Seated forward-leaning thoracic spine articulation | ■ Physician controls upper extremity and thorax (best position chosen based on body habitus and location of restriction). ■ Physician’s knee blocks against patient’s knee to stabilize the participant on the table. ■ Contact on transverse process or costotransverse junction. ■ Patient is drawn forward to restrictive barrier ■ Low-velocity, medium-amplitude springing is applied until release is felt. ■ Component of sidebending or rotation may be added. ■ Focus may be on rib or segmental motion. ■ Recheck. |
Supine cervical soft tissue | ■ Contact medial aspect of cervical paraspinal muscles. ■ Draw anteriorly in a kneading fashion. ■ Continue until relaxation of tissues. ■ Recheck. |
Occipitoatlantal decompression | ■ Contact is on the occiput as close to the condyles as possible. ■ Tension is applied toward the participant’s orbits. ■ Traction is created between the fingers by moving the elbows medially. ■ Respiratory assistance may be used to enhance release. ■ Position is held until release is felt and motion is improved, at least 20-30 s. ■ Recheck. |
Thoracic inlet MFR | ■ Anterior contact is across sternoclavicular junction and ribs 1 and 2. ■ Posterior contact is T1-2 and costovertebral junction. ■ Assess rotation with sidebending and flexion/extension. ■ Use all 3 planes to approach barrier (direct) or position if ease (indirect) to point of balance. ■ Hold 20-60 s until tissue creep indicates a release of tissue tension. ■ Recheck. |
Lateral recumbent scapulothoracic soft tissue | Part 1: ■ Contact is on the superior and inferior medial angles of the scapula with the ■ patient’s arm over the physician’s caudad arm. ■ The cephalad hand initiates a circular motion into the shoulder, and the scapula is carried laterally in a rhythmical fashion to release muscular attachment. ■ The caudad hand contacts the rhomboids and paraspinal muscles along the medial border of the scapula. ■ Fascial restrictions are then assessed in superior/inferior, medial/lateral, and rotary motions. ■ Scapula is taken either directly or indirectly to balance point and held for 20-60 s or until release is palpated. ■ Recheck. |
| Part 2: ■ Patient’s arm is moved to drape over physician’s cephalad arm. ■ Contact is broad over the superior aspect of the shoulder, with the caudad hand’s thenar eminence engaged in the posterior axillary fold. ■ Tissue texture is assessed. ■ Compressive force is applied into the axillary and subscapular tissues in a rhythmic fashion until a change in tissue texture is felt. ■ Recheck. |
Lateral recumbent lumbosacral soft tissue | ■ Physician’s arms are braced on the patient’s axilla and iliac crest. ■ Contact is medial aspect of lumbar (up to lower thoracic) paraspinal muscles. ■ Three motions are then applied rhythmically: 1. Physician’s arms carry patient’s arms and ilia apart to stretch and sidebend the lumbar area. 2. Physician’s arms twist to push the patient’s shoulder posteriorly and her iliac crest anteriorly. 3. Lateral motion is applