OMM FINAL TECHNIQUES PRACTICAL

OMM FOR THE HOSPITALIZED PATIENT

OA Release (N 86; MFR)
o TECHNIQUE: Patient supine. Hands on occiput & move caudad to find occipital
shelf. Apply anterior force & cephalad traction. Pt may put chin to chest using OA to
exaggerate flexion & prevent hyperextension. Maintain position while pt holds 1 or
more deep inspirations to enhance articular release. Reassess OA motion.
o TREATMENT MODEL: Occipitoatlantal decompression is a myofascial release
technique that engages continual palpatory feedback to achieve release of
myofascial tissues, taking advantage of fascias ability to change length with
associated changes in energy. Additionally, it allows us to normalize
parasympathetic tone via the vagus nerve. It is indicated to treat cardiac
arrhythmias and respiratory dysfunctions, and contraindicated if fractures, open
wounds, or neoplasms are present.
o BIOMECHANICS: OA dysfunction results from rotation of the occiput on its axis, causing misalignment
of the condyles in the facets of the atlas. OA decompression allows us to carry the occipital condyles
posteriorly, tense the ligaments in the region, and stretch the contracted muscles in the occipital
triangle.
o HIGH YIELD:

Thoracic Inlet Release (N 125)

o TECHNIQUE: pt is supine. Place index finger on clavicle (or supraclavicular
fossa) & place thumb on 1st rib. Assess rotation & translation. Treat directly
or indirectly for 30-60 seconds, using patient inhalation to take inlet further
into barrier or ease.
o TREATMENT MODEL: Thoracic inlet diaphragm release is a myofascial release
technique that opens myofascial pathways, increase differentials to augment
fluid flow beyond normal levels, and mobilize targeted tissue fluids into the
lymphatic system.
o BIOMECHANICS: Release of the thoracic inlet diaphragm engages the upper thoracics, ribs, clavicle,
scalenes, pectoral muscles, and the pre-tracheal fascia, and enhances lymphatic drainage from the
head & neck to thoracic duct.
o HIGH YIELD:

Sacral Rocking (N 483)

o TECHNIQUE: Pt prone. Contact lumbars & move down to sacral base. Place
caudad hand underneath cephalad hand. Apply gentle pressure with
rocking motion in conjunction with respiration, extending the sacrum
during inhalation (counternutation), & flexing the sacrum during
exhalation (nutation). Repeat for 30-60 seconds. Reassess with sacral
landmarks.
o TREATMENT MODEL: Sacral rocking is a myofascial release technique that
engages continual palpatory feedback to achieve release of myofascial
tissues, taking advantage of the fascias ability to change length with
associated changes in energy. Additionally, it can directly normalize
parasympathetic tone via the sacral splanchnic nerves. Sacral rocking is
indicated in dysmenorrhea and sacroiliac dysfunction, and contraindicated
in pelvic malignancy and pain.

BIOMECHANICS: Sacral rocking utilizes a rocking motion synchronous with the natural movement of
the sacrum, extension in inhalation, and flexion in exhalation, to normalize parasympathetic tone by
engaging the sacral splanchnic nerves.
HIGH YIELD:

Thoracic Pump ( N 504)

o TECHNIQUE: Pt supine with head to one side, hips & knees flexed & feet flat
on table. Stand at head of table with 1 foot in front of other. Place thenar
eminences inferior to pts clavicles with fingers spreading out over upper
rib cage (or over sternum for women). Increase pressure on anterior rib
cage during exhalation & add a vibratory motion at 2 compressions per
second. Continue applying pumps for 30-60 seconds throughout breathing
cycle for 5-6 cycles. Reassess with rib motions.
o TREATMENT MODEL: The thoracic pump is a lymphatic technique designed
to open myofascial pathways, increase differentials to augment fluid flow
beyond normal levels & mobilize targeted tissue fluids into the lymphatic
system. It is indicated for infection, fever, & lymphatic congestion, and
contraindicated in the presence of fractures, osteoporosis, severe dyspnea,
& malignancy of the lymphatic system.
o BIOMECHANICS: The thoracic pump accentuates negative intrathoracic pressure, increases lymphatic
return, loosens mucus plugs via vibration, and potentially stimulates the autoimmune system.
o HIGH YIELD:

Pectoral Traction (N 508)

o TECHNIQUE: Pt supine with hips & knees flexed & feet flat on table.
Place finger pads inferior to pts clavicles at anterior axillary fold.
Slowly & gently lean backward, causing hands & fingers to move
cephalad into axilla. Pull cephalad during inhalation & resist during
exhalation. Repeat for 3-5 breath cycles. Reassess rib motions near
pectoralis muscles.
o TREATMENT MODEL: Pectoral traction is a lymphatic technique
designed to open myofascial pathways, increase differentials to augment fluid flow beyond normal
levels & mobilize targeted tissue fluids into the lymphatic system. It is indicated for lymphatic
congestion, upper extremity edema, & respiratory impairments, & is contraindicated in the presence of
pacemakers & metastatic cancer.
o BIOMECHANICS: Pectoral traction augments thoracic range of motion via stretching of the pectoralis
minor, which originates on ribs 3, 4, & 5, & inserts on the coracoid process. This improves lymphatic
return.
o HIGH YIELD:

Doming of the Diaphragm (N 510)

o TECHNIQUE: Pt is supine. Place thumbs or thenar eminence inferior to pts lower coastal margin &
xiphoid process with thumbs pointing cephalad. Pt takes a deep breath & exhales. On exhalation,
follow the diaphragm inward, permitting the thumbs to move posteriorly. On inhalation, resist the
motion & follow more posteriorly & cephalad on exhalation. Repeat for 3 to 5 respiratory cycles.

TREATMENT MODEL: Doming of the diaphragm is a lymphatic technique

that opens myofascial pathways, increase differentials to augment fluid flow
beyond normal levels, & mobilize targeted tissue fluids into the lymphatic
system. It is indicated for lymphatic congestion distal to the diaphragm,
and
contraindicated if there are drainage lines, IV lines, hiatal hernia, fracture,
or
malignancy present.
BIOMECHANICS: Doming of the diaphragm engages the patients natural
breathing cycles to free lymphatic flow restrictions. It engages the diaphragm itself, which attaches to
the lower ribs, the upper lumbars, and the xiphoid process.
HIGH YIELD:

