General Osteopathic Technique Flashcards
Guy who first described GOT
First described by John Martin Littlejohn (1865-1947)
Scottish physiologist who studied with A.T. Still
Went on to establish the Chicago College of Osteopathic Medicine and the British School of Osteopathy
Teachings have continued through the work of John Wernham (1907-2007) at The John Wernham College of Classical Osteopathy in Maidstone England
Basic Principles of GOT
Uses rhythmic oscillation to treat the body regionally (globally) and then segmentally
Treating regionally results in the clinical resolution of approximately 80% of segmental dysfunction
Can be applied to almost any patient including adults and children
Overall goal – improve the motion and function of the entire patient, getting the entire system to integrate as a unit and establish an environment where the body can heal and exist in health
Is sequential, however, not a rigid and mindless regimen of Osteopathic wrestling holds
Allows for infinite variables specifically adapted to each individual patient’s needs, physiology and structural findings
Uses fluid circles and rhythmic oscillation to facilitate a release
Improves the physiology of bone, muscles and connective tissues, promotes lymphatic drainage and balances the autonomic nervous system
Improves rhythmicity – areas move more smoothly
Very fast, as you are diagnosing and treating simultaneously. Advantageous in a busy clinical setting
The treatment of any one part of the body should not take more than a few seconds. A slightly palpable physiologic change is enough for that treatment
Very gently – only moves the tissues about 4mm past the feather edge of the restrictive barrier
You are integrating the entire body into a harmonious, functional unit
Abdomen
Efficient, effortless breathing is vital to health
When a person undergoes a physical or psychological trauma, one of the first things they do is to inhale and hold it. The abdomen subsequently tightens
This restricts normal diaphragmatic motion and thereafter, the person cannot breathe properly. The entire body frequently becomes tight
Why? Increased tension within the abdominal wall may irritate the three sympathetic ganglions that lie within the abdominal region (celiac ganglion T5-T9, superior mesenteric ganglion T10-T11 and inferior mesenteric ganglion T12-L2).
What happens when there is increased sympathetic tone to tissues (especially muscles)? They tighten
If a patient has recurring somatic dysfunction in the upper or lower back, despite OMT and the proper performance of stretching exercises, the abdomen and diaphragm may need to be addressed before the somatic dysfunction in these regions permanently disappears
When the abdomen and diaphragm are restricted, the neck muscles may tighten with each breath to assist with rib elevation in an attempt to allow the person to breathe more fully
May result in chronic neck tightness and headaches, especially migraines
Visceral brain
Dx and treatment of abdomen
Patient supine on the table. Flex the patient’s hip and knees and hold their knees against your chest or body wall with your elbow. Start in the epigastric area and use one hand to gently palpate for increased tension and tissue texture changes within the abdominal wall. If present, apply slight posterior pressure to the abdomen with your hand. Maintain this pressure while moving the patients hip and knees in fluid circles (clockwise or counterclockwise, whichever is more comfortable to you) until a release is palpated (tissues soften or tissue texture changes improve). Work your way down the midline (linea alba) to the pubic symphysis, treating any dysfunction in the above manner.
After treating the midline, work your way around the remainder of the abdomen and evaluate and treat the right lower quadrant, right upper quadrant, left upper quadrant and down the left lower quadrant. Assess each area but only treat areas with significant somatic dysfunction. Remember, you are trying to get the entire abdomen to integrate and function as a unit.
Avoid treating in the area of the spleen if the patient has recently had mononucleosis.
Hips/Innominates
A common dysfunctional pattern is the right anterior/left posterior innominate, which is present in approximately 80% of patients
Treating the anterior/posterior rotation first may result in improvement of any associated innominate shear (superior or inferior) or flare (inflare or outflare)
Individualize and treat what you find
This technique looks at both innominates as a unit and both sides are treated if dysfunctional. It does not isolate dysfunction to one innominate based on the results of the standing flexion test
Hips/Innominates – right anterior DX and treatment
Diagnosis – patient supine. Place your left palm over the right ASIS (anterior superior iliac spine) and your right palm over the left ASIS. Rock them back and forth, one side at a time, toward the table. Do the innominates feel stiff and restricted? Also hook your thumbs underneath both ASIS’s and look at their position. Is the right ASIS more inferior than the left? This is most consistent with a right anterior/left posterior innominate. You can also ask the patient to turn over and assess the position of the PSISs’.
Treatment – patient supine
Right anterior innominate – flex the patient’s right hip and knee and place their proximal leg against your right shoulder. Stabilize the leg against your right shoulder with your left hand. Reach your right hand around and under their left innominate and place your fingertips medial to the left PSIS (posterior superior iliac spine). Use your entire body (not just your arms) to move the right hip through fluid counterclockwise circles (flexion, adduction, abduction and extension). This does not take much force and you are only moving approximately 4mm past the feather edge of the restrictive barrier. Especially focus on portions of the motion that are the most restricted. Continue until a release is palpated, which usually occurs within ten repetitions.
