omm final techniques

8/18/2019 Omm Final Techniques

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OMM FINAL TECHNIQUES PRACTICAL

OMM FOR THE HOSPITALIZED PATIENT

• OA Release (N 86; MFR)

o TECHNIQUE: Patient supine. Hands on occiput & move caudad to nd occipital

s!el". Appl# ante$io$ "o$ce & cep!alad t$action. Pt ma# put c!in to c!est usin% OA to

ea%%e$ate 'eion & p$event !#pe$etension. Maintain position !ile pt !olds o$

mo$e deep inspi$ations to en!ance a$ticula$ $elease. Reassess OA motion.

o TREATMENT MODEL: Occipitoatlantal decomp$ession is a m#o"ascial $eleasetec!ni*ue t!at en%a%es continual palpato$# "eed+ac, to ac!ieve $elease o"

m#o"ascial tissues- ta,in% advanta%e o" "ascias a+ilit# to c!an%e len%t! it!

associated c!an%es in ene$%#. Additionall#- it allos us to no$mali/e

pa$as#mpat!etic tone via t!e va%us ne$ve. 0t is indicated to t$eat ca$diac

a$$!#t!mias and $espi$ato$# d#s"unctions- and cont$aindicated i" "$actu$es- open

ounds- o$ neoplasms a$e p$esent.o BIOMECHANICS: OA d#s"unction $esults "$om $otation o" t!e occiput on its ais- causin% misali%nment

o" t!e cond#les in t!e "acets o" t!e atlas. OA decomp$ession allos us to ca$$# t!e occipital cond#les

poste$io$l#- tense t!e li%aments in t!e $e%ion- and st$etc! t!e cont$acted muscles in t!e occipital

t$ian%le.o HIGH YIELD:

• 1!o$acic 0nlet Release (N 23)

o TECHNIQUE: pt is supine. Place inde n%e$ on clavicle (o$ sup$aclavicula$

"ossa) & place t!um+ on st $i+. Assess $otation & t$anslation. 1$eat di$ectl#o$ indi$ectl# "o$ 4565 seconds- usin% patient in!alation to ta,e inlet "u$t!e$into +a$$ie$ o$ ease.

o TREATMENT MODEL: 1!o$acic inlet diap!$a%m $elease is a m#o"ascial $elease

tec!ni*ue t!at opens m#o"ascial pat!a#s- inc$ease di7e$entials to au%ment'uid 'o +e#ond no$mal levels- and mo+ili/e ta$%eted tissue 'uids into t!el#mp!atic s#stem.

o BIOMECHANICS: Release o" t!e t!o$acic inlet diap!$a%m en%a%es t!e uppe$ t!o$acics- $i+s- clavicle-

scalenes- pecto$al muscles- and t!e p$et$ac!eal "ascia- and en!ances l#mp!atic d$aina%e "$om t!e!ead & nec, to t!o$acic duct.

o HIGH YIELD:

• ac$al Roc,in% (N 984)

o TECHNIQUE: Pt p$one. ontact lum+a$s & move don to sac$al +ase. Place

caudad !and unde$neat! cep!alad !and. Appl# %entle p$essu$e it!

$oc,in% motion in conunction it! $espi$ation- etendin% t!e sac$um

du$in% in!alation (counte$nutation)- & 'ein% t!e sac$um du$in%

e!alation (nutation). Repeat "o$ 4565 seconds. Reassess it! sac$al

landma$,s.o TREATMENT MODEL: ac$al $oc,in% is a m#o"ascial $elease tec!ni*ue t!at

en%a%es continual palpato$# "eed+ac, to ac!ieve $elease o" m#o"ascial

tissues- ta,in% advanta%e o" t!e "ascias a+ilit# to c!an%e len%t! it!

associated c!an%es in ene$%#. Additionall#- it can di$ectl# no$mali/e

pa$as#mpat!etic tone via t!e sac$al splanc!nic ne$ves. ac$al $oc,in% is

indicated in d#smeno$$!ea and sac$oiliac d#s"unction- and cont$aindicated

in pelvic mali%nanc# and pain.


