfunction
  62. 62. Balanced Ligamentous Tension  The goal is to also find the balance point of release away from the barrier of motion or restriction.  The motive force of release is initiated by the inherent forces of healing (tides or rhythmic power, the Health, or other non-material vital elements).  This gentle approach is like using Cranial Osteopathy on areas outside of the head.
  63. 63. MET – Muscle Energy Technqiue The patient actively uses his muscle, on request, “from a precisely controlled position in a specific direction, against a distinctly executed counterforce. The somatic dysfunction is diagnosed first, then reverses all components in all planes and engages the restrictive barrier. The patient contracts the affected area equally against the offered counterforce by the physician. This induces an ISOMETRIC CONTRACTION for about 3-5 seconds. The patient and physician BOTH relax for a few seconds during the post-isometric relaxation phase, after which the physician takes up the slack in the tissues Because of the reflex relaxation, the physician is then able to passively stretch the patient in all planes of motion to the new restrictive barrier.
  64. 64. An Example of MET Technqiue Positional Diagnosis: OA E SlRr ( extended, sidebent left, rotated right) Engage the restrictive barrier in all three planes by sidebending the head to the right, rotating left, and flexing the patient’s head until tension is felt under the monitoring finger by the left OA joint. Have the patient use a small amount of force to straighten their head while the physician exerts an equal amount of counterforce. After 3-5 seconds re-engage the new restrictive barrier. Repeat. Recheck.
  65. 65. The Ribs THREE TYPES OF MOVEMENT: 1. PUMP HANDLE MOTION – the first 5 ribs - the upper ribs 2. BUCKET HANDLE MOTION – ribs 6-10 - the middle ribs 3. CALIPER MOTION - ribs 11 and 12 - the lower ribs
  66. 66. RIB DYSFUNCTIONS INHALATION DYSFUNCTION – The rib will be “stuck up” in inhalation Key Rib – that rib which will prevent the rib/ group of ribs from going “down” , or into exhalation, will be the lowest rib in the group EXHALATION DYSFUNCTION - The rib will be “stuck down” in exhalation Key Rib - that rib which will prevent the rib/ group of ribs from going “up”, or into inhalation, will be the highest rib in the group REF: Savarese, R.G. OMT Review. 2nd edition. p.13
  67. 67. RIB DYSFUNCTION TECHNIQUES ATTACHMENT OF MUSCLES TO THE VARIOUS RIBS FOR CONSIDERATION OF TREATMENT OF EXHALATION DYSFUNCTIONS: RIBS MUSCLES RIB 1 Anterior and Middle Scalenes RIB 2 Posterior Scalene RIBS 3-5 Pectoralis Minor RIBS 6-9 Serratus Anterior RIBS 10-12 Latissimus Dorsi REF: Savarese, R.G. OMT Review. 2nd edition. p.74
  68. 68. MUSCLES FOR TECHNIQUES FOR RIB DYSFUNCTIONS (exhalation dysfunctions) SCALENES Nerves – C4,5 and 6 PECTORALIS MINOR Nerves – C6- T1 Serratus Anterior Nerves – the long thoracic nerve of Bell; C5,6 and 7 Latissimus Dorsi Nerves – C 6.7 and 8
  69. 69. TECHNIQUES FOR TREATMENT OF RIB DYSFUNCTIONS 1. Still Articulatory Technique 2. MET – Muscle Energy Techniques 3. HVLA – High Velocity Low Amplitude Techniques 4. BLT – Balanced Ligamentous Tension
  70. 70. TECHNIQUES FOR TREATMENT OF THORACIC DYSFUNCTIONS HVLA MET FPR
  71. 71. HVLA FOR THORACIC DYSFUNCTONS  Diagnose the somatic dysfunction : flexion/ extension; sidebending; rotation  With patient supine, stand on side opposite the posterior transverse process  The patient crosses their arms over their chest – “opposite over adjacent “ to the physician – the top arm is a LEVER  Place the thenar emminence over the posterior transverse process of the dysfunctional segment  Flex the torso to the level of the dysfunction  Sidebend the patient to engage the restrictive barrier  Have the patient take a deep breath and exhale
  72. 72. TECHNIQUE OF HVLA DEPENDING ON FLEXION OR EXTENSION DYSFUNCTON If the somatic dysfunction is in FLEXION ;  Place the thenar emminence on the posterior transverse process of the somatic dysfunction  apply a downward thrust towards the floor  If the somatic dysfunction is in EXTENSION;  Place the thenar emminence on the posterior transverse process of the VERTEBRA BELOW the dysfunctional segment  Apply a 45 dgree cephalad thrust
  73. 73. MET FOR THORACIC DYSFUNCTIONS The patient is sitting and the somatic dysfunction is identiied.  The physician stands behind the patient  The patient places one hand on their opposite shoulder.  Depending on the arm used, the physician can place their arm under the patient’s arm to use it as a lever , or wrap their arm over the patient’s hand and holds the opposite shoulder.  The patient is placed in the position of the dysfunction ( e.g. if T6 ESlRl , then flex the torso to the level of the dysfunction, sidebend and rotate the patient to the right)  Place a thumb on the dorsal spine at the level of dysfunction, resisting rotation of that vetebra  Have the patient attempt to straighten up as the physician resists their attempt with their hand or arm  Allow the segment to relax ( post-isometric relaxation phase)for a few seconds before taking up the slack in the tissues, and repeating.  Recheck the somatic dysfunction
