We're gonna talk about osteopathic manipulative
treatments in the thoracic region.
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.
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.
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.
When I examine somebody,
yes it's good to look at it.
I also like to do what's called
the triple response.
Watch for the histamine release,
watch for the redness
to help direct treatment
to areas of hypertonicity.
To find the muscles that are gonna
be more swollen, more tight,
more tender and are gonna be
more ammendable to treatment.
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.
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.
So, the two areas that look like they
might benefit from treatment the most
are the lower thoracics and
right here, the mid thoracics.
There are many different ways
to treat the thoracic region.
We're gonna talk about myofascial release,
spontaneous release by
positioning and muscle energy.
I'm gonna talk about myofascial release.
People tend to like having
myofascial release done on them.
It's kneading and pushing on
the muscles to help decrease
the congestion, the tightness, relieve
some anxiety, release some stress.
So what's the difference between
manipulation and massage on this area?
Manipulation starts from a diagnosis.
You're not just taking every
muscle and kneading it.
You're saying, "Okay, mid thoracics, lower
thoracics, area of greater tightness."
those are areas that are gonna
benefit from myofascial release.
And I want to stand on the opposite
side to use my body weight and pressure
to help with myofascial release.
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.
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.
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.
And typically I do it for
3 to 5 seconds at a time,
focusing on one area or
another of the muscle.
And that should have him feel a little
bit more relaxed, a little bit looser.
It should free up motion spend his
range of motion of his thoracic spine,
of his twisting and his side-bending.
It's going to be enhanced.
So that's the parallel motion.
You can also do a perpendicular motion,
Generally when you push on the spinous processes,
people feel a little bit of tenderness.
So you go to the transverse processes
and a little bit lateral to that.
In order to make it
comfortable for the patient
and to help release some of the tension
and enhance the motion.