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o BIOMECHANICS: ac$al $oc,in% utili/es a $oc,in% motion s#nc!$onous it! t!e natu$al movement o"

t!e sac$um- etension in in!alation- and 'eion in e!alation- to no$mali/e pa$as#mpat!etic tone +#

en%a%in% t!e sac$al splanc!nic ne$ves.o HIGH YIELD:

• 1!o$acic Pump ( N 359)

o TECHNIQUE: Pt supine it! !ead to one side- !ips & ,nees 'eed & "eet 'at

on ta+le. tand at !ead o" ta+le it! "oot in "$ont o" ot!e$. Place t!ena$

eminences in"e$io$ to pts clavicles it! n%e$s sp$eadin% out ove$ uppe$

$i+ ca%e (o$ ove$ ste$num "o$ omen). 0nc$ease p$essu$e on ante$io$ $i+

ca%e du$in% e!alation & add a vi+$ato$# motion at 2 comp$essions pe$

second. ontinue appl#in% pumps "o$ 4565 seconds t!$ou%!out +$eat!in%

c#cle "o$ 36 c#cles. Reassess it! $i+ motions.o TREATMENT MODEL: 1!e t!o$acic pump is a l#mp!atic tec!ni*ue desi%ned

to open m#o"ascial pat!a#s- inc$ease di7e$entials to au%ment 'uid 'o

+e#ond no$mal levels & mo+ili/e ta$%eted tissue 'uids into t!e l#mp!atic

s#stem. 0t is indicated "o$ in"ection- "eve$- & l#mp!atic con%estion- and

cont$aindicated in t!e p$esence o" "$actu$es- osteopo$osis- seve$e d#spnea-

& mali%nanc# o" t!e l#mp!atic s#stem.o BIOMECHANICS: 1!e t!o$acic pump accentuates ne%ative int$at!o$acic p$essu$e- inc$eases l#mp!atic

$etu$n- loosens mucus plu%s via vi+$ation- and potentiall# stimulates t!e autoimmune s#stem.o HIGH YIELD:

• Pecto$al 1$action (N 358)

o TECHNIQUE: Pt supine it! !ips & ,nees 'eed & "eet 'at on ta+le.

Place n%e$ pads in"e$io$ to pts clavicles at ante$io$ ailla$# "old.

lol# & %entl# lean +ac,a$d- causin% !ands & n%e$s to move

cep!alad into ailla. Pull cep!alad du$in% in!alation & $esist du$in%e!alation. Repeat "o$ 43 +$eat! c#cles. Reassess $i+ motions nea$

pecto$alis muscles.o TREATMENT MODEL: Pecto$al t$action is a l#mp!atic tec!ni*ue

desi%ned to open m#o"ascial pat!a#s- inc$ease di7e$entials to au%ment 'uid 'o +e#ond no$mal

levels & mo+ili/e ta$%eted tissue 'uids into t!e l#mp!atic s#stem. 0t is indicated "o$ l#mp!atic

con%estion- uppe$ et$emit# edema- & $espi$ato$# impai$ments- & is cont$aindicated in t!e p$esence

pacema,e$s & metastatic cance$.o BIOMECHANICS: Pecto$al t$action au%ments t!o$acic $an%e o" motion via st$etc!in% o" t!e pecto$alis

mino$- !ic! o$i%inates on $i+s 4- 9- & 3- & inse$ts on t!e co$acoid p$ocess. 1!is imp$oves l#mp!atic

$etu$n.o HIGH YIELD:

•


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cep!alad !and. Release a little p$essu$e- "eel "o$ t!e o$%an- and t!en appl# mo$e t$action. Hold "o$

45 seconds o$ until a $elease is "elt 1$ansve$se olon: Place !ands unde$neat! t!e $i+ca%e (t!um+s mediall#). Appl# a poste$io$ and

in"e$io$ "o$ce. Release a little p$essu$e- "eel "o$ t!e o$%an- and t!en appl# mo$e t$action. Hold "o$ 4

seconds o$ until a $elease is "elt Ascendin% olon: tand on patients @F1 side. Find t!e $i%!t A0- move sli%!tl# supe$io$. an%lion Release

o TECHNIQUE: Pt is supine. Find t!e um+ilicus & ip!oid. eliac %an%lion is cm +elo ip!oid. upe$io

mesente$ic %an%lion +eteen celiac & in"e$io$ mesente$ic %an%lion. 0n"e$io$ mesente$ic %an%lion cm

a+ove t!e um+ilicus. Palpate all 4 landma$,s & as, "o$ tende$ness. Assess all planes o" motion & t$eat

ease o$ $est$iction "o$ 45 seconds.


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TREATMENT MODEL: Muscle ene$%# is an active and di$ect tec!ni*ue-

meanin% +ot! t!e patient and p!#sician a$e appl#in% "o$ce- and t!e

p!#sician is ta,in% t!e patient into t!e +a$$ie$ and aa# "$om t!e

position o" ease. 0mmediatel# a"te$ a muscle cont$action- t!e

neu$omuscula$ appa$atus is in a $e"$acto$# state du$in% !ic! passive

st$etc!in% is pe$"o$med it!out encounte$in% a st$on% opposition. 0n

P0R- immediatel# a"te$ a muscle cont$action- t!e neu$omuscula$ appa$atu

is in a $e"$acto$# state du$in% !ic! passive st$etc!in% is pe$"o$med it!out encounte$in%

st$on% opposition.o BIOMECHANICS:


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• AP Pelvic ?nindin% (N 45)

o TECHNIQUE: Pt is supine. ontact lo on t!e sac$um & cocc# poste$io$l# it!

n%e$s toa$d cont$alate$al isc!ial tu+e$osit#. ontact ac$oss t!e pu+ic

s#mp!#sis ante$io$l#. Assess $otation it! side+endin% & 'eionCetension.

