OMT Without The Table Saroj Misra, DO, FACOFP and Marissa Rogers, DO

Transcription

1 OMT Without The Table Saroj Misra, DO, FACOFP and Marissa Rogers, DO

2 Why bother? May not always have the table present Patient may not be able to lay prone or supine Some techniques may be easier to accomplish

3 Goals & Objectives By the end of this presentation, you will Recall Fryette s Three Laws as they apply to vertebral motion Review the concept of Direct vs. Indirect technique Identify 2 techniques for each vertebral segment that may be accomplished in non-prone, non-supine positions

4 Fryette s Three Laws

5 Fryette s First Law When the spine is neutral.. Sidebending and Rotation are in opposite directions.. and this usually happens to groups of vertebrae

6 When the spine is flexed or extended Rotation and Sidebending are in the same direction and this usually happens to single vertebra Fryette s Second Law

7 Fryette s Third Law If you induce motion in a vertebral segment in one plane, you will modify motion in the other planes If you improve motion in one plane, you will improve motion in other planes

8 Other Quick Reminders C1-C2 motion is rotation; OA motion, sidebending and rotation always occur to the opposite side (Type 1 Motion) In the cervical vertebrae (C2-C7), Sidebending and Rotation always occur to the same side (Type 2 Motion) Treat Type 2 SD before Type 1 SD (Single before Group)

9 Vs. Direct vs. Indirect Treatment

10 Direct Techniques Engage restrictive barrier Soft Tissue Articulatory Treatment Direct Myofascial Release Muscle Energy High Velocity, Low-Amplitude

11 Indirect Techniques Goes away from barrier; moves in the direction the body likes to go Balanced Ligamentous Tension (BLT) Counterstrain Facilitated Position Release (FPR) Indirect Myofascial Release Still Techniques

12 Cervical Techniques

13 Still Technique - C2-C7 Example: C3 Flexed, Rotated and Sidebent to Right (FRS right) Patient seated; Doctor in front of patient Doctor s right hand senses and left hand positions Right hand contacts C3 R articular pillar Left hand induces rotation/sidebending to R Left hand introduces vector force towards C3 R Left hand then sidebends and rotates to L while extending spine at C3 Return to neutral

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15 Still Technique - OA Example: Posterior R Occiput (Rotated Right, Sidebend Left) Patient seated; Doctor facing patient Doctor s left hand senses and right hand positions Left middle finger on the R posterolateral aspect of occiput Right middle finger on the L posterolateral aspect of occiput Right hand induces R rotation and maintains L sidebending Right hand distracts and moves the head L into restrictive barrier Return to neutral

16 Thoracic Techniques

17 Still Technique - T2-T10 Example: T5-6, Extended, Rotated and Sidebent to Right Patient seated; Doctor behind patient on Left R hand senses; L hand positions Doctor places L arm across chest and drapes onto R shoulder Right hand at T5 to sense L hand uses R shoulder to extend, rotate and sidebend to R L hand then introduces vector force towards T5 via R shoulder While maintaining force, patient is flexed, rotated and sidebent to L to barrier Return to neutral

18 Thoracic Muscle Energy T2-10 Example: T5-6, Extended, Rotated and Sidebent to Right Patient seated at end of table; Doctor standing behind patient R hand senses and L hand positions Patient clasps hands behind neck; doctor comes under L axilla and over R arm to grasp R humeral head Patient slumps to induce flexion at T5; doctor s R hand at T5-6 Doctor introduces R translation with R hand and L rotation with L hand Patient turns back to R and tries to straighten up while doctor resists Doctor gathers up slack, then repeats 2-3 times

19 Lumbar Techniques

20 Lumbar Muscle Energy L1-5 Example: L1, Extended, Rotated and Sidebent to Right Patient seated at end of table; Doctor standing behind patient R hand senses and L hand positions Patient clasps hands behind neck; doctor comes under L axilla and over R arm to grasp R humeral head Patient slumps to induce flexion at L1; doctor s R hand at L1-2 Doctor introduces R translation with R hand and L rotation with L hand Patient turns back to R and tries to straighten up while doctor resists Doctor gathers up slack, then repeats 2-3 times

21 Lumbar Facilitated Positional Release L1-5 Example: L1 Flexed, Sidebent and Rotated to Right Patient seated; Doctor behind patient on the opposite side Both hands sense and position Doctor contacts transverse process of L1 with thumbs Rotate transverse process to R with thumbs to point of balance Thumbs are rolled cephalic and anteriorly to induce flexion Anterior force is applied until release is felt (3-5 seconds)