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CORE OMM Curriculum


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Title: CORE OMM Curriculum

CORE OMM Curriculum Board Review
Developed for OUCOM CORE By Janet Burns, D.O.
Edited by James Preston, D.O., Clay Walsh, D.O.,
and the CORE Osteopathic Principles and
Practices Committee Series A, B, C - Session
  • It is not the intention of this review to be
    comprehensive or exhaustive that is best left to
    the several OMM board review books available.
  • The best use of your limited time is on high
    yield subject areas.
  • Current CORE residents provided the following
    recommendations for areas to focus on

Suggested Areas of Study
  • 1. Memorize Chapmans Reflexes
  • 2. Dx and Tx of Sacral Dysfunctions via Muscle
    Energy model
  • 3. Know the difference between Direct and
    Indirect techniques
  • 4. Know contraindications to certain techniques

Suggested Areas of Study - continued
  • 5. Memorize Viscerosomatic reflex levels
  • 6. Memorize steps to Spencer Technique
  • 7. Diagnosis and treatment of somatic dysfunction
    in cervical, thoracic, lumbar spine, sacrum,
    pelvis, ribs, and extremities utilizing Direct
    and Indirect approaches

Board Review Web Sites
  • OMM Board Review, John D. Capobianco, D.O.,
  • http//
  • - A free 32 page outline format review.
    Excellent for last minute studying includes
    mnemonics for recall, clinical correlations,
    functionally relevant anatomy. Highly
  • 60 multiple choice questions with key
  • - Free, good questions, but are not labeled as
    to whether they are
  • Level I, II, or III

Board Review Resources
  • OMT Review 3rd edition - A Comprehensive Review
    in Osteopathic Medicine Robert G. Savarese,
    D.O., 2003
  • - 36 Suitable for Levels I - III, has updated
    COMLEX-style questions, includes a lot more
    relevant anatomy than previousedition.
  • There are a few errors, if you own this book go
  • http//

OMM Terminology
  • Major Resource for appropriate terminology

Found in the back of Foundations for Osteopathic
Medicine, 2nd Ed.
Sympathetic Innervations
  • Physiologic limit of active motion
  • Anatomic limit of passive motion
  • Elastic range between physiologic and anatomic
  • Restrictive limit within anatomic range which
    decreases Physiologic range
  • Pathologic permanent restrictive barrier
    associated with pathologic change in tissue


Foundations for Osteopathic Medicine, 2nd Ed.,
pp. 575-576
Somatic Dysfunction
  • Definition impaired of altered function of
    related components of the somatic system
    skeletal, arthrodial and myofascial structures
    and related vascular, lymphatic and neural

Naming/Diagnosing Somatic Dysfunction
  • All somatic dysfunctions are named according to
    the POSITION of the dysfunctional structural
  • The POSITION of the structural element EQUALS the
    EASE OF MOTION of that structural element.
  • Therefore RESTRICTION OF MOTION of the structural
    element is OPPOSITE the POSTION diagnosis

Somatic Dysfunction Physical Findings
  • (T) A. R. T.
  • T Tissue Texture changes
  • A Asymmetry
  • R Range of Motion (ROM)
  • (T) Tenderness

Somatic Dysfunction Acute
  • Acute Chronic
  • Temperature increased cool
  • Texture boggy, rough doughy, thin
  • Moisture increased decreased
  • Tension increased sl. increased
  • Tenderness Increased less tender
  • Edema yes no
  • Erythema yes, stays fades quick

  • Concentric shortening of muscle during
  • Eccentric lengthening of muscle during
  • Isolytic contraction while forcing to
    lengthening operatorgtpatient
  • Isometric inc. tension, length constant
    operator patient
  • Isotonic approximation without change in
    tension operatorltpatient

  • Transverse Shoulder to shoulder
  • Anterior-Posterior Front to back
  • Longitudinal (Vertical) Head to toe

  • Transverse Separates top from bottom
  • Sagittal Separates left from right
  • Coronal Separates front from back

  • Def. ends of arc approximate
  • Sacral base anterior
  • Craniosacral sacrum counter nutates (base
    posterior) sphenobasilar ascends
  • Regional cervical, thoracic, lumbar