Pedal Pump (N 522)

o TECHNIQUE: Pt supine with heels of feet on table. Stand at food of table with one foot behind the other
for balance. Grasp plantar surface of feet at distal metatarsals and
plantarflex foot to
neutral. Apply cephalad pressure in rhythmic fashion at 2 per second for
30-60
seconds. Reassess tissue texture changes in legs & check for
improvement of edema.
o TREATMENT MODEL: The pedal pump is a lymphatic technique designed
to open myofascial pathways, increase differentials to augment fluid flow
beyond normal levels & mobilize targeted tissue fluids into the lymphatic
system. It is indicated for lymphatic congestion & fever, and contraindicated in the presence of deep
vein thrombosis, lower extremity strain, or recent abdominal surgery.
o BIOMECHANICS: The pedal pump accentuates negative intraabdominal pressure, increases lymphatic
return, and increases endothelial nitrous oxide, which has an anti-inflammatory effect. It also uses the
pumping motion to improve edema.
o HIGH YIELD:

UE LE Effleurage
o TECHNIQUE: For effleurage, lightly massage/stroke the skin. For petrissage, deeply massage the
muscles, kneading, wringing, & skin-rolling. Always begin proximally on the limb, and apply a distal to
proximal motion, and continue for 30-60 seconds.
o TREATMENT MODEL: Effleurage & petrissage are lymphatic techniques that open myofascial pathways,
increase differentials to augment fluid flow beyond normal levels & mobilize targeted tissue fluids into
the lymphatic system. These are indicated in lymphatic congestion and edema, and contraindicated in
breast cancer malignancy, skin breakdown, & fracture.
o BIOMECHANICS: Effleurage & petrissage actively mobilize fluids superficially & deeply, respectively.
They open the diaphragms and maximize fluid motion back to the lymphatic system.
o HIGH YIELD:

Mesenteric Release (N 512-517)

o TECHNIQUE: Patient can be
Descending Colon: Start
move medially). Stand
towards the URQ w/ the

either lateral recumbent or supine.

at the sigmoid colon (find ASIS and
on pts RIGHT side. Apply traction
caudad hand. Pull medially w/ the

cephalad hand. Release a little pressure, feel for the organ, and then apply more traction. Hold for
30 seconds or until a release is felt
Transverse Colon: Place hands underneath the ribcage (thumbs medially). Apply a posterior and
inferior force. Release a little pressure, feel for the organ, and then apply more traction. Hold for 30
seconds or until a release is felt
Ascending Colon: Stand on patients LEFT side. Find the right ASIS, move slightly superior. Dig
hands in applying a posterior and medial force over the ascending colon. Hold for 30 seconds
Small Intestine: Stand on pts right side. Start over umbilicus & place hands diagonally (palms
facing you) (Can also use ASISs & move superiorly). Apply pressure, pulling superiorly & laterally
(vector is towards RUQ). Pt might find this uncomfortable but should not feel any real pain. Hold for
30 seconds or until a release is felt
TREATMENT MODEL: Mesenteric release is a myofascial release technique that engages continual
palpatory feedback to achieve release of myofascial tissues, taking advantage of the fascias ability to
change length with associated changes in energy.
HIGH YIELD:

Hepatic Release (N 485)

o TECHNIQUE: Pt is supine. 1 hand under rib cage posteriorly. Other hand over the
costal margin; squeeze to feel motion of liver. Pt takes a deep breath. Check all
planes of motion (superior/inferior, medial/lateral, rotation). Can resist or
exaggerate the ease of motion of the liver. Hold for 30 seconds.
o TREATMENT MODEL: Hepatic is a myofascial release technique that engages
continual palpatory feedback to achieve release of myofascial tissues,
taking advantage of the fascias ability to change length with
associated changes in energy.
o HIGH YIELD:

Colonic Stimulation (N 481)

o TECHNIQUE: Pt is supine. Stand on right side of pt. Start over sigmoid
colon & upside down U shape to other side, pushing toward the rectum. Start
ASIS & move medially. Repeat for 30 seconds.
o TREATMENT MODEL: Colonic stimulation is a myofascial release technique that
engages continual palpatory feedback to achieve release of myofascial tissues,
taking advantage of the fascias ability to change length with
associated changes in energy.
o HIGH YIELD:

over

Collateral Ganglion Release

o TECHNIQUE: Pt is supine. Find the umbilicus & xiphoid. Celiac ganglion is 1 cm below xiphoid. Superior
mesenteric ganglion between celiac & inferior mesenteric ganglion. Inferior mesenteric ganglion 1 cm
above the umbilicus. Palpate all 3 landmarks & ask for tenderness. Assess all planes of motion & treat
ease or restriction for 30 seconds.

TREATMENT MODEL: Collateral ganglion release is a myofascial release technique that engages
continual palpatory feedback to achieve release of myofascial tissues, taking advantage of the fascias
ability to change length with associated changes in energy.
HIGH YIELD:

OMM FOR THE PREGNANT PATIENT

Seated Forward Leaning T-Spine Articulation (N 103)
o TECHNIQUE: Pt is seated. Contact on spinous or transverse
process. PT is drawn forward to restrictive barrier. LVMA springing is
applied until release is felt. Recheck.
o TREATMENT MODEL: Soft Tissue
o HIGH YIELD:

SI Joint Articulation
o TECHNIQUE: Pt is supine. Contact sacrum w/ fingers at base &
palm at apex. Pts hips & knees are flexed w/ feet together &
knees falling to the side. Sacrum is taken to a point of
ligamentous balance w/ respiratory assistance. As the pt
holds breath in most useful phase, she straightens out legs to
rotate innominates. Reassess.
o TREATMENT MODEL:
o HIGH YIELD:

Frogleg Sacral Articulation

o TECHNIQUE: Pt is supine. Contact pts flexed knee & hip.
Hip is externally rotated & circumducted into straightened
position. Then, the hip is internally rotated & circumducted
into straightened position. Repeat on opposite side &
reassess.
o TREATMENT MODEL:
o HIGH YIELD:

Pubic Decompression (N 292-293)

o TECHNIQUE: Fixed compression - have the pt abduct the knees while applying a counterforce. Hold
for 3-5 seconds & ask the pt to stop & relax. Repeat 3-7 times. Reassess for TART. Fixed gapping Pt lies supine & physician stands at either side of table. Pts hips are flexed to 45 degrees & knees
are flexed to 90 degrees w/ feet flat on table. Phys. Separates the pts knees & places the forearm
between the pts knees. Phys instructs the pt to pull both knees medially (adduction) against the
physs palm & elbow while the phys applies an equal counterforce. The isometric contraction is
maintained for 3-5 seconds & then the pt is instructed to stop & relax. Once the pt has completely
relaxed, separate the knees slightly farther from the midline. Repeat 3-7 times.

