omm lab practical 1
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Static Landmarks (ex. OA SL RR) Left transverse process (of C1) approximates left
mastoid process (since you’re sidebending them close together)
Right transverse process separates from angle of jaw
Right occipital condyle posterior Deep occipital shelf (it forms an “awning”)
Left occipital condyle anterior Shallow occipital shelf
Chin points slightly to right of midline
Check static landmarks
Dx TP closer to Mastoid
TP closer to Mandible
Deep Occipital
Shelf
Shallow Occipital
Shelf
SLRR Left Right Right Left
SRRL Right Left Left Right
Hands cradle occiput with fingertips of index and middle fingers over occipital articulation
Test right and left translation (side-slippage)
May also check forward and backward bending
Somatic dysfunction named for the way the segment wants to move Opposite of the
restriction
Hands cradle occiput with fingertips of index and middle fingers over occipital articulation
Test right and left translation
Also check in flexion/extension
If more symetrical in flexion, then it has a flexion component
If more symmetrical in extension, then it has an extension component
OA SRRL
Place pads of fingers just beneath superior nuchal line in the soft tissues
Lift head slightly so its entire weight is supported on fingers
Pull forearms gently toward operator at 45 degrees
Rib raising: Anterior pressure on ganglia will initially produce a short-lived increase in sympathetic activity, but this is followed by long lasting sympathetic inhibition Normalize sympathetic activity Improve lymphatic return Encourages maximum inhalation-more
effective negative intrathoracic pressure
A. RIB RAISING - CHEST CAGE ARTICULATION
Dysfunction: Decreased chest cage compliance.
Objective: Improve chest cage motion, ease of respiration
Discussion: This technique is useful for the hospitalized or bedridden patient with a chest cage exhibiting general decreased freedom or range of motion. It is also thought to help decrease sympathetic tone and improve respiration and gastrointestinal function.
Patient Position: Lying supine. Physician Position: Standing or sitting at
the patient’s side that is to be treated.
Procedure: 1. With the patient lying supine on the
treatment table or in bed, the physician slides their hands, palms up, under the patient's thorax. The hands are positioned so that the finger pads contact the posterior aspect of the ribs (just lateral to the costo-transverse articulation area).
2. The fingers are then moderately flexed and held firmly against the patient's back. An upward springing force is then applied to the rib cage. This may be accomplished through hand/wrist effort. The technique may be more efficiently; and comfortably accomplished by the physician using their arms and trunk as a unit. This is done by holding your fingers, hands, wrists, and volar surfaces of your forearms as a fulcrum.
3. The position of the hands is shifted along the rib cage until each area has been satisfactorily treated. The physician then applies the same treatment to the opposite side.
Patient supine, Physician at head of table Cervical spine is flexed Physician places the thumb on the anterior, superior Physician places the thumb on the anterior, superior
surface of the rib (between the heads of the SCM)surface of the rib (between the heads of the SCM) Patient inhales deeply and holds for 3-5 sec Physician resists motion of rib (effecting an isometric Physician resists motion of rib (effecting an isometric
contraction)contraction) Patient exhales Physician takes up the slack after a two-second pausePhysician takes up the slack after a two-second pause The process is repeated 3-5 times
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Grasp the inferior lateral rib cage. With thumbs pointed towards each other and caudad to the xiphoid process.
Follow the diaphragm motion as the pt. exhales. (posterior/anterior) Hold the end position and resist movement during inhalation.
During exhalation follow the diaphragm to a new barrier. Repeat three times, then move thumbs laterally along
the costochondral margin to a new restriction and repeat.
16
Contact the inferior lateral rib cage. With thumbs pointed towards each other and caudad to the xiphoid process, move to the restriction (“direct”) balance point
Alternatively or additionally, reposition with thumbs laterally along the costal margin to a new restriction balance point
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Dysfunction: Lymphatic stasis Objective: Improve lymphatic flow and fluid
exchange Discussion: The thoracic lymphatic pump
technique utilizes the elastic recoil of the thoracic cage to create an abrupt inhalation. This inhalation creates a negative intrathoracic pressure which mobilizes lymph and intrabronchial phlegm.
Patient Position: Supine Physician Position: Standing at the head of
the table
20
Procedure: Place your hands on the patient’s thoracic wall with the thenar eminence
of each hand just distal to the respective clavicle, with the fingers spreading out over the chest wall. NOTE: In the female patient it is important not to apply heavy pressure to the breast tissue. Alternative hand placement is best lateral to the breasts and will require your force to be directed medially and posteriorly.
Have the patient turn their head turned to one side with their mouth open.
