More OMT treatments

Question 1

Sacral Dysfunction

Answer 1

1. Sacral sulcus is superior lateral margin just medial to PSIS
2. Use seated flexion test
   ILA is the origin of the sacrotuberous and sacrospinous ligaments
   When these are tight, the ILA is inferior or posterior relative to the other side
3. If seated flexion is positive on the opposite side to the positive ILA, it’s a diagonal sacrum
   Named for the side of the positive seated flexion
   Most of the time when a diagonal sacrum is diagnosed, there is also a single segment lumbar neutral dysfunction

Question 2

Left Diagonal Sacrum Tx

Answer 2

Pt is seated with you behind
Monitor left sacral sulcus for relaxation with right hand
Sidebend towards left and rotate right
Compress toward restricted sacral base
Sidebend right and rotate left
Release compression, return to neutral, retest

Question 3

Unilateral sacrum

Answer 3

Dx: ILA is inferior and tight on same side as positive seated flexion test
Tx for Right Unilateral Sacrum
Pt seated with you behind
Monitor right SI joint for relaxation with left hand
Rotate right
Maintaining compression, rotate left
Release, return, and retest

Question 4

Anterior Sacral Base

Answer 4

Pt is seated
Hand placed on inferior aspect of sacrum
Pt flexed forward
Pt instructed try to sit up against resistance while monitoring hand maintains pressure on apex of sacrum

Question 5

Abdominal Diaphragm Release

Answer 5

One hand anterior under xiphoid
One hand posterior spanning T12-L3
Test fascial tension superior/inferior, L/R, clockwise/counterclockwise
Treat direct or indirect fascially, with or without resp assistance

Question 6

Clavicle/Fascial Release

Answer 6

Hook fingers over clavicle & into supraclavicular space
Other hand grasps pt’s wrist and initially pulls inferior & anterior, lifting clavicle. Fingers progress behind clavicle to point fascial tension
Begin sweeping motion of arm into flexion, then abduction, then extension
Repeat until tissue responds

Question 7

Pectoral Traction

Answer 7

Place hands over pecs and grasp inferior margins
Lean back and apply cephalad traction to ant axial fold
Pt instructed to take deep breath. As pt inhales follow axillary fold as it moves cephalad
As pt exhales maintain traction to stretch fascia
Repeat until tissue releases

Question 8

Epigastric Thrust

Answer 8

Pt. sits with hands clasped behind neck, operator stands behind.
Place an object (towel) on posterior TP of the dysfunctional segment
Operator puts epigastric/chest area on the towel and puts hands under the axillae
Operator takes a step back from the table and exerts a backwards force movement of the patient’s upper torso while at the same time exerting a forward force through the rolled-up towel (really want the towel pushed up tight against the segment)
Operator flexes patient’s body to localize to segment then slight flexion/ext is added to reach the barrier
Operator introduces slight side bending to the barrier. (The rotation is already to the barrier by positioning)
A lifting posterior/superior force is exerted by the arms of the operator while simultaneously the epigastric area advances suddenly slightly anterior and superior