Anterior and Posterior Pelvis (Visceral Manipulation) OSCE w/ pics Flashcards
describe BLT treatment for the scalenes (anterior, middle, posterior)
- Cup the occiput with contralateral hand.
- Place middle finger on TVP that is most affected (TART)
- Other hand place 1-2 fingers on attachment at 1st or second rib to stabilize and monitor.
- Side bend away for direct Tx
- Rotate the head away for anterior muscles or anterior portions of muscles.
- Rotate the head towards for posterior muscle or posterior portions.
- Gently engage barrier and hold waiting for elastic changes.
Retest TART for efficacy.
describe the BLT treatment for the longus coli m.
Physician: Standing behind patient
Patient: Supine
- Cradle and hold the head in the forearm with hand supporting the occiput and forehead at axilla
- Free hand monitors the anterior lateral neck medial to TVP and deep to SCM (not carotid)
- Extend the neck through posterior translation.
- Side bend away through lateral translation
- Patient contracts muscle for 3 seconds and then relaxes.
- Forehead to ceiling
- Ear towards affected side shoulder
- Await tissue relaxation
- Repeat 3 cycles. Can treat bilaterally if needed.
describe the BLT treatment for serratus m.
PHYSICIAN: STANDING, FACING PATIENT
PATIENT: LATERAL RECUMBENT
- ENGAGE SCAPULA:
- CAUDAD ARM PASSES UNDER PATIENT’S ARM
- INTERNALLY ROTATE THE INFERIOR ARM TO PRODUCE POSTERIOR SCAPULAR MOTION
- GENTLY PUSH POSTERIOR AND MEDIAL ON THE LATERAL EDGE OF THE SCAPULA
- USE RESPIRATORY ASSIST
- SMALL INHALATION FOR 3-5 SECONDS WHILE MAINTAINING POSITION
- GENTLY FOLLOW FURTHER MOTION ON EXHALATION
- RETEST GLOBAL SCAPULAR MOTION
describe reduction of visceral strain
Physician: Standing behind patient
Patient: Supine
- Engage the mediastinum globally with one hand anterior and one posterior mid-portion contact
- Test for motion restrictions:
- Parallel hand motions and opposite hand motions
- Left / right
- Superior / inferior
- Clockwise / counter clockwise rotations
Treat with direct or indirect fascial release
abdominal diaphragm treatment with respiratory force
Physician: Standing at side of patient
Patient: Supine
- Grasp the lateral sides of the rib cage OR place one hand posteriorly behind the diaphragm and one hand in subxiphoid region
- Carry the rib cage through the three planes of motion to the point of balance
- Test respiratory phases and have patient hold breath as long as possible at point of best ligamentous balance (BLT)
- Repeat until best response is achieved.
- Recheck
supine psoas release
Physician: Standing, at side of patient
Patient: Supine, at edge of table or bed so that the side to be stretched can drop off toward the floor (right side)
- Apply superior pressure on ipsilateral pelvis at ASIS to prevent induction of anterior rotation dysfunction
- Provide GENTLE barrier engagement of hip flexors
- Hold for myofascial release, awaiting elastic change
- Patient contracts muscle for 3 seconds
- Repeat 3x
prone psoas release
Physician: Standing, at side of patient
Patient: Prone
- Apply anterior pressure at the hip joint to prevent pelvic rotation
- Provide GENTLE barrier engagement of hip flexors
- Hold for myofascial release, awaiting elastic change
- Patient contracts muscle for 3 seconds
- Repeat 3x
seated quadratus lumborum release
Physician: Standing slightly beside and behind patient
Patient: Seated
- Monitor the QL
- Induce side bending away from affected side (contralateral to affected QL muscle)
- Rotate away from affected side (contralateral to the affected QL)
- Do not engage spinal barriers as this may induce joint dysfunction
- Keep the curves regional and mild
- Place palm on QL, gently pressing laterally
- Engage and hold 30 sec waiting for elastic release, or have patient contract muscle for 3 seconds.
- Repeat 3x
lateral recumbent quadratus lumborum release
Physician: Standing next to patient, facing patient
Patient: Lateral recumbent with affected side facing up
- Operator places proximal forearms on iliac crest and inferior shoulder
- Fingers grasp QL muscle and fascia
- Physician leans forward and creates a spread of forearms to separate the region and lengthening of QL
- Apply a lateral pull on QL through the hands
- Can also add kneading component
- Perform rhythmically OR slow static hold OR muscle contraction (pull hip towards head)
reduction of visceral strain
Physician: Standing at side of patient
Patient: Supine
- Contact the anterior and posterior aspect of abdomen
- With the anterior hand, following respiration of patient, gradually sinking deeper until the anterior aspect of the kidney is palpated.
- Engage the kidney GENTLY
- The kidney is then motion tested anteriorly and posteriorly, medially and laterally, and superiorly and inferiorly.
- Test for motion restrictions in those planes
- Treat with direct or indirect fascial release
PS1 counterstrain
Physician: Standing next to patient
Patient: Prone (or seated)
- Tenderpoints may be found medial to PSIS and in mid-portion of sacral sulci
- CS Position: Apply anterior pressure at location diagonally opposite the TP
point out posterior sacral tenderpoints PS1-PS5
PS2-4 counterstrain
Physician: Standing next to patient
Patient: Prone (or seated)
- Tender points may be midline on sacrum, between sacral spines
- CS Position: Apply anterior pressure at location diagonally opposite the TP
PS5 counterstrain
Physician: Standing next to patient
Patient: Prone
- Tenderpoints may be found supero-medial to the ILA
- Counterstrain position: Apply anterior pressure at location diagonally opposite the tender point
visceral technique and release
Physician: Standing next to patient
Patient: Supine
- Operator may be inferior or lateral on the lower abdomen
- One hand is placed at the lumbosacral junction
- Other hand is placed at the anterior low abdomen
- Alternate approach: the anterior hand provides a focused transabdominal approach – uterus, bladder, other structures
