West Virginia Osteopathic Medical Association Annual CME Conference. Josephine Shen, DO, MAOM November 3, 2018
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1 West Virginia Osteopathic Medical Association Annual CME Conference Josephine Shen, DO, MAOM November 3, 2018
2 Anterior Cervical Fascia Lift Rib Ligamentous Articular Strain Twelfth Rib/Arcuate Ligament/Diaphragm Release Condyloatlantal (OA) Release Anterior-Posterior Mobilization of the Rib Cage Shoulder Circles
3 Patient is seated facing the operator with body flexed and head forward Place your thumbs posteriorly and downward over the clavicle just lateral to the attachment of the SCM With the arms lateral to yours, patient rests hands on your shoulders and slowly drops his/her weight forward, slumping while exhaling Your thumbs advance inferiorly into the mediastinum just anterior and to either side of the trachea as the space opens Approximate your thumbs slightly to gently hold the pretracheal fascia while the patient slowly straightens the thoracic spine, keeping the neck in flexion as he/she inhales
4 Patient is seated. Sit on the side of the patient and place the middle finger of one hand on the angle of the rib, and the middle finger of the other hand on the anterior end of the shaft of the same rib. The thumbs are placed laterally on the shaft. Firm contact is obtained by asking the patient to lean toward you. The rib is held to prevent it from moving anteriorly, and the patient slowly rotates the upper part of the body, carrying the opposite shoulder posteriorly, to the point of balanced tension of the ligaments. Patient inhales and holds the breath. Hold until correction.
5 Patient is supine. Sit on the side to be treated and make a plastic contact along the 12 th rib with middle finger. The main leverage is slightly lateral to the costovertebral junction. The other hand is placed over the lower ribs and under the costochondral junction anteriorly to monitor rib and diaphragm movement. Lean away to give slight lateral traction to the 12 th rib. It is noticeable that every time the patient breathes out, it is possible to take advantage of the natural lateral relaxation at the costovertebral junction. Maintain light lateral traction until release.
6 Patient is supine. Place the tip of a finger against the posterior tubercle of the atlas (C1) to hold it anteriorly. Patient gently nods/tips head forward, avoiding flexion of the cervical spine. This rocks the occiput posteriorly in the articular pits of the atlas, releasing the condyles from the atlas, and tenses the ligaments. The right and left articulations will find a point of balance, and the position is held while the patient holds the breath in either inhalation or exhalation. Hold point of balance until release.
7 To restore thoracic spine rotation to the left: Patient lies on right side with hips flexed Patient places left hand behind head and rotates back to the left Assess rib mobility from T1-T7 to identify the most significant restrictions Place thumbs on superior border of rib at the sternochondral junction and apply AP glide to promote external rotation (torsion) of the rib
8 To evaluate/restore thoracic rotation to the right: Lie on the left side with hips flexed between and both hands out in front Take the right arm and sweep the hand up over the head with the hand remaining in contact with the floor and the elbow straight Rotate the trunk and rib cage back as you circle around with an emphasis on opening the chest If the hand comes off the floor, reverse directions and circle around the opposite way
9 Thank you!
10 Bookhout M, Chase L. Lectures presented: Exercise Prescription as a Complement to Manual Medicine at Michigan State University; October 26-29, 2018; East Lansing, MI. DeStefano L. Greenman s Principles of Manual Medicine. 4 th ed. Baltimore, MD: Lippincott Williams & Wilkins; Sutherland WG. Teachings in the Science of Osteopathy. Fort Worth, TX: Sutherland Cranial Teaching Foundation; Turner S, Gill K, Hankinson D, Burruano M. Lectures presented: 2017 Osteopathic Cranial Academy Conference The Legacy of Anne Wales: Passing Osteopathy Hand to Hand at Hyatt Regency; June 15-18, 2017; Minneapolis, MN.
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