Osteopathic Hands-on manual techniques for low back pain

Indication for Treatment.

Somatic dysfunction of the lumbar region. The patient may present with lower back pain in the area of the tender point.

Tender Point Location.

PL1-5 spinous process: On the inferolateral aspect of the deviated spinous process of dysfunctional segment.

PL1-3 transverse process: On the lateral aspect of the transverse process of the dysfunctional segment.

Indication for Treatment

Somatic dysfunction of the lumbar region. The patient may present with lower back pain in the area of the tender point.

Tender Point Location

PL1-5 spinous process: On the inferolateral aspect of the deviated spinous process of dysfunctional segment.

PL1-3 transverse process: On the lateral aspect of the transverse process of the dysfunctional segment

INDICATIONS
1. Somatic dysfunctions of articular basis
2. Somatic dysfunctions of myofascial basis
3. Areas of lymphatic congestion or local edema
RELATIVE CONTRAINDICATIONS
1. Fracture, dislocation, or gross instability in area to be treated
2. Malignancy, infection, or severe osteoporosis in area to be treated

Indication for Treatment

Somatic dysfunction of the pelvic region. The patient may complain of pain in the buttock and the posterior thigh (sciatic neuritis)

Tender Point Location

Classically found at the midpoint between the lower half of the lateral aspect of the sacrum (ILA) and the greater trochanter. This is near the sciatic notch and therefore, to avoid sciatic irritation, we have commonly used the tender points either proximal to the sacrum or the trochanter. If both of these can be simultaneously reduced effectively, the treatment can be extremely successful.

Indications:

Dysmenorrhea

Pelvic congestion syndrome

Sacroiliac dysfunction

Contraindications:

Undiagnosed pelvic pain

Pelvic malignancy

Indication for Treatment

Somatic dysfunction of the lumbar and/or pelvic region.

The patient may complain of pain below the iliac crest in the posterior gluteal region while walking or getting up from seated position.

Tender Point Location:

On the upper outer portion of the gluteus medius muscle, between the PSIS and the tensor fasciae latae.

On the lateral portion of the gluteus medius  near the posterior margin of the tensor fasciae latae.

INDICATIONS:

1. Use as part of the musculoskeletal screening examination to quickly identify regions of potential motion restriction and tissue texture changes.

2. Reduce muscle tension and fascial tension.

3. Stretch and increase elasticity of shortened, inelastic, and/or fibrotic myofascial structures to improve regional and/or intersegmental ranges of motion.

4. Reduce the tight-loose asymmetry to improve the tissue consistency in the loose tissues by increasing elasticity in the tight tissues.

5. Improve circulation to the specific region being treated by local physical and thermodynamic effects or by reflex phenomena to improve circulation in a distal area (e.g., through somatosomatic, somato-visceral reflexes).

6. Increase venous and lymphatic drainage to decrease local and/or distal swelling and edema and potentially improve the overall immune response.

7. Potentiate the effect of other osteopathic techniques.

CONTRAINDICATIONS:

Relative Contraindications

As myofascial technique may be performed with extremely light pressure in a direct or indirect manner, there is little likelihood of adverse effects other than aches post treatment that are secondary to compensation and decompensation reactions and similar to aches post exercise. As in other techniques, increased water intake and ice pack application as needed post treatment will generally reduce any such reaction.

1. Acute sprain or strain

2. Fracture or dislocation

3. Neurologic or vascular compromise

4. Osteoporosis and osteopenia

5. Malignancy: Most restrictions are for treatment

in the affected area of malignancy; however, care

should be taken in other distal areas depending on type of malignancy and/or lymphatic involvement.

6. Infection (e.g., osteomyelitis)

Absolute Contraindications:

None, as the technique may be performed with very light pressure. The physician may work proximal or distal to the affected area and alter the patient’s position or style of technique to achieve some beneficial effect.

This technique can greatly enhance your results in sacral and lumbar treatments. When you release the iliolumbar ligament, continue to move anteriorly and superiorly to release the latissimus dorsi.
TECHNIQUE : Lateral recumbent direct ligamentous articular release
SYMPTOMS/DIAGNOSIS : Pain in lower back, radicular pain down the back of
the leg, or restricted motion of the sacroiliac joints and lumbar spine

INDICATIONS:

1. Use as part of the musculoskeletal screening examination to quickly identify regions of potential motion restriction and tissue texture changes.

2. Reduce muscle tension and fascial tension.

3. Stretch and increase elasticity of shortened, inelastic, and/or fibrotic myofascial structures to improve regional and/or intersegmental ranges of motion.

4. Reduce the tight-loose asymmetry to improve the tissue consistency in the loose tissues by increasing elasticity in the tight tissues.

