OMM CPA 1 Treatments Flashcards
Cervical Traction, Supine
- one hand cradles occiput
- other gently on chin
- keep head neutral
- 2-5 minutes
- One hand cradles occiput
- Other hand grasps gently below chin(avoid squeezing the chin) -Keep head neutral or slightly flexed. Avoid extension
- Exert cephalad traction slowly and rhythmically with both hands, gradually increasing amplitudes.
- Continue until desired soft tissue or disc response or 2-5 minutes
Forward Bending (Unilateral Fulcrum), Supine
- one hand under neck
- slide other arm under patient’s head with hand palm down on opposite
- rotate head toward and away from the elbow of your arm under patient’s head
- rotate head toward direction of tension
- pattern or constant until tissue softened
- Use one hand to flex patient’s neck in order to slide the other arm under patient’s head with hand palm down on opposite shoulder
- Keeping the neck in flexion, rotate the patient’s head toward and away from the elbow of the arm that is under the patient’s head to assess for the direction of tension.
- Rotate the patient’s head toward the direction of tension. A rhythmical pattern to the technique or a constant force is applied until tissue is softer and lengthened.
- Repeat on opposite side of cervical spinal tissue
Forward Bending (Bilateral Fulcrum), Supine
- arms crossed under patient’s head and hands placed palm down patient’s shoulders
- flex neck
- Arms are crossed under patient’s head and hands placed palm down on patient’s shoulders
- Flex patient’s neck to induce a longitudinal stretch of the paravertebral muscles
-A rhythmical pattern or a constant force is applied until tissue is softer and lengthened.
Contralateral Traction, Supine
- Physician: At side of table opposite side being treated
- Caudad hand reaches across and contacts paravertebral muscles on side opposite of where you are standing (make sure to be lateral to spinous processes, not on them)
- Cephalad hand rests on patient’s forehead to stabilize head
- Engage tissue with ventral force and continue to apply traction moving ventrally and slightly laterally creating a perpendicular stretch
Cradling with Traction, Supine
- Fingers placed under patient’s neck bilaterally on paraspinal muscles, just lateral to the spinous process
- Engage soft tissue with ventral and lateral force
- Apply a cephalad force to induce longitudinal traction
-Repeat above steps by repositioning hands to contact different levels of the cervical spine
Suboccipital Release
- Finger pads placed in suboccipital region (find occipital ridge and move inferiorly until fingers fall into suboccipital region)
- Inhibition: Apply a constant inhibitory pressure for 30 seconds to 1 minute
-Kneading: pressure may be slowly and rhythmically applied until tissue texture change occur or for 2 minutes
Thoracic Prone Pressure
- Patient: Prone
- Physician: Standing at side of table opposite the side to be treated
- Place thenar and hypothenar eminence on paravertebral muscles opposite the side you are standing
- Place other hand on top of hand contacting the muscles
- Keeping your elbows straight and using your own body weight, engage soft tissues with a ventral force and move out laterally to induce a perpendicular stretch
- Repeat by repositioning hands on different levels of the thoracic spine
Prone Pressure with Counterpressure
- Patient: Prone
- Physician: Side of the table
- Place thumb and thenar eminence of caudad hand over the thoracic paravertebral muscles opposite the side you are standing
- Place hypothenar eminence of cephalad hand on paravertebral muscles on the same side you are standing
- Engage tissues with a ventral force and then move the hands in the direction in which the fingers are pointing, creating a longitudinal stretch
Subscapular Stretch
- Patient: Prone
- Physician: Standing at side to be treated
- Take patient’s arm, on the side being treated, and place it behind their back
- Place fingers around medial border of scapula
- Engage the tissue upward and laterally, pulling scapula away from rib cage
Upper Thoracic with Shoulder Block, Lateral Recumbent
- Patient: Lateral recumbent with side to be treated up
- Physician: Standing at side of table facing patient
- Caudad hand passes under patient’s arm and contacts paravertebral muscles
- Cephalad hand contacts anterior portion of shoulder to give counterforce. -Drape patient’s arm over your arm.
