OMM #21 Thursday, February 20, 11am Dr. Williams Jennifer Thompson Pa e 1 of !

Treatment of Non-neutral Somatic Dysfunction of the Lumbar Spine """The po#erpoin$ for $his le%$ure has no$ been pos$ed for $he &prin 200! se%$ion of $he OMM %ourse #ebsi$e, bu$ i$ is pos$ed in $he &prin 2002 se%$ion. 'f you loo( you #ill find $ha$ i$ is $he e)a%$ same po#erpoin$ presen$a$ion $ha$ Dr. Williams used in his le%$ure * you %an $ell by all $hose pre%ious pi%$ures of him $rea$in his #ife+. ,lso, Dr. Williams s$ar$ed $he le%$ure by s$a$in $ha$ #e should all use the Kimberly manual $o re-ie# $he $e%hni.ues $au h$ $o use. They reser-e $he ri h$ $o quiz us directly from $he /imberly manual000 '. Mo$ion of $he 1umbar &pine 2 3The posi$ion of $he sa i$$al plane #hen $he side bendin or $he ro$a$ion o%%urs de$ermines #he$her mul$i4plane mo$ion o%%urs a%%ordin $o neu$ral or non4neu$ral me%hani%s.5 a. Remember to take into account all 3 planes of motion *refer $o slide #! of po#erpoin$s+6 i. 7oronal *sidebendin + ii. 8ori9on$al *ro$a$ion+ iii. &a i$$al *F: or ::+ b. Type '' Me%hani%s 2 #hen side4bendin is in$rodu%ed in$o $he $hora%i% and;or lumbar spine and $he re ion is in one of $he 2 non4neu$ral ran es *e). F: in lumbar+, $he body of $he superior -er$ebrae of $ypi%ally one -er$ebral uni$ #ill ro$a$e in$o $he in$ended %on%a-i$y *see slide #< of po#erpoin$s+ i. For#ard;:a%(#ard :endin 2 limi$ed mo$ion ii. =o$a$ion;&ide bendin $o same side 2 ro$a$ion o%%urs 1s$, &: 2nd iii. >omen%la$ure 2 =)&) *ro$a$ion firs$, bo$h in same dire%$ion+ Presen$in &i ns; &ymp$oms a. Pain pa$$ern 2 usually more painful $han neu$ral &;D i. =ela$ed ana$omy 2 -er$ebral uni$s abo-e and belo# may e)hibi$ $ype ' *neu$ral+ me%hani%s ii. &ympa$he$i%;Parasympa$he$i% -is%eral inner-a$ion 2 of$en asso%ia$ed #; sympa$he$i% hypera%$i-i$y in or ans inner-a$ed by T12412 area Trea$men$ of Type '' &;D 2 Don t memorize techniques! Think it throu"h! a. &ea$ed 2 dire%$ me$hod6 M? 2 >> =1&1 *@@22.11:+ i. Pa$ien$ Posi$ion6 sea$ed, s$raddlin $ableA pa$ien$ does $he os$eopa$hi% salu$e $o $he same side as ro$a$ion &;D ii. Opera$or Posi$ion6 sea$ed or s$andin behind $he pa$ien$ on $he side opposi$e of salu$eA rea%hes hand o-er pa$ien$Bs shoulder and %on$a%$s spinous pro%ess of lesioned se men$ #i$h $humb

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OMM #21 Thursday, February 20, 11am Dr. Williams Jennifer Thompson Pa e 2 of ! iii. *al$erna$i-ely, %an pu$ heel of hand on opposi$e $rans-erse pro%ess 2 #ha$e-er #or(s for you and your pa$ien$0+ i-. Opera$or applies for%e $o &P of -er$ebrae $o lo%ali9e &:, $hen rasps pa$ien$Bs pro)imal humerus on side of salu$e and indu%es &:, ro$a$ion and F:;:: un$il all ! planes are lo%ali9ed -. Pa$ien$ is ins$ru%$ed $o $ry $o $#is$ ba%( up $o s$rai h$ posi$ion #hile opera$or resis$s, $hen $o rela) -i. #ait 3-$ seconds and $hen &:, ro$a$e, ::;F: $o ne# barrier and repea$ *donB$ Cus$ do ro$a$ion, lo%ali9e all $hree planes of mo$ion+ %ii& Do as many times as necessary and then reassess! b. &upine 4 'ndire%$;P$. 7oopera$ion;=espira$ory For%e 4 >> =1&1 *@@22.11?+ i. Pa$ien$ posi$ion6 supine, #i$h head and fee$ mo-ed $o side of $able so as $o indu%e &: $o side of &;D *in $his %ase, $he lef$+ 2 make sure patient S' is such that it is occurrin" in the affected re"ion! ii. Opera$or posi$ion6 sea$ed or s$andin on side opposi$e ro$a$ion, rea%hes hand under $o &P of lesioned se men$ and indu%es ro$a$ion $o $he side of &;D *pull &P $o#ards you 2 $his indu%es ro$a$ion $o#ard &;D and $hus also indu%es a %er$ain amoun$ of &:+ iii. Pa$ien$ is ins$ru%$ed $o 3ar%h or fla$$en ba%(5, and minor adCus$men$s %an be made in all $hree planes un$il a 3poin$ of balan%ed $ension5 is found i-. 'ns$ru%$ pa$ien$ $o inhale deeply and $hen e)hale all $he #ay and hold i$ for as lon as possible #hile opera$or moni$ors for a release, #hile also balan%in $ension in ro$a$ion, &:, and sa i$$al *F:;::+ plane -. 'ns$ead of ha-in pa$ien$ $o blo# ou$ all $heir air, you %an also find $ha$ poin$ in $he respira$ory %y%le $ha$ feels ri h$ and ha-e $hem hold $heir brea$h a$ $his poin$ %. &i$$in 2 Dire%$6 8D1, 4 >> =1&1 *@@22.11E+ i. Pa$ien$ Posi$ion6 sea$ed, s$raddlin $ableA pa$ien$ does $he os$eopa$hi% salu$e $o $he same side as ro$a$ion &;D ii. Opera$or Posi$ion6 sea$ed or s$andin behind $he pa$ien$ on $he side opposi$e of salu$e #i$h a (ide stanceA rea%hes hand o-er pa$ien$Bs shoulder and %on$a%$s spinous pro%ess of lesioned se men$ #i$h $humb *al$erna$i-ely, %an pu$ heel of hand on opposi$e $rans-erse pro%ess 2 #ha$e-er #or(s for you and your pa$ien$0+ OMM #21