5. Improve circulation to the specific region being treated by local physical and thermodynamic effects or by reflex phenomena to improve circulation in a distal area (e.g., through somatosomatic, somato-visceral reflexes).

6. Increase venous and lymphatic drainage to decrease local and/or distal swelling and edema and potentially improve the overall immune response.

7. Potentiate the effect of other osteopathic techniques.

CONTRAINDICATIONS:

Relative Contraindications

As myofascial technique may be performed with extremely light pressure in a direct or indirect manner, there is little likelihood of adverse effects other than aches post treatment that are secondary to compensation and decompensation reactions and similar to aches post exercise. As in other techniques, increased water intake and ice pack application as needed post treatment will generally reduce any such reaction.

1. Acute sprain or strain

2. Fracture or dislocation

3. Neurologic or vascular compromise

4. Osteoporosis and osteopenia

5. Malignancy: Most restrictions are for treatment

in the affected area of malignancy; however, care

should be taken in other distal areas depending on type of malignancy and/or lymphatic involvement.

6. Infection (e.g., osteomyelitis)

Absolute Contraindications:

None, as the technique may be performed with very light pressure. The physician may work proximal or distal to the affected area and alter the patient’s position or style of technique to achieve some beneficial effect.

Internal and External Abdominal Oblique Muscles

and Quadratus Lumborum Muscle

TECHNIQUE: Lateral recumbent direct myofascial release

SYMPTOMS/DIAGNOSIS: Lateral abdominal pain or restricted rotational

motion of lumbar and lower thoracic spine

INDICATIONS:

1. Use as part of the musculoskeletal screening examination to quickly identify regions of potential motion restriction and tissue texture changes.

2. Reduce muscle tension and fascial tension.

3. Stretch and increase elasticity of shortened, inelastic, and/or fibrotic myofascial structures to improve regional and/or intersegmental ranges of motion.

4. Reduce the tight-loose asymmetry to improve the tissue consistency in the loose tissues by increasing elasticity in the tight tissues.

5. Improve circulation to the specific region being treated by local physical and thermodynamic effects or by reflex phenomena to improve circulation in a distal area (e.g., through somatosomatic, somato-visceral reflexes).

6. Increase venous and lymphatic drainage to decrease local and/or distal swelling and edema and potentially improve the overall immune response.

7. Potentiate the effect of other osteopathic techniques.

CONTRAINDICATIONS:

Relative Contraindications

As myofascial technique may be performed with extremely light pressure in a direct or indirect manner, there is little likelihood of adverse effects other than aches post treatment that are secondary to compensation and decompensation reactions and similar to aches post exercise. As in other techniques, increased water intake and ice pack application as needed post treatment will generally reduce any such reaction.

1. Acute sprain or strain

2. Fracture or dislocation

3. Neurologic or vascular compromise

4. Osteoporosis and osteopenia

5. Malignancy: Most restrictions are for treatment

in the affected area of malignancy; however, care

should be taken in other distal areas depending on type of malignancy and/or lymphatic involvement.

6. Infection (e.g., osteomyelitis)

Absolute Contraindications:

None, as the technique may be performed with very light pressure. The physician may work proximal or distal to the affected area and alter the patient’s position or style of technique to achieve some beneficial effect.

INDICATIONS:

1. Use as part of the musculoskeletal screening examination to quickly identify regions of potential motion restriction and tissue texture changes.

2. Reduce muscle tension and fascial tension.

3. Stretch and increase elasticity of shortened, inelastic, and/or fibrotic myofascial structures to improve regional and/or intersegmental ranges of motion.

4. Reduce the tight-loose asymmetry to improve the tissue consistency in the loose tissues by increasing elasticity in the tight tissues.

5. Improve circulation to the specific region being treated by local physical and thermodynamic effects or by reflex phenomena to improve circulation in a distal area (e.g., through somatosomatic, somato-visceral reflexes).

6. Increase venous and lymphatic drainage to decrease local and/or distal swelling and edema and potentially improve the overall immune response.

7. Potentiate the effect of other osteopathic techniques.

CONTRAINDICATIONS:

Relative Contraindications

As myofascial technique may be performed with extremely light pressure in a direct or indirect manner, there is little likelihood of adverse effects other than aches post treatment that are secondary to compensation and decompensation reactions and similar to aches post exercise. As in other techniques, increased water intake and ice pack application as needed post treatment will generally reduce any such reaction.

1. Acute sprain or strain

2. Fracture or dislocation

3. Neurologic or vascular compromise

4. Osteoporosis and osteopenia

5. Malignancy: Most restrictions are for treatment

in the affected area of malignancy; however, care

should be taken in other distal areas depending on type of malignancy and/or lymphatic involvement.