?se all 4 plates to app$oac! t!e +a$$ie$ o$ position o" ease. Hold until $elease

& $eassess.o TREATMENT MODEL: AP pelvic unindin% is a m#o"ascial $elease tec!ni*ue

t!at en%a%es continual palpato$# "eed+ac, to ac!ieve $elease o" m#o"ascial

tissues- ta,in% advanta%e o" t!e "ascias a+ilit# to c!an%e len%t! it!associated c!an%es in ene$%#.

o HIGH YIELD:

PEDIATRIC

• e$vical !ain


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• Mandi+ula$ al+$eat! 1ec!ni*ue (N 9G3)

o TECHNIQUE: Pt lies supine C !ead tu$ned aa# sli%!tl# toa$d t!e

p!#sician- & t!e p!#s sits at t!e pts side nea$ t!e !ead o" t!e ta+le.

ta+ili/e t!e pts !ead +# placin% t!e cep!alad !and +eneat! t!e !ead

to elevated it sli%!tl#. Place t!e caudad !and it! t!e 4 $d- 9t! & 3t!

n%e$tips alon% t!e poste$io$ $amus o" t!e mandi+le & t!e !#pot!ena$

eminence alon% t!e +od# o" t!e mandi+le. Have pt open t!e mout!

sli%!tl#. Iit! t!e caudad !and- p$ess on t!e mandi+le so as to d$a it sli%!tl# "o$a$d at t!e 1M &

%entl# toa$d t!e midline. Hold "o$ 3 seconds & $elease. Repeat 6 times.o TREATMENT MODEL: Mandi+ula$


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• =9 o TECHNIQUE: Pt lies supine & p!#s is seated at t!e !ead o" t!e ta+le 0nte$lac

n%e$s C t!um+ on top (volle#+all !old). 1!ena$ eminences s!ould +e places

poste$io$ & medial to t!e occipitomastoid sutu$es. Appl# a %entle "o$ce ante$io

& late$al (p$omotin% etension). Keep appl#in% an ante$io$ "o$ce until #ou $eac

a still point. Hold t!is point "o$ 45 seconds (L4 R0). @ventuall# t!e

occiput ill $elease (pus!es +ac, into #ou$ !and). Reassess it! vault

!old "o$ 45 seconds.o TREATMENT MODEL: $anial

o HIGH YIELD:

• Pa$ietal i"t

o TECHNIQUE: Pt lies supine & p!#s is seated at t!e !ead o" t!e ta+le. Place

n%e$s on t!e late$al po$tion o" t!e pa$ietal +one. an c$ossCp$ess

t!um+s to%et!e$ in midai$ to %et a +ette$ !old on t!e pa$ietal +ones.

@n%a%e t!e tissue it! n%e$s & pull cep!alad. Hold "o$ 45 seconds o$

until a $elease is "elt. Reassess it! vault !old "o$ 45 seconds.o TREATMENT MODEL: $anial

o HIGH YIELD:

• Mailla$# @Beu$a%e o TECHNIQUE: Pt is supine. ta$t ust late$al to t!e nose +elo t!e e#e & use

t!um+s to contact t!e "ascia !ile movin% late$all# ac$oss t!e c!ec,s.

ontinue "o$ 45 seconds. Reassess it! vault !old "o$ 45 seconds.o TREATMENT MODEL: $anial

o HIGH YIELD:

CERVICAL

• Muscle @ne$%#

o TECHNIQUE: Pt lies supine- p!#s at !ead o" ta+le. Place $st MP o" $i%!t !and

at a$ticula$ pilla$ o" se%ment +ein% t$eated. Heel o" !and closes in a%ainst t!e

occiput. $adle t!e pts !ead +eteen t!e !ands. Fle o$ etend until t!e d#s"unctional se%ment ien%a%ed. ide+end don to t!e d#s"unctional se%ment & $otate aa# to t!e $est$ictive +a$$ie$.

0nst$uct t!e pt to $otate t!e !ead +ac, !ile appl#in% a counte$"o$ce. Hold "o$ 43 seconds & !ave

t!e pt $ela. Repeat 43 times. Appl# a nal st$etc! & palpate to $eassess.o TREATMENT MODEL: P0R Muscle @ne$%#

o CONTRAINDICATIONS: ina+ilit# to "ollo di$ections- lac, o" ca$diopulmona$# $ese$ve-

in"ectionC!ematoma- "$actu$e- positionin% t!at comp$omises vasculatu$eo HIGH YIELD:


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• H=A

o TECHNIQUE: Pt lies supine- p!#s at !ead o" ta+le. Place $st MP o" $i%!t !and at a$ticula$ pilla$ o"

se%ment +ein% t$eated. Heel o" !and closes in a%ainst t!e occiput. $adle t!e pts !ead +eteen

t!e !ands. Fle o$ etend until t!e d#s"unctional se%ment is en%a%ed. ide+end don to t!e

d#s"unctional se%ment & $otate aa# to t!e $est$ictive +a$$ie$. @plain t!at at t!is point #ou oul

appl# a !i%! velocit#- lo amplitude t!$ust t!$ou%! t!e +a$$ie$- it!out appl#in% t!e vecto$ o"

"o$ce. Palpate to $eassess.

o TREATMENT MODEL: H=A emplo#s a $apid- t!e$apeutic "o$ce o" +$ie" du$ation t!at t$avels a s!o$tdistance it!in t!e anatomic $an%e o" motion o" a oint. 0t en%a%es a $est$ictive +a$$ie$ in one o$

mo$e planes o" motion to elicit $elease o" $est$iction. 1!is allos us to $etu$n t!e st$uctu$e to its "u

$an%e o" motion in a di$ect manne$ +# $eleasin% ent$apped s#novial "olds & dis$uptin% pe$ia$ticula

o$ a$ticula$ ad!esions.o CONTRAINDICATIONS: a+solute J RA-


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THORACIC

• Muscle @ne$%#

o TECHNIQUE:

119


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o TREATMENT MODEL: FPR is a tec!ni*ue t!at places emp!asis on dec$easin% muscle !#pe$tonicit#

t!at is involved in maintainin% a somatic d#s"unction. An aial comp$essive "o$ce is applied and

causes a $eve$sal in spindle output.o HIGH YIELD:

LUMBAR

• Muscle @ne$%#o TECHNIQUE:

1#pe 0


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o

o

o TECHNIQUE:

o TREATMENT MODEL: ounte$st$ain

o HIGH YIELD:

SACRUM

• Muscle @ne$%#

o TECHNIQUE:

Ante$io$ 1o$sion: Have t!e pt lie late$al $ecum+ent it! c!est and ais up. Fle t!e !ips and

,nees to t!e level o" t!e sac$um. Hold t!e pts an,les and appl# an upa$d "o$ce. Have t!e p

appl# a dona$d "o$ce & !old "o$ 43 seconds. Have t!e pt $ela & move "u$t!e$ into t!e

+a$$ie$. Repeat 43 times- appl# a nal st$etc!- and $eassess. Poste$io$ 1o$sion: Have t!e pt lie late$al $ecum+ent it! c!est up and t!e ais don. Fle t!e

!ips and ,nees to t!e level o" t!e sac$um and c$oss t!e top le% ove$ so t!at it is o7 t!e ta+le.

Appl# a dona$d "o$ce. Have t!e pt appl# an upa$d "o$ce & !old "o$ 43 seconds. Have t!e

pt $ela & move "u$t!e$ into t!e +a$$ie$. Repeat 43 times- appl# a nal st$etc!- and $eassess. ?nilate$al Fleion !ea$: Have t!e pt lie p$one. ontact t!e 0A on t!e d#s"unctional side.

0nte$nall# $otate & a+duct t!e pts !ip. Have t!e pt pe$"o$m 4 lon%- slo c#cles o" in!alation &

e!alation.


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INNOMINATES/PELVIS

• Muscle @ne$%#

o TECHNIQUE:

Poste$io$ 0nnominate: Have t!e pt lie supine it! t!e le% o" t!e d#s"unctional side o7 o" t!e

ta+le- ma,in% su$e t!at t!e "oot is not touc!in% t!e 'oo$. I!ile sta+ili/in% t!e opposite side-

appl# a dona$d "o$ce on t!e t!i%!- !ile !avin% t!e pt appl# an upa$d "o$ce. Hold "o$ 43

seconds- move "u$t!e$ into t!e +a$$ie$- and $epeat 43 times. Appl# a nal st$etc! and $eassesit! A0 comp$ession o$ standin% 'eion test. (Mo+ili/in% *uads to in!i+it !amst$in%s). Ante$io$ 0nnominate: Have t!e pt lie supine. Fle t!e le% o" t!e d#s"unctional side at t!e ,nee

and !ip & place t!e le% on #ou$ s!oulde$. Pus! "u$t!e$ into 'eion !ile !avin% t!e pt cont$act

into #ou$ c!est & !old "o$ 43 seconds. Move "u$t!e$ into t!e +a$$ie$ & $epeat 43 times. Appl#

nal st$etc! & $eassess it! A0 comp$ession o$ standin% 'eion test. (Mo+ili/in% !amst$in%s

to in!i+it *uads). 0n'a$e 0nnominate: Have t!e pt lie supine. Fle t!e pts le% at t!e ,nee- and c$oss t!e le% ove$

t!e opposite ,nee. Appl# a "o$ce to a+duct t!e ,nee- !ile !avin% t!e pt adduct t!e ,nee. Hold

