So osteopathic structural
exam of the newborn
So we start by looking at the feet, making
sure that there is symmetry bilaterally,
how are the hips looking, checking for any sort
of hip clicks, as we are moving the hips around,
looking at the alignment of the hip and legs,
seeing if there is any issues with the feet,
or if there is any tibial torsions or
the tibia is interacting with the femur.
We're gonna check the pelvis.
You could check the SI joints
for a little bit of traction.
Check the abdomen, make sure you
don't feel any masses or bumps.
You want to check the rib cage,
see how the baby is breathing,
how the rib cage is
moving with breathing.
A little bit articulatory on the rib cage to
see if the rib cage has any restrictions.
You're going to grab the arms here
and just do a little bit of a lift
and then see the
strength, grip strength.
Check for mobility and motion at
the upper extremities, alignment.
Check for the clavicles and the
tension around the clavicles.
You could see based on age, how well
the baby could hold their head up.
Make sure that the baby is meeting
a motor milestones regarding face,
observing their environment,
Posteriorly, we could check
the back, check the spine.
We could also check the cervical spine, the head, the
neck, seeing if there is increased tension here.
Check the spine to see if
there's any gross curvatures.
How do the musculature feel back here? How
does the musculature feel in the neck?
So in a seated position, what we could try to
do is to get an assessment of the thoracic cage.
We could have more of a anterior-posterior
hold, assessing the thoracic inlet.
We could hold on to the the rib
cage bilaterally and gently
motion test and then move the ribs to where
it likes to go and allow for it to release.
You could gently get a sense
of the abdominal diaphragm.
You could do some gentle doming
or you could do a AP-hold
and gently treat the abdominal
diaphragm in this position.
Posteriorly, what we could try to do
is to get a sense of the back here
And from here, you could gently articulate the
thoracic spine, the lumbar spine.
Check for regions of potential muscle spasm
hypertonicity and do a little bit of gentle
articulatory technique on the
spine, up and down the spine
to mobilize the spine and free up
any restrictions along the spine.
For checking the head, we want
to take a look at the cranium,
Check for symmetry, see if
there is any asymmetry.
We could do a posterior hold to get a better
sense of the posterior aspect of the head.
We could also get into a vault hold and get a
sense of the cranial motion and mechanism.
And also we could do a AP hold,
we get our fingers along the frontal and
across the posterior aspect of the head here,
to get a better view of what
is going on with the cranium.
When we contact the head here, we get a
sense of those any cranial strain patterns
and to perform balance
what we could dois to gently
encourage the freedom of motion.
In babies, in certain instances, if it
does not respond to indirect treatment,
sometimes you could do
balance membranous tension
and move it into the barrier and
hold it to feel for release.
The base spread
what we're going to do is hold on to
the occiput with our middle finger
and with our pointer finger get on the
temporal bone by the mastoid process.
And so, what we have to do is to gently
bring a traction towards the table
and kind of get a sense of whether
or not there is increased tension
along the occiput on mastoid
suture or at the occiput.
If there is more tension in my
pointer finger on the temporal bone,
that tells me that there
is a temporal issue.
If there is more strain and
resistance with my middle finger,
then it tells me that it's
more of an occipital issue
And so the base spread itself could be
diagnostic and it also could be therapeutic
so if you feel a resistance, just match the tension
in the tissue and try to feel for a release
and once you feel a release, you
could go back and then recheck
With condyle decompression, what we want
to do is to get our fingers on the occiput
and then slowly project or sense anterior to
the anterior portion of foramen magnum.
And what we're doing with our fingers is to
kind of come up and then project out laterally.
And so we get our fingers into the occipital
space and then gently project our sense.
And it's a very gentle
lift and spread
and sometimes we can add a little more
traction to try to decompress the condyle.
And when you feel decreased tension in the
area, then you could release the tension,
come back and then recheck to see if
the condyle still feels compressed.
With Galbreath's technique what we want to do is to
try to improve drainage to the eustachian tubes.
So what we're going to do is we're
going to gently contact the mandible
and provide a little bit of a gentle lift
of that mandible, anterior and inferior.
And so, when you perform the Galbreath technique
that helps to open the eustachian tube
and allow for improved drainage.
Another technique that you could perform
to help with eustachian tube drainage is just
to do a little bit of ear tug.
So what you want to do is to get your
fingers on the tip of the ear here
and apply a little bit of a
superior and posterior tug.
and this tug helps to straighten out the eustachian
tube a little bit and allow for improved drainage.
