Station 1 – 5 multiple choice or matching questions information covered in 

OMM lab and workshops

during the GU course. 5 multiple choice questions information covered in the OMM workshop during the
reproductive course.

GU lab 2
cv4 helps improve sleep and heart and otitis media and dec surgical procedures
• watch video it has the power point that dr yao took from dr king Indirect (exaggeration),Direct, Disengagement, Directing
the ride, Respiratory assist

Repro lab 2
Dr ettlinger
Treatment Lab- Osteopathy in the Cranial Field
Genitourinary wshop 2
-Tension type HA description.
TTH is characterized by having at least two of the following four features:
The location of the pain is bilateral in either the head or neck
The quality of the pain is steady (eg, pressing or tightening) and nonthrobbing
The intensity of the pain is mild to moderate
There is no aggravation of the headache by normal physical activity
-the sacrum with cranial inhalation phase (counternutates) and exhalation phase (nutates)
-dura attaches to C2, C3 and S2

-Venous sinus drainage technique:

1. utilized to help decrease venous congestion and improve circulation and drainage of the head.
2. focus is to remove restrictions form the membranes (dura) that contain the venous sinuses
Contraindication to OCF:
• Absolute – Acute intracranial bleed or increased intracranial pressure or skull fracture
• Relative – patients with seizures or history of traumatic brain injury

-Prior to VSD open up thoracic inlet and OM to free up jugular foramen.

-What can be effected by v-spread?

CN 9, 10, 11 along with jugular. Effects digestion, HR, respiratory secretions. Besides output to the various
organs in the body, the vagus nerve conveys sensory information about the state of the body's organs to the
central nervous system. 80-90% of the nerve fibers in the vagus nerve are afferent (sensory) nerves
communicating the state of the viscera to the brain, Swallowing (vagus and glossopharyngeal), SCM and trap
spasms (spinal accessory)

-the rate of the Primary Respiratory Mechanism (PRM) or Cranial Rhythmic Impulse (CRI) should be between
10-12 (+/-2) and if it is not normal, you can bring back to normal via CV4

Repro workshop applications in obstetrics

1) What should one check at every f/u OB visit? Why?(fundal height, weight, urinalysis, blood pressure…)

2) What are some of her complaints that may be helped by OMT? How would you approach treating these
complaints? (LBP, rib pain, HA, constipation, reflux… remember SNS supply…)

3) Why would treating these areas be important? (If left untreated, a) she is uncomfortable b) if her body is not
at its best structurally, then it may impede progress of labor)

4) Which positions may be most comfortable for her to get an osteopathic treatment?( seated, lateral recumbent,
head of bed raised up so not obstructing the vena cava on the R side)
5) What are the transitional zones of the spine? Why are these areas significant? How do the gravid uterus and
changing center of gravity affect these transition zones? ( O-A, C-T, T-L, L-S… these areas take the stress of
gravity since they are the transition zones. With incd wt during pregnancy, these areas endure even more stress)
1) What is back labor? (labor pain felt in the back usually with occiput posterior presentations)

2) Research shows that this technique helps decrease intrapartum requests for minor and major pain
medications. What is it? (paraspinal or lumbar inhibition)

3) Research shows that this technique helps in stalled labor. What is it? (CV4)

4) After delivery, what is the protocol followed regarding positioning the mother’s legs so as to decrease her
chances of having pelvic problems in the future.(Carefully, take the feet out of the stirrups and while flexed
ADDUCT, INTERNALLY ROTATE and then EXTEND the hips)

1) What is the sympathetic innervation to the breast? (gray’s T4-T6 SNS) To the upper extremities? (DSD says
T1-5, Kuchera says T2-8) To the lower extremities? (T11-L2 Kuchera and DSD

2) Give a differential diagnosis that could be causing her paresthesias? (cervical problems, thyroid disease,
edema of pregnancy, carpal tunnel, pronator muscle tightness…)

