OMT FOR CONCUSSIONS KIMBERLY WOLF, D.O. FEBRUARY 17, 2017

Transcription

1 OMT FOR CONCUSSIONS KIMBERLY WOLF, D.O. FEBRUARY 17, 2017

2 POTENTIAL SEQUENCE Address lymphatics including all transition zones/diaphragms Address somatic dysfunction in spine Focus on upper cervical spine Address cranial dysfunction Fluids venous sinus drainage, CV4 Bones SBS decompression Dura

3 LYMPHATICS

4 THORACIC INLET RELEASE - MFR Pt is supine with physician at head of the patient Physician contacts the thoracic inlet with both hands (palms near acromion process, first digits near T1, and second digits near clavicle/first rib Motion test in 3 planes (lateral, superior/inferior, rotational) using a steering wheel motion Engage the tissue in either a direct or indirect manner, and let the tissue unwind. Follow the tissue as it releases until it feels the tissue has softened under your hands Reassess for change following treatment

5 THORACIC INLET RELEASE Seekoptimalhealth.com

6 CERVICAL SPINE

7 CERVICAL STILL TECHNIQUE, SUPINE (C2-7) Pitfalls: Not maintaining compression or distraction! Not localizing well enough! Pt position: Supine with physician at head of the table Place your right hand at the level of the dysfunction and your left hand on top of the head Induce gentle flexion to the level of the lesion + compression with your left hand Position the dysfunctional segment in its position of ease to a point of balance (F/E, SB, R) Maintain your vector with compression and quickly turn the segment in the opposite direction and ultimately through the restrictive barriers in all 3 planes Reassess!

8 CERVICAL STILL TECHNIQUE

9 SUBOCCIPITAL RELEASE Pt supine with physician at head of the table Physician places fingertips (excluding thumbs) in the occipital sulcus bilaterally so both hands meet in the midline Occiput is cupped in the patient s palms while pt s neck is maintained in slightly flexed position Physician allows the weight of the patient s head on their hands to create the force for the treatment Physician waits while a softening of the muscles is felt and their fingertips are able to sink in deeper in the suboccipital musculature Can add a ME component by asking the pt to press their head towards the table Recheck after completing the treatment

10 OCCIPUT SUBOCCIPITAL RELEASE

11 CONDYLAR DECOMPRESSION Infant is supine- head cradled in both hands of the physician Physician curls fingers into the craniocervical space so ring fingers lie on the approximate plane of the condyles and middle fingers approximate the plane of the atlas Use the ring fingers to introduce a firm but gentle force in a lateral direction to lift and spread the tissues posteriorly and away from atlas (Move the wrists) Middle fingers may be used to decompress atlas from occiput Performed until balanced tension felt between occiput and atlas and position maintained until change in tissue texture or improved freedom of motion

12 CONDYLAR DECOMPRESSION Need pic

13 CRANIAL

14 SPHENOBASILAR SYNCHONDROSIS The sphenoid and occiput form the key articulation at the base of the skull Movement is about a transverse axis Move through flexion and extension Rises in flexion Descends in extension

15 FLEXION Flexion at the SBS dura pulled up moving the sacral base posterior through a transverse axis about S2 COUNTERNUTATION (sacral extension) Head in flexion Ernie! Transverse diameter increased AP diameter decreased Vertical distance decreased Palate wide and flat Eyeballs prominent Orbits with wide diagonal diameter

16 EXTENSION Flexion at the SBS dura pulled down moving the sacral base anterior through a transverse axis about S2 NUTATION (sacral flexion) Head in extension Bert! Transverse diameter decreased AP diameter increased Vertical distance increased Palate narrow and elevated Eyeballs not prominent

17 STRAINS OF THE SBS 6 TYPES 1. Flexion/extension 2. Torsion 3. Sidebending and rotation 4. Vertical strain 5. Lateral strain 6. Compression

18 SBS DECOMPRESSION Pt is supine and physician is at side of the pt with dominant hand more inferior (towards pt s feet) Physician gently grasps the greater wings at the pterion bilaterally with thumb and middle fingers of one hand The other hand (usually dominant hand) contact the posterior aspect of the upper last molar teeth bilaterally with DIP joints slightly flexed With equal force on all 4 fingers, lift the sphenoid and maxillae straight up towards the ceiling until balance is reached with the occiput Hold until there is a sense of decreased resistance (and often a very palpable increased amplitude in CRI)

19 SBS DECOMPRESSION Pic to come!

20 CV4 Patient should be supine, but if in 3 rd trimester have at approximately 45 Pillow under head and/or knees for comfort Physician is at the head of the table with hands forming a cup Physician s hands are placed with thenar eminences lateral to the external occipital masses but medial to the lower angles of the occiput Do not cross the OM suture as you can trigger N/V

21 CV4 Palpate and begin to follow the CRI from this position The physician exaggerates extension by applying very very slight but persistent pressure medially through the thenar eminences Contract the deep forearm muscles to help exert this pressure This pressure is maintained and the CRI will slow with each successive cycle until a still point is reached often accompanied by a change in the patient s respirations Hold the still point until you feel an expansion of tissues/fluid under your hands takes seconds to minutes Release your pressure and you will often notice warmth under your hands

22 CV4

23 VENOUS SINUSES

24 LATERAL VIEW

25 VENOUS SINUS TECHNIQUE Pt supine, physician at head of table Occipital Sinus: Two middle fingers tip to tip at the EOP until there is a softening under their fingers. Then move a finger s width down the occipital sinus, ultimately until they are at 45 degree angles at the level of the condyles. Then decompress the condyles by approximating the wrists.

26 VST CONTINUED Transverse sinus: Approximate pads of little fingers beneath the EOP and let the pads of other fingers support the head along the superior nuchal line to the ILA of the parietals. Thumbs are placed over one another over the sagittal suture. Maintain until softens.

27 VST CONTINUED Superior Sagittal Sinus: Flex patient s head and place thumb pads at the EOP. Place the pad of the right thumb just to the left of the midline, and the pad of the left thumb just to the right of the midline. Thumbs are crossed and apply a gentle distracting force. When softening is felt, move thumbs about an inch forward and repeat along the sagittal suture. To complete the anterior portion, place finger pads on either side of the metopic suture and apply gentle traction laterally until softens.

28 SUPERIOR SAGITTAL SINUS