Sacral Flexion
Foundations for Osteopathic Medicine, 1st Ed.,
pp. 1130
  • Def. ends of arc move apart
  • Sacral base posterior
  • Craniosacral sacrum nutates (base forward)
    sphenobasilar descends
  • Regional cervical, thoracic, lumbar

Sacral Extension
Foundations for Osteopathic Medicine, 1st Ed.,
pp. 1130
Fryettes Principles
  • Rules apply to thoracic and lumbar spine only
  • Fryettes I with spine in neutral side
    bending and rotation are opposite
  • Fryettes II with spine hyperflexed or
    hyperextended sidebending and rotation are to the
    same side.
  • Fryettes III motion in any plane of motion
    modifies motion in all other planes of motion.

Thoracic Mechanics
  • Non-neutral Mechanics
  • Type II Rotation Before SB
  • Non-neutral Mechanics
  • Type II Rotation Before SB

Kimberly Manual, millennium edition, pp. 11-12
  • Definition area of impairment or restriction
    that develops a lower threshold for irritation
    and dysfunction when other areas are stimulated.
  • Reflex hyper-excitability
  • Hyper-irritable
  • Hyper-responsive

Spinal Motion
  • OA Type I only with flexion/extension
  • AA Rotation only
  • C2 C7 Type II only
  • Thoracic Type I and Type II
  • Lumbar Type I and Type II

Gravitational Line
  • External auditory meatus
  • Lateral head of humerus
  • Third lumbar vertebrae (center)
  • Greater trochanter
  • Lateral condyle of knee
  • Lateral malleolus

Gravitational Line
Foundations for Osteopathic Medicine, 1st Ed.,
pp. 1131
Iliosacral Somatic Dysfunctions
  • Movement of ilium on sacrum
  • Standing Flexion test
  • Landmarks ASIS, PSIS
  • Anterior rotation ASIS down, PSIS up
  • Posterior rotation ASIS up, PSIS down
  • Inflare ASIS in
  • Outflare ASIS out
  • Inferior shear ASIS down, PSIS down
  • Superior shear ASIS up, PSIS up

DiGiovanna, 3rd Ed, p. 289
DiGiovanna, 3rd Ed, p. 288
DiGiovanna, 3rd Ed, p. 291
Sacral Somatic Dysfunctions
  • Extension unilateral and bilateral
  • Flexion unilateral and bilateral
  • Forward Torsions L on L, R on R (rotation on an
  • Backward Torsions L on R, R on L
  • Sacral Shear
  • Anterior Sacrum (translated)
  • Posterior Sacrum (translated)

Sacral Torsions
Pubic Somatic Dysfunction
  • Motion of pubic symphysis
  • Landmarks pubic bone
  • Dysfunctions superior, inferior

DiGiovanna, 3rd Ed, p. 291
Sacral Somatic Dysfunctions
  • Seated flexion test
  • Sphinx test (lumbar extension)
  • Spring test
  • 2 Landmarks Sacral Sulcus ILA (inferior
    lateral angle)

Glossary of Osteopathic Terminology
Sacral Motion
  • 7 axes of motion
  • Vertical rotation
  • A/P sidebending
  • 2 Obliques (diagonals) R and L torsions
  • 3 Transverse axes flexion and extension
  • Superior transverse - respiratory axis
  • Middle transverse - postural axis
  • Inferior Transverse Innominate rotation axis

Sacral Axes
  • 1 Longitudinal axis
  • 1 Anterior-posterior axis
  • 2 Oblique axes
  • Right and Left
  • 3 Transverse axes
  • Superior, Middle, and Inferior

DiGiovanna, 3rd Ed, p. 287
Sacral Axes
  • 3 Transverse Axes
  • Superior Respiratory axis
  • Motion relative to the pull of the dura occurs
    around this axis
  • Middle Postural axis
  • Bilateral Flexion Extension occur around this
    axis (motion during flexion/extension of spine)
  • Inferior Innominate rotation axis