Thursday, February 20, 11am Dr. Williams Jennifer Thompson Pa e ! of ! iii. Opera$or applies for%e $o &P of -er$ebrae $o lo%ali9e &:, $hen rasps pa$ien$Bs pro)imal humerus on side of salu$e and indu%es &:, ro$a$ion and F:;:: un$il all ! planes are lo%ali9ed i-. ,$ $his poin$ an 8D1, $hrus$ is dire%$ed an$;sup d. 1a$eral re%umben$ 2 Dire%$6 7ombined Opera$or and Pa$ien$ For%es *a(a ar$i%ula$ory #i$h pa$ien$ %oopera$ion+ 4 >> =1&1 *@@22.118+ i. Pa$ien$ posi$ion6 la$eral re%umben$, layin on side opposi$e &;D ii. Opera$or posi$ion6 s$andin , fa%in an$erior side of pa$ien$ iii. Opera$or palpa$es in$erspinnous spa%e of lesioned se men$ #i$h inde) and middle fin ers of %ephalad hand, and rasps pa$ien$Bs an(les and lif$s $hem sli h$ly *$o indu%e &:+ #i$h %audad hand i-. Opera$or lo%ali9es sa i$$al plane by fle)in or e)$endin hips and (nees of pa$ien$ *$his %an also be done by pla%in $he pa$ien$Bs (nees on your $hi h and %on$rollin $hem $ha$ #ay+ -. Opera$or pla%es his;her #ei h$ on pa$ien$Bs le s $o immobili9e $hem, and $hen ins$ru%$s pa$ien$ $o roll o-er on %hes$ and %ome up on $heir elbo#s *mu%h li(e a sphin)+ -i. Pa$ien$ is $hen ins$ru%$ed $o #al( elbo#s $o#ard side of $able opposi$e from #here opera$or is s$andin and $hen $o e)$end $heir head and $urn i$ a#ay from opera$or -ii. Opera$or $hen pulls &P of lesioned se men$ up#ard *sendin i$ in$o ro$a$ion a#ay from &;D+ #i$h %ephalad hand, and $hen lif$Bs pa$ien$s an(les #i$h %audad hand -iii. Opera$or $hen pushes pa$ien$Bs $hi hs $o#ard $he %en$er of $he $able and s$rai h$ens ou$ $heir le s so $ha$ $he pa$ien$ is no# prone. There is >OT a pop #i$h $his $e%hni.ue0 i). =e%he%(0 2 >o$e6 #atch the %ideo of this that Dr& #illiams has uploaded on the course (ebsite! )t is much more fluid than a %erbal e*planation can communicate! &$eps for &u%%essful Manipula$ion of $he &pine a. Dia nose a%%ura$ely b. De%ide #ha$ $rea$men$ $o use, indi%a$ions;%on$raindi%a$ions, %ondi$ions of $he pa$ien$, dire%$ or indire%$ me$hod %. ,pply $he prin%iples #hi%h uide $he me$hod %hosen *lo%ali9e $o $he poin$ of ease or lo%ali9e a$ $he res$ri%$i-e barrier in all ! planes+ d. 8old $he pa$ien$ se%urely, bu$ li h$ly and %omfor$ably e. &ense $he pa$ien$ rela)ed and $he for%es lo%ali9ed f. Fse $he %orre%$ dire%$ion and dosa e of a%$i-a$in for%e . =e%he%( $o de$ermine $he %han e produ%ed

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