OMM for the pregnant patient

Question 1

indications for rib raising

Answer 1

• aid respiration
• aid circulation for congestion
• pre- or post-operative care

Question 2

hyper-extension technique

Answer 2

• patient seated on table with head resting on pillow against physician’s chest
• patient’s arms resting on physician’s shoulders
• physician leans back while pulling laterally on posterior structures

Question 3

hyper-extension of cervical spine

Answer 3

• patient seated facing physician, arms crossed over pillow
• physician’s hands on articular pillars
• physician leans back while pulling laterally on c spine

Question 4

seated segmental cervicals treatment

Answer 4

• patient seated
• physician monitors with hand on forehead and thumb / fingers on posterior aspect of articular pillars
• level identified, head brought into flexion / extension at that level
• translation left / right to see where freedom of motion is
• isometric ME

Question 5

chicago roll (example: left shift)

Answer 5

• patient supine with hands behind neck
• physician on same side as shift
• physician’s right hand loops through patient’s right arm placing back of hand mid-chest with hand pointing toward opposite lower rib cage
• physician’s left hand stabilizes right ASIS
• physician pulls patient toward left lower rib cage with a slight tug or thrust on exhalation

Question 6

psoas ME

Answer 6

1. patient in lateral recumbent position with knees bent
2. stabilize IT
3. extend thigh with knee bent
4. follow ME steps

Question 7

ME for increased lumbar lordosis

Answer 7

1. patient supine
2. bring up knees and flex hips
3. place forearm over tibial tuberosity region while other hand supports feet
4. patient pushes equally with both knees back into your forearm
5. follow ME steps

Question 8

frog leg

Answer 8

1. patient supine
2. physician standing beside patient
3. patient brings knees up and flops them outward
4. physicians puts hand under sacrum with fingertips grasping the base
5. patient takes deep breath and exhales
6. during exhalation, patient extends legs and physician pulls caudally on sacral base
7. repeat 3x

Question 9

lumbar decompression

Answer 9

1. patient lateral recumbent
2. physician stands behind
3. physician puts on hand on base of sacrum with elbow tucked into their side or hip while other hand supports ASIS
4. hand on sacral base pushes caudad and slightly anterior while hand on ASIS hold pelvis stable
5. goal is to cause sacral extension
6. hold until a release is felt

Question 10

chicago roll for L/P roll

Answer 10

1. patient supine with hands behind neck
2. physician stands on same side of roll
3. physician’s hand loops through patient’s same sided arm placing the back of their hand mid-chest with the hand pointing toward opposite ASIS
4. physician’s hand stabilizes opposite ASIS
5. physician pulls patient toward their same side ASIS with slight tug or thrust on exhalation

Question 11

supine soft tissue (SI joint mobilization for sacrum)

Answer 11

1. patient supine
2. flex knee and hip placing one hand on medial aspect of PSIS and other on knee
3. apply lateral traction on PSIS as other hand on knee moves knee medially as a counterforce
4. may be turned into ME

Question 12

supine ME for sacrum

Answer 12

• monitor SI joint with one hand as other resists motions of the hip
• flex thigh and knee to 90 degree and bring through flexion, extension, abduction, adduction
• follow ME steps

Question 13

lateral sims mobilization

Answer 13

• patient lies on side hugging table
• physician stands behind and palpates at S2
• patient’s bottom leg is slightly flexed and top leg is grasped just below knee and knee and hip are flexed until motion is felt at S2
• slight abduction is introduced until resistance
• external or internal rotation is introduced until a point of balance is achieved
• patient is asked to take a deep breath and hold it
• with pressure on sacrum, leg is 1) abducted and 2) extended allowing the leg to fall back off the table at end of extension
• repeat 2-3x

Question 14

mirror image technique - what is it for? what is the treatment?

Answer 14

• indication: FSTs
• patient rotates to side of axis and lies on back
• monitor at L5/S1 and flex hips until motion is felt
• keeping knees and hips bent, lift legs toward ceiling
• have patient pull feet down toward ground

Question 15

what are the indications for axillary pumps? what is the technique?

Answer 15

• mastitis, delayed milk letdown, carpal tunnel
• patient supine
• physician at side of table facing the head
• place hand in patient’s axilla with palm toward thorax
• grasp patient’s wrist and have patient relax arm
• pump arm while applying gentle traction in different planes
• with hand on thorax gently push cephalad against chest wall in a pumping action