nicholas ch00 contents

7/29/2019 Nicholas Ch00 Contents

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Authors

Alexander S. Nicholas DO, FAAO

Professor and Chairman

Department of Osteopathic Manipulat ive Medic ine, Phi ladelphia Col lege of Osteopathic

Medic ine, Phi ladelphia, Pennsylvania

Evan A. Nicholas DO

Associate Professor

Department of Osteopathic Manipulat ive Medic ine, Phi ladelphia Col lege of Osteopathic

Medic ine, Phi ladelphia, Pennsylvania


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Secondary Editors

Donna Balado

Acquisi t ions EditorKathleen H. Scogna

Development Editor

Keith Donnellan

Managing Editor

Dovetai l Content Solut ions

Emilie Moyer

Market ing Manager

Eve Malakoff-Klein

Product ion Editor

Stephen Druding

Design Coordinator

Michael Ferreira

Indexer

Maryland Composit ion, Inc.

Compositor

R.R. Donnelley and SonsWillard

Printer


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Dedication

Dr. Nick

In 1974, the authors ' father, Nicholas S. Nicholas, DO, FAAO, chairman of the Osteopathic

Pr inc iples and Pract ice Department at Phi ladelphia Col lege of Osteopathic Medic ine

(PCOM) publ ished the f i rs t edi t ion of At las of Osteopathic Techniques . His goal was to put

into pr int a number of the commonly used osteopathic manipulat ive techniques of that t ime.

They were to be used by medical s tudents to reference the techniques being taught in t he

classroom and to s tandardize the techniques so that in the oral examinat ion, the evaluat ion

of their work could be more object ively evaluated.

Nicholas S. Nicholas, DO, a 1939 graduate of Kirksv i l le Col lege of Osteopathy, was a

general pract i t ioner who also special ized in industr ial and sports medic ine. He used

osteopathic techniques rout inely in his pract ice, and because of the c l inical results , he wasvery exc i ted to teach these techniques to medical s tudents. Affect ionately known as Dr.

Nick to his s tudents, he began teaching at PCOM in 1946 and in 1974 became chairman of

the Osteopathic Pr inc iples and Pract ice Department. In 1974, he enl is ted PCOM faculty

members to develop a l is t of techniques to inc lude in the or iginal edi t ion of his at las. These

faculty members inc luded David Hei l ig, DO, FAAO; Robert England, DO, FAAO; Marv in

Blumberg, DO, FAAO; Jerome Sulman, DO; and Kather ine England, DO.

The students benef i ted, and their at tempts to learn t he techniques were improved, as was

seen dur ing PCOM examinat ions. As word of this text spread, PCOM alumni and othe r

osteopathic physic ians also saw a need for this text as a rev iew and/or reference of

s tandard techniques for their pract ices. Because of i l lness, Dr. Nick was able to produce

only two edit ions of his work.

Over the years, the at las gave way to v ideotape demonstrat ions of techniques and fur ther

edited and expanded vers ions of the wr i t ten techniques. From the t ime of the incept ion of

the at las, the number of named sty les of osteopathic techniques being taught i n osteopathic

medical schools has grown from approximately three to twelve dis t inct ly named sty les.

Many of the sty les have s imi lar i t ies that can lead to confus ion, which is why we have

decided to expand the or iginal vers ion and upda te i t to the present level of pract ice.

We dedicate this book to our father, who would most l ikely have wanted to dedicate i t t o al l

of his former s tudents and to al l the future osteopathic physic ians he thought would

appreciate a comprehensive work on osteopathic manipulat ive techniques.


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Preface

Osteopathic medic ine as taught and pract iced in the United States at the end of the 19th

century through the beginning of the 21st century has undergone many changes. The

evolut ion of sc ient i f ic f indings and understanding of b iologic processes by which the body

funct ions and at tempts to maintain health has had a direct ef fe ct on the way osteopathic

medical curr icula are developed.