TREATMENT MODEL: Muscle energy is an active and direct technique,

meaning both the patient and physician are applying force, and the
physician is taking the patient into the barrier and away from the
position of ease. Immediately after a muscle contraction, the
neuromuscular apparatus is in a refractory state during which passive
stretching is performed without encountering a strong opposition. In
PIR, immediately after a muscle contraction, the neuromuscular
apparatus
is in a refractory state during which passive stretching is performed without encountering
strong opposition.
BIOMECHANICS: During fixed gapping, the patient is using the adductor muscles against the
physicians counterforce to mobilize the articulation. During fixed compression, the patient is using
the abductor muscles to mobilize the articulation.
HIGH YIELD:

Lateral Recumbent Lumbosacral Soft Tissue (N 110)

o TECHNIQUE: Brace arms on pts axilla & iliac crest. Contact the medial aspect of the lumbar (up to
lower thoracic) paraspinal muscles. Motion laterally to bowstring the
muscles. Carry the pts arms & ilia apart to stretch & sidebend the
lumbar area. Can also add a rotatory component. Repeat to soften
muscles 30 seconds & reassess.
o TREATMENT MODEL: Lateral recumbent lumbosacral soft tissue aims to
identify tissuerestriction. It allows for release of tension and
improvement of range of motion by applying direct force to the superficial tissue working through
the tension.
o HIGH YIELD:

Lateral Recumbent Scapulothoracic Myofascial Release (N 128-129)

o TECHNIQUE: Contact the superior & inferior aspects of
the scapula. Assess motion in superior/inferior,
medial/lateral/ & rotatory motions. Take directly or
indirectly to release. Hold 30 seconds. Reassess in all
planes.
o TREATMENT MODEL: Lateral recumbent
scapulothoracic myofascial release is an MFR
technique
that engages continual palpatory feedback to achieve release of myofascial tissues, taking
advantage of the fascias ability to change length with associated changes in energy.
o HIGH YIELD:

Supine Diaphragm Release

o TECHNIQUE: Pt is supine. Contact either with fingers spread over lower ribs
laterally or AP with hands at subxiphoid & TL junction. Assess rotation with
sidebending & flexion/extension. Use all 3 planes to approach barrier or
position of ease. Add respiratory cooperation to assist in release & reassess.
o TREATMENT MODEL:
o HIGH YIELD:

AP Pelvic Unwinding (N 130)

o TECHNIQUE: Pt is supine. Contact low on the sacrum & coccyx posteriorly with
fingers toward contralateral ischial tuberosity. Contact across the pubic
symphysis anteriorly. Assess rotation with sidebending & flexion/extension.
Use all 3 plates to approach the barrier or position of ease. Hold until release
& reassess.
o TREATMENT MODEL: AP pelvic unwinding is a myofascial release technique
that engages continual palpatory feedback to achieve release of myofascial
tissues, taking advantage of the fascias ability to change length with
associated changes in energy.
o HIGH YIELD:

PEDIATRIC

Cervical Chain Drainage (N 493)

o TECHNIQUE: Pt lies supine, & phys at pts side, near head of table. Stabilize the
pts head by placing the cephalad hand beneath the head to elevated it
slightly or by gently grasping the forehead. With caudad hand, make broad
contact over the SCM near the angle of the mandible. From cephalad to
caudad, the fingers roll along the muscle in a milking fashion. The hand
may be moved slightly more caudad along the muscle & repeat the rolling motion, going cephalad
to caudad. Repeat twice at each site.
o TREATMENT MODEL: Cervical chain drainage is a lymphatic technique that opens myofascial
pathways, increase differentials to augment fluid flow beyond normal levels, & mobilize targeted
tissue fluids into the lymphatic system. It is indicated for any dysfunction or lymphatic congestion
in the ENT region. It is contraindicated over painful, indurated lymph nodes.
o HIGH YIELD:

Submandibular Release (N 494)

o TECHNIQUE: Pt lies supine, & phys sits at head of table. Place index &
third fingertips (may include fourth fingers) immediately below the inferior
rim of the mandible. The fingers are then directed superiorly into the
submandibular fascia to determine whether an ease-bind asymmetry is
present. Impart a direct or indirect vectored force until meeting the bind or ease
barrier.
The force may be applied very gently to moderately. Continue until a release is palpated & follow
the creep until it doesnt not recur (30 seconds 2 minutes). Take care to avoid too much pressure
over enlarged/painful lymph nodes.
o TREATMENT MODEL: Submandibular release is a lymphatic technique that opens myofascial
pathways, increase differentials to augment fluid flow beyond normal levels, & mobilize targeted
tissue fluids into the lymphatic system. It is indicated for any dysfunction or lymphatic congestion
in the ENT region, especially those affecting the tongue, salivary glands, lower teeth &
temporomandibular dysfunctions.
o HIGH YIELD:

Mandibular Drainage: Galbreath Technique (N 495)

o TECHNIQUE: Pt lies supine w/ head turned away slightly toward the
physician, & the phys sits at the pts side near the head of the table.
Stabilize the pts head by placing the cephalad hand beneath the head
to elevated it slightly. Place the caudad hand with the 3rd, 4th & 5th
fingertips along the posterior ramus of the mandible & the hypothenar
eminence along the body of the mandible. Have pt open the mouth
slightly. With the caudad hand, press on the mandible so as to draw it slightly forward at the TMJ &
gently toward the midline. Hold for 5 seconds & release. Repeat 6 times.
o TREATMENT MODEL: Mandibular Drainage is a lymphatic technique that opens myofascial
pathways, increase differentials to augment fluid flow beyond normal levels, & mobilize targeted
tissue fluids into the lymphatic system. It is indicated for any dysfunction or lymphatic congestion
in the ENT region or submandibular region, especially dysfunction in the Eustachian tubes. Care
must be taken in pt w/ sever TMJ dysfunction with severe loss of mobility and/or locking.
o HIGH YIELD:
Auricular Drainage (N 496)
o TECHNIQUE: Pt lies supine with head turned slightly toward the phys, &
the phys sits at the pts side near the head of the table. Stablize the pts head
by placing the
cephalad hand beneath the head to elevate it slightly. Place the caudad hand
flat against the side of the head, with fingers pointing cephalad and the earr
between the 4th & 3rd fingers. Caudad hand makes clockwise &
counterclockwise circular motions, moving the skin & fascia over the
surface of the skull. There should be no sliding over the skin & no friction. Move 15 seconds
clockwise & 15 second counterclockwise.
o TREATMENT MODEL: Drainage is a lymphatic technique that opens myofascial pathways, increase
differentials to augment fluid flow beyond normal levels, & mobilize targeted tissue fluids into the
lymphatic system. It is indicated for any dysfunction or lymphatic congestion in the ear region,
otitis media, & otitis externa.
o HIGH YIELD:

Occipital Condylar Decompression (N 562)

o TECHNIQUE: Pt lies supine & phys is seated at the head of the table with
both forearms resting on the table establishing a fulcrum. Pts head rests
on
the physs palms, & the physs index & middle fingers approximate the
pts condylar processes. Fingers of both hands initiate a gentle cephalad &
lateral
force at the base of the occiput. Hold for 30 seconds. Reassess with vault
hold (30 seconds).
o TREATMENT MODEL: Occipital condylar decompression is a cranial technique. The premise of OCF
is based on the primary respiratory mechanism, which is as follows: there
is inherent motility of the brain and spinal cord, fluctuation of the CSF,
mobility of membranes, articular mobility of the cranial bones, and involuntary
mobility of the sacrum between the ilia.
o HIGH YIELD:

HEAD

CV4
o

o
o

TECHNIQUE: Pt lies supine & phys is seated at the head of the table
fingers w/ thumb on top (volleyball hold). Thenar eminences should be
posterior & medial to the occipitomastoid sutures. Apply a gentle force
& lateral (promoting extension). Keep applying an anterior force until you
a still point. Hold this point for 30 seconds (~3 CRI). Eventually the
occiput will release (pushes back into your hand). Reassess with vault
hold for 30 seconds.
TREATMENT MODEL: Cranial
HIGH YIELD:

Parietal Lift
o TECHNIQUE: Pt lies supine & phys is seated at the head of the table.
fingers on the lateral portion of the parietal bone. Can cross/press
thumbs together in midair to get a better hold on the parietal bones.
Engage the tissue with fingers & pull cephalad. Hold for 30 seconds or
until a release is felt. Reassess with vault hold for 30 seconds.
o TREATMENT MODEL: Cranial
o HIGH YIELD:

Interlace
places
anterior
reach

Place

Maxillary Effleurage
o TECHNIQUE: Pt is supine. Start just lateral to the nose below the eye & use
thumbs to contact the fascia while moving laterally across the checks.
Continue for 30 seconds. Reassess with vault hold for 30 seconds.
o TREATMENT MODEL: Cranial
o HIGH YIELD:

CERVICAL
Muscle Energy
o TECHNIQUE: Pt lies supine, phys at head of table. Place first MCP of right
hand
at articular pillar of segment being treated. Heel of hand closes in against
the
occiput. Cradle the pts head between the hands. Flex or extend until the dysfunctional segment is
engaged. Sidebend down to the dysfunctional segment & rotate away to the restrictive barrier.
Instruct the pt to rotate the head back while applying a counterforce. Hold for 3-5 seconds & have
the pt relax. Repeat 3-5 times. Apply a final stretch & palpate to reassess.
o TREATMENT MODEL: PIR Muscle Energy
o CONTRAINDICATIONS: inability to follow directions, lack of cardio-pulmonary reserve,
infection/hematoma, fracture, positioning that compromises vasculature
o HIGH YIELD:

HVLA
o TECHNIQUE: Pt lies supine, phys at head of table. Place first MCP of right hand at articular pillar of
segment being treated. Heel of hand closes in against the occiput. Cradle the pts head between
the hands. Flex or extend until the dysfunctional segment is engaged. Sidebend down to the
dysfunctional segment & rotate away to the restrictive barrier. Explain that at this point you would
apply a high velocity, low amplitude thrust through the barrier, without applying the vector of
force. Palpate to reassess.
o TREATMENT MODEL: HVLA employs a rapid, therapeutic force of brief duration that travels a short
distance within the anatomic range of motion of a joint. It engages a restrictive barrier in one or
more planes of motion to elicit release of restriction. This allows us to return the structure to its full
range of motion in a direct manner by releasing entrapped synovial folds & disrupting periarticular
or articular adhesions.
o CONTRAINDICATIONS: absolute RA, Down Syndrome, fracture/dislocation, fusion; relative acute
herniated nucleus pulposis, acute whiplash, severe muscle spasm/strain/sprain,
osteopenia/osteoporosis
o HIGH YIELD:

Counterstrain
o TECHNIQUE:

TREATMENT MODEL: Counterstrain is an indirect and passive technique in which the patients
somatic dysfunction is diagnosed by an associated myofascial tenderpoint. SD is due to
neuromuscular dysfunction involving the muscle spindle receptors & inappropriate proprioception.
By using passive body positioning of spasmed muscles & dysfunctional joints towards a position of
tissue ease. This helps relax aberrant reflexes that produce the muscle spasm by forcing
immediate reduction of tone to normal.
HIGH YIELD:

10

THORACIC
Muscle Energy
o TECHNIQUE:
T1-T4 Dysfunction: Pt is seated at the end of the table & phys stands at side of pt. With left
hand, palpate the spinous processes of T4 & T5 or the T4-5 interspace to monitor flexion &
extension as the right hand flexes the pts head & neck to the edge of the barrier. Instruct the
pt to place head in position of ease in flexion/extension & sidebending. Rotate the pts head
toward the barrier. Have the pt try to straighten head out while applying a counterforce. Hold
for 3-5 seconds & have the pt stop & relax. Rotate further into the barrier & repeat 3-5 times.
Apply a final stretch & reassess.
T5-T12 Type 1: Pt is seated w/ arms folded in front of them genie style. Phys stands on the
side opposite the rotational component. Place arm over the patients arms. With other hand,
palpate the dysfunctional segment. Flex/extend, & sidebend & rotate toward the barriers in
both planes. Have the pt try to rotate back to neutral while applying a counterforce. Hold for 35 seconds & have the pt relax. Sidebend & rotate further into the barrier & repeat 3-5 times.
Apply a final stretch & reassess.
T5-T12 Type 2: Type 1: Pt is seated w/ arms folded in front of them genie style. Phys stands
on the side opposite the rotational component. Place arm under pts arm & grasp opposite
upper arm by weaving through. With other hand, palpate the apex of the dysfunctional
segments. Flex/extend, & sidebend & rotate toward the barriers in both planes. Have the pt try
to rotate back to neutral while applying a counterforce. Hold for 3-5 seconds & have the pt
relax. Sidebend & rotate further into the barrier & repeat 3-5 times. Apply a final stretch &
reassess.
o TREATMENT MODEL: PIR Muscle Energy
o HIGH YIELD:

HVLA
o TECHNIQUE:
Seated (T1-T4): Stand behind the pt. Have pt interlock hands behind head & put them on top of
your hands. Have pt bring elbows together, relax & look up. Explain that at this point you would
exert a quick & gentle thrust superiorly & posteriorly. Reassess.
Supine: Stand on side opposite the rotational component. Have pt cross arms one on top of the
other with rotational arm on top, with elbows lining up. Roll the pt towards you using the pts
elbow. Place thenar eminence on the transverse process at the apex of the curve. Place your
hand under the pts head. Add sidebending until restrictive barrier is engaged. Have pt inhale &
exhale. Explain at this point that you would apply a rapid downward thrust through pts arms
into thenar eminence. Reassess.
o TREATMENT MODEL: HVLA
o HIGH YIELD:

FPR
o

TECHNIQUE: Pt is seated with arms in front in genie pose. Stand behind the pt. Monitor the TP at
the apex of the rotational component. Reach across the arms & sidebend & rotate into position of
ease. Apply an axial force for 3-5 seconds. Release, return the pt to neutral & reassess.