DiGiovanna, 3rd Ed, p. 287
ME Sacral Diagnosis -Tips
  • Similar to algebra, you will be expected to solve
    the equation for the unknown, you need to know
    the rules and algorhythms
  • () Spring or Sphinx (prone backward bending)
    tests reflect an extended sacral base (unilateral
    or bilateral extensions or backward torsions)
  • Sacral torsion rules of L5 on S1
  • Sacrum rotates opposite L5
  • When L5 is sidebent, it forms an oblique axis on
    that side
  • The () seated flexion test is found on the side
    opposite the oblique axis
  • Forward Torsions occur in Neutral (Type 1)
  • Backward torsions occur in Non-neutral (Type 2)

ME Sacral Diagnosis -Tips
  • Using these rules, if you are given L5 FrSr
  • There will be a () flexion test on L, sacrum
    rotated L on R oblique axis
  • You then extrapolate that this is a backward
    torsion (because forward torsions are named same
    on same, i.e. L on L, Backward torsions are vice
  • Therefore the Spring or Sphinx tests would be ()
    reflecting the extended (posterior) sacral base
    on the L
  • Deep Sulcus (DS) is therefore on the R, Posterior
    /Inferior ILA is on the L

Forward Torsions - Review
  • Findings for Left on Left
  • () Standing flexion test on R
  • Deep sacral sulcus (DS) on R
  • Posterior/Inferior ILA on L
  • (-) Spring / Sphinx Test
  • Sacrotuberous Ligament taut on the L

Mitchell, The Muscle Energy Manual, Volume III,
p. 62
Forward Torsions Causes
  • Forward Torsions
  • Occurs when lumbar spine is in neutral mechanics
  • Exaggerated ambulation mechanics
  • Sacrotuberous Ligament is taut on side of
    Posterior/Inferior ILA

Backward Torsions - Review
  • Findings for Right on Left
  • () Standing flexion test on R
  • Deep sacral sulcus (DS) on L
  • Posterior/Inferior ILA on R
  • () Spring / Sphinx Test
  • Sacrotuberous Ligament taut on the R

Mitchell, The Muscle Energy Manual, Volume III,
p. 62
Backward Torsions Causes
  • Backward Torsions
  • How do these occur?
  • Physiologically during Non-Neutral Lumbar
  • Is backward torsional motion always
  • No, only if it cant return to neutral

  • Backward Torsion
  • possible mechanism
  • Mitchell, The Muscle Energy Manual, Volume III,
    p. 64

L. Unilateral Sacral Flexion
  • L half of Sacrum has moved forward down
    relative to R
  • (-) Sphinx test
  • () Seated flexion test on L
  • Sacrotuberous lig. taut on L

Mitchell, The Muscle Energy Manual, Volume III,
p. 60
Mitchell, The Muscle Energy Manual, Volume III,
p. 61
Unilateral Sacral Flexions / Extensions
  • Deep Sulcus and Posterior/ Inferior ILA on Same
    side (i.e. both on L, could be L Flex or R Ext)
  • What separates a L sacral Flexion from a R sacral
    Extension is
  • the Sphinx test (-) in flex () in ext
  • or the Seated flexion test () R on R Ext, () L
    on L Flex
  • Some find it easier to think of it as a shear or
    combination of Sidebending and Rotational
  • Sidebending and Rotation occur to opposite sides
  • Caused by unbalanced sacral base loading during
    trunk sidebending- same mech. that can cause
    innominate upslip, but trunk is sidebent, not

Bilateral Flexion / Extension
  • Extension Dysfunction
  • PSISs level
  • ILAs level
  • Bilateral shallow (posterior) sacral sulci
  • () Spring / Sphinx test (restricted motion)
  • Flexion Dysfunction
  • PSISs level
  • ILAs level
  • Bilateral deep (anterior) sacral sulci
  • (-) Spring / Sphinx test (unrestricted motion)

DiGiovanna, 2nd Ed
Causes of Bilateral Sacral Flexion / Extension
  • Bilateral Sacral Extension
  • Improper lifting techniques
  • Fall in a seated position
  • Bilateral Sacral Flexion
  • Extremely common postpartum
  • Arched while holding heavy load

Optional Activities
  1. Practice Diagnosing and Treating Sacral
    Dysfunctions according to ME model
  2. Some Sacral ME treatments commonly found on exams
    are included in the following slides

ME Forward Torsion Left on Left
1 of 3
  • Operator flexes the hips to at least 90 degrees,
    (Non-Neutral) guides the knees to the right side
    of the table and facilitates lumbo-pelvic
    rotation right.
  • Pt. Prone
  • Operator stands on the right side
  • Pt. is instructed to allow knees to be flexed
    raise right hip.