- With both hands, engage soft tissues ventrally and move out laterally to create a perpendicular stretch
Lower Thoracic Under the Shoulder, Lateral Recumbent
- Patient: Lateral recumbent with side to be treated up
- Physician: Standing at side of table facing patient
- Forearms contacting the axilla and iliac crest, fingers contact medial aspect of the erector spinae
- Elbows spread apart, elongating distance between the shoulder and the hip
- Engage muscle with ventral force and move out laterally to give perpendicular stretch
Paraspinal Inhibitory Technique
- Patient: Supine or Prone
- Physician: Standing on side being treated
- Place finger pads over the paraspinal tissues
- Apply gentle, firm pressure to engage tissue for 30-60 seconds or until release occurs
Lumbar Prone Pressure
Patient: Prone
- Physician: Standing at side of the table opposite the side being treated -Place thenar and hypothenar eminence of one hand on patient’s lumbar paravertebral muscle on side opposite you
- Place other hand’s thenar eminence over the other hand
- Keep elbows straight and exert a gentle ventral and lateral force using your body weight to induce a perpendicular stretch
- Repeat the above steps along the lumbar spine
Lumbar Prone Pressure with Counterleverage
- Patient: Prone
- Physician: Stand at side of table opposite the side being treated
- Thenar eminence of cephalad hand contacts paravertebral muscles on the side opposite you
- Caudad hand gently grasps patient’s ASIS on the side opposite of you. Gently lift it towards the ceiling in order to create the counterleverage -Cephalad hand will engage tissues ventrally and move out laterally creating a perpendicular stretch
- Repeat by repositioning caudad hand along the paravertebral lumbar musculature
Paraspinal Perpendicular Stretch
- Patient: Lateral recumbent position with side to be treated up -Physician: At side of table facing patient
- Reach over patient’s back and place finger pads on the paravertebral muscles
-Engage tissues with a ventral and lateral force to create a perpendicular stretch
*bottom pic is alternative method
Iliotibial Band Tension(ITB) Prone, Counterleverage
The patient lies prone and the physician stands on the left side of the patient.
The patient’s right knee is flexed to 90 degrees
The physician’s right hand grasps the patient’s right foot
or lower leg while reaching over the patient to place the left hand, palm down, over the patient’s right lateral thigh (fig.1)
The physician begins to push the patient’s foot and lower leg laterally while simultaneously compressing the right hand into the patient’s lateral thigh to engage the ITB pulling posteromedially to its restrictive barrier (fig.2)
On meeting the ITB’s restrictive barrier, the physician can maintain the tension for 10 to 20 seconds and slowly release the tension and repeat until a maximum release of the tissue is noted or perform this technique in a slow, rhythmic manner, which is repeated over a few minutes or until the tissue texture is maximally improved.
To disengage the tension on the ITB, the physician pulls the patient’s foot/lower leg back toward the midline while decreasing the pressure on the lateral thigh (fig.3)
Tissue tension is reevaluated to assess the effectiveness of the technique
Iliotibial Band Tension(ITB) Lateral Recumbent, Effleurage/Petrissage
The patient lies in the right lateral recumbent position and the physician stands facing the front of the patient.
The physician’s left hand rests on the posterolateral aspect of the patient’s left iliac crest to stabilize the pelvis.
The physician makes a “fist” with the right hand and places the flat portion of the proximal phalanges over the distal, lateral thigh (fig.1).
The physician adds slight pressure into the distal ITB and begins to slide the hand toward the trochanteric.
This is repeated for 1 to 2 minutes and then the tissue tension is reevaluated to assess the effectiveness of the technique.
If preferred, the physician can alternate from the distal to proximal stroking and perform a proximal to distal stroking, ending at the distal ITB (fig.2).
Thoracolumbar MFR/INR, prone (Direct or Indirect)
Setup: patient prone, physician at side of table
Physician right hand at the right TLJ with thumb pads medial to
the longissimus thoracis and thenar eminence upon it; the left hand
is placed similarly on the left side •Internally rotate your arms at your shoulders to load the tissues
•Assess flexion/extension, rotation, & sidebending myofascial and joint-related tightness and looseness. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– leg extension, IR/ER; arm motion
•Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Prone Regional Thoracic MFR/INR (Direct or Indirect)
Setup: patient prone, physician at side of table
Physician right hand with thumb pads medial to the longissimus thoracis and thenar eminence upon it at T7-9; the left hand his placed similarly on the left side
•Assess each hand independently for flexion/extension, rotation, & sidebending myofascially for tightness and looseness. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– arm motion flex/extend, IR/ER,
Ab/Ad
•Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Prone Sacral Base MFR/INR (Direct or Indirect)
Setup: patient prone, physician at side of table
Physician places one hand with pinky just superior to the lumbosacral junction, thenar & hypothenar eminence lateral to one of the sacroiliac joints and the contralateral finger pad on the lateral aspect of the other sacroiliac joint
•Assess flexion/extension, rotation, & sidebending myofascial and joint-related tightness and looseness. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– leg flex/extend, IR/ER •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Cervical MFR/INR (Direct or Indirect)
*caution* to protect vertebral arteries - avoid sidebending and extension at same time
Setup: patient is supine, physician at head of table
Physician cups the subocciput with hands (no pressure with thumbs)
•Gently, add traction to engage the hypertonic tissues
•Assess flexion/extension, rotation, & sidebending myofascial and joint-related tightness and looseness.