  74. 74. FPR for THORACIC DYSFUNCTONS 1. A modified Spurling test is conducted first to assure that the person does not have a herniated thoracic disc. 2. It is not necessary to know if the dysfunction is in flexion or extension, only to which side the vertebra is rotated 3. One palpates for the rotated transverse process 4. While one hand/ thumb or finger monitors the area of dysfunction, the other arm/ forearm/ hand is placed on the ipsilateral shoulder/ trapezius area 5. A firm pressure is applied , with the vector of pressure directed at the area of dysfunction 6. The thoracic spine is extended, and rotated to the level of the dysfunction 7. The position is held for a short period of time ( classically 3-5 seconds) 8. With pressure maintained, the torso is rotated back to the midline and then placed into neutral 9. Only then is pressure released from the shoulder/ trapezius area
  75. 75. Lumbar  HVLA  ARTICULATORY TECHNIQUE  LIGAMENTOUS ARTICULAR STRAIN TECHNIQUE
  76. 76. Considerations for Lumbar Somatic Dysfunction Be sure of the diagnosis that there is no contraindication such as the possibility of: Compression fracture Possibility of primary or metastatic cancer Herniated lumbar disc Cauda Equina Syndrome
  77. 77. Red Flag “Danger” Signs Requiring Further Workup Rather than OMT  Age of onset less than 20 yrs or more than 55yrs  Recent history of violent trauma  Constant progressive, non mechanical pain (no relief with bed rest)  Thoracic pain  Past medical history of malignant tumour  Prolonged use of corticosteroids  Drug abuse, immunosuppression, HIV  Systematically unwell  Unexplained weight loss  Widespread neurological symptoms (including cauda equine syndrome)  Structural deformity  Fever
  78. 78. Cauda Equina Syndrome Symptoms of cauda equina syndrome include: Low back pain Numbness and/or tingling in the buttocks and lower extremities (sciatica) Weakness in the legs Incontinence of bladder and/or bowels “Saddle anesthesia“ - where the body would touch a saddle
  79. 79. HVLA - Lumbar  HVLA of the lumbar spine – also known as the “LUMBAR ROLL ‘  Patient is in the lateral recumbent position  Stand in front of the patient  Flex the patient’s legs until you feel motion at the level of the somatic dysfunction  Straighten the patient’s inferior leg  Hook the superior foot in the lower leg’s popliteal fossa  If transverse process “up”, pull patient’s inferior arm out and caudad.  If transverse process “down”, pull patient’s inferior arm out and cephalad.  Place one arm in patient’s axilla and the other on the patient’s iliac crest  Have patient take a deep breath and exhale  Apply HVLA thrust by rotating patient’s pelvic forward and toward the table REF: Savarese, R.G. OMT Review. 2nd edition. p.84
  80. 80. Positioning for lumbar HVLA
  81. 81. MET – Muscle Energy Technique for Lumbar spine NOTE: The positioning for MET can be the same as for HVLA but using the principles of MET instead For a TYPE I group dysfunction in the lumbar spine: 1. Patient assumes the lateral recumbent position 2. The knees are bent and the lumbar spine is flexed to take out the lumbar lordosis 3. The knees are placed over the physician’s knee/ thigh, which acts as a fulcrum 4. The patient’s feet and ankles are raised or lowered, to open up the concavity of the lumbar spine dysfunction 5. The patient pushes against a physician counterforce for a few seconds , then relaxes. The slack is then taken up and the technique is repeated.
  82. 82. MET in the lumbar spine for a type I group dysfunction
  83. 83. Spencer Technique for the shoulder  Glenohumeral extension  Use slow gentle springing motion at the point of resistance and muscle energy.  Glenohumeral flexion  Circumduction with compression  Circumduction with traction  Abduction of the shoulder joint  Internal Rotation  Joint Pump
  84. 84. A Variation on the Spencer Technique  Stage 1: shoulder extension with elbow flexion  Stage 2: shoulder and elbow extension shoulder and elbow flexion  Stage 3: abduct to 90°, stabilize shoulder, move in circumduction with compression toward joint  Stage 4: abduct to 90°, stabilize shoulder, move in circumduction with traction  Stage 5: abduction  Stage 6: test internal rotation by placing pts hand behind back and pulling elbow forward  Stage 7: arm traction and deltoid pump. This may also be used to start treatment.
  85. 85. Examples of techniques used at the Falcon Clinic for various clinical situations THE INFLUENZA PROTOCOL  a. Thoracic pump  b. stretching of Sibsen’s fascia, lymphatic drainage of the anterior and posterior cervical chains  c. suboccipital release  d. massaging of the frontal and maxillary sinuses  e. Hepatic pump  f. Splenic pump  g. effleurage of the thighs and lower legs  h. Pedal pump (Dalrymple pump)
  86. 86. Examples of techniques used at the Falcon Clinic for various clinical situations THE TRIPLE TECHNIQUE FOR THE KNEE  a. MET for the medial and lateral collateral ligaments of the knee  b. Modified counterstrain technique ( anterior and posterior cruciate ligaments)  c. Modified BLT technique to balance out the muscle and ligamentous tensions on all of the soft tissues of the lower leg, from the ankle, through the knee and through the hip and into the lower back

×