GI counterstrain

Question 1

Lower Thoracic Under the Shoulder, lateral Recumbent

Answer 1

• Patient lateral recumbent, treatment side up
• Finger pads placed on paravertebral muscles, lateral to the spinous processes
• Engage muscle with ventral force and move out laterally to give perpendicular stretch

Question 2

Thoracic: Prone Pressure with Counterpressure

Answer 2

1. Patient prone; physician at side of table.
2. Place thenar eminence and thumb of caudad hand over the thoracic paravertebral muscles opposite the side you are standing
3. Place hypothenar eminence of cephalad hand on paravertebral muscles on the same side you are standing
4. Engage tissues with a ventral force and then move your hands in direction in which they are facing creating a longitudinal stretch

Question 3

Thoracic Inlet Fascia

Answer 3

Pt supine Physician at the head of the table

Place index fingers on SC joint, the angle of rib1, and place thumb on the transverse process of T1

Press caudally towards pt.’s feet

Rotate tissues clockwise/counterclock wise and feel ROM

Rotate tissues to the restrictive barrier

Hold in barrier until you feel tissue creep:

Always “drive the osteopathic bus” before and after any lymphatic treatments

Question 4

Thoracolumbar diaphragm fascia

Answer 4

1. Pt supine. Physician stands at side of table
2. Place palmar surface of hands on right and left side of lower rib cage, fingers pointing toward table
3. Rotate tissues of thoracoabdominal region right & left about vertical axis looking for ease/restriction of motion. Can also check sidebending by translating the region.
4. To tx, rotate to the restrictive barrier. Hold there asking pt to take deep breaths. Increase rotation as tissues relax, going further into the barrier
5. Continue until restriction is no longer felt

Question 5

Pelvic Diaphragm fascial: Supine Technique

Answer 5

Pt supine w/ knee & hip flexed on side to be treated. Physician seated on treatment side

Find ischial tuberosity w/ outside hand. Introduce fingers of other hand medial to ischial tuberosity, putting pads of fingers on medial surface of ischium

Have pt inhale and exhale. On exhalation, encourage diaphragm to move superiorly by providing fingertip pressure in cephalad direction

Maintain this position and resist motion with inhalation

Follow again in cephalad direction with exhalation.

Repeat treatment until both thoracic and pelvic diaphragms come into phase w/ good amplitude

Question 6

Pelvic diaphragm fascia: prone

Answer 6

Prone Technique

Pt prone. Physician stands at the side of the table facing the head of the table

Place thumbs medial to ischial tuberosity’s on each side

Gentle cephalad pressure is exerted into the ischiorectal fossa until resistance is met, and then a lateral force is applied

Have pt inhale and exhale. On exhalation, encourage diaphragm to move superior by providing fingertip pressure in the cephalad direction

Maintain this position and resist motion with inhalation

Follow again in cephalad direction with exhalation.

Repeat treatment until both the thoracic and pelvic diaphragm come into phase w/ good amplitude