Kimberly Manual, p.203-204
Forward Torsion Left on Left
2 of 3
  • Sidebending is introduced by supporting the
    pts. knees on the operators thighs and lowering
    the feet off the table
  • Localized to L-S Junction
  • Pt is instructed to inhale, then reach to the
    floor with the right upper arm during exhalation
    while monitoring L5
  • Operator may assist this motion by pushing the
    shoulder toward the floor to achieve rotation of
    L5 left

Kimberly Manual, p.203-204
Forward Torsion Left on Left
3 of 3
  • Pt. is instructed to lift the feet toward the
    ceiling against isometric resistance
  • Sufficient force is needed to feel the
    localization at of the muscle effort to the right
    sacral base.
  • Hold for 3-5 seconds
  • Relax about 2 seconds, breathe as a reminder!
  • Repeat
  • Retest
  • Operator may additionally contact the spinous
    process of L5 to encourage rotation of that
    vertebra to the left.
  • This is usually not necessary. It is important
    to monitor the right sacral base simultaneously.

Kimberly Manual, p.203-204
ME Right on Left Sacral Torsion
1 of 4
  • Patient in left lateral recumbent position
  • The right lower extremity is flexed until the
    vector of force is palpated at the right sacral
    base by the monitoring fingers
  • The right knee is supported between the
    operators two thighs

Courtesy of David C. Eland, DO,FAAO - OUCOM
Right on Left Sacral Torsion - continued
2 of 4
  • The left lower extremity is extended by the
  • This encourages sacral base anterior motion

Courtesy of David C. Eland, DO,FAAO - OUCOM
Right on Left Sacral Torsion - continued
3 of 4
  • Trunk rotation to the right is accomplished via a
    pull through the left upper extremity.
    - This right rotation is carried down
    through L5, which, in turn, encourages the right
    sacral base to move anterior.
  • Continue to support the right knee throughout the
  • This helps maintain the fulcrum for change.

Courtesy of David C. Eland, DO,FAAO - OUCOM
Right on Left Sacral Torsion - continued
4 of 4
  • -Carry the right ankle toward the floor
  • -The patient is instructed to try to lift the
    ankle toward the ceiling isometric contraction
    with operator resistance
  • This gaps the sacroiliac and allows the other
    forces acting upon the sacrum to carry the right
    base anterior.
  • -Relax
  • -Reposition ankle knee according to response
    noted by monitoring hand
  • -Repeat, Retest

Courtesy of David C. Eland, DO,FAAO - OUCOM
L. Unilateral Sacral Flexion (Sacrum Sidebent L
Rotated R) ME, LVMA
  • - Patient prone, Doc on side of Dysfunction
  • - ABduct Int Rot Hip to gap SI Joint, brace
    with docs body
  • - Apply anterior pressure to Inferior/Posterior
    ILA to move (DS) base posteriorly Cephalad to
    side bend it Right. Can spring it or use
    respiratory assist Pt inhales deeply and
    holds-should feel Base move posterior

  • Kimberly Manual, p.214

L. Unilateral Sacrum Extended LVMA
  • Heel of Caudad hand on Inferior Ischial
  • Hypothenar eminence of cephalad hand on Sacral
  • Carry Ischial Tuberosity SUPERIORLY
  • This produces an anterior rotation of the
    innominate to help engage the barrier
  • Carry Sacral Base Anterior and Inferior to

Kimberly Manual, p.214
ME Bilateral Sacral Flexion
1 of 2
  • Pt. Sits with feet knees apart
  • Operator
  • Heel of sacral hand contacts below the middle
    transverse axis
  • Cephalad hand monitors maintains trunk flexion
    via contact with the mid to lower thoracic area
  • Kimberly Manual,

Bilateral Sacral Flexion
2 of 2
  • - Pt. is instructed to push the lumbosacral
    junction posterior while operator maintains
    isometric counterforce
  • -3-5 second contraction followed by about 2
    second relaxation
  • -Repeat
  • -Recheck