Dur ing our osteopathic medical school matr iculat ion, we were taught only three or four

separate sty les of osteopathic technique. Since that t ime, many new diagnost ic and

therapeut ic procedures have been added to the armamentar ium of osteopathic t reatment,

and there are now over a dozen indiv idual s ty les. Some of these sty les are very s imi lar ,

and as descr ibed in the chapters of this at las, they have developed by nuance into dis t i nct ,

indiv idual ly named categor ies of technique.Because of these addit ions and changes, both osteopathic medical s tudents and

pract i t ioners have had a much more di f f icul t t ime try ing to learn and remember these

techniques, and pract i t ioners have faced an increasingly complex process in deciding which

technique is c l inical ly indicated for a part icular pat ient . To aid the study and pract ice, we

have gradual ly developed a compi lat ion of techniques that a re commonly used by

osteopathic physic ians and that are c l inical ly ef fect ive. The result of this ef for t is the At las

of Osteopathic Techniques .

At Phi ladelphia Col lege of Os teopathic Medic ine, a t radi t ion of technique at las goes back to

at least 1949 with the publ icat ion of Osteopathic Techniques , by Samuel Rubinstein, DO. I t

was dedicated to two highl y respected physic ians, Otterbein Dressler, DO, and John

Eimerbr ink, DO. In his preface, Dr. Rubinstein noted, The necessity for this type of

textbook has become increasingly apparent with t ime because of the need to have a v isual

record of the var ious physic ian and pat ient posi t ions and force vectors at play. Yet no other

example was readi ly reproduced unt i l N. S. Nicholas, DO, FAAO, publ ished his At las of

Osteopathic Technique in 1974.

Throughout our years of t eaching, many pract ic ing physic ians have asked us why there

were no new edit ions of the At las of Osteopathic Technique . Our ini t ial answer was that

other texts had been publ ished. However, these reference textbooks focus on the

phi losophy and pr inc iples of osteopathic medical pract ice and inc lude only a few useful

techniques. The need for an updated, comprehensive at las of techniques became

increasingly c lear, and we have responded with a textbook that inc ludes a straightforward,

highly organized, and easi ly navigable compendium of osteopathic techniques along with

the phi losophy and pr inc iples that support them. This mater ial is intended to help s tudents

and pract i t ioners understand the reasoning behind the procedures and the ramif icat ions of

their use in the c l inical set t ing.

One of the major improvements in the At las of Ost eopath ic Techniques is the presentat ion

of more than 1000 color photos of every procedural s tep involved in each technique. T he

photos for each technique are placed together on t he same or adjacent pages, along with

descr ipt ive text , to make the book easy to use in the c l inical set t ing. The new photos were

created specif ical ly for this at las under the direct ion of the authors and a professional


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photographer. Arrows and other annotat ions direct ly on the pho tos guide the reader through

the techniques. The c lar i ty of these photos and their annotat ions, combined with their

organizat ion into an easy-to-use format, make this at las an extremely useful tool in both the

laboratory and the c l inic .

Also included in the at las are the var ious d iagnost ic procedures common to osteopathic

medic ine. The descr ipt ions for these inc lude the musculoskeletal s tructural examinat ion,

regional range of mot ion assessment, layer-by- layer palpatory examinat ion, and the

intersegmental examinat ion of the spinal and pelv ic regions. Diagnosis is inc luded so th e

reader can relate the specif ic t reatment to the diagnost ic cr i ter ia that g overn i ts use. This is

important, as the physic ian must understand the nature of the dysfunct ion and the

technique best sui ted to t reat i t successful ly .

We have organized this at las into two sect ions: Part 1, Osteopathic Pr inc iples in Diagnosis ,

and Part 2 Osteopathic Manipulat ive Techniques. The order of Part 1 is s imi lar to how we

present the mater ial to osteopathic medical s tudents and is in keeping with what we bel ie ve

is the most appropr iate and safe method of performing the osteopathic musculoskeletalexaminat ion. We have arranged Part 2 in what we consider the c lass ical format, by

technique sty le, as the reader should f i rs t decide on a sty le, then proceed to the

appropr iate chapter and to the specif ic anatomic region within t hat chapter.

We hope that the reader wi l l f ind thi s useful in al l s tages of osteopathic educat ion:

undergraduate, postgraduate res idency, and cont inuing medical educat ion . We hope use of

this text wi l l inst i l l more conf idence in performing these techniques and thereby hel p

readers to better help pat ients. As physic ians, we are trained to use our minds and hands,

and as osteopathic physic ians, we are frequent ly reminded that i t is inherent to ou r pract ice

to do so. As the seal of Phi ladelphia Col lege of Osteopathic Medic ine states, Mens et

Manus.

