1. OMM Exam 3

2. Osteopathic Consideration in Respritory Dysfunction

3. Chapman’s Reflex Points

4. Chapman’s characteristics

5. Cardiac Anterior

6. Cardiac Posterior

7. Pulmonary Anterior

8. Pulmonary Posterior

9. Area to Address First – Thoracic Inlet! Thoracic Inlet Rib raising OA, AA Cervical Spine: Indirect, Respiratory

10. Thoracic Inlet (“unclog the sink 1 st !”)

11. Pneumonia Protocol Recovery Phase 1. Thoracic Inlet 2. Thoracoabdominal Diaphragm 3. Suboccipital Inhibition, ST to C spine 4. Mobilization of C 7 to T 3, indirect or direct 5. MFR of anterior cervical fascia 6. TX C-spine segmental areas, esp C 3 -C 5 7. ST / MFR of subscapular mm and fascia 8. Rib raising 9. Treat segmental areas (esp T 1 -T 6 ) 10. Lymphatic Pump

12. Abdominal Diaphragm

13. Kneading Objective: Relax the cervical paravertebral muscles (PVM). 1) doctor standing on patient’s side; patient supine. 2) With caudad hand, reach across patient and cup PVM; Place cephalad hand on pt’s forehead 4) Push head away from you, then pull up and laterally on PVM tissue letting head roll back toward you.

14. Lateral recumbent kneading Objective: Relax thoracic PVM and deep intrinsic spinal muscles 1) Patient on left side; doctor facing patient 2) Let patient’s arm fall over caudad arm 3) Grasp PVM with fingers and pull toward you (lean back) 4) Flip patient’s arm over cephalad arm and work behind rhomboid muscles.

15. Lateral recumbent kneading Objective: Relax thoracic PVM and deep intrinsic spinal muscles (esp. levator scapula and trapezius) 1) Patient lateral recumbent; doctor facing patient 2) Let patient’s arm fall over caudad arm 3) Grasp PVM with fingers and pull toward you (lean back) 4) Flip patient’s arm over cephalad arm and use same techniques on rhomboid muscles.

16. Lateral recumbent kneading Objective: Relax thoracic PVM and deep intrinsic spinal muscles 1) Patient lying on side (lateral recumbent); doctor facing patient 2) pads of Doctor’s fingers in PVM sulcus lateral to spinal processes 3) Stabilize forearms on patients shoulder and hips 4) Pull tissues toward you while simultaneously pushing elbows toward floor Alternately, stand and lean back to apply traction.

17. Anterior Cervical Fascial Dysfunction

18. Thoracic Pump!

19. Supine-direct-respiratory force (thoracic pump) Kimberly Manual 4933.11A, P 61. 1. Patient supine. D.O. at head of table. 2. Patient turns head to one side. 3. D.O. places thumbs at midline with fingers spread over patient’s chest below clavicles. Hands are more anterior in males and more lateral in females to avoid compressing breast tissue (Female patients may also wish to place hands over breasts and have D.O. place his/her hands over the patient’s hands).

20. Thoracic Lymphatic Pump 4. Have patient take a deep breath and let in all the way out. As patient exhales follow thorax to full exhalation with gentle springing applied to the chest wall to the barrier. Maintain this compression and have patient take another breath and follow to barrier as patient exhales. Can repeat this several times. 5. As patient takes another deep breath, while resisting the chest wall during inhalation, suddenly release compression (This increases negative intrathoracic pressure). 6. Repeat. 7. Recheck.

23. Counterstrain for POSTERIOR Ribs Diagnose more significant TP ID location of rib TPs

24. Posterior TPs

25. Inhaled – Elevated

27. ANTERIOR TPs Diagnose more significant TP ID location of rip TPs

30. Exhaled – Depressed

32. Floating Ribs 11-12 Screen ribs 11-12 for inhaled/exhaled on left/right

34. Inhaled & exhaled – Direct

35. Rib 1 Diagnose rib 1 as elevated/depress on left/right

39. Depressed Rib 1