Kimberly Manual, p.192
ME Bilateral Sacrum Extended
  • Pt. Positioning Refinement Pt. Is instructed to
    arch the back by pushing the abdomen toward the
  • Operator maintains compressive force on sacral
  • 3-5 repetitions of pt. Attempted trunk flexion
    (isometric), relax between efforts
  • Innate Force
  • Exhalation assists in
  • Carrying the sacral
  • base anterior
  • Pt. Seated on stool
  • Feet together, knees apart, arms crossed
  • Operator
  • Hand on sacral base
  • Other hand across chest

Greenman, 3rd Ed., p. 383
  • Atypical Ribs 1, 2, 10, 11, 12
  • Typical Ribs 3 9
  • Pump handle upper ribs
  • Mixed middle ribs
  • Bucket handle lower ribs (to rib 10)
  • Caliper Ribs 11 and 12

Foundations for Osteopathic Medicine, 1st Ed.,
pp. 1128
Foundations for Osteopathic Medicine, 1st Ed.,
pp. 1128
Rib Somatic Dysfunction
  • Exhalation Rib free motion in exhalation other
    exhalation strain, depressed rib, anterior rib
  • Inhalation Rib free motion in inhalation other
    inhalation strain, elevated rib, posterior rib

Foundations for Osteopathic Medicine, 1st Ed.,
pp. 1128
Foundations for Osteopathic Medicine, 1st Ed.,
pp. 1128
Rule of Threes (Thorax)
  • Refers to the position of a spinous process
    relative to its vertebral segment level.
  • T1 T3 same level
  • T4 T6 ½ segment below
  • T7 T9 1 segment below
  • T10 1 segment below
  • T11 ½ segment below
  • T12 same level

What are Chapmans Reflexes?
  • A system of predictable anterior and posterior
    fascial tissue texture abnormalities described in
    the 1920s by Frank Chapman, D.O.
  • They indicate increased functional activity of
    the sympathetic nervous system
  • Thought to reflect visceral dysfunction or
  • They follow Sympathetic afferent pathways
  • Do NOT reflect parasympathetic nervous system
  • Treating them may alter sympathetic influences on
    the corresponding viscera

Chapmans vs. Viscerosomatic Reflexes
  • Similarities
  • Somatic result of a visceral input
  • Will return if underlying problem is not
  • Tx of Somatic Component can improve Visceral
  • Differences
  • Chapmans are neurolymphatic reflexes
    viscerosomatic are neural reflexes
  • Chapmans manifest in the same place all of the
    time viscerosomatic manifest within a range of
    vertebral segments, and of varying intensity

Chapmans Reflexes Anterior Points
  • Kuchera ML, Kuchera WA. Osteopathic
    Considerations in Systemic Dysfunction. 2nd ed.
    Columbus OH Greyden Press 1994 pp. 232-3.
  • or
  • Ward R. Foundations for Osteopathic Medicine. 2nd
    ed. Philadelphia Williams Wilkins 2002 pp.

Chapmans Reflexes Posterior Points
Kuchera ML, Kuchera WA. Osteopathic
Considerations in Systemic Dysfunction. 2nd ed.
Columbus OH Greyden Press 1994 pp.
232-3. or Ward R. Foundations for Osteopathic
Medicine. 2nd ed. Philadelphia Williams
Wilkins 2002 pp. 1053-4.
  • Discoverer Sutherland
  • Midline Bones Flex/Extend
  • Paired Bones External/Internal Rotation
  • Inspiration Cranial Flexion Ext. Rotation
  • Expiration Cranial Extension Internal
  • CV4 Gently hold cranial extension forces CSF
  • Still point - Sutherland

Cranial Concept 5 Components
  • The intrinsic motility of the brain and spinal
  • The fluctuation of the cerebrospinal fluid
  • The mobility of the intracranial and intraspinous
    membrane as functional system known as the
    reciprocal tension membrane
  • The sutural mobility of the cranial bones
  • The involuntary movement of the sacrum between
    the ilia