A. S. Nicholas

E. A. Nicholas


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Acknowledgments

The At las of Osteopathic Techniques is our ef for t to maintain a his tor ical cont inuum of the

many var iat ions of osteopathic manipulat ive techniques that have been used for over a

century in the United States and now in many other countr ies. We obviously have not

invented any techniques, nor have any been named after us. The many osteopathic

physic ians who have preceded us into this profess ion have taught us these techniques, and

we hope that this may cont inue their legacy.

A few phys ic ians must be part icular ly thanked. F irst , we must recognize our father ,

Nicholas S. Nicholas. Over many years of witnessing his pat ients ' overwhelmingly posi t ive

feel ings about the care they received at his hands, we could not choose any other form of

occupat ion, as they just seemed minor compared to the work he did. Second, we must thank

David Hei l ig. Our father many t imes stated that Hei l ig was the most able physic ian he had

ever seen with osteopathic diagnosis and technique. We were lucky enough to know him as

chi ldren and later to be taught b y him. We then worked s ide-by-s ide for more than 25 years,

shar ing ideas and techniques. We were blessed to be his f r iends.

Walter Ehrenfeuchter, our f r iend and col league f or many years, must also be recognized, as

he helped in developing the sty le of thi s at las and put to pen many of the techniques in our

or iginal manuals at PCOM. His understanding of muscle energy technique was specif ical ly

used as a model in development of that chapter, and his impr int can be f ound in other

chapters as wel l .

We must thank others who have inf luenced us as role models, teachers, and pract i t ioners

Bery l Arbuckle, Marv in Blumberg, Albert D'Alonzo, Henry D'Alonzo, Fairman Denl inger,Kather ine England, Robert England, W ayne Engl ish, Robert Kappler, Anthony Leone, Paul

T. Lloyd, Robert Meals, Ida Schmidt, Edward St i les, James Stookey, Jerome Sulman, Galen

D. Young, Galen S. Young, and Abraham Zel l isfor al l of their support and helpful

comments over three decades. More recent ly , we have had important input f rom our f r iends

and associates Denise Burns, Wil l iam Thomas Crow, John Jones, and Michael Kuchera.

We cannot forget the many undergraduate PCOM osteopathic manipulat ive medic ine fel lows

who have been associated with this ef for t . Everyone associated with our department has

had some effect on the outcome, but some should be s ingled out for their or i ginal ideas,

edit ing, photo layouts, ar twork, and graphics on the manuals that preceded and eventual ly

culminated in this at las: Sandra Ranier i-Costa, Daniel Csaszar, Todd Feathers, Troy

Henning, Payce Handler-Haly, Thomas Haly, Shery l Lynn Ole ski , Concetta Oter i , Tara

Heinz-Lawlor, David Glusko, David Kel ler , Lauren Noto-Bel l , Francisco Laboy, Scott

Peerenboom, Daniel le Campbel l , Richard Sloan, Eun Strawser, and Kel l i Young. Special

thanks to Kyl ie Johnston-Kanze for her work on the cranial chapter.

Thanks to our other PCOM students who put in t ime helping with this project : Nimi Patel

and Nicholas Rossi (models) ; Kate Story, Ashley Palese, and Amanda Schompert (edi t ing);

Brad Taicher (computer sk i l ls ) ; and Patr ick Soto and Just in Snyder (medical i l lustrat ion).

Appreciat ion to Donna Balado for bringing this possibi l i ty to Lippincot t W il l iams & Wilk ins

and thanks to Keith Donnel len and Brett MacNaughton for their proddi ng, edi t ing, and


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i l lustrat ing, which f inal ly moved this project to complet ion, as wel l as helping t o give i t i ts

dis t inct ive look.

We a lso must thank our w ives, Ben i ta and Vick i , fo r the i r pa t ience w i th us dur ing th is en terpr ise .