So if your infant has increased
tension in the cervical musculature,
what you could do potentially is
to try to release that tension,
you could do a little myofascial release by applying
a little bit of just pressure and then lift.
Sometimes you could treat the muscle
with just a little bit of gentle,
direct pressure until the muscle softens up
or sometimes like in the case of torticollis
if you know that is the
sternocleidomastoid that's tight,
you can apply a little bit of just
gentle compression down to the area,
sidebending towards and rotating away and
I'll be using facilitated positional release.
So there's a lot of different ways
to very gently move the baby's head
and help stretch the
muscles of the neck
to make sure that the muscles
feel a little bit softer.
Upper rib and thoracic
In infants, what you want to do is to make
a good contact with the posterior aspect
of the rib cage and the upper rib cage here and
just give it a little bit of motion testing to see
where the restrictions are and gently move all
the structures and fascia towards their freedom.
So is there an
improvement in rotation?
Is there an improvement
in side bending?
Is there improvement
And based on those motions, you could just
want to gently hold the positions of freedom
allowing for decreased tension and come
back and then re-assess those motions
and you should feel it would be a
little bit easier to move after that.
Balance membranous tension
for the extremities
So, if there is a restrictions in the extremities
in the infants, what you could do sometimes
is just kind of hold the extremity and get
a sense of the freedoms or restrictions,
whether it be flexion or extension, pronation or
supination, internal rotation, external rotation
and kind of stack all
those different freedoms.
Sometimes adding a little
gentle compression could help
with releasing some of the fascial
strains surrounding the joint
So if infants have restrictions
with the lower extremity -
the foot, the ankle,
the knee, the hip,
sometimes what you could do is a little bit of
balance ligamentous tension, contacted joints,
add a little bit of motion testing to
see where the freedom of motion is
and then bring the joint into a point of balance and
hold that until you feel a little bit of a release.
Afterwards you can recheck to see if
there's improved motion at the joint.
Sacrao-Iliac joint BLT
So in infants, it's easy enough to
kind of contact the entire pelvis
so you're gonna get your fingers
on the SI joint bilaterally.
Remember, at birth the sacrum is in parts and
anteriorly, you can grasp on to the ASIS.
So we have the both innominates in our hands and
then you could apply a little bit of a superior
force with your fingers in the back and
then a little bit of a gentle traction
bringing the innonimates
into a state of balance.
Once you find the state of balance,
you could kind of hold that
and then wait for release.
And once you feel release, then
you could bring everything back
and then recheck to see if there is
improved symmetry and motion in the pelvis.
You could perform sacral treatments on
infants by getting our hands on the sacrum.
And so, I want to gently put my
entire hand on the tail bone here,
and my other hand is just going to get a
sense of the pelvis across the top here.
And so now I have the entire pelvis
in my hand and we get a sense of
how the sacrum feels by adding
a little bit of gentle,
medial pressure on the ASIS here that
could help gap the SI joints posteriorly
With my hand on the sacrum here, i'm
getting a sense of the sacrum itself.
So remember, at birth the sacrum
could also still be in 5 parts.
There might be individual motions or
movements or intraosseous strain.
So that might be an intraosseous strain on the
tail bone so you want to get a sense of that
and if you feel any strain just kind of take
things towards it's freedoms, either rotation,
right or left side bending, a little bit
of traction to help decompress the region
and bring the sacrum to a point of
balance and then so you hold that
in a point of balance
and allow for release
and then you come back and the you
could recheck the motion of sacrum
Abdominal diaphragm doming
So you're going to get your thumbs underneath
the diaphragm at the costal margin
and just kind of get a sense
of the lower ribs here
and just feel for any tension
underneath the rib cage
and then if you do feel the tension,
just follow breathing a little bit,
a little gentle pressure and match the
tension underneath the costal margin.
And then you're gonna feel the diaphragm release
and when it releases, then you come back
and then reassess and as you feel a
little bit more easier to move there.
One of the techniques that
we could utilize to help
balance the spine from the occiput and
cervical spine down to the sacrum,
is to contact the occiput with one
hand and the sacrum with the other,
and get a sense of the spine
between your hands here.
You got a little bit of a gentle traction and then
find the point of balance between your hands here
and hold that and now you're treating and getting
a sense of the entire spine between your hands
and the sense of the space
between your hands holding that.
And when you feel things
to release and loosen up,
And when you're done you come back, and
then this should feel a little bit
less tensed and less restricted
after the treatment.