"o$ 43 seconds- move "u$t!e$ into t!e +a$$ie$ & $epeat 43 times. Appl# a nal st$etc! and

$eassess A0 positions as compa$ed to t!e um+ilicus. Out'a$e 0nnominate: Have t!e pt lie supine. Fle t!e pts le% on t!e d#s"unctional side at t!e

!ip and ,nee- and c$oss it ove$ t!e opposite le%. Adduct t!e pts ,nee !ile !avin% t!e pta+duct. Hold "o$ 43 seconds- move "u$t!e$ into t!e +a$$ie$s & $epeat 43 times. Appl# a nal

st$etc! and $eassess A0 positions as compa$ed to t!e um+ilicus. 0n"e$io$ 0nnominate !ea$: ame as ante$io$ innominate- +ut add a cep!alad "o$ce to t!e isc!ia

tu+e$osit#.o TREATMENT MODEL:

Recip$ocal 0n!i+ition (Ante$io$ & poste$io$ innominate & in"e$io$ s!ea$)

P0R (0n'a$e & out'a$e)

o HIGH YIELD:

•

H=Ao TECHNIQUE:

upe$io$ 0nnominate !ea$: Have t!e pt lie supine & %$asp t!e an,le $ml#. 0nte$nall# $otate t!

an,le & +$in% it to t!e +a$$ie$. @plain t!at at t!is point #oud appl# a *uic, t!$ust t!$ou%! a

s!o$t distance- pullin% t!e an,le toa$ds #ou. Retu$n t!e pt to a neut$al position and $eassess.o TREATMENT MODEL: H=A

o HIGH YIELD:

LOWER EXTREMITY

• Pi$i"o$misCPsoas Muscle @ne$%#o TECHNIQUE:

Psoas: Have t!e pt lie p$one. Fle t!e ,nee & li"t t!e le%- usin% #ou$ ,nee to suppo$t it i"

necessa$#. Have t!e pt pus! le% don toa$ds t!e ta+le "o$ 43 seconds. Move "u$t!e$ into t!e

+a$$ie$- & $epeat 43 times. Appl# a nal st$etc! and $eassess it! t!e 1!omas test. Pi$i"o$mis: Have t!e pt lie supine. Fle t!e pts le% at t!e ,nee & c$oss t!e le% on t!e

d#s"unctional side ove$ t!e ot!e$ le%. ta+ili/e t!e A0 it! t!e cep!alad !and. Pull t!e pts

,nee into adduction- and !ave t!e pt a+duct "o$ 43 seconds. Move "u$t!e$ into t!e +a$$ie$ and

$epeat 43 times. Appl# a nal st$etc! and $eassess it! t!e FA0R test.


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o TREATMENT MODEL: P0R Muscle @ne$%#

o HIGH YIELD:

• Fi+ula$ Head Muscle @ne$%#CH=A

o TECHNIQUE:

Ante$io$ Fi+ula$ Head P0R: Have t!e pt lie supine & sit at t!e side o"

d#s"unction. ontact t!e ante$olate$al aspect o" t!e +ula$ !ead

it! t!e t!um+ o" t!e !and closest to t!e pts ,nee. Iit! t!e

ot!e$ !and- cont$ol t!e pts "oot and an,le & inte$nall# $otate &

p$onate t!e an,le until t!e +ula$ !ead meets its $est$ictive +a$$ie$. 0nst$uct t!e pt to ete$nall

$otate & supinate !ile appl#in% a counte$"o$ce. Hold "o$ 43 seconds- move "u$t!e$ into t!e

+a$$ie$ & $epeat 43 times. Appl# a nal st$etc! & $eassess. Poste$io$ Fi+ula$ Head P0R: Have t!e pt lie supine & sit at t!e side o" d#s"unction. Place t!e

!and closest to t!e ,nee in t!e popliteal "ossa so t!at MP o" t!e inde n%e$ app$oimates t!

poste$io$ p$oimal +ula. Iit! t!e ot!e$ !and- cont$ol t!e "oot and an,le-

ete$nall# $otatin% t!e loe$ le% & p$onate t!e an,le until t!e +ula$ !ead

meets its $est$ictive +a$$ie$. 0nst$uct t!e pt to inte$nall# $otate & supinate

!ile appl#in% a counte$"o$ce. Hold "o$ 43 seconds- move "u$t!e$ into t!