6. Infection (e.g., osteomyelitis)

Absolute Contraindications:

None, as the technique may be performed with very light pressure. The physician may work proximal or distal to the affected area and alter the patient’s position or style of technique to achieve some beneficial effect.

TECHNIQUE: Lateral recumbent direct myofascial release

SYMPTOMS/DIAGNOSIS: Pain in the posterior lateral lower back or restricted motion of the shoulder

INDICATIONS:

1. Use as part of the musculoskeletal screening examination to quickly identify regions of potential motion restriction and tissue texture changes.

2. Reduce muscle tension and fascial tension.

3. Stretch and increase elasticity of shortened, inelastic, and/or fibrotic myofascial structures to improve regional and/or intersegmental ranges of motion.

4. Reduce the tight-loose asymmetry to improve the tissue consistency in the loose tissues by increasing elasticity in the tight tissues.

5. Improve circulation to the specific region being treated by local physical and thermodynamic effects or by reflex phenomena to improve circulation in a distal area (e.g., through somatosomatic, somato-visceral reflexes).

6. Increase venous and lymphatic drainage to decrease local and/or distal swelling and edema and potentially improve the overall immune response.

7. Potentiate the effect of other osteopathic techniques.

CONTRAINDICATIONS:

Relative Contraindications

As myofascial technique may be performed with extremely light pressure in a direct or indirect manner, there is little likelihood of adverse effects other than aches post treatment that are secondary to compensation and decompensation reactions and similar to aches post exercise. As in other techniques, increased water intake and ice pack application as needed post treatment will generally reduce any such reaction.

1. Acute sprain or strain

2. Fracture or dislocation

3. Neurologic or vascular compromise

4. Osteoporosis and osteopenia

5. Malignancy: Most restrictions are for treatment

in the affected area of malignancy; however, care

should be taken in other distal areas depending on type of malignancy and/or lymphatic involvement.

6. Infection (e.g., osteomyelitis)

Absolute Contraindications:

None, as the technique may be performed with very light pressure. The physician may work proximal or distal to the affected area and alter the patient’s position or style of technique to achieve some beneficial effect.

INDICATIONS for MET:

Primary Indications

1. Somatic dysfunction of myofascial origin, especially to reduce hypertonic muscles, lengthen shortened muscles, or stretch and improve elasticity in fibrotic muscles.

2. Somatic dysfunction of articular origin to mobilize restricted joints and improve the range of motion Secondary Indications.

1. To improve local circulation and respiratory function.

2. To balance neuromuscular relationships by altering muscle tone.

3. To increase tone in hypotonic or weak muscles.

CONTRAINDICATIONS

Relative Contraindications

1. Moderate to severe muscle strains

2. Severe osteoporosis in which the physician believes that a risk of tendinous evulsion could occur with the correction

3. Severe illness (i.e., postsurgical or intensive care patient)

Absolute Contraindications

1. Fracture, dislocation, or moderate to severe joint instability at treatment site

2. Lack of cooperation or a patient who cannot understand the instructions of the technique (i.e., an infant or young child or a patient who does not understand the physician’s language)

Latissimus Dorsi Muscle

Origin

The origin of the latissimus dorsi muscle is at spinous processes of T7-S3, the thoracolumbar fascia, the inferior angle of the scapula, the lower four ribs, and the iliac crest.

Insertion

The insertion of the latissimus dorsi muscle is at the intertubercular (bicipital) groove of the humerus.

Action

The latissimus dorsi muscle extends, adducts, and medially rotates the humerus.

Innervation

The thoracodorsal nerve (C6-8) innervates the latissimus dorsi muscle.

INDICATIONS for MET:

Primary Indications

1. Somatic dysfunction of myofascial origin, especially to reduce hypertonic muscles, lengthen shortened muscles, or stretch and improve elasticity in fibrotic muscles.

2. Somatic dysfunction of articular origin to mobilize restricted joints and improve the range of motion Secondary Indications.

1. To improve local circulation and respiratory function.

2. To balance neuromuscular relationships by altering muscle tone.

3. To increase tone in hypotonic or weak muscles.

CONTRAINDICATIONS

Relative Contraindications

1. Moderate to severe muscle strains

2. Severe osteoporosis in which the physician believes that a risk of tendinous evulsion could occur with the correction

3. Severe illness (i.e., postsurgical or intensive care patient)

Absolute Contraindications

1. Fracture, dislocation, or moderate to severe joint instability at treatment site

2. Lack of cooperation or a patient who cannot understand the instructions of the technique (i.e., an infant or young child or a patient who does not understand the physician’s language)

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