OMM: Practical Video for Osteopathic Treatment in Pediatrics

by Sheldon C. Yao, DO

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    00:01 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.

    00:24 We're gonna check the pelvis.

    00:26 You could check the SI joints for a little bit of traction.

    00:29 Check the abdomen, make sure you don't feel any masses or bumps.

    00:33 You want to check the rib cage, see how the baby is breathing, how the rib cage is moving with breathing.

    00:40 A little bit articulatory on the rib cage to see if the rib cage has any restrictions.

    00:47 You're going to grab the arms here and just do a little bit of a lift and then see the strength, grip strength.

    00:54 Check for mobility and motion at the upper extremities, alignment.

    00:58 Check for the clavicles and the tension around the clavicles.

    01:03 You could see based on age, how well the baby could hold their head up.

    01:07 Make sure that the baby is meeting a motor milestones regarding face, observing their environment, babbling, cooing.

    01:15 Posteriorly, we could check the back, check the spine.

    01:22 We could also check the cervical spine, the head, the neck, seeing if there is increased tension here.

    01:30 Check the spine to see if there's any gross curvatures.

    01:33 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.

    01:44 We could have more of a anterior-posterior hold, assessing the thoracic inlet.

    01:50 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.

    01:59 You could gently get a sense of the abdominal diaphragm.

    02:02 You could do some gentle doming or you could do a AP-hold and gently treat the abdominal diaphragm in this position.

    02:11 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.

    02:26 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.

    02:41 For checking the head, we want to take a look at the cranium, Check for symmetry, see if there is any asymmetry.

    02:49 We could do a posterior hold to get a better sense of the posterior aspect of the head.

    02:56 We could also get into a vault hold and get a sense of the cranial motion and mechanism.

    03:02 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.

    03:14 When we contact the head here, we get a sense of those any cranial strain patterns and to perform balance membranous tension, what we could dois to gently encourage the freedom of motion.

    03:25 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.

    03:38 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.

    03:48 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.

    04:02 If there is more tension in my pointer finger on the temporal bone, that tells me that there is a temporal issue.

    04:07 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 Condyle decompression 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.

    04:39 And what we're doing with our fingers is to kind of come up and then project out laterally.

    04:45 And so we get our fingers into the occipital space and then gently project our sense.

    04:51 And it's a very gentle lift and spread and sometimes we can add a little more traction to try to decompress the condyle.

    05:01 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.

    05:13 Galbreath Technique With Galbreath's technique what we want to do is to try to improve drainage to the eustachian tubes.

    05:20 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.

    05:29 And so, when you perform the Galbreath technique that helps to open the eustachian tube and allow for improved drainage.

    05:36 Another technique that you could perform to help with eustachian tube drainage is just to do a little bit of ear tug.

    05:42 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.

    05:51 and this tug helps to straighten out the eustachian tube a little bit and allow for improved drainage.

    05:57 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.

    06:13 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.

    06:35 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.

    06:47 Upper rib and thoracic inlet release 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.

    07:05 So is there an improvement in rotation? Is there an improvement in side bending? Is there improvement in flexion-extension? 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.

    07:24 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.

    07:45 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.

    08:17 Afterwards you can recheck to see if there's improved motion at the joint.

    08:22 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.

    08:31 Remember, at birth the sacrum is in parts and anteriorly, you can grasp on to the ASIS.

    08:37 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.

    08:51 Once you find the state of balance, you could kind of hold that and then wait for release.

    08:56 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.

    09:05 You could perform sacral treatments on infants by getting our hands on the sacrum.

    09:09 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.

    09:19 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.

    09:38 So remember, at birth the sacrum could also still be in 5 parts.

    09:42 There might be individual motions or movements or intraosseous strain.

    09:48 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.

    10:36 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.

    10:45 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.

    11:01 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.

    11:16 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.

    About the Lecture

    The lecture OMM: Practical Video for Osteopathic Treatment in Pediatrics by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by Specialty. It contains the following chapters:

    • Newborn Screening
    • Cranial Holds – Vault, Fronto-occipital, Posterior-occipital
    • Balance Membranous Tension
    • Base Spread
    • Condile Decompression
    • Galbreath Technique
    • Ear Tug
    • Cervical Myofascial Release
    • Thoracic Inlet Release
    • Balance Membranous Tension for Upper Extremities
    • Balance Membranous Tension for Lower Extremities
    • Sacro-iliac Joint Balance Ligamentous Tension
    • Sacral Treatments
    • Abdominal Diaphragm Doming
    • Spine Balanced Ligamentous Tension

    Author of lecture OMM: Practical Video for Osteopathic Treatment in Pediatrics

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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