+a$$ie$ & $epeat 43 times. Appl# a nal st$etc! & $eassess. Ante$io$ Fi+ula$ Head H=A: Have t!e pt lie supine it! a small

pillo unde$ t!e d#s"unctional ,nee to maintain sli%!t 'eion. Iit! t!e

caudad !and- inte$nall# $otate t!e pts an,le to +$in% t!e p$oimal +ula mo$e ante$io$. Place

t!e !eel o" t!e cep!alad !and ove$ t!e ante$io$ su$"ace o" t!e p$oimal +ula. @plain t!at at

t!is point- #ou ould delive$ a *uic, t!$ust t!$ou%! t!e +ula$ !ead st$ai%!t +ac, toa$d t!e

ta+le !ile simultaneousl# int$oducin% an inte$nal $otation counte$"o$ce at t!e an,le. Poste$io$ Fi+ula$ Head H=A: Have t!e pt lie p$one it! t!e d#s"unctional ,nee 'eed at G5

de%$ees. tand at t!e side o" t!e ta+le opposite t!e side o" d#s"unction. Place t!e MP o" t!e

cep!alad inde n%e$ +e!ind t!e d#s"unctional +ula$ !ead & t!e !#pot!ena$ eminence an%le

don into t!e !amst$in% to "o$m a ed%e +e!ind t!e ,nee. Iit! t!e caudad !and- %$asp t!e

an,le on t!e side o" d#s"unction and %entl# 'e t!e ,nee until t!e +a$$ie$ is $eac!ed. >entl#

ete$nall# $otate t!e "oot and le% to ca$$# t!e +ula$ !ead +ac, a%ainst t!e "ulc$um. @plain

t!at at t!is point- #ou ould delive$ a *uic, t!$ust toa$d t!e pts +uttoc, in a manne$ t!at

ould $esult in "u$t!e$ 'eion o" t!e ,nee. (1!e ed%e "ulc$um "o$med +# t!e cep!alad !and

p$events t!at motion.)o TREATMENT MODEL: P0R & H=A

o HIGH YIELD:

• 1i+ia on 1alus H=A

o TECHNIQUE:

Ante$io$ 1i+ia on 1alus patient supine. P!#sician stands at t!e "oot o" t!e ta+le. P!#sician !an

cups t!e calcaneus anc!o$in% t!e "oot (sli%!t t$action applied.) P!#sician places ot!e$ !and on

t!e ante$io$ ti+ia p$oimal to t!e an,le mo$tise. 1!$ust delive$ed it! t!e !and on t!e ti+ia

st$ai%!t don toa$d t!e ta+le. Reassess +# c!ec,in% $an%e o" motion. Poste$io$ 1i+ia on 1alus Patient supine. P!#sicians stands at t!e "oot o" t!e ta+le. P!#sician

!ands $apped a$ound t!e "oot it! t!e n%e$s inte$laced on t!e do$sum. 1!e "oot is

do$si'eed to t!e motion +a$$ie$ usin% p$essu$e "$om t!e p!#sicians t!um+s on t!e +all o" t!e

"oot. 1$action is placed on t!e le% at t!e same time do$si'eion o" t!e "oot is inc$eased.

P!#sician delive$s a t$actional t!$ust "oot !ile inc$easin% t!e de%$ee o" do$si'eion.

@7ectiveness dete$mine +# $eassessin% t!e an,le $an%e o" motion.o TREATMENT MODEL: H=A

o HIGH YIELD:


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UPPER EXTREMITY

• pence$s 1ec!ni*ue Muscle @ne$%#

o TECHNIQUE: Pt late$al $ecum+ent. tand "acin% pt. Iit! cep!alad !and- +$id%e t!e s!oulde$ to loc

out t!e A oint & scapulot!o$acic motion. Place n%e$s on t!e spine o" t!e scapula & t!um+ on

t!e ante$io$ clavicle. Iit! caudad !and- %$asp t!e pts el+o. Move t!e s!oulde$ into etension to

t!e +a$$ie$. 0nst$uct t!e pt to attempt to 'e t!e s!oulde$ a%ainst $esistance "o$ 43 second and

$epeat 43 times. 1!en ta,e pts s!oulde$ into 'eion. 0nst$uct t!e pt to attempt to etend t!es!oulde$ a%ainst $esistance "o$ 43 second and $epeat 43 times. 1!en ta,e pts el+o & ta,e

s!oulde$ into a+duction. Move pts a$m t!$ou%! "ull ci$cumduction it! sli%!t comp$ession. Ma,e

la$%e$ & la$%e$ ci$cles- inc$easin% $an%e o" motion. Repeat 345 seconds in eac! di$ection. A+duc

pts s!oulde$ it! el+o "ull# etended. Iit! caudad !and- %$asp t!e pts $ist & ee$t ve$tical

t$action. Iit! cep!alad !and- +$ace t!e s!oulde$. Move pts a$m t!$ou%! "ull ci$cumduction it!