List of TechniquesChapter 3

Forward Bending and Backward Bending (Flexion and Extension), Active 18

Forward Bending and Backward Bending (Flexion and Extension), Passive 19

Side Bending, Active and Passive 20

Rotation, Active and Passive 21

T1 to T4 Side Bending, Passive 22



T9 to T12 Rotation, Active 25

T9 to T12 Rotation, Passive 26

Forward Bending and Backward Bending (Flexion and Extension), Active 27

Side Bending, Active 28

Side Bending, Passive, with Active Hip Drop Test 29

Chapter 5
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L1 to L5-S1 Rotation, Short-Lever Method, Prone (L4 Example) 37

L1 to L5-S1 Side Bending, Translational Short-Lever Method, Prone (L4 Example) 38

L1 to L5-S1 Type 2, Extension (Sphinx Position) and Flexion, Prone 39

L1 to L5-S1 Passive Flexion and Extension, Lateral Recumbent Position 40

L1 to L5-S1 Passive Side Bending, Lateral Recumbent Position (L5-S1 Example) 42

T1 to T4 Side Bending, Lateral Recumbent Position (Long Lever) 43

T1 to T4 Passive Flexion, Extension, Side Bending, and Rotation, Seated, Long-Lever Method 44

T1 to T12 Passive Flexion and Extension, Translatory Method, Seated (T6-T7 Example) 46

T1 to T12 Translatory Method (Passive Side Bending), Seated 47

T1 to T12 Prone Short-Lever Method, Passive Rotation, Side Bending (Example T7) 48

T8 to T12 Long-Lever Method, Passive Flexion and Extension, Lateral Recumbent 49

T8 to T12 Long-Lever Method, Passive Side Bending, Lateral Recumbent 50

Upper Ribs 1 and 2, Supine Method 54

First Rib, Elevated, Seated Method 55

Upper Ribs 3 to 6, Supine Method 56

Lower Ribs 7 to 10, Supine Method 57

Floating Ribs 11 and 12, Prone Method 58

Occipitoatlantal Articulation (Occiput-C1), Type I Coupling Motion 60

Atlantoaxial Articulation (C1-C2), Rotation 62
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Atlantoaxial (C1-C2), Supine, with Flexion Alternative 63

C2 to C7 Articulations, Short-Lever Translatory Effect, Type II Motion 64

C2 to C7 Articulations, Long-Lever Method, Type II Motion (e.g., C3SRRR or SLRL) 65

Pelvis on Sacrum (Iliosacral), Anteroposterior Rotation, Supine, Long Lever (Leg Length) 66

Sacroiliac Joint and Pelvic Dysfunctions, Pelvic (e.g., Innominate Rotation, Shear, Inflare-

Outflare), Standing Flexion Test 67

Sacroiliac Joint and Pelvic Dysfunctions, Pelvic (Innominate) or Sacral, Seated Flexion Test 68

Sacroiliac Joint Motion, Pelvis on Sacrum (Iliosacral Dysfunction), Anteroposterior Rotation

Prone, Long Lever 69

Sacroiliac Joint Motion, Pelvis on Sacrum (Iliosacral Dysfunction), Inflare-Outflare Prone, Long

Lever 70

Sacroiliac Joint Motion, General Restriction, Prone, Short Lever 71

Sacroiliac Joint Motion, General Restriction or Anteroposterior Rotation, Supine, Short Lever 72

Chapter 7
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Traction, Supine 81

Forward Bending (Forearm Fulcrum), Supine 82

Forward Bending (Bilateral Fulcrum), Supine 83

Contralateral Traction, Supine 84

Cradling with Traction, Supine 85

Suboccipital Release, Supine 86

Rotation, Supine 87

Supine, Forefingers Cradling 88

Thumb Rest, Supine 89

Coupling with Shoulder Block, Supine 90

Lateral Traction, Seated (Example: Left Cervical Paravertebral Muscle Hypertonicity, FascialInelasticity, and Others) 91

Sitting Traction (Example, Using Right Knee) 92

Head and Chest Position, Seated 93

Prone Pressure 94

Prone Pressure with Two Hands (Catwalk) 95

Prone Pressure with Counterpressure 96

Side Leverage, Lateral Recumbent 97

Bilateral Thumb Pressure, Prone 98

Trapezius, Inhibitory Pressure, Supine 99

Upper Thoracic with Shoulder Block, Lateral Recumbent 100
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Chapter 8

