Download Dr. Harden OMM Lecture – Indirect Techniques for C/T Spine

Dr. Harden OMM Lecture – Indirect Techniques for C/T Spine
Indirect Techniques:
Balanced Ligamentous Tension (BLT)
Inherent force
Ligamentous Articular Strain (LAS)
Exaggeration
Jones Strain Counterstrain (JSCS)
Respiratory force
Facilitated Positional Release (FPR)
Patient cooperation
Myofascial Release (MFR)
Balanced ligamentous tension – ligaments provide a proprioceptive guide to muscle response for positioning the joint and ligaments
to guide motion of articular components
Ligamentous articular strain – manipulative technique with a goal to balance tension in opposite ligaments where there is abnormal
tension present, myofascial release techniques
Jones strain counterstrain – diagnosis and tx considering dysf to be continuing, inappropriate strain reflex, accomplished by specific
directed positioning about the pt of tenderness to achieve therapeutic response
Facilitated positional release – myofascial release tx, mixed direct/indirect tech, body placed in neutral position to diminish tissue
and joint tension in all planes with an activating force (compression or torsion) added, positioning similar to counterstrain then
activating force applied, goal is to reduce muscle hypertonicity and restore lost ROM
1.
2.
Superficial type – normalization of palpable abnormal tissue
Deep type – muscle involvement in joint mobility
Myofascial release – engages continual palpatory feedback to achieve release of myofascial tissues
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MFR can be direct by engaging the restrictive barrier then loading the tissues with constant force until a release is
achieved.
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MFR can indirect by guiding the tissues along the path of least resistance until free motion is achieved
Inherent force – rhythmic activity present in all cells and tissues within living body >> homeostasis around restricted tissues
Exaggeration – taking lesioned segment of dysf in direction of injury and minutely exaggerating the dysf to gain balanced tension
Respiratory force - Force produced by the motion of the thoracic cage during respiration and the physiologic changes noted with
“air hunger”
•
Utilized as a direct technique with “cough”
•
Used to enhance technique with utilization of “air hunger”
•
Used as an articulatory technique by positioning the dysfunction and then having the patient repeatedly inhale and exhale
•
Respiration can be held in any “phase “ of respiration to enhance the technique
Indirect technique - If the dysfunctional segment is positioned appropriately, the fibers may return to normal length, which
decreases tension in the fibers, reduced tension in the area of the muscle spindle eliminates the afferent excitatory impulses,
“quiets” the gamma motor gain, reducing the stretch stimuli, and eliminates the reflex activation of the α-motor neuron, allows the
tension and hypertonicity of the muscles to “reset”
Facilitated Positional Release Guidelines:
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Straighten out any A-P curves
•
Take the dysfunctional segment to position of ease
•
Facilitating force applied either before or after segmental motion*
•
Wait 3-5 seconds & return patient to the neutral position passively
•
Take affected area past neutral into the “Feathered edge “ of the direct barrier
SUPERFICIAL:
1.
2.
3.
4.
5.
6.
7.
Palpate (tissue texture abnormality)
Flatten the anteroposterior spinal curve to reduce myofascial tension(if area is near axial skeleton)
Place the dysfunctional myofascial structure into its ease (shortened, relaxed) position
Add a compression or torsional facilitating force
Hold for 3 to 5 seconds, then slowly release pressure while returning to neutral. *
May take area past neutral and into edge of restrictive barrier to encourage increased ROM.
Reassesses the dysfunctional components (tissue texture abnormality, asymmetry of position, restriction of motion,
tenderness [TART])
DEEP:
1.
Make diagnosis (e.g., type I or II)
2.
Flatten (flex or extend) the anteroposterior curve in the spinal region of treatment
3.
Add the facilitating force FIRST (compression or torsion)
4.
Move the dysfunctional segment toward its flexion or extension ease
5.
Move the dysfunctional segment toward its side bending and rotational ease
6.
Hold for 3 to 5 seconds, then slowly release pressure while returning to neutral
7.
May take area past neutral and into edge of restrictive barrier to encourage increased ROM.
8.
Reassess the dysfunctional components (TART)
Indication
1.
Myofascial or articular somatic dysfunction
2.
*must have a muscular component maintaining the dysfunction
Contraindications
3.
Inability to relax
4.
Herniated disc where the positioning could exacerbate the condition
5.
Moderate to severe intervertebral foraminal stenosis, especially in the presence of radicular symptoms at the level
to be treated if the positioning could cause exacerbation of the symptoms by further narrowing the foramen
6.
Severe sprains and strains where the positioning may exacerbate the injury
Cervical Review:
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7 vertebrae
Atlas and axis are atypical
C3-7 are typical
OA joint has F/E (50%) and a little R/S
AA joint has rotation only (50%)
C3-7 facets form the palpable pillar of articulation
Rotation of typ vertebrae is toward eye not horizontal
Synovial joints on lateral surfaces are joints of Luschka
Thoracic Review:
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Rule of 3s
Fryette principles apply
I.
When the spine is in neutral position and sidebending is induced, rotation and sidebending will be in
opposite directions.
II.
When the spine is flexed or extended beyond the neutral position and sidebending is induced,
rotation and sidebending, of at least one segment ,will be to the same side.
III.
Initiation of motion in any one plane will modify motion in the other two planes.