As the patient exhales apply a compressive force through your arms, following the patient into full exhalation.
While keeping compression that prevents the patient from inhaling, apply a rhythmic pumping action for ten cycles.
Upon completion of the tenth compressive cycle, quickly remove your hands from the patient’s chest allowing the patient to take a deep inspiration.
As the patient quickly inhales, this creates a vacuum or negative intrathoracic pressure within the thoracic cavity. You should hear a suction or vacuum release.
Allow the patient to take several normal breaths then repeat this process four additional times.
NOTE: A patient with secretions within the bronchial tree may go into a spasm of coughing. This is beneficial in clearing the secretions and further enhances the flow of lymph. Allow the patient to catch his/her breath before proceeding.
F. Supine--direct method-respiratory force (pectoralis lift) (4933.11F)
Diagnosis: Lymphatic congestion
1. Physician places his/her hand over the pectoralis muscles and grasps their inferior margins (anterior axillary folds) between his/her fingers and palms
2. Physician leans backwards and pulls the pectoralis musclessuperiorly and medially putting superior and anterior tension on its muscular attachments to the sternum andcostal cartilages of ribs 2-6 and sometimes 7 to enhanceinhalation
3. Patient is instructed, “Breathe in and out very deeply.” The physician holds continued pectoral traction throughoutrepeated respiratory cycles (average is about 2 minutes)
4. Recheck lymphatic status
C1- InionC1- Muscle mass lateral to nuchal line
C2- articular pillar
C3- articular pillar
C4 – articular pillar
C5 – articular pillar
C6 – articular pillar
C7 – articular pillar
C1- Inion FlexC1- Extend & SARA
C2- Extend & SARA
C3- Flex & STRAw
C4 – Extend & SARA (off the table)
C5 – Extend & SARA (off the table) C6 – Extend & SARA (off the
table)C7 – Extend & SARA (off the table)
C3C4
C8 – medial tip of clavicle
C5
C7 – lateral attachment of
SCM to clavicle
C6
C2
C1 – Posterior edge of the ascending mandible
C3 – Flex & SARAC4 – Flex SARA (might extend)
C8 – Flex & SARA
C5 – Flex & SARA
C7 – Flex & STRAwC6 – Flex & SARA
C2 – Flex & SARA
C1 – Rotate Away
Rib raising: Anterior pressure on ganglia will initially produce a short-lived increase in sympathetic activity, but this is followed by long lasting sympathetic inhibition Normalize sympathetic activity Improve lymphatic return Encourages maximum inhalation-more
effective negative intrathoracic pressure
A. RIB RAISING - CHEST CAGE ARTICULATION
Dysfunction: Decreased chest cage compliance.
Objective: Improve chest cage motion, ease of respiration
Discussion: This technique is useful for the hospitalized or bedridden patient with a chest cage exhibiting general decreased freedom or range of motion. It is also thought to help decrease sympathetic tone and improve respiration and gastrointestinal function.
Patient Position: Lying supine. Physician Position: Standing or
sitting at the patient’s side that is to be treated. Procedure:
1. With the patient lying supine on the treatment table or in bed, the physician slides their hands, palms up, under the patient's thorax. The hands are positioned so that the finger pads contact the posterior aspect of the ribs (just lateral to the costo-transverse articulation area).
2. The fingers are then moderately flexed and held firmly against the patient's back. An upward springing force is then applied to the rib cage. This may be accomplished through hand/wrist effort. The technique may be more efficiently; and comfortably accomplished by the physician using their arms and trunk as a unit. This is done by holding your fingers, hands, wrists, and volar surfaces of your forearms as a fulcrum.
3. The position of the hands is shifted along the rib cage until each area has been satisfactorily treated. The physician then applies the same treatment to the opposite side.
Direct Contact Use pad of the finger
Gentle rotary motion over the point Approximately 15 seconds Pressure should be firm Do NOT make the patient grimace!