Hips/Innominates – left posterior dx and treatment
Left posterior innominate – flex the patient’s left hip and knee and place their proximal leg against your left shoulder. Stabilize the leg against your left shoulder with your left hand. Reach your right hand under the left innominate and place your fingertips medial to the left PSIS. Use your entire body to move the left hip through counterclockwise circles (flexion, adduction and extension). Continue until a release occurs.
Reassess both innominates. Has the pelvic rock improved? Are the ASIS’s and PSIS’s more symmetrical? You can treat any residual innominate shear or flare with another technique of your choosing.
Piriformis Muscles
Can be great mischief makers in the pelvis and are frequently associated with pelvic floor and sacral dysfunction (especially the Chicago posterior sacrum)
May also be associated with sciatica
When the hip is extended, the piriformis muscle serves as an external hip rotator and is an abductor when the hip is flexed
Piriformis diagnosis and treatment
Diagnosis and treatment – patient supine. You are diagnosing and treating this area simultaneously. If one side is tight, treat that side and if both sides are tight, treat both sides.
Example – right piriformis muscle tight. Stand next to the patient’s right side. Flex their right hip and knee and externally rotate their right hip. You must maintain this external rotation throughout the treatment or it will not be as effective. Contact the patient’s right knee with your left hand and their right ankle (over the lateral malleolus) with your right hand. Keep their right leg close to your body and move their hip in fluid counterclockwise circles (flexion/adduction, abduction and extension). Continue until a release occurs and reassess.
Adductor Muscles
Are frequently associated with pubic symphysis dysfunction and groin strains
Can also help maintain innominate dysfunction. For example, a tight right adductor can produce a right inferior pubic symphysis shear and contribute to a right anterior innominate. The innominate may not completely respond until the adductor and pubic symphysis dysfunctions are addressed
This technique looks at both pubic bones as functioning as a unit and does not lateralize using the standing flexion test. Both sides are treated in most instances
Adductor Muscles diagnosis and treatment
Diagnosis – patient supine. Place your left middle finger over the superior aspect of the right pubic bone and your right middle finger over the superior aspect of the left pubic bone. Is one side more inferior? To assess the right adductors, flex the patient’s right hip and knee and place their right foot on the table medial to their left knee. Use your right hand to stabilize their left ASIS and place your right hand over the medial aspect of their right knee. Gently abduct their hip by pushing their knee laterally toward the floor. Is a restriction present?
Treatment - the treatment position is the same. To treat the right adductors, abduct their right hip 4mm past the feather edge of the restrictive barrier. Oscillate the right knee back and forth toward the floor until the adductors release.
Use the same principles to diagnose the left side and treat if a restriction is present. Reassess. Are the pubic bones more symmetrical? Has the motion and symmetry of the innominates improved?
Ankles/Feet
Talocalcaneal articulation - very important biomechanical shock absorber. If it is restricted, more force is transmitted during ambulation to the ankle, knee, hip and low back, potentially compromising these areas and predisposing them to injury
Influences the overall motion of the hindfoot. As the hindfoot influences the forefoot, many forefoot problems can be addressed by improving the motion and function of the talocalaneal articulation
ankles and feet diagnosis
Diagnosis – patient supine. Contact the foot with one hand and dorsiflex the ankle. This stabilizes the talus within the ankle mortise. Cup the calcaneus with your other hand and take it through inversion/eversion and abduction/adduction. Is there a restriction?
Treatment – same hand position as diagnosis. Maintain ankle dorsiflexion and move the calcaneus through clockwise or counterclockwise circles. This will introduce multiple motions through the talocalcaneal articulation. Continue until a release is palpated and reassess.
This technique can be easily modified to treat an anterior/posterior lateral malleolus or any tarsal or metatarsal restriction. Remember the basic principles and adapt it to the specific dysfunction. Many tarsal, metatarsal or phalangeal dysfunctions will improve when the talocalcaneal articulation is addressed.
Hamstrings/Psoas Major Muscle
Frequently tight
Facilitated by somatic dysfunction in the low thoracic and upper lumbar areas
Can be treated with MET or Counterstrain
Sacrum
Has been referred to as the bone of contention, because multiple axes and models of motion have been described
Ask a simple question - is the sacrum in trouble, why is it in trouble and what are you going to do about it?
Motion is influenced by the innominates, lower extremity and lumbar spine. All of these may need to be addressed before the sacral dysfunction completely resolves.
This model does not localize dysfunction to a single side of the sacrum using the seated flexion test. It is one bone, and frequently both sacroiliac joints are restricted
Diagnosis – patient prone. You can use your preferred method, or you can simply cup the sacrum in the palm of your hands. Sidebend it to the left and right. Is a restriction present? Also assess the motion and position of the sacral sulci and ILA’s (inferolateral angles). Also palpate for any tension or tissue texture changes from the ILA’s down to the ischial tuberosities
Multiple different techniques to treat the sacrum