Supine Cradling 118

Thoracic Inlet and Outlet, Seated Steering Wheel 119

Prone 120

Bilateral Sacroiliac Joint with Forearm Pressure, Supine 121

Prone 122

Interosseous Membrane, Seated 123

Supine Leg Traction 124

Chapter 9
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AC1 136

AC2 to AC6 138

AC7 (Sternocleidomastoid Muscle) 139

AC8 140

PC1 Inion 142

PC1 and PC2 143

PC3 to PC7, Midline 144

PC3 to PC7, Lateral 145

AT1 and AT2 147

AT1 to AT6 148

AT3 to AT4, Alternative Technique 149

AT7 to AT9 150

AT 9 to AT12 151

PT1 to PT4, Midline 153



PT4 to PT9, Lateral 156

PT4 to PT9, Lateral 157

PT9 to PT12 158

Anterior Rib, Exhaled and Depressed, AR1 and AR2 160
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Chapter 10
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Trapezius Muscle Spasm (Long Restrictor): Post Isometric Relaxation 184

Left Sternocleidomastoid Spasm (Acute Torticollis): Reciprocal Inhibition 185

Left Sternocleidomastoid Contracture (Chronic): Post Isometric Relaxation 186

Cervical Range of Motion: Oculocervical Reflex 187

Occipitoatlantal (C0-C1) Dysfunction, Example: CO ESLRR, Post Isometric Relaxation 188

Occipitoatlantal (C0-C1) Dysfunction, Example: CO FSLRR, Post Isometric Relaxation 190

Atlantoaxial (C1-2) Dysfunction, Example: RL, Post Isometric Relaxation 192

C2C7 Dysfunction, Example: C3-FSRRR, Post Isometric Relaxation 193

T1T4 Dysfunction, Example: T4-ESRRR, Post Isometric Relaxation 194

T1T6 Dysfunction, Example: T4-FSRRR, Post Isometric Relaxation 196

T5T12 Dysfunction, Example: T8 ESRRR, Post Isometric Relaxation 198

Right First Rib, Inhalation Dysfunction: Respiratory Assist, Seated 200

Right First Rib, Inhalation Dysfunction: Respiratory Assist, Supine 201

Right Ribs 1 and 2, Inhalation Dysfunction: Post Isometric Relaxation to Relax Scalene

Muscles, Seated 202

Right Ribs 1 and 2, Inhalation Dysfunction: Post Isometric Relaxation to Relax ScaleneMuscles, Supine 203

Right Ribs 2 to 6, Inhalation Dysfunction: Respiratory Assist 204

Right Ribs 7 to 10, Inhalation Dysfunction: Respiratory Assist 205

Right Ribs 11 and 12, Inhalation Dysfunction: Respiratory Assist 206

Right Ribs 1 and 2, Exhalation Dysfunction: Contraction of Scalene Muscles MobilizesDysfunctional Ribs 208
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Chapter 11
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Occipitoatlantal (C0C1, OA) Dysfunctions, Example: OA, F/E/or N-SLRR 278

Atlantoaxial (C1C2, AA) Dysfunction, Example: C1 RL 280

C2 to C7 Dysfunctions, Example: C4 FSLRL, Short-Lever, Rotational Emphasis 281

C2 to C7 Dysfunctions, Example: C5 ESRRR, Long-Lever Rotational Emphasis 282

C2 to C7 Dysfunctions, Example: C5 NSLRL, Short-Lever Technique, Side-Bending Emphasis 283

T1 to T12 Dysfunctions, Example: T4 FSLRL, Supine 284

T1 to T12 Dysfunctions, Example: T9 ESRRR, Supine 286

T1 to T8 Dysfunctions, Example: T2 FSLRL, Supine Over the Thigh 288

T3 to T8 Dysfunctions, Example: T6 FSRRR, Prone 289

T1 to T4 Dysfunctions, Example: T2 FSRRR, Prone (Long Lever) 290

T8 to T12 Dysfunctions, Example: T9 ESRRR, Seated (Short Lever) 291

T8 to T12 Dysfunctions, Example: T10 ESRRR, Seated (Long Lever) 292

Right First Rib Inhalation Dysfunction, Seated 293

Left First Rib Inhalation Dysfunction, Supine 294

Left Rib 6 Inhalation Dysfunction, Supine 295

Left Rib 8 Exhalation Dysfunction, Supine 296

Right Ribs 11 and 12 Inhalation Dysfunction, Prone 297

Right Ribs 11 and 12 Exhalation Dysfunction, Prone 298

L1 to L5 Dysfunctions, Example: L5 NSLRR, Lateral Recumbent (Long Lever) 299

L1 to L5 Dysfunctions, Example: L4 FRRS, Lateral Recumbent (Long Lever) 300
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Chapter 12