3) What somatic dysfunctions could be contributing to her paresthesias? (T1-6 boggy, erythematous, T 3,5
FRSl, 1st rib elevated L>R, Ribs 2 & 3 anterior B/L, 12th rib inhalation and diaphragm restriction B/L,
Anterior Intercostal spaces 1-3: Boggy, congestion B/L, L lateral border of scapula: congested, subscapularis
mu. Spasm, Intercarpal compression L>R, Anterior sacral base)

4) What somatic dysfunctions could be contributing to her problems nursing? same

5) Which areas of somatic dysfunction would you think to treat for the edema? (T.O., upper thoracic and rib
dysfunctions, UE problems, diaphragm….)

6) Also good to talk about, splints, need for NCS/EMGpossibly need surgery if severe, usually improves with
cessation of breast feeding….
Station 2 GU – Part I – You will be assigned a strain pattern and asked to demonstrate how to treat with indirect technique.  You
should be able to demo the cranial strain pattern (s) with your hands in a vault hold position and be able to describe the motion of
the occiput and sphenoid in regards to axis(es) and direction of movement.
Vault hold
Feet flat on floor, sit up straight, look ahead, keep eyes open, put hands on patient’s head.
Keep your elbows on table, thumbs touching each other, NOT touching head. Index fingers
should be on greater wing of sphenoid bone Third and fourth finger should be on either side
of EAM (so on temporal and parietal bones on both side) Pinky on occiput. Finger pads
touching head, not tips of finger. Thumbs crossed. Make sure not to compress patient’s head.
Flexion(inhalation) and Extension(exhalation)  
Put patient’s head into Vault Hold, sit quietly, once rhythm perceived you should
be able to distinguish flexion, neutral, and extension. Upon Flexion, the patient
inhales and your hands should slightly move apart with your fingers also
separating. Upon extension your hands should come together with your fingers
getting closer to one another.
Torsion  
Put patient’s head into Vault Hold, sit quietly, once rhythm perceived you should be able
to distinguish the vertical axis of your hands and if the fingers of one of your hands are
moving more superiorly (towards the ceiling) than the other. If you sense your fingers of
your right hand moving superiorly and your fingers of your left hand moving inferiorly
than the pt has a right torsion (opp hand should move inferiorly)
Sidebending and Rotation  
Put patient’s head into Vault Hold, sit quietly, once rhythm perceived you should
be able to distinguish sidebending (where your become wider at the side of the
convexity/sidebending) and rotation (where you feel your hand move further
down towards the pts feet is the side of rotation) sidebending and rotation are
always on the same side.
Vertical Shears  
Put patient’s head into Vault Hold, sit quietly, once rhythm perceived you should
be able to distinguish superior shear (where your thenar eminences move towards
the ceiling and your finger tips move towards the floor) and an inferior shear
(where your thenar eminences move towards the floor and your finger tips move
towards the ceiling)
Lateral Shears  
Put patient’s head into Vault Hold, sit quietly, once rhythm perceived you should
be able to distinguish a lateral strain with the greater wings of the sphenoid to the
right (where your right hand supinates and your left hand pronates) or a lateral
strain with the greater wings of the sphenoid to the left (where your left hand
supinates and your right hand pronates).
AXIS
Torsion – TRAP (torsion, rotation through AP axis)
Sidebending and Rotation – RAP VS (Rotation is about AP axis and Sidebending is from 2 vertical axis)
Vertical – TV (2 transverse axis for vertical shear)
Lateral – VAL (2 vertical axis for lateral shear)

Balanced MEMBRANOUS tension / INDIRECT TREATMENT: (GU OMM LAB 2)

