Techniques For The Thoracolumbar Junction Area

When referring to the thoraco-lumbar region we are encompassing the area from about the tenth thoracic to the second lumbar vertebrae, not just the twelfth thoracic to first lumbar articulations. The term refers to an area rather than a specific segment. Like all the junctional areas of the spine, there are differences from adjacent areas. As the curves are changing and the stability of one area meets the relative mobility of the other, difficulties occur. From a technique and treatment...

Somatic Dysfunction

The traditional term osteopathic lesion has been largely superseded by the term somatic dysfunction. Although this is not strictly synonymous, it is in accord with the World Health Organization International classification of diseases. When the original definition of an osteopathic lesion was coined by Andrew Taylor Still the concept of the possibility of a dysfunction in the musculoskeletal system without the presence of disease was revolutionary. It has taken many years for the medical...

Thrust to tibiotalar joint prone Put the

Patient's foot over the end of the table and fix the tibia with your cephalic hand while taking up the slack with the other hand pushing down on the calcaneum. You can vary the dorsiflexion to achieve the optimum tension and then apply the thrust toward the floor. Tips Most useful for small operators as this technique relies on application of weight rather than use of levers and force. Extra considerations Try using the operator's inner thigh to produce the relevant amount of dorsiflexion. 33.8...

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21.14 Kneading of anterior tissues supine Stand to the side of the table and stabilize the head on the pillow with the upper hand. Use the heel of the lower hand to push carefully into the scaleni until resistance is felt. Hold the muscles on this slight tension and roll the head away to bow the muscles over the thenar eminence. Tips As the scaleni are so sensitive to pressure, this allows quite strong stretch and kneading effect by using a lever rather than pressure. 21.16 Stretching of...

Kjr

20.6 Articulation sidelying Fix the under-surface of the patient's flexed upper arms against your side and hold her elbows. Use a firm grip on the spinous process of the target vertebra with the other hand. Introduce flexion and extension by rocking your body into rotation, thereby carrying her arms back and forth. Tips Least useful where the patient has any condition of her shoulders making the flexed position difficult. Try using one flexed arm only. Most useful where it is desired to...

Thrust meniscus supine Fix the femur3113 Thrust medial meniscus supine Firmly

Between your hand, the table and the lateral aspect clasp the ankle between your body and forearm. of your thigh. You can then circumduct the tibia to Grip around the leg just below the knee and alternately apply medial and lateral gapping to the introduce a circumduction movement. Within this knee. This forms a very efficient articulation tech- circumduction there will be a point of tension. This nique and if the fixing hand presses directly over point usually occurs with a combination of...

Spine

Supine Translation Traction

The term 'thoracic' will be used in preference to the term dorsal, which has now been largely superseded. If the reader is accustomed to 'dorsal', he will need to make a mental translation at each reference. The thoracic spinal area is more accessible than the lumbar in that the embryological curve is maintained. The facet joints are liable to be involved in mechanical dysfunction syndromes as they are in apposition during normal posture, not just in flexion of the spine. Despite the torsional...

Techniques For The Foot33

Some osteopaths neglect foot technique in patient care as they find the techniques difficult to master, and sometimes uncomfortable on the hands. Many cases of foot dysfunction receive benefit from general mobilization and some practitioners are happy to use such methods rather than specific techniques. However, specific techniques can often be a short cut to good results, and save not only time and effort, but can produce a better and longer-lasting relief from mechanical dysfunction problems....

Techniques For The Cervicothoracic Junction Area

The cervico-thoracic, or cervico-dorsal, region can be a source of more frustration in attempting to achieve successful technique results than almost any other area. There are many reasons for this. The area is junctional which means that there will be a change in orientation of anatomical curves. There is a mobile area of the neck meeting a less mobile area of the thoracic spine and ribs. There are emotional factors which manifest in the area relating to stress and tension. The use of the arms...

Friction or vibration frontal sinus supine

Direct friction over the emission of the supra-orbital nerve as it emits from the ridge of the frontal bone is being used here. The operator's fingers are directly applied to the notch, and either circular friction or vibration can be performed. Tips Most useful in conjunction with other friction and vibration points and particularly when the frontal sinus is involved. Least useful where acute sinusitis makes the friction points too tender. Extra considerations Start slowly and superficially...