11

TREATMENT MODEL: FPR is a technique that places emphasis on decreasing muscle hypertonicity
that is involved in maintaining a somatic dysfunction. An axial compressive force is applied and
causes a reversal in spindle output.
HIGH YIELD:

LUMBAR
Muscle Energy
o TECHNIQUE:
Type I Dysfunction (L1-L5 N SxRy): Pt is seated with arms in front in genie position. Stand
behind the pt opposite the side of the rotational component & monitor the TP at the apex of the
rotational component. Weave arm across the pts arms. Sidebend & rotate into the barrier &
ask pt to push against you. Hold for 3-5 seconds, release & repeat 3-5 times. Apply a final
stretch, return the pt to neutral & reassess.
Type II Dysfunction (L1 F/E RxSx): Pt is seated with arms in front in genie position. Stand
behind the pt opposite the side of the rotational component & monitor the TP at the apex of the
rotational component. Weave arm under the pts arms. Sidebend & rotate into the barrier & ask
pt to push against you. Hold for 3-5 seconds, release & repeat 3-5 times. Apply a final stretch,
return the pt to neutral & reassess.
Lateral Recumbent: Pt is lateral recumbent with rotational side up. Stand facing the pt.. Flex the
pts hips & knees tot the level of the dysfunction. Have the pt straighten the bottom leg to
neutral, and secure the top leg by tucking the foot behind the knee of the opposite leg. Ask the
pt to grab your shoulder and straight their torso. Weave your arm through the pts arms (in
genie position) & monitor the segment. With other arm, rotate the pts torso to the end of the
barrier & have them try to straighten it out. Hold for 3-5 seconds, release, and repeat 3-5
times. Apply a final stretch and return the pt to neutral to reassess.
o TREATMENT MODEL: PIR Muscle Energy
o HIGH YIELD:

HVLA
o TECHNIQUE: Pt is lateral recumbent with rotational side up. Stand facing the pt.. Flex the pts hips
& knees tot the level of the dysfunction. Have the pt straighten the bottom leg to neutral, and
secure the top leg by tucking the foot behind the knee of the opposite leg. Ask the pt to grab your
shoulder and straight their torso. Weave your arm through the pts arms (in genie position) &
monitor the segment. With other arm, rotate the pts torso to the end of the barrier. Explain that at
this point, you would apply a quick, thrust over a short distance through the barrier. Return the pt
to neutral & reassess.
o TREATMENT MODEL: HVLA
o HIGH YIELD:

Counterstrain

12

o
o

o
o
o

TECHNIQUE:
TREATMENT MODEL: Counterstrain
HIGH YIELD:

SACRUM
Muscle Energy
o TECHNIQUE:
Anterior Torsion: Have the pt lie lateral recumbent with chest and axis up. Flex the hips and
knees to the level of the sacrum. Hold the pts ankles and apply an upward force. Have the pt
apply a downward force & hold for 3-5 seconds. Have the pt relax & move further into the
barrier. Repeat 3-5 times, apply a final stretch, and reassess.
Posterior Torsion: Have the pt lie lateral recumbent with chest up and the axis down. Flex the
hips and knees to the level of the sacrum and cross the top leg over so that it is off the table.
Apply a downward force. Have the pt apply an upward force & hold for 3-5 seconds. Have the
pt relax & move further into the barrier. Repeat 3-5 times, apply a final stretch, and reassess.
Unilateral Flexion Shear: Have the pt lie prone. Contact the ILA on the dysfunctional side.
Internally rotate & abduct the pts hip. Have the pt perform 3 long, slow cycles of inhalation &
exhalation. During inhalation, apply a firm downward pressure onto the ILA. During exhalation,
actively resist sacral nutation. Return the pt to neutral and reassess with seated flexion.
Unilateral Extension Shear: Have the pt lie prone in the Sphinx position. Abduct & internally
rotate the lower extremity until the ilium is as laterally displaced as possible. Contact the base
of the sacrum on the dysfunctional side. Instruct the pt to perform 3 long, slow cycles of
inhalation & exhalation. During exhalation, apply a firm, downward pressure on the sacral base.
During inhalation, actively resist sacral counternutation. Return the lower extremity to neutral
& reassess with seated flexion.
Bilateral Flexion: Same as above but with hands on both ILAs.
Bilateral Extension: Same as above with both hands on sacral base.
o TREATMENT MODEL:
Reciprocal inhibition is a form of muscle energy in which we mobilize one muscle group in order
to inhibit the action of the antagonist muscle group.
Anterior Biomechanics: Mobilize gluteus maximus to inhibit hypertonic piriformis
Posterior Biomechanics: Mobilize piriformis to inhibit hypertonic gluteus maximus
Respiratory Assist is a form of muscle energy in which muscular forces involved are generated
in conjunction with breathing. This allows us to encourage or resist the bodys natural motions
during ventilation.
o HIGH YIELD:

13

INNOMINATES/PELVIS
Muscle Energy
o TECHNIQUE:
Posterior Innominate: Have the pt lie supine with the leg of the dysfunctional side off of the
table, making sure that the foot is not touching the floor. While stabilizing the opposite side,
apply a downward force on the thigh, while having the pt apply an upward force. Hold for 3-5
seconds, move further into the barrier, and repeat 3-5 times. Apply a final stretch and reassess
with ASIS compression or standing flexion test. (Mobilizing quads to inhibit hamstrings).
Anterior Innominate: Have the pt lie supine. Flex the leg of the dysfunctional side at the knee
and hip & place the leg on your shoulder. Push further into flexion while having the pt contract
into your chest & hold for 3-5 seconds. Move further into the barrier & repeat 3-5 times. Apply a
final stretch & reassess with ASIS compression or standing flexion test. (Mobilizing hamstrings
to inhibit quads).
Inflare Innominate: Have the pt lie supine. Flex the pts leg at the knee, and cross the leg over
the opposite knee. Apply a force to abduct the knee, while having the pt adduct the knee. Hold
for 3-5 seconds, move further into the barrier & repeat 3-5 times. Apply a final stretch and
reassess ASIS positions as compared to the umbilicus.
Outflare Innominate: Have the pt lie supine. Flex the pts leg on the dysfunctional side at the
hip and knee, and cross it over the opposite leg. Adduct the pts knee while having the pt
abduct. Hold for 3-5 seconds, move further into the barriers & repeat 3-5 times. Apply a final
stretch and reassess ASIS positions as compared to the umbilicus.
Inferior Innominate Shear: Same as anterior innominate, but add a cephalad force to the ischial
tuberosity.
o TREATMENT MODEL:
Reciprocal Inhibition (Anterior & posterior innominate & inferior shear)
PIR (Inflare & outflare)
o HIGH YIELD:

HVLA
o TECHNIQUE:
Superior Innominate Shear: Have the pt lie supine & grasp the ankle firmly. Internally rotate the
ankle & bring it to the barrier. Explain that at this point youd apply a quick thrust through a
short distance, pulling the ankle towards you. Return the pt to a neutral position and reassess.
o TREATMENT MODEL: HVLA
o HIGH YIELD:

LOWER EXTREMITY
Piriformis/Psoas Muscle Energy
o TECHNIQUE:
Psoas: Have the pt lie prone. Flex the knee & lift the leg, using your knee to support it if
necessary. Have the pt push leg down towards the table for 3-5 seconds. Move further into the
barrier, & repeat 3-5 times. Apply a final stretch and reassess with the Thomas test.
Piriformis: Have the pt lie supine. Flex the pts leg at the knee & cross the leg on the
dysfunctional side over the other leg. Stabilize the ASIS with the cephalad hand. Pull the pts
knee into adduction, and have the pt abduct for 3-5 seconds. Move further into the barrier and
repeat 3-5 times. Apply a final stretch and reassess with the FAIR test.

14

o
o

TREATMENT MODEL: PIR Muscle Energy

HIGH YIELD:

Fibular Head Muscle Energy/HVLA

o TECHNIQUE:
Anterior Fibular Head PIR: Have the pt lie supine & sit at the side of
dysfunction. Contact the anterolateral aspect of the fibular head
with the thumb of the hand closest to the pts knee. With the
other hand, control the pts foot and ankle & internally rotate &
pronate the ankle until the fibular head meets its restrictive barrier. Instruct the pt to externally
rotate & supinate while applying a counterforce. Hold for 3-5 seconds, move further into the
barrier & repeat 3-5 times. Apply a final stretch & reassess.
Posterior Fibular Head PIR: Have the pt lie supine & sit at the side of dysfunction. Place the
hand closest to the knee in the popliteal fossa so that MCP of the index finger approximates the
posterior proximal fibula. With the other hand, control the foot and ankle,
externally rotating the lower leg & pronate the ankle until the fibular head
meets its restrictive barrier. Instruct the pt to internally rotate & supinate
while applying a counterforce. Hold for 3-5 seconds, move further into
the
barrier & repeat 3-5 times. Apply a final stretch & reassess.
Anterior Fibular Head HVLA: Have the pt lie supine with a small
pillow under the dysfunctional knee to maintain slight flexion. With
the
caudad hand, internally rotate the pts ankle to bring the proximal fibula more anterior. Place
the heel of the cephalad hand over the anterior surface of the proximal fibula. Explain that at
this point, you would deliver a quick thrust through the fibular head straight back toward the
table while simultaneously introducing an internal rotation counterforce at the ankle.
Posterior Fibular Head HVLA: Have the pt lie prone with the dysfunctional knee flexed at 90
degrees. Stand at the side of the table opposite the side of dysfunction. Place the MCP of the
cephalad index finger behind the dysfunctional fibular head & the hypothenar eminence angled
down into the hamstring to form a wedge behind the knee. With the caudad hand, grasp the
ankle on the side of dysfunction and gently flex the knee until the barrier is reached. Gently
externally rotate the foot and leg to carry the fibular head back against the fulcrum. Explain
that at this point, you would deliver a quick thrust toward the pts buttock in a manner that
would result in further flexion of the knee. (The wedge fulcrum formed by the cephalad hand
prevents that motion.)
o TREATMENT MODEL: PIR & HVLA
o HIGH YIELD:
Tibia on Talus HVLA
o TECHNIQUE:

Anterior Tibia on Talus- patient supine. Physician stands at the foot of the table. Physician hand
cups the calcaneus anchoring the foot (slight traction applied.) Physician places other hand on
the anterior tibia proximal to the ankle mortise. Thrust delivered with the hand on the tibia
straight down toward the table. Reassess by checking range of motion.
Posterior Tibia on Talus- Patient supine. Physicians stands at the foot of the table. Physician
hands wrapped around the foot with the fingers interlaced on the dorsum. The foot is
dorsiflexed to the motion barrier using pressure from the physicians thumbs on the ball of the
foot. Traction is placed on the leg at the same time dorsiflexion of the foot is increased.
Physician delivers a tractional thrust foot while increasing the degree of dorsiflexion.
Effectiveness determine by reassessing the ankle range of motion.
o TREATMENT MODEL: HVLA
o HIGH YIELD:

15

UPPER EXTREMITY
Spencers Technique Muscle Energy
o TECHNIQUE: Pt lateral recumbent. Stand facing pt. With cephalad hand, bridge the shoulder to lock
out the AC joint & scapulothoracic motion. Place fingers on the spine of the scapula & thumb on
the anterior clavicle. With caudad hand, grasp the pts elbow. Move the shoulder into extension to
the barrier. Instruct the pt to attempt to flex the shoulder against resistance for 3-5 second and
repeat 3-5 times. Then take pts shoulder into flexion. Instruct the pt to attempt to extend the
shoulder against resistance for 3-5 second and repeat 3-5 times. Then take pts elbow & take
shoulder into abduction. Move pts arm through full circumduction with slight compression. Make
larger & larger circles, increasing range of motion. Repeat 15-30 seconds in each direction. Abduct
pts shoulder with elbow fully extended. With caudad hand, grasp the pts wrist & exert vertical
traction. With cephalad hand, brace the shoulder. Move pts arm through full circumduction with
traction, making larger concentric circles, increasing range of motion. Repeat for 15-30 seconds in
each direction. Then Flex pts arm to allow elbow to pass in front of chest wall. Rest pts wrist
against your forearm, & adduct shoulder to edge of restrictive barrier. Instruct pt to lift elbow
against resistance for 3-5 seconds 3-5 times. Brace shoulder, and grasp pts elbow. Instruct pt to
grasp your forearm. Abduct shoulder to edge of restrictive barrier. Have pt adduct against
resistance for 3-5 seconds 3-5 times. Brace shoulder with cephalad hand, and grasp pts elbow.
Abduct to 45 degrees & internally rotate to 90 degrees. Place the dorsum of the pts hand in the
small of the back. Gently pull pts elbow forward into internal rotation to the barrier. Instruct pt to
pull elbow backward against resistance 3-5 seconds 3-5 times. Abduct the pts shoulder & place
hand & forearm on your shoulder. With fingers interlaced, position hands just distal to acromion
process. Scoop the pts shoulder inferiorly, squeezing the deltoid between palms. Continue for 1530 seconds.
o TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the pt
into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier. Spencers Technique for the deltoid is a myofascial release technique,
which engages continual palpatory feedback to achieve release of myofascial tissues, taking
advantage of the fascias ability to change length with associated changes in energy.
o