–Keep in mind the principle that “less is more” and adding too much motion loses localization.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– eye, tongue & UE movement •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position & Re-assess
Hip region MFR/INR, standing (Direct or Indirect)
Setup: patient supine, physician at side of table
Physician places one hand on the proximal anterolateral aspect of the leg (over quadricep and greater trochanter) and the other posteromedially (over hamstrings
and adductors)
•Care is taken to avoid the genitalia
Assess IR/ER of hip region myofascia for tightness and looseness
.Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– knee/hip flexion/extension, AB/AD, IR/ER
•Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Popliteal Space MFR/INR (Direct or Indirect)
Setup: patient supine, physician at side of table
Physician uses finger pads to grasp the medial & lateral aspects of the hamstrings (superior) or the gastrocs (inferior) as they create the superior/inferior popliteal space
•Use a separating force to load the tissues, then assess IR/ER of area for tightness and looseness
.Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– knee flexion/relaxation; IR/ER at the hip
•Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position & Re-assess
Knee MFR/INR (Direct or Indirect)
Setup: patient supine, physician at side of table
Physician uses superior hand to grasp thigh superior to the patella & other hand inferior to patella on tibia and fibula
•Compress hands together to loose pack the joint, then assess IR/ER of area for myofascial tightness and looseness.
Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– knee flexion/extension •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position & Re-assess
Ankle MFR/INR (Direct or Indirect)
Setup: patient supine, physician at side of table
Physician grasps the patient’s distal leg crossing the ankle joint (holding medial & lateral malleoli) with superior hand and with inferior hand grasp the forefoot
•Assess IR/ER of ankle with the malleolar hand for myofascial tightness and looseness. Then assess inversion/eversion & dorsiflexion/plantarflexion. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– dorsiflexion/plantarflexion •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position & Re-assess
Plantar Fascia MFR/INR (Direct)
Setup: patient supine, physician at the foot of table
Physician’s thumbs are crossed, making an X, with the thumb pads over the area of concern at the plantar fascia.
•The thumbs provide a separating force to load tissues appropriate to dMFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– plantarflexion/dorsiflexion •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position & Re-assess
Glenohumeral and Scapular MFR/INR (Direct or Indirect)
Setup: patient prone, physician at side of table
Physician grasps the proximal humerus inferiorly near the axilla and superiorly placing thumb & 5th digit on humerus and digits 2-4 on scapula
•Assess F/E, IR/ER & AD/Abduction of the GH joint & lateral/medial, superior/inferior, & sidebending of the scapula. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– arm F/E, IR/ER, AD/ABduction •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Elbow MFR/INR (Direct or Indirect)
Setup: patient supine, physician at side of table
Physician grasps the radioulnar area near the radiohumeral joint with one hand positioned inferior to the joint and the other superior
•Assess the IR/ER for the fascia at the joint. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– dorsiflexion/plantarflexion •Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Wrist MFR/INR (Direct or Indirect)
Setup: patient seated, physician facing patient
Physician a) Grasp the wrist just proximal to the wrist joint; b) Grasp distal to the wrist joint with the other hand
•Assess the IR/ER for the fascia at the joint. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– wrist flexion/extension, radial/ulnar deviation & clenching/unclenching fists
•Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
Still’s Wrist MFR/INR (Direct or Indirect)
Setup: patient seated, physician facing patient
Physician a) Grasp the wrist anteriorly/posteriorly using your thenar and hypothenar eminences
• Assess fascial response to Flexion/Extension, Ulnar/Radial deviation at the joint. Load tissues appropriate to indirect (away from restriction) MFR or direct (into restriction) MFR.
Activating forces:
•MFR: Inherent and respiratory
•INR: REMs– wrist flexion/extension, radial/ulnar deviation & clenching/unclenching fists
•Timing= 20-60 seconds or until palpable release
Follow & Monitor release/s
Finishing position: no more releases noted; assist pt. to assessment position &Re-assess