Treatment can last from 15 sec to 2 minutes
End point is achieved when the physician notes the softening of the firm nodule
Myocardium
(Bilateral)
ANTERIOR2nd intercostal space at the Sternal Border
An Osteopathic Approach to Diagnosis and Treatment, DiGiovanna, 3rd ed, pp 113-117
POSTERIORThe space between the transverse processes of T2 and T3 midway between the spinous process and the tip of the transverse process
Adrenals
(Bilateral)
Adrenals
(Bilateral)
POSTERIORIntertransverse spaces on both sides of T11 and T12 midway between the spinous processes and transverse processes
ANTERIORLateral Aspect of rectus abdominus at the level of the inferior margin of the costal margin
An Osteopathic Approach to Diagnosis and Treatment, DiGiovanna, 3rd ed, pp 113-117
F. Supine--direct method-respiratory force (pectoralis lift) (4933.11F)
Diagnosis: Lymphatic congestion
1. Physician places his/her hand over the pectoralis muscles and grasps their inferior margins (anterior axillary folds) between his/her fingers and palms
2. Physician leans backwards and pulls the pectoralis musclessuperiorly and medially putting superior and anterior tension on its muscular attachments to the sternum andcostal cartilages of ribs 2-6 and sometimes 7 to enhanceinhalation
3. Patient is instructed, “Breathe in and out very deeply.” The physician holds continued pectoral traction throughoutrepeated respiratory cycles (average is about 2 minutes)
4. Recheck lymphatic status
Place pads of fingers just beneath superior nuchal line in the soft tissues
Lift head slightly so its entire weight is supported on fingers
Pull forearms gently toward operator at 45 degrees
Forth ventricle contains Medulla which regulates respiration
Used to treat fluid motion/potency: Through promotion of
movement of nutrients into cells
Metabolic wastes out of the cells
Indications: Normalize PRM Reduce tone in sympathetic
nervous system Reduces fevers Venous congestion Promotes uterine
contraction i.e. induction of labor
Arthritic/autoimmune disorders
Contraindications: Acute CVA Aneurysm Malignant HTN Skull fracture Pregnancy from 7th month
because my induce labor
CV-4 means compression of the 4th ventricle, i.e. that space in between the cerebellum and the brainstem filled with cerebrospinal fluid.
The brainstem underlying the 4th ventricle consists primarily of the pons and upper medulla.
Sutherland believed that compression of the 4th ventricle affected all the vital nerve centers located throughout this region of the brainstem.
CV-4 is one of the most important techniques you will learn.
According to Viola Frymann, DO, it is thought that CV-4 technique stimulates the
body’s inherent therapeutic potency to overcome whatever dysfunction is present.
In this sense it is a general technique. It seems to have a global influence on a lot of different body systems.
CV-4 seems to decrease overall sympathetic tone and has a balancing
effect on the autonomic nervous system.
Patient lies Supine Physician seated at head of the table With both forearms resting on the table to establish a
fulcrum Place one hand in the palm of the other so that the
thenar eminences lie uppermost and parallel to each other
Slip them under the occipital squama. Fig 4-3 Make sure they lie medial to the occipitomastoid
suture! Thumbs are at the level of C2 The weight of the head rests on the thenar eminences
and thereby gently compresses the lateral angles of the occiput.
Become aware of the CRI motion of the occiput. The occiput will press against your thenar eminences in
flexion, and will move away in extension. Follow the motion into EXTENSION by maintaining
bilateral medial force. Discourage (inhibit) flexion. The amplitude of the motion gets progressively smaller
with each cycle until a STILL POINT is reached. At the still point, the CRI will seem to stop. You may feel a sensation of a fine vibration which builds
in a crescendo fashion to a peak, and then starts to diminish in a decrescendo fashion.
At the end of the still point, there is a sense of softening and warmth in the occiput and a gentle rocking motion of flexion/extension returns like a boat on quiet water.
At the same time, thoracic respiration should be diaphragmatic at about the same
rate as the CRI. Observe the CRI through a few cycles, and then gently
remove your hand.
The still point may last only a few moments or several minutes.
You may observe in some patients a gentle perspiration on the forehead.
The patient may have a deep sigh in the respiration as the still point releases.
You must be patient and wait for it to complete itself.
You may feel the head move through more than one still point.
The CV-4 technique can also be performed by following the temporals or even lower extremities into internal rotation, or the sacrum into extension, holding through a still point, and then releasing.
Soft tissue paraspinal inhibition (lumbar) Normalize sympathetic activity to help prevent ileus
Celiac, superior & inferior mesenteric ganglia releases Normalize sympathetic activity
Both hands palms up at L1-2 under supine patient
Finger tips on distal erector spinae masses (ESM) & thenar eminences on proximal ESM
Hands are then closed approximating ESM So THIS is the one where you reach BEYOND the spine
Tensions balanced in rotational component Further balance achieved by moving one
forearm towards or away from operator Balance held for 60-90 seconds or until
relaxation achieved
COLLATERAL GANGLION TECHNIQUE Dysfunction: Increased sympathetic input
to abdominal viscera. Objective: Normalize sympathetic tone
through inhibitory pressure of the collateral ganglia.
Discussion: The three collateral sympathetic ganglia are located between the xiphoid process and the umbilicus. Cephalad to caudad they are the celiac, superior mesenteric and the inferior mesenteric ganglia.
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