HIGH YIELD:

Radial Head HVLA

o TECHNIQUE:
Anterior Radial Head (Supination Dysfunction) - patient seated on table, physician faces the
patient. Physician holds the hand of the dysfunctional arm as if shaking hands with the patient.
The physician places the thumb of the opposite hand anterior to the radial head. Physician
rotate the forearm into pronation until the restrictive barrier is reached. With the patient
completely relaxed the physician carries the forearm into slight flexion and pronation while
maintaining thumb pressure over the anterior radial head. Effectiveness of the technique is
determined by retesting pronation of the forearm and palpating of reduced prominence of the
radial head.
Posterior Radial Head (Pronation Dysfunction) - The patient seated, physician faces patient.
Physician holds the hand of the dysfunctional arm as if shaking hands with the patient. The
physician places the thumb of the opposite hand posterior to the radial head. The physician
rotates the forearm into supination until the restrictive barrier is reached. With the patient
completely relaxed the physician carries the forearm into extension and supination while
maintaining thumb pressure of the posterior radial head. Effectiveness of the technique is

16

o
o

determined by retesting pronation of the forearm and palpating for reduced prominence of the
radial head.
TREATMENT MODEL: HVLA
HIGH YIELD:

Radial Head Muscle Energy

o TECHNIQUE:
Anterior Radial Head (Supination Dysfunction) - Patient seated, physician faces the patient.
Physician grasps the patients hand of the side of the dysfunction, contacting the dorsal aspect
of the distal radius with the thumb. Physicians other hand is palm up with the thumb resting
against the anterior and medial aspect of the radial head. The physician pronates the patients
forearm to the edge of the restrictive barrier. The physician instructs the patients to attempt
supination while the physician resist. Held for 3-5 seconds, move to new barrier, exaggerates
the posterior rotation of the radial head and repeat 3-5 times.
Posterior Radial Head (Pronation Dysfunction) Patient seated, physician faces the patient.
Physician grasps the patients hand on the side of dysfunction (handshake position), contacting
the palmar aspect of the distal radius with the index finger. Physicians other hand is palm up
with the thumb resting against the posterolateral aspect of the radial head. Physician supinates
the patients forearm until the edge of the restriction barrier is reached at the radial head. The
physician instructs the patient to attempt pronation while the physician resists. Isometric
contraction held for 3-5 seconds. Patient relaxes and physician supinates the patient to the new
barrier while exaggerating the anterior rotation of the radial head. Repeat 3-5 times.
o TREATMENT MODEL: Post isometric relaxation muscle energy
o HIGH YIELD:

Carpal Tunnel Myofascial Release

o TECHNIQUE: Place patient hand in the palm up (supinated) position. Physician thumbs are placed
over the medial and lateral eminences of the patients carpal region while the physicians fingers
are wrapped around the dorsal aspect of the patients hand contacting the dorsal carpal region.
Physician exerts tension on the carpal region (flexor retinaculum) by pressing thumbs into the volar
surface of the base of the hand and pushing the thumbs apart. While dragging the skin and
superficial fascia with the thumbs. Pressure maintained for 20 to 60 seconds or until a release of
tissue tension is palpated.
o TREATMENT MODEL: MFR- releasing tension in the flexor retinaculum which will result in decreased
pressure and tension in the carpal tunnel. Releases tension on the median nerve.
o HIGH YIELD:

RIBS
Rib Raising
o TECHNIQUE:pt supine. Place fingers 2 inches lateral of spinous processes on costotransverse
angles. Apply anterior & lateral force. Hold until release or move in cyclical motion for 30-60
seconds, moving down the spine. Reassess with rib motions.

17

TREATMENT MODEL: Rib raising is a myofascial release technique that engages continual palpatory
feedback to achieve release of myofascial tissues, taking advantage of the fascias ability to
change length with associated changes in energy. Additionally, it can directly normalize
sympathetic tone by applying pressure to the sympathetic ganglion, improve lymphatic return, and
encourage maximum inhalation. It is indicated in visceral dysfunction, decreased rib excursion, and
lymphatic congestion, and contraindicated in spinal or rib fracture or recent spinal surgery.
BIOMECHANICS: Rib raising allows us to contact the costotransverse angles, which align with the
sympathetic chain ganglia. It initially produces a short-lived increase in sympathetic activity, but
provides long-lasting sympathetic inhibition to normalize sympathetic tone. It also enhances
lymphatic return and encourages inhalation.
HIGH YIELD:

Muscle Energy
o TECHNIQUE:
Inhalation Dysfunctions:
Rib 1- patient lies supine,, physician stands or sits behind the patient. The MCP of the
physicians right index finger contacts the superior surface of the dysfunctional right rib
posterior and lateral to the costotransverse articulation. Patients head slightly flexed, SB
toward R away from the dysfunctional rib. Patient inhales, then exhales deeply. During
exhalation the physicians hand follows the first rib down and forward (further into
exhalation.) The patient inhales deeply and physician resists the inhalation motion of the
rib. This is repeated 3-7 times.
Rib 2-6- patient lies supine. Physicians flexed knee is placed under the patients upper
thoracic region on the dysfunctional side at the level of the dysfunctional rib. Patients body
is sidebent to the side of the dysfunction. Web formed by physicians right thumb and index
finger is placed on the intercostal space above the dysfunctional rib on its superior surface.
The patient inhales and exhales deeply. During exhalation, the physicians right hand
exaggerates the exhalation motion of the dysfunctional rib. When the patient inhales the
physician resists the inhalation motion of the dysfuncitnal rib. This is done 3-7 times.
Rib 7-10- patient lies supine, physician stands at the side of the dysfunctional rib. Patients
upper body is bent to the side of the dysfunction. Web formed by the physicians right
thumb and index finger is placed on the intercostal space above the dysfunctional rib on its
superior surface. The patient inhales and exhales deeply. During exhalation, the physicians
right hand exaggerates the exhalation motion of the dysfunctional rib. When the patient
inhales the physician resists the inhalation motion of the dysfuncitnal rib. This is done 3-7
times.
Rib 11-12- Patient lies prone, physician stands to the side of the table opposite the
dysfunction. Patients legs are positioned 15-20 degrees toward the side of the dysfunction
(takes tension off of the quadratus lumborum.) Physician places hypothenar eminence
medial and inferior to the angle of the dysfunctional rib and exerts gentle. Sustained lateral
and cephalad traction. Physician may grab the ipsilateral ASIS to stabilize. Patient inhales
and exhales deeply. During exhalation the physicians hand exaggerates the exhalation
motion of the dysfunctional rib by exerting cephalad and lateral traction. On inhalation eh
physician rests the inhalation motion of the dysfunctional rib. Repeat 3-7 times.
Exhalation Dysfunction
Rib 1-2- Patient lies supine. Physician stands on side opposite the dysfunction. For Rib 1
patients head is straight. For rib 2 the patients head is turned to the side opposite the
dysfunction. Dorsal surface of the patients hand is placed against their forehead (or side of
the head for rib 2.) Physicians hand reaches under the patient and grabs the superior angle
of the dysfunctional rib and exerts a caudad and lateral traction. The physician instructs the