t$action- ma,in% la$%e$ concent$ic ci$cles- inc$easin% $an%e o" motion. Repeat "o$ 345 seconds in

eac! di$ection. 1!en Fle pts a$m to allo el+o to pass in "$ont o" c!est all. Rest pts $ist

a%ainst #ou$ "o$ea$m- & adduct s!oulde$ to ed%e o" $est$ictive +a$$ie$. 0nst$uct pt to li"t el+o

a%ainst $esistance "o$ 43 seconds 43 times. $ace s!oulde$- and %$asp pts el+o. 0nst$uct pt to

%$asp #ou$ "o$ea$m. A+duct s!oulde$ to ed%e o" $est$ictive +a$$ie$. Have pt adduct a%ainst

$esistance "o$ 43 seconds 43 times. $ace s!oulde$ it! cep!alad !and- and %$asp pts el+o.

A+duct to 93 de%$ees & inte$nall# $otate to G5 de%$ees. Place t!e do$sum o" t!e pts !and in t!e

small o" t!e +ac,. >entl# pull pts el+o "o$a$d into inte$nal $otation to t!e +a$$ie$. 0nst$uct pt to

pull el+o +ac,a$d a%ainst $esistance 43 seconds 43 times. A+duct t!e pts s!oulde$ & place

!and & "o$ea$m on #ou$ s!oulde$. Iit! n%e$s inte$laced- position !ands ust distal to ac$omion

p$ocess. coop t!e pts s!oulde$ in"e$io$l#- s*uee/in% t!e deltoid +eteen palms. ontinue "o$ 3

45 seconds.o TREATMENT MODEL: Muscle ene$%# is a di$ect and active tec!ni*ue- di$ect meanin% 0 put t!e pt

into t!e +a$$ie$- and active meanin% t!e pts muscles a$e activel# used. 1!is postisomet$ic

tec!ni*ue uses t!e muscles $e"$acto$# state a"te$ muscle cont$action to allo passive st$etc!in%

"u$t!e$ into t!e +a$$ie$. pence$s 1ec!ni*ue "o$ t!e deltoid is a m#o"ascial $elease tec!ni*ue-

!ic! en%a%es continual palpato$# "eed+ac, to ac!ieve $elease o" m#o"ascial tissues- ta,in%

advanta%e o" t!e "ascias a+ilit# to c!an%e len%t! it! associated c!an%es in ene$%#.

o HIGH YIELD:

• Radial Head H=A

o TECHNIQUE:

Ante$io$ Radial Head (upination


17/21

dete$mined +# $etestin% p$onation o" t!e "o$ea$m and palpatin% "o$ $educed p$ominence o" t!e

$adial !ead.o TREATMENT MODEL: H=A

o HIGH YIELD:

• Radial Head Muscle @ne$%#

o TECHNIQUE:

Ante$io$ Radial Head (upination


18/21

o TREATMENT MODEL: Ri+ $aisin% is a m#o"ascial $elease tec!ni*ue t!at en%a%es continual palpato$

"eed+ac, to ac!ieve $elease o" m#o"ascial tissues- ta,in% advanta%e o" t!e "ascias a+ilit# to

c!an%e len%t! it! associated c!an%es in ene$%#. Additionall#- it can di$ectl# no$mali/e

s#mpat!etic tone +# appl#in% p$essu$e to t!e s#mpat!etic %an%lion- imp$ove l#mp!atic $etu$n- an

encou$a%e maimum in!alation. 0t is indicated in visce$al d#s"unction- dec$eased $i+ ecu$sion- an

l#mp!atic con%estion- and cont$aindicated in spinal o$ $i+ "$actu$e o$ $ecent spinal su$%e$#.o BIOMECHANICS: Ri+ $aisin% allos us to contact t!e costot$ansve$se an%les- !ic! ali%n it! t!e

s#mpat!etic c!ain %an%lia. 0t initiall# p$oduces a s!o$tlived inc$ease in s#mpat!etic activit#- +ut

p$ovides lon%lastin% s#mpat!etic in!i+ition to no$mali/e s#mpat!etic tone. 0t also en!ances

l#mp!atic $etu$n and encou$a%es in!alation.o HIGH YIELD:

• Muscle @ne$%#

o TECHNIQUE:

0n!alation


19/21

patient to 'e t!e !ead and nec, it!out alte$in% t!e $otation o" t!e !ead !ile t!e

p!#sician $esists t!is "o$ce. Patient s!ould +e inst$ucted to in!ale du$in% t!e cont$action-

!ic! s!ould +e !eld "o$ 43 seconds. I!en t!e patient completel# $elaes t!e p!#sician

ee$ts an inc$eased caudad and late$al t$action on t!e an%le o" t!e d#s"unctional $i+. 1!is i

$epeated 4D times. Fo$ $i+ t!e muscle +ein% activated is t!e ante$io$ scalene. Fo$ $i+ 2 it

is t!e middle and poste$io$ scalenes.

