Osteopathic Thoracic Treatment: Myofascial Techniques

by Tyler Cymet, DO, FACOFP

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    00:01 We're gonna talk about osteopathic manipulative treatments in the thoracic region.

    00:05 Unlike any part of the body, you start by examining it and looking for any asymmetries, any range of motion abnormalities, tissue texture changes or changes in temperature to the musculature.

    00:17 In looking at the symmetry of the thorax, it's typically easy to see if one shoulder is higher, one side is fuller than the other.

    00:25 And it's not unusual to have a right sided person having larger muscles on the scapular region on that side or a left handed person having larger muscles on the left side.

    00:35 When I examine somebody, yes it's good to look at it.

    00:39 I also like to do what's called the triple response.

    00:41 Watch for the histamine release, watch for the redness to help direct treatment to areas of hypertonicity.

    00:49 To find the muscles that are gonna be more swollen, more tight, more tender and are gonna be more ammendable to treatment.

    00:57 So you just stroke it deeply three times and then you watch the redness come out in the back and that's the histamine release from the muscles.

    01:06 Areas of greater congestion may have a white spot, you may have some areas that come out a little bit more than other areas and may have an increased tightness either from stress, muscle use or something else.

    01:19 So, the two areas that look like they might benefit from treatment the most are the lower thoracics and right here, the mid thoracics.

    01:28 There are many different ways to treat the thoracic region.

    01:32 We're gonna talk about myofascial release, strain, counter-strain, spontaneous release by positioning and muscle energy.

    01:40 I'm gonna talk about myofascial release.

    01:43 People tend to like having myofascial release done on them.

    01:46 It's kneading and pushing on the muscles to help decrease the congestion, the tightness, relieve some anxiety, release some stress.

    01:55 So what's the difference between manipulation and massage on this area? Manipulation starts from a diagnosis.

    02:03 You're not just taking every muscle and kneading it.

    02:05 You're saying, "Okay, mid thoracics, lower thoracics, area of greater tightness." those are areas that are gonna benefit from myofascial release.

    02:14 And I want to stand on the opposite side to use my body weight and pressure to help with myofascial release.

    02:21 I can take it either both sides or I could take it with my arms crossed over, bring them together, ease up the fascial planes, make sure to find out where things move and where the body wants to go.

    02:36 And then I could put pressure on it, stretching out the muscle over the areas of the muscle with the greatest hypertonicity, the greatest tightness and the ones that will benefit the most from treatment.

    02:49 This is a parallel technique which takes the long muscles that go from the base of the skull from the occipital region, the longissimus, spinalis and iliocostalis and go all the way down to the sacrum.

    03:03 And typically I do it for 3 to 5 seconds at a time, focusing on one area or another of the muscle.

    03:13 And that should have him feel a little bit more relaxed, a little bit looser.

    03:18 It should free up motion spend his range of motion of his thoracic spine, of his twisting and his side-bending.

    03:24 It's going to be enhanced.

    03:28 So that's the parallel motion.

    03:30 You can also do a perpendicular motion, pushing away.

    03:34 Generally when you push on the spinous processes, people feel a little bit of tenderness.

    03:38 So you go to the transverse processes and a little bit lateral to that.

    03:43 In order to make it comfortable for the patient and to help release some of the tension and enhance the motion.

    About the Lecture

    The lecture Osteopathic Thoracic Treatment: Myofascial Techniques by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by Region.

    Author of lecture Osteopathic Thoracic Treatment: Myofascial Techniques

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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