Inflammation

A joint that is acutely inflamed is best left to rest for a while until treatment is com menced. Over-zealous attempts to force a joint to become fully functional in this situation will often lead to extreme reactions. Inflammation due to ankylosing spondylitis or Reiter's disease is a situation where excessive active treatment is best avoided. Gentle settling techniques can be of use to reduce the irritability enough so more powerful procedures can be used later. The timing and selection of...

Exercises For Developing Technical Skill

Any psychomotor skill can be improved and developed by suitable practice. It is not possible to practise every technique or method sufficiently to become skilled enough so that the process is automatic without a considerable quantity of time and effort. However, there are some exercises or drills that may help to shorten the learning time for students and I have included a few here. It is unfortunate that it is extremely difficult to find activities that are similar to the skills needed for...

Operator Posture And Stance

Factors relevant to operator posture are weight in relation to gravity the contact with the floor or table the position of his head and all other aspects of weight distribution consistent with the ability to transmit forces in the best way for each technique. The term stance relates more to the position of the operator in relation to the table, and the proximity to the patient. Although the two are to some extent interdependent, there are differences. For example, an operator can be in a good...

Cage And Ribs

The ribs and thorax present certain of their own particular problems from the point of view of efficient performance of technique. These problems mainly relate to the variations in shape of the thoracic curve in different individuals and the need to modify approaches accordingly. There are several pathological conditions that need particular care. Although this is not the place to be detailing all these, the reader is encouraged to think in particular about osteochondrosis, osteoporosis,...

Indirect Technique

Although the teaching at most osteopathic training establishments world-wide has been predominantly structural in approach, there is a considerable interest, and validity, in many of the more newly developed methods. Indirect methods are generally less invasive in application, although they may be no less effective in action. They require just as long to perfect as direct methods, but give the student or practitioner who is not experienced in direct technique an ability to treat the patient...

Techniques For The Lumbar Area

Accurate and efficient techniques for the lumbar area are extremely important. The highest percentage of patients presenting to osteopathic practitioners are suffering with low back pain, and techniques for the lumbar spine will probably be used more often than any others. The practical difficulties for a small operator in reaching a facet joint no bigger than the thumb nail, in the back of a patient weighing anything up to around 200 pounds, can be considerable. The sheer depth of the joints,...

Techniques For The Cervical Area

The cervical spine poses several problems for the manipulative practitioner. Patients are often nervous of having their neck handled. This is either through natural fear of damage to the area from its apparent fragility, or due to having had a previous bad experience. Some operators are also afraid of harming the patient with techniques in the neck and unconsciously transmit this to the patient. The patient then finds relaxation impossible, thus perpetuating the vicious circle. There are...

Friction and vibration maxillary sinus

Supine The operator is sitting at the head of the table and has applied the tips of middle fingers to the maxilla so that direct pressure can be used over the emission of the nerve. Vibration can be applied over the maxillary sinus in this position also. The patient's head is stabilized by the heels of the operator's hands. Tips Most useful where maxillary sinus is involved. Least useful where acute sinusitis makes pressure extremely uncomfortable. Extra considerations Start gently and...

Strain And Counterstrain

Strain and counter-strain technique was first described by Lawrence Jones DO in 1981. He put forward the notion that many somatic dysfunction syndromes are accompanied by specific trigger points. These points are often very remote from the lesion and may not accord with conventional anatomical thinking, but are consistent and have a characteristic sensitivity and tenderness The technique consists of locating the trigger point relevant to the particular dysfunction and then positioning the...

Principles Of Locking

All techniques that work by focusing forces to a specific joint need some method of producing that specificity. The usual method is to combine levers in such a way as to produce a locking or focusing. This means that other adjacent structures are excluded from being the target for the forces and are, therefore, to some extent, protected. Excessive attempts to 'protect' them, however, are just as likely to harm, from 'over-locking' which can produce discomfort and potential trauma. How is...

Techniques For The Gluteal Region And Coccyx

As the glutei are such strong muscles and are in close proximity to the sciatic nerve they may play an important role in production and maintenance of sciatic pain syndromes. Hypertonic glutei can affect posture and prevent normal mechanical relationship of the hips to the rest of the body. There may be a tendency for the hips to rotate outwards and thus upset locomotion, sitting and standing postures. Lumbar origin pain syndromes will often present as tense painful areas in the glutei,...