Right: Suboccipital Muscle Hypertonicity 334

C2 to C4 Dysfunction Example: C4 FSRRR 335

T4 to T12 Dysfunctions Example: T6 ESRRR 336

Right-Sided Trapezius Muscle Hypertonicity 337

Left First Rib Dysfunction, Posterior Elevation: Nonrespiratory Model, Soft-Tissue Effect 338

Left Seventh Rib, Inhalation Dysfunction 339

L1 to L5 Dysfunctions Example: L3 NSLRR 340

L1 to L5 Dysfunctions Example: L4 FSRRR 341

Left-Sided Erector Spinae Muscle Hypertonicity 342

Left Posterior Innominate Dysfunction 343

Left Anterior Innominate Dysfunction 344

Chapter 13
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Occipitoatlantal (C0C1, OA) Dysfunction, Example: C0 ESRRL, Seated 349

Atlantoaxial (C1C2) Dysfunction, Example: C1 RL, Supine 350

C2 to C7 Dysfunction, Example: C4 ESRRR, Supine 351

T1 and T2 Dysfunctions, Example: T1 ERRSR, Seated 352

T1 and T2 Dysfunctions, Example: T2 FRLSL, Supine 353

T3 to T12 Dysfunctions, Example: T5 NSLRR, Seated 354

First Rib Dysfunction, Example: Right, Posterior, Elevated First Rib (Nonphysiologic,Nonrespiratory) 355

First or Second Rib, Example: Left, First Rib Exhalation Dysfunction, Seated 356

First Rib, Example: Right, First Rib Exhalation Dysfunction, Seated 357

L1 to L5 Dysfunctions, Example: L4 NSRRL, Supine 358

L1 to L5 Dysfunctions, Example: L3 ESRRR, Lateral Recumbent 359

Innominate Dysfunction, Example: Right Anterior Innominate, Modified Sims Position 360

Innominate Dysfunction, Example: Right Posterior Innominate, Modified Sims Position 361

Elbow: Radial Head, Pronation Dysfunction 362

Elbow: Radial Head, Supination Dysfunction 363

Acromioclavicular Joint, Example: Right Distal Clavicle Elevated 364

Acromioclavicular Joint, Example: Right, Proximal Clavicle Elevated (Distal Clavical

Depressed) 365

Chapter 14
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Occipitoatlantal (C0C1, OA) Dysfunction, Example: C0-C1 ESLRR 370

Atlantoaxial (C1C2, AA) Dysfunction, Example: C1 RR 371

Atlantoaxial (C1C2) Dysfunction, Example: C1 Right, Lateral Translation 372

C2 to C7 Dysfunction, Example: C4 ESRRR 373

T1 and T2 Dysfunctions, Example: T1 FSRRR 374

Anterior Cervical Fascia, Direct Technique 375

T3 to L4, Example: T12 ESLRL 376

T8 to L5, Example: L5 FSRRR with Sacral Tethering 377

First Rib Dysfunction, Example: Left, Posterior, Elevated First Rib (Nonphysiologic,Nonrespiratory) 378

Dysfunction of the Respiratory Diaphragm and/or Exhalation Dysfunction of the Lower Ribs 379

Clavicle: Left Sternoclavicular Dysfunction (Direct Method) 380

Shoulder: Spasm in the Teres Minor Muscle (Direct Method) 381

Shoulder: Glenohumeral Dysfunction 382

Forearm and Elbow: Ulnohumeral and Radioulnar Dysfunctions 383

Wrist: Carpal Tunnel Syndrome 384

Hypertonicity of the External Hip Rotators and Abductors of the Femur (Example: PiriformisHypertonicity and Fibrous Inelasticity) 385

Knee: Posterior Fibular Head Dysfunction 386

Knee: Femorotibial Dysfunctions, Example: Sprain of the Cruciate Ligaments 387
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Gastrocnemius Hypertonicity, Direct Method 388

Ankle: Posterior Tibia on Talus 389

Foot and Ankle, Example: Left Calcaneus Dysfunction, the Boot Jack Technique 390

Foot Dysfunction: Metatarsalgia 391

Foot: Plantar Fasciitis, Direct Method 392

Chapter 15

Occipitomastoid Suture Pressure 398

Alternating Pressure, Left Second Rib 400

Singultus (Hiccups) 402

Rib Raising 404

Colonic Stimulation 405

Splenic Stimulation 406

Sacral Rock 407

Gastric Release 408

Hepatic Release 409

Gallbladder 410

Kidney Release 411

Chapter 16
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Anterior Cervical Arches: Hyoid and Cricoid Release 416