1. Put pt into strain pattern 2. Slightly exaggerate pattern to move towards freedom 3. Hold until release felt
“Since your moving it more and more indirect it should feel looser as you move it into its freedom and once you find that point of
balanced membranous tension just hold it there and let everything unwind and loosen up. As that dura loosens up the bones will have
improved excursion and you will feel more of a pressure pushing out on flexion into your fingertips”
Part II - You will be asked to demonstrate one of the following (be prepared to be able to fully explain the application of the
technique including what anatomy it effects)1.One of the steps of the venous sinus drainage techniques 2.CV4 3.Galbreath’s
4.Eustatian tube traction 5. V-spread 
Venous Sinus Drainage  
pt supine with physician at the head of table. Sequence is important for proper technique.
1 to address occipital sinus place the fingers of both hands below the inion so that all the fingers are midline and allow the pts head to
rest on your fingers until a release is felt.
2 place your fingers along the transverse sinus along nuchal line (in a vector in line with the pts eyebrows) and allow pts head to rest
on your fingers and hold until a release is felt.
3 place your pinky’s along the straight sinus on the inion with a vector towards the pts nose and hold until release felt.
4 to address the superior saggital sinus place your right thumb on the left side of lambda and your left thumb on the right side of
lambda, using this criss cross positioning walk your way up to bregma.
5 place your fingers along the metopic suture (saggital sinus)so that your fingers are midline, hold until you feel release.
Once completed reassess by using the vault hold to assess the primary respiratory mechanism.

Venous sinus
- utilized to help decrease venous congestion and improve circulation and drainage of the head.
- focus is to remove restrictions form the membranes (dura) that contain the venous sinuses
• Absolute – Acute intracranial bleed or increased intracranial pressure or skull fracture
• Relative – patients with seizures or history of traumatic brain injury

CV4
Pt supine with physician at the head of table. Place one hand onto the other so that
your fingers are perpendicular, bring both your thenar eminences together so that
your thumbs are adjacent. Place this hand position under the pts head so that your
thenar eminences are medial to the mastoid process and below the inion and on
the supraocciput. Once in position, place your fingers towards the table and
traction towards you to encourage extension. Bring pt back to neutral and
reassess.

• Clinical outcome studies have demonstrated that the CV4 procedure produces
- profound relaxation
- balances autonomic tone
- improves the function of various body fluids
- facilitate resolution and recovery from infections
- decreases pain
- alters sleep latency and sympathetic nerve activity
C Technique  
To Help open Eustachian tube to provide drainage there, relieve congestion. Pt
supine with physician at opposite side. place one hand onto the forehead to
stabilize and with the other hand use your fingers to curl around the posterior
aspect of the mandible by the ramus and above the angle. Gently lift jaw towards
ceiling and towards physician while stabilizing the head to help lift the mandible
and the Eustachian tube to provide lymphatic drainage. Hold, release, repeat and
reassess.

“The Galbreath technique, also known as the jaw lift, assists in the opening of the Eustachian tube.
It is effective in otitis media and also in treating the stuffiness of the ear often experienced by
airline passengers, especially if it persists despite swallowing and yawning. the medial third of the Eustachian
tube lies in the temporal bone”

Eustacian tube traction

Pt supine with physician at head of table, grasp onto the pinna of the ear and
gently pull the ear superiorly and posteriorly to help straighten Eustachian tube.
Hold until any resistance felt is released, then reassess by looking into the ear for
fluid assessment.

V-Spread                
Pt supine with physician at head of table, find the mastoid process and place one
finger there, with the same hand place another finger onto the occiput so that the
occipitomastoid suture is between your fingers, turn the pts head onto your
fingers. While the weight of the pt’s head is on your fingers gently spread your
fingers apart so that the sutures are being released. Hold until a softening or
release is felt, once felt bring pt back to neutral and reassess.