Foundations for Osteopathic Medicine, 1st Ed.
Foundations for Osteopathic Medicine, 1st Ed.
Flexion at SBS
Foundations for Osteopathic Medicine, 1st Ed.
Cranial Flexion
Flexion Phase Sphenobasilar symphysis rises
pulling the sacral base superior/posterior
Magoun, Osteopathy in the Cranial Field, 3rd
Edition, p. 39
Cranial Flexion/Extension
Upledger, Cranial Sacral Therapy
Strain Patterns
  • There are essentially six strain patterns to
    concern yourself with. They are
  • Flexion Extension
  • Torsion
  • Sidebending, Rotation
  • Vertical Strain
  • Lateral Strain
  • Compression

Flexion and Extension
Pratt-Harrington, Except for OMT, p 37
Pratt-Harrington, Except for OMT, p 38
Pratt-Harrington, Except for OMT, p 39
Vertical Strain
Pratt-Harrington, Except for OMT, p 40
Lateral Strain
Pratt-Harrington, Except for OMT, p 41
SBS Compression
Foundations for Osteopathic Medicine, 1st Ed.
Direct Techniques
  • HVLA
  • LVLA
  • Muscle Energy - Mitchell

Indirect Techniques
  • Counterstrain Lawrence Jones
  • Facilitated Positional Release Schiowitz
  • Functional Technique

Direct/Indirect Techniques
  • Myofascial
  • Cranial Sutherland
  • Still Technique

Facilitated Positional Release
  • Schiowitz
  • Patient relaxed
  • Flatten A/P curve
  • Place in position of ease
  • Facilitated force compression, traction,
  • Hold 3 4 seconds

  • Lawrence Jones, D.O.
  • Patient relaxed
  • Position of least discomfort (70 better)
  • Hold 90 sec. (120 sec. ribs)
  • Slowly release

  • There is no single definitive reference for
  • The Savarese review book has lists that are
    compiled from major Osteopathic texts including
    DiGiovanna, Greenman, Foundations, and Kuchera
  • Know the absolute vs. relative contraindications
    for different techniques, when noted.
  • Not all techniques have nice, clear-cut lists of
    relative vs. absolute.
  • Board questions tend to ask about
    contraindications that are commonly agreed upon,
    not the controversial ones.

Contraindications HVLA
  • Absolute
  • Osteoporosis
  • Osteomyelitis, incl. Potts Dz
  • Bone Metastasis
  • Fractures in area of thrust
  • Tx of C-Spine in patients w/ severe RA or Downs
  • Weakened ligament of Dens
  • Relative
  • Acute Whiplash
  • Pregnancy
  • Post- surgical conditions
  • Herniated nucleus pulposus
  • Hemophiliacs, anticoagulated patients
  • Vertebral artery ischemia

Contraindications ME
  • Absolute
  • Fractures severe neuromuscular injuries to
    potential Tx sites
  • Inability of patient to cooperate
  • Relative
  • Patients w/ low vitality, who could be further
    compromised by active muscular exertion
  • Post surgical
  • ICU /CCU patients
  • These pts may tolerate gentler forms of ME such
    as reciprocal inhibition

Contraindications Counterstrain
  • Absolute
  • Inability to relax muscles
  • Disease
  • Physical
  • Emotional
  • Severe pain
  • Age
  • Drugs
  • Relative
  • Severely debilitated patient
  • Decrease DOSAGE (intensity of treatment)
  • Do less than six points
  • Position for less than maximal relief of TP
  • - Avoid positions of extreme thoracolumbar
    flexion in osteoporotic patients

Osteopathy in the Cranial Field Indications
  • Indirect Action / Exaggeration
  • Commonly used in ages 5 thru adult
  • NOT used in
  • Overriding sutures
  • In acute head trauma when exaggeration could
    cause or increase intracranial bleeds
  • In young children who do not yet have a developed
    sutural pattern

Osteopathy in the Cranial Field Indications
  • Direct Action
  • Recommended in ages 5 and under
  • used in
  • Overriding sutures
  • In acute head trauma when exaggeration could
    cause or increase intracranial bleeds
  • In young children who dont have a developed
    sutural pattern yet
  • NOT used when it could cause or increase
    intracranial bleeds, or tissue trauma.