Cervical Chain Drainage Technique 417

Mandibular Drainage: Galbreath Technique 418

Auricular Drainage Technique 419

Alternating Nasal Pressure Technique 420

Submandibular Release 421

Trigeminal Stimulation Technique 422

Maxillary Drainage: Effleurage 424

Frontal Temporomandibular Drainage: Effleurage 425

Thoracic Inlet and Outlet: Myofascial Release, Direct or Indirect, Seated, Steering WheelTechnique 426

Thoracic Inlet and Outlet: Myofascial Release, Direct, Supine 427

Miller Thoracic (Lymphatic) Pump 428

Miller Thoracic (Lymphatic) Pump, Exaggerated Respiration 429

Thoracic (Lymphatic) Pump, Side Modification 430

Thoracic (Lymphatic) Pump, Atelectasis Modification 431

Pectoral Traction: Pectoralis Major, Pectoralis Minor, and Anterior Deltoid 432

Anterior Axillary Folds: Pectoralis Major and Anterior Deltoid Muscles 433

Doming the Diaphragm 434

Rib Raising: Bilateral Upper Thoracic Variation 436
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Marian Clark Drainage 437

Mesenteric Release, Small Intestine 438

Mesenteric Release, Ascending Colon 440

Mesenteric Release, Descending Colon 442

Presacral Release, Direct or Indirect 444

Ischiorectal Fossa Release, Supine 445

Ischiorectal Fossa Release, Prone 446

Pedal Pump (Dalrymple Technique), Supine 447

Pedal Pump (Dalrymple Technique), Prone Variation 448

Hip, Indirect LAS/BLT, Supine 449

Popliteal Fossa Release, Supine 450

Chapter 17
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Shoulder Girdle: Spencer Technique Stage 1Shoulder Extension with Elbow Flexed 456

Shoulder Girdle: Spencer Technique Stage 2Shoulder Flexion with Elbow Extended 457

Shoulder Girdle: Spencer Technique Stage 3Circumduction with Slight Compression andElbow Flexed 458

Shoulder Girdle: Spencer Technique Stage 4Circumduction and Traction with ElbowExtended 459

Shoulder Girdle: Spencer Technique Stage 5AAbduction with Elbow Flexed 460

Shoulder Girdle: Spencer Technique Stage 5BAdduction and External Rotation with ElbowFlexed 461

Shoulder Girdle: Spencer Technique Stage 6Internal Rotation with Arm Abducted, HandBehind Back 462

Shoulder Girdle: Spencer Technique Stage 7Distraction, Stretching Tissues, and Enhancing

Fluid Drainage with Arm Extended 463

Hip Girdle: Spencer Technique Stage 1Hip Flexion 464

Hip Girdle: Spencer Technique Stage 2Hip Extension 465

Hip Girdle: Spencer Technique Stages 3 and 4Circumduction 466

Hip Girdle: Spencer Technique Stages 5 and 6Internal and External Rotation 467

Hip Girdle: Spencer Technique, Stages 7 and 8Abduction and Adduction 468

Elbow: Radioulnar Dysfunction, Long Axis, Pronation Dysfunction (Loss of Supination),Muscle Energy, HVLA 469

Elbow: Radioulnar Dysfunction, Long Axis, Supination Dysfunction (Loss of Pronation),Muscle Energy, HVLA 470

Right Anterior Innominate Dysfunction: HVLA with Respiratory Assistance, Leg-PullTechnique 471
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C2 to C7, Articulatory, Type 2 Motion 472

T1 to T4, Articulatory, Side Bending 473

Chapter 18

Cranial Vault Hold 481

Fronto-occipital Hold 482

Sacral Hold 483

Decompression of the Occipital Condyles 484

Occipitoatlantal Decompression 485

Compression of the Fourth Ventricle 486

Interparietal Sutural Opening (V-Spread) 488

Sutural Spread (V-Spread, Direction-of-Fluid Technique) 489

Venous Sinus Drainage 490

Unilateral Temporal Rocking Example: Left Temporal Bone in External or Internal Rotation 492

Frontal Lift 493

Parietal Lift
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