1. Technique List

2. Prone-direct method-LVMA (springing) Diagnosis: T1-T3 flexion -they like to flex and don’t want to extend (restriction in extension) 1.Patient is prone and the physician stands at the side of the table 2.Physician places one hand on the upper half of the sternum 3.Physician places the heel of the other hand over the spinous processes of the involved segment 4.Both hands carry the upper thorax into extension to the restricted barrier 5.Low velocity, moderate amplitude springing is applied to the spinous process against the sternal counterforce until the best motion is obtained 6.Recheck

3. Seated-direct method-LVMA (springing) Diagnosis: T4-T12 flexion -they like to flex and don’t like to extend (restriction in extension) 1.Patient sits on a stool or chair and the physician stands in front, facing the patient 2.Patient places one forearm on top of the other and rests his/her forehead against the top forearm 3.Physician passes both arms under the patient’s forearms and over the shoulder to reach the dysfunctional area with his/her fingertips 4.Patient is drawn foreward, flexing the hips. The thorax is extended to the restrictive barrier 5.Low velocity, moderate amplitude springing is applied until the best release is obtained 6.Recheck

4. Supine-direct method-respiratory cooperation Diagnosis: T4-T12 flexion -they like to flex and don’t like to extend (restriction in extension) 1.Patient is supine and they physician is seated on either side of the patient 2.Physician contacts the spinous processes of the involved vertebrae with his/her fingertips and applies an anterior (lifting) pressure to engage the restrictive barrier 3.Patient is instructed to inhale and the physician increases the extension of the fingertips 4.Patient is instructed to exhale as the physician follows extension of the spine to the new restrictive barrier 5.Steps 3-4 are repeated several times until the dysfunctional area releases 6.Recheck Note: Inhalation causes the thoracic spine to extend. Exhalation causes the thoracic spine to flex. So in this case, since they are stuck in flexion, you want them to inhale so you can induce extension and when they exhale, you want to prevent it from going into flexion (which is what it will want to do) so that’s why you try to hold the extension as they breathe out.

5. Seated-direct method-Muscle Energy (isometric) Diagnosis: T4-T12 extension -they like to extend and don’t like to flex (restriction in flexion) 1.Patients sits on a stool or chair and the physician stands beside the patient 2.Physician places the heel of the caudad hand over the spinous process of the lower segment of the dysfunctional unit 3.Physician places the other hand over the spinous processes above the dysfunctional unity and flexes the thoracic spine to the restrictive barrier 4.Physician taps the interspinous ligament of the dysfunctional unit with the fingers of his/her cephalic hand and instructs the patient “Push this area back against my finger, like a cat arches it back”. The physician offer isometric counterforce with his/her cephalic forearm. 5.Physician has the patient maintain the force long enough to sense that the patient’s contractile force is localized at the dysfunctional segment (typically 3-5 seconds) 6.Patient is instructed to gently cease the directive force and the physician simultaneously ceases his/her counterforce 7.The physician waits for the tissues to relax completely (about 2 seconds) and then flexes to the restrictive barrier 8.Steps 4-7 are repeated until the best motion is obtained (average is 3 times) 9.Recheck

6. The previous 4 techniques occur in what plane?

7. Neutral Spine T-spine Techniques

8. Seated-direct method-muscle energy (isometric) Diagnosis: T4-T12, neutral (SLRR) 1.Patient sits on the table and the physician stands behind the patient 2.Patient places his/her right hand on the back of his/her head or neck and grasps the elbow with the other hand 3.Physician reaches under the patient’s left arm, across the chest and grasps the right shoulder. The thumb of the other hand is placed over the right transverse process of the dysfunctional segment 4.The thoracic spine is flexed or extended as needed, to localize the sagittal plane. The patient is then sidebent right and rotated left until the restrictive barrier is engaged in all three planes. 5.Patient is instructed “turn to the right” or “bend to the left” while the physician offers isometric counterforce. 6.Physician has the patient maintain the force long enough to sense that the patient’s contractile force is localized at the dysfunctional segment (typically 3-5 seconds) 7.Patient is instructed to gently cease the directive force and the physician simultaneously ceases his/her counterforce 8.The physician waits for the tissues to relax completely (about 2 seconds) and then flexes to the restrictive barrier 9.Steps 5-8 are repeated until the best motion is obtained (average is 3 times) 10.Recheck Note: Physician goes UNDER and OVER. Patient salutes on side of rotation.

9. Supine-indirect method-patient cooperation, respiratory force Diagnosis: T4-T12, neutral (S L R R ) 1.Patient is supine and the physician sits at the right side of the patient 2.Physician reaches under the patient with his/her right hand and contacts the left transverse process of the dysfunctional segment with the pad of a finger. His/her left hand is placed on the left side of the patient’s rib cage 3.Physician pulls the thorax gently toward him/her to induce left sidebending and applies anterior pressure to life the transverse process and induce right rotation to the point of balanced ligamentous tension. 4.The respiratory phases are tested and the patient is instructed to hold his/her breath as long as possible in the phase that provides the best ligamentous balance. 5.Step 4 is repeated until the best motion is obtained (average is 3 times) 6.Recheck Note: In this case, the physician sits on the SAME SIDE as the rotation. Pushing on the LEFT transverse process causes RIGHT rotation.

10. Seated-indirect method-patient cooperation, respiratory force Diagnosis: T4-T12, neutral (S L R R ) 1.Patient sits on a table and the physician is seated on a stool behind patient 2.Physician’s right thumb contacts the right transverse process of the lower vertebra of the dysfunctional unity 3.Physician’s left thumb contacts the left transverse process of the upper vertebra of the dysfunctional unit 4.Patient leans backward at the hips to establish firm contact. He/she is then instructed to sit up straighter or slouch forward slightly to localize the sagittal plane at the dysfunctional unit 5.Patient is instructed “lean a little to the left and turn to the right” in small increments until all three planes are at the point of balanced ligamentous tension 6.The respiratory phases are tested and the patient is instructed to hold his/her breath as long as possible in the phase that provides the best ligamentous balance. 7.Step 6 is repeated until the best motion is obtained (average is 3 times) 8.Recheck

11. Supine-direct method- muscle energy (isometric) Diagnosis: T1-T3 neutral, (S L R R ) 1.Patient is supine and the physician sits or stands at the head of the table 2.Physician places the pad of a finger of the right hand on the left side of the spinous process of the dysfunctional segment to monitor to induce left rotation and extension 3.Physician’s left hand is placed on patient’s head and upper neck so that the neck can be moved into left rotation and right sidebending down to the dysfunctional segment 4.Patient is instructed “Push your head to the left against my hand” while the physician offers isometric counterforce 5.Physician has the patient maintain the force long enough to sense the patient’s contractile force is localized at the dysfunctional segment (typically 3-5 seconds) 6.Patient is instructed to gently cease the directive force and the physician simultaneously ceases his/her counterforce 7.Physician waits for the tissues to relax completely (about 2 seconds) and then moves the dysfunctional segment to the new restrictive barrier 8.Steps 4-7 are repeated until the best motion is obtained (average is 3 times) 9.Recheck Note: If you put fingers on LEFT side of the spinous process, you induce LEFT rotation

12. His technique list says seated, direct method, ME (as shown in OMM lab) but I don’t see one that’s different from the first technique under neutral spine (slide 7) but there is seated, direct method, HVLA in the lab that’s like ME…next slide shows it. If anyone knows if there is another technique, please share!

13. Direct HVLA – Seated Ex: NS R R L Set up pt. in same position as ME treatment, engaging restrictive barrier Place hypothenar eminence on posterior TVP Brace your elbow against hip Doc should have wide stance and be well-balanced Apply HVLA thrust antero-superiorly through hand on back Recheck

14. Which way goes which way?? If you push on the LEFT side of the SPINOUS process, it induces LEFT rotation. If you push on the RIGHT side of the SPINOUS process, it induces RIGHT rotation. If you push on the LEFT side of the TRANSVERSE process, it induces RIGHT rotation. If you push on the RIGHT side of the TRANSVERSE process, it induces LEFT rotation.

15. Which way goes which way?? Part 2 If you TRANSLATE to the LEFT, it induces RIGHT sidebending. (Okay, so your fingers are on the right side of the spinous process, but you are pushing towards the left which makes it sidebend to the right) If you TRANSLATE to the RIGHT, it induces LEFT sidebending. (So your fingers are on the left side of the spinous process, but you are pushing towards the right which makes it sidebend to the left)

16. Non-neutral T-spine Techniques

17. Seated-direct method- muscle energy (isometric) Diagnosis: T4-T12 non-neutral, extension RLSL 1.Patient sits straddling the table and the physician stands behind and to the side of the patient 2.Physician contacts the left articular fact and left transverse process or the right side of the spinous process of the dysfunctional segment with his/her left thumb. His/her right hand is on the top of the patient’s head for treatment of higher segments or on the patient’s left shoulder for treatment of lower segments. 3.Physician guides the patient into flexion, right rotation and right sidebending to localize at the restrictive barrier. 4.Patient is instructed “try to bend to the left” or “try to turn to the left” while the physician offers isometric counterforce 5.Physician has the patient maintain the force long enough to sense that the patient’s contractile force is localized at the dysfunctional unit (typically 3-5 seconds) 6.Patient is instructed to gently cease the directive force and the physician simultaneously ceases his/her counterforce 7.Physician waits for the tissues to relax completely (about 2 seconds) and then moves the dysfunctional segment to the new restrictive barrier 8.Steps 4-7 are repeated until the best motion is obtained (average is 3 times) 9.Recheck Note: We also learned to treat this by the technique that is like neutral spine seated direct method-muscle energy but with the physician going OVER and OVER. In that case, if the pt is RLSL, you would rotate them RIGHT and sidebend them RIGHT.

18. Supine-indirect method-respiratory force Diagnosis: T4-T12 non-neutral, extension, RLSL 1.Patient is supine and the physician is seated at the patient’s right side 2.Physician reaches under the patient and places the pad of his/her finger on the left side of the spinous process of the dysfunctional segment. The left hand is place on the left side of the patient’s chest 3.Physician pulls the spinous process towards him/her and adds slight anterior lift to induce left rotation and extension. He/she draws the chest toward him/her to induce left sidebending. These are carried to the point of balanced ligamentous tension in all three planes 4.Patient’s left shoulder may be moved toward his/her hip to aid sidebending when treating lower segments 5.The respiratory phases are tested and the patient is instructed to hold his/her breath as long as possible in the phase that provides the best ligamentous balance. The physician may need to make minor adjustments in the patient’s position to maintain tissue balance 6.Step 5 is repeated until the best motion is obtained (average is 3 times) 7.Recheck

19. On which side do I stand on? (applicable to only some of the techniques) For NN DIRECT method, physician stands on the OPPOSITE of rotation. For N INDIRECT method, physician stands on SAME side of rotation.

20. What are the rules of three’s? T1-T3: spinous process is located at the level of the corresponding transverse process T4-T6: spinous process is located one-half a segment below the corresponding transverse process T7-T9: spinous process is located at the level of the transverse process of the vertebrae below T10: follows T7-T9 rule T11: follows T4-T6 rule T12: follows T1-T3 rule

21. Practice Questions 1.The spinous process of T8 is at what level? 2.What is the main motion of the thoracic spine? 3.The transverse process of T5 is can be located where? a. half way between the spinous process of T4 and T5 b. at the level of the spinous process of T5 c. half way between the spinous process of T5 and T6 d. at the level of the spinous proves of T6

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