Osteopathy in the Cranial Field
  • Absolute
  • Acute intracranial bleed
  • Increased intracranial pressure
  • Skull fracture
  • Relative
  • Traumatic brain injury
  • In patients with Hx of seizures or dystonia,
    great care must be used in order to not
    exacerbate any neurological Sx

Contraindications - Articulatory Techniques
Springing, Low Velocity/Moderate Amplitude (LVMA)
  • Contraindications
  • Acutely inflamed joints, especially if due to
    infection or fracture
  • Recent surgery to Tx area
  • Repeated hyper-rotation of an extended upper
    Cervical spine may damage the Vertebral Art.

Contraindications Facilitated Positional Release
  • None listed in Savarese or the FPR chapter in
    Foundations 2nd ed..
  • If it shows up on boards, apply fundamental
    principles to reason it out
  • It uses compression (usually) or distraction as
    its activating force after putting patient in
    position of ease
  • Think of things that cant tolerate compression,
    i.e. injured discs, etc.
  • Therefore it would not be the Tx of choice in an
    acute whiplash injury

Contraindications Myofascial Release
  • No absolute vs. relative, no discussion found
  • Direct vs. Indirect contraindications
  • In general
  • Nearby surgical wound or infection
  • Fracture
  • Specific Contraindications to Celiac, Inf.,
    Sup. Mesenteric Ganglia releases
  • Aortic Aneurysm
  • Nearby surgical wound

Contraindications Lymphatic Techniques
  • No clear distinction currently made between
    Relative and Absolute.
  • The term Absolute is therefore generally not
    used with regard to Lymphatic Treatment.
  • Be aware of the difference between Lymphatic
    Pump and other lymphatic techniques.

Contraindications Lymphatics
  • There are many different kinds of Lymphatic
    Techniques rather than try to memorize a
    separate contraindication list for every one, it
    is simpler to think about what category a
    specific technique falls under.
  • i.e., rib raising is a direct Articulatory
    technique and therefore shares the same list of
  • redoming the diaphragm shares those of the other
    direct myofascial release techniques

Relative Contraindications Lymphatic Pump Tx
  • Fractures
  • Bacterial infections with a temp gt 102o F
  • Abscesses or localized infection
  • Thromboses
  • Fragility of nearby organs
  • Certain stages of Carcinoma, or Malignancy of
    Lymphatic System
  • Controversial Area
  • No clinical evidence to support this as a

Relative Contraindications Lymphatic Tx
  • Physiologically, there is a difference between
  • Merely restoring normal motion and function to
    the components of the lymphatic system i.e.
    diaphragm/ fascial release and
  • Actively pumping lymph around, augmenting its
    flow, i.e. pedal, abdominal, or thoracic pumps.
  • For sake of boards, on a lymphatic
    contraindication question, its safest to go with
    malignancy as a contraindication
  • unless they make you choose between several types
    of lymphatic tech., in which case techniques in
    category 2 would be more contraindicated than
    techniques in 1.

A. T. Still
  • 1828 1917
  • 1874 announced osteopathic tenets
  • 1892 established first school

Seven Stages of Spencer
  • Purpose improve glenohumeral joint restrictions
  • Some schools include a warm-up sequence with the
    Spencer Technique. For the sake of boards, the
    warm-up exercises do not officially count toward
    the 7 stages.

Seven Stages of Spencer
  • Spencer Technique has undergone modification may
    be done passively or Muscle Energy Techniques may
    be used at each of the restrictive barriers.
  • Depending on reference, the stages may be labeled
    differently (i.e. I, II, III, IVa, IVb) however,
    the basic sequence is still the same.

Seven Stages of Spencer
  • I Shoulder Abduction with traction /compression
  • II Extension / Flexion (elbow bent)
  • III Flexion / Extension (elbow straight)
  • IVa Circumduction w/ Compression (elbow bent)
  • IVb Circumduction w/ Traction (elbow straight)
  • V Adduction Ext Rotation (elbow bent)
  • VI Abduction Int. Rotation Arm behind back
  • VII Repeat Stage I

Ward R. Foundations for Osteopathic Medicine. 2nd
ed. 2002 pp.850-52.
  • Good luck!