Kania Lower Resp CIS (10/27)- with Still Technique for ribs/ thoracics/ etc.

Question 1

COPD dude– how to treat him using the OPP models?

Answer 1

Biomechanical

• Need to make diaphragm more mobile
• Need to improve the bellows function of the ribcage
• Need to address scalenes/1st rib

Respiratory/Circulatory/Lymph

• Need better air exchange
• Avoid thoracic lymphatic pump technique

Neurological
- Viscerosomatics

Metabolic
- Breathing is hard work and many with COPD cannot breathe while eating

Behavioral
- smoking cessation

Question 2

Diaphragm visualization

Answer 2

If one thinks of the hemi-diaphragm as an upside-down ladle, then the bowl is the domed portion of the upper diaphragm and the handle is the crus.

Then the ribs outline the rim of the bowl.

The handle is attached to the anterior lumbar vertebrae.

Question 3

Diaphragm Principles of MFR (direct and indirect)

Answer 3

Direct: Identify the restrictive barrier in multiple planes. Engage the tissue in opposition to the pattern of dysfunction. Load a constant force on the area of greatest restriction. Wait for the tissues to unwind or release.

Indirect: Identify the position of free motion in all planes. Place the tissue into the position of ease and maintain this until the tissues release.

Question 4

How to do MFR for the diaphragm

Answer 4

Stand behind seated patient. Placing patient so that their center of gravity is close to yours will make the biomechanics of the technique easier and allow you to use your arms and torso to support the patient.
Place finger pads under the anterior costal margin and contact the diaphragm.
Assess where the greatest area of restriction is. The restriction may be in the mediastinum or the lumbar spine.
Expand your anatomical awareness and try to think in 3 dimensions.
Use the patient’s torso to place them into the barrier (direct) or position of ease (indirect).
Use MFR principles to resolve the somatic dysfunction.

Question 5

Still Technique

Answer 5

Place the dysfunctional tissues into their position of ease.
Add a force vector (usually compression) through the dysfunctional tissues.
Move the tissues through the restrictive barrier.
It works better to correct the sagittal plane last.

Question 6

Still Technique for the First Rib(seated)- INHALED FIRST RIB

Answer 6

Brace opposite hand on the table with the elbow locked in extension.

Hand on affected side is placed on the anterior chest.

Place medial hand on rib head to monitor it. The forearm becomes a fulcrum as the technique progresses.

Lateral hand applies a compressive vector force from the elbow to the rib head to decrease tension on the joint capsule.

Lift the elbow cephalad while maintaining the compressive force throughout the arc.

This mimics the “up in front” position of the inhaled rib.

Continue moving the elbow cephalad and then posteriorly while maintaining the compressive force.

As you move the elbow posteriorly and inferiorly, the rib head is now pushed through the physiologic barrier.

You may feel it “clunk” back into place.

Recheck to ascertain resolution of the somatic dysfunction.

Question 7

Still technique for EXHALED FIRST RIB (seated)

Answer 7

Place medial hand on rib head to monitor it.

Lateral hand applies a compressive vector force from the elbow to the rib head to decrease tension on the joint capsule.

Lift the elbow cephalad while maintaining the compressive force throughout the arc.

This mimics the “up in back” position of the exhaled rib.

Continue lifting the elbow cephalad and swing it anteriorly while maintaining the compressive force throughout the arc.

This mimics the “up in back, down in front” position of the exhaled rib.

As you move the elbow superiorly and anteriorly, the rib head is now pushed through the physiologic barrier.

You may feel it “clunk” back into place.

Recheck to ascertain resolution of the somatic dysfunction.

Question 8

Still Technique for Thoracic and Lumbar Vertebral Somatic Dysfunction(seated)

Answer 8

Check for area of greatest restriction.
Identify the SD within the AGR.
Can use head & neck as a lever for treating upper Ts with compressive force coming from top of head, through neck to SD.

For lower Ts and Ls, place your hand on one of the patient’s shoulders and your opposite axilla on the other shoulder. Compress from both shoulders to the level of the SD.
If there are multiple SDs, treat the worst one first. Place it in the position of ease and then quickly check the other SDs. If they are not apparent, don’t treat them. They are compensatory SDs.

Question 9

STILL TECHNIQUE for inhaled RIBS

Answer 9

Rib(s) held in inhalation are more anterior and move more freely anteriorly.

Rotation of the thorax anteriorly to the opposite side of the affected rib should put the tissues into ease.

Hold the posterior portion of the rib to move it anteriorly.
Rotate the ipsilateral shoulder anteriorly to the opposite side.

Add compression with your hand on the shoulder (and your axilla on the other shoulder).

Return the ipsilateral shoulder posteriorly.

Question 10

STILL TECHNIQUE for exhaled RIBS

Answer 10

Rib(s) held in exhalation are more posterior and move more freely posteriorly.
Rotation of the thorax posteriorly to the opposite side of the affected rib should put the tissues into ease.
Hold the anterior portion of the rib to move it posteriorly.
Rotate the ipsilateral shoulder posteriorly to the opposite side.
Add compression with your hand on the shoulder (and your axilla on the other shoulder).
Return the ipsilateral shoulder anteriorly.