18

patient to flex the head and neck without altering the rotation of the head while the
physician resists this force. Patient should be instructed to inhale during the contraction,
which should be held for 3-5 seconds. When the patient completely relaxes the physician
exerts an increased caudad and lateral traction on the angle of the dysfunctional rib. This is
repeated 3-7 times. For rib 1 the muscle being activated is the anterior scalene. For rib 2 it
is the middle and posterior scalenes.
Rib 3-5. Patient lies supine. Physician stands on side opposite the dysfunction. Patient laces
the arm on the dysfunctional side over their head. Physicians hand reaches under the
dysfunctional side of the patient and grasps the superior angle of the dysfunctional rib and
exerts a caudad and lateral traction. Physician places the other hand on the anterior aspect
of the patients elbow. Physician instructs the patient to push the elbow against the
physicians hand while the physician resists the motion. Patient should be instructed to
inhale during the contraction, which should be held for 3-5 seconds. When the patient
completely relaxes the physician exerts an increased caudad and lateral traction on the
angle of the dysfunctional rib. This is repeated 3-7 times. Pectoralis Minor is used to
mobilize ribs 3-5.
Ribs 6-8- Patient lies supine and the physician stands at the side of the dysfunctional rib.
Patients is instructed to abduct the shoulder to 90 degrees and flex the elbow to 90
degrees. Physicians hand reaches under the patient and grabs the superior angle of the
dysfunctional rib and exerts a caudad and lateral traction. Physician instructs the patient to
bring the flexed elbow across the body toward the contralateral hip while the physician
resist this motion. Patient should be instructed to inhale during the contraction, which
should be held for 3-5 seconds. When the patient completely relaxes the physician exerts
an increased caudad and lateral traction on the angle of the dysfunctional rib. This is
repeated 3-7 times. Serratus Anterior is the muscle used to mobilize ribs 6-8.
Ribs 9-10- Patient lies supine and the physician stands at the side of the dysfunctional rib.
Patients is instructed to abduct the shoulder to 90 degrees and flex the elbow to 90
degrees. Physicians hand reaches under the patient and grabs the superior angle of the
dysfunctional rib and exerts a caudad and lateral traction. Physician instructs the patient to
try to push their elbow downward as if to contact the ipsilateral hip while the physician
resists this motion. Patient should be instructed to inhale during the contraction, which
should be held for 3-5 seconds. When the patient completely relaxes the physician exerts
an increased caudad and lateral traction on the angle of the dysfunctional rib. This is
repeated 3-7 times. Latissimus Dorsi is the muscle mobilizing ribs 9-10.
Ribs 11-12- Patient lies prone and physician stands on the contralateral side of the
dysfunctional rib. Patient is positioned with legs 15-20 degrees to the contralateral side of
the dysfunction to put tension on the quadratus lumborum. Physicians left thenar
eminence is placed superior and lateral to the angle of the dysfunctional rib and exerts a
gentle sustained caudal and lateral traction. Physicians hand grasps the patients
ipsilateral ASIS and gently lifts toward the ceiling. During inhalation, the physician
exaggerates the motion of the dysfunctional rib by exerting a medial and caudad traction
while also pilling the patients ASIS toward the ceiling. On exhalation the physician resists
the exhalation motion of the rib. Repeat 3-7 times.
TREATMENT MODEL
Inhalation Dysfunction- Muscle Energy- respiratory assist
Exhalation Dysfunction- post-isometric relaxation with respiratory assist, except for 11-12
which are just respiratory assist.
HIGH YIELD:

19

Counterstrain
Anterior Rib (Exhalation Dysfunction)

Location
o Rib 1: located just below the medial end of the
clavicle (right off costal sternal junction)
o Rib 2: located 6-8cm lateral to the sternum at the
angle of Louis
o Ribs 3-6: located along the mid-axillary line on the
corresponding rib
Technique
o Rib 1/2
Patient is supine
Use hand contralateral to the side you are treating to
monitor tenderpoint
Flex head, sidebend and rotate TOWARDS
Hold for 120 seconds
o Ribs 3-6
Patient is seated upright
Lower table as much as possible
Put leg CONTRALATERAL to the side of the tenderpoint
on the table and drape patients arm over the leg
Put other arm behind the patient (helps rotate the
patient)
Ask patient to put legs completely on the table towards
side of the tenderpoint (knees bent)
Flex head (and trunk slightly), sidebend and rotate trunk TOWARDS
Hold for 120 seconds

the

Posterior Rib (Inhalation Dysfunction)

Location
o Angle of the corresponding rib
Technique
o Rib 1
Patient is seated upright
Lower table as much as possible

20

Put leg CONTRALATERAL to the side of the tenderpoint

the table and drape patients arm over the leg
Put other arm behind the patient (helps rotate the
patient)
E SART (head)
Hold for 120 seconds
Rib 2-6
Patient is seated upright
Lower table as much as possible
Put leg IPSILATERAL to the side of the tenderpoint on
the table and drape patients arm over the leg
Put other arm behind the patient (helps rotate the
patient)
Ask patient to bend leg ipsilateral to tenderpoint and
place foot under opposite leg
F (head) SARA (trunk)
Hold for 120 seconds
o HIGH YIELD:

on

ABDOMEN
Prevertebral Ganglion Release
o TECHNIQUE: Patient is supine. Find the umbilicus and xyphoid. Celiac ganglion: 1cm below the
xiphoid, Superior mesenteric ganglion: between celiac & inferior, Inferior mesenteric ganglion: 1cm
above the umbilicus. PALPATE ALL 3 OF THESE LANDMARKS. Ask if there is tenderness and note
any tissue texture change at any of these points. Use pointer finger to assess planes of motion
over any landmark that is tender/TTC Inferior/superior, lateral/medial, clockwise/counterclockwise.
Find ease/restriction depending on indirect/direct. Apply a posterior force w/ the index finger. Hold
for 30 seconds or until a release is felt. Reassess planes of motion.
o TREATMENT MODEL: MFR- allows for normalization of the sympathetic outflow from the ganglia.
o HIGH YIELD:

21