OMT Minute  |   December 2017
OMT for Patients With Multiple Sclerosis
Author Notes
• From the Touro University College of Osteopathic Medicine-CA in Vallejo.
• Financial Disclosures: None reported
• Support: This video was produced by Touro University College of Osteopathic Medicine-CA.
•  *Address correspondence to Kimberly Wolf, DO, 1310 Club Dr, Mare Island, Vallejo, CA 94592-1187. E-mail: kimberly.wolf@tu.edu

Article Information
Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment
OMT Minute   |   December 2017
##### OMT for Patients With Multiple Sclerosis
The Journal of the American Osteopathic Association, December 2017, Vol. 117, e141. doi:10.7556/jaoa.2017.153
The Journal of the American Osteopathic Association, December 2017, Vol. 117, e141. doi:10.7556/jaoa.2017.153
Many patients with multiple sclerosis (MS) struggle with decreased mobility and range of motion. Two osteopathic manipulative treatment techniques—thoracic inlet myofascial release and sacral wobble (video)—can be safely used to increase motion in these regions in patients with MS. These techniques ease biomechanical respiration and flow of venous and arterial blood and lymphatics and may improve parasympathetic tone.
When applying thoracic inlet myofascial release, the patient should be supine with the physician at the head of the patient or with the patient seated and the physician standing behind the patient. The physician contacts the patient's thoracic inlet bilaterally by placing palms over the trapezius and gathering up the fascial planes, including the Sibson fascia—a thickened portion of cervical fascia that attaches to the transverse process of the seventh cervical vertebrae and the first rib through which the thoracic duct must traverse, twice. The thumbs are directed along the posterior first rib while the second and third digits contact the first rib anteriorly just under the clavicle. This hold allows the physician to motion test and diagnose thoracic inlet dysfunction with anterior-posterior gliding, translation (which induces sidebending), and rotational movements with gentle to moderate pressure to engage the fascia. The physician treats either directly by moving into the palpable barrier or indirectly by moving into the position of ease. After motion testing, each plane is held in its ease. The patient's deep breathing may assist with the treatment by allowing a little release with each exhalation. The final position is held until the tissues release, usually after 20 to 60 seconds. After the treatment, the physician may recheck each motion direction again for improvement in tissue motion.
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