• Ri+ 43. Patient lies supine. P!#sician stands on side opposite t!e d#s"unction. Patient lace

t!e a$m on t!e d#s"unctional side ove$ t!ei$ !ead. P!#sicians !and $eac!es unde$ t!e

d#s"unctional side o" t!e patient and %$asps t!e supe$io$ an%le o" t!e d#s"unctional $i+ and

ee$ts a caudad and late$al t$action. P!#sician places t!e ot!e$ !and on t!e ante$io$ aspeco" t!e patients el+o. P!#sician inst$ucts t!e patient to pus! t!e el+o a%ainst t!e

p!#sicians !and !ile t!e p!#sician $esists t!e motion. Patient s!ould +e inst$ucted to

in!ale du$in% t!e cont$action- !ic! s!ould +e !eld "o$ 43 seconds. I!en t!e patient

completel# $elaes t!e p!#sician ee$ts an inc$eased caudad and late$al t$action on t!e

an%le o" t!e d#s"unctional $i+. 1!is is $epeated 4D times. Pecto$alis Mino$ is used to

mo+ili/e $i+s 43.

• Ri+s 68 Patient lies supine and t!e p!#sician stands at t!e side o" t!e d#s"unctional $i+.

Patients is inst$ucted to a+duct t!e s!oulde$ to G5 de%$ees and 'e t!e el+o to G5

de%$ees. P!#sicians !and $eac!es unde$ t!e patient and %$a+s t!e supe$io$ an%le o" t!e

d#s"unctional $i+ and ee$ts a caudad and late$al t$action. P!#sician inst$ucts t!e patient to

+$in% t!e 'eed el+o ac$oss t!e +od# toa$d t!e cont$alate$al !ip !ile t!e p!#sician$esist t!is motion. Patient s!ould +e inst$ucted to in!ale du$in% t!e cont$action- !ic!

s!ould +e !eld "o$ 43 seconds. I!en t!e patient completel# $elaes t!e p!#sician ee$ts

an inc$eased caudad and late$al t$action on t!e an%le o" t!e d#s"unctional $i+. 1!is is

$epeated 4D times. e$$atus Ante$io$ is t!e muscle used to mo+ili/e $i+s 68.

• Ri+s G5 Patient lies supine and t!e p!#sician stands at t!e side o" t!e d#s"unctional $i+.

Patients is inst$ucted to a+duct t!e s!oulde$ to G5 de%$ees and 'e t!e el+o to G5

de%$ees. P!#sicians !and $eac!es unde$ t!e patient and %$a+s t!e supe$io$ an%le o" t!e

d#s"unctional $i+ and ee$ts a caudad and late$al t$action. P!#sician inst$ucts t!e patient to

t$# to pus! t!ei$ el+o dona$d as i" to contact t!e ipsilate$al !ip !ile t!e p!#sician

$esists t!is motion. Patient s!ould +e inst$ucted to in!ale du$in% t!e cont$action- !ic!

s!ould +e !eld "o$ 43 seconds. I!en t!e patient completel# $elaes t!e p!#sician ee$ts

an inc$eased caudad and late$al t$action on t!e an%le o" t!e d#s"unctional $i+. 1!is is$epeated 4D times. atissimus


20/21


21/21

Put le% ON1RAA1@RA to t!e side o" t!e tende$point on

t!e ta+le and d$ape patients a$m ove$ t!e le% Put ot!e$ a$m +e!ind t!e patient (!elps $otate t!e

patient) @ AR1 (!ead)

Hold "o$ 25 seconds

o Ri+ 26

Patient is seated up$i%!t

oe$ ta+le as muc! as possi+le

Put le% 0P0A1@RA to t!e side o" t!e tende$point ont!e ta+le and d$ape patients a$m ove$ t!e le% Put ot!e$ a$m +e!ind t!e patient (!elps $otate t!e

patient) As, patient to +end le% ipsilate$al to tende$point and

place "oot unde$ opposite le% F (!ead) ARA (t$un,)

Hold "o$ 25 seconds

o HIGH YIELD:

ABDOMEN

• P$eve$te+$al >an%lion Release

o TECHNIQUE: Patient is supine. Find t!e um+ilicus and #p!oid. eliac %an%lion: cm +elo t!e

ip!oid- upe$io$ mesente$ic %an%lion: +eteen celiac & in"e$io$- 0n"e$io$ mesente$ic %an%lion: c

a+ove t!e um+ilicus. PAPA1@ A 4 OF 1H@@ AN

omm final techniques

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