• Cranial Nerves 9,10,11 exit through the jugular foramen

“V-spread is a combination of disengagement and directing ihe tide. The physician places two fingers of one
hand on either side of the suture to be released and exerts genile traction to disengage the suture.
Simultaneously, one or two fingers are placed on the point of greatest distance from the suture on the
contralateral side. The intention to direct the fluid with these fingers, combined with gentle pressure, if
necessary, willsend a fluid fluctuation toward that suture. This fluid fluctuation should be palpated by the V-
spread fingers and will continue to manifest an effect between the two guiding and directing hands. The
physician adjusts the directing fingers until a response is palpated between the two V-spread fingers. Release or
an apparent softening of the tissues will occur.”
Station 3 Reproductive –
Part I - You will be asked to demonstrate one of the following techniques and be able to perform the necessary diagnosis prior
to treatment and fully explain application of the technique including what anatomy it effects and how it influences the
reproductive system.  You are responsible for the material in the workshop and readings and videos.

Seated Articulatory technique for:

T and L spine (using spinous process) and Costo-vertebral articulation (using rib angles)  
Pt seated, physician at back of pt. have pt cross arms, while grasping onto pts opposite
shoulder. Place your axilla over the pts shoulder and grasp onto their far shoulder to
stabilize. Place thenar eminence medial to the spine or far rib angle. With an
anteriolateral force, as well as aiding disengagement by rotating the pt towards your,
disengage the rib. In areas of restriction repeat several times until increased motion is felt.
Disengage both left ribs and right ribs and reassess for dysfunction.
Lateral Recumbent:
Articulatory technique for the spine and Myofacial stretch for paravertebral areas
Pt lateral recumbent with physician at front of patient, with your fingertips on the
side of the spinous process closest to the table, articulate the spinous process
towards you (up towards the ceiling) to assess the articular mobility of the spine.
If a facilitated area is found repeat motion until motion is increased. Reassess.

Recumbant myofascial to the paraspinal tissues

Scapular Release  
Pt lateral recumbent with physician at front of patient, physicians caudal hand is
placed under pts arm to grasp onto the inferior angle of the scapula with the
cephalad hand grasping onto the top and scapular spine of the scapula. Articulate
the spine in its superior/inferior planes of motion and keep it at its freedom, then
protract/retract scapula and maintain the freedom. Then place the scapula into its
counterclockwise or clockwise freedom and stack the three motions of freedom
until release is felt, bring the pt to neutral and reassess.
Carpal tunnel Release  
Pt in position where hand is accessible by physician, with both hands grasp pts
hand so that your thumbs are in contact with pt’s anterior carpal bones. With your
thumbs in the middle of pts wrist traction out towards the pts thenar and
hypothenar eminences, repeat for several cycles, adding extension to the wrist
may help. Reassess
  Paraspinal Inhibition (T-L junction, lumbar area and sometimes over the sacrum)  
Pt in any position where back is accessible, physician at back, find tense
paravertebral muscle section that you are trying to treat, place your fist into
muscle and provide anterior force onto muscle until you feel the muscle loosen
up.
Part II - You will be asked to demonstrate one of the following (be prepared to be able to fully explain the application of the
technique including what anatomy it effects) 1. Frontal lift 2.  Zygomatic lift 3.  Nasion spread / Frontal-nasal bone lift 4. OA
decompression

OA Decompression  
Pt supine with physician at the head of table, ask pt to lift head, place one
hand underneath the pt’s head and curl fingers underneath the occiput into
the space that C1 occupies, ask pt to place their chin into their chest, apply
a gentle pressure to maintain head flexion until tip of C1 process if felt.
Once felt, hold until you feel the occipital chondyle slide back and
disappear. Reassess

frontal lift
pt supine with physician at the head of table. Place the thenar eminences
of both hands along frontal bones on both sides. Add a compression of
frontal bone and lift superiorly and anteriorly, hold for 90 seconds or until
you feel release of the bone. Reassess.

  zygomatic lift
pt supine with physician at the head of table. Place the thenar eminences
of both hands in front of the suture above the zygomatic arch on both
sides. Add a compression of the zygomatic bone and lift anteriorly, hold
for 90 seconds or until you feel release of the bone. Reassess.

nasion spread    
pt supine with physician at the head of table. Contact the frontal bone with
one hand and with the opposite hand gently contact the nasal bone and
spread both hands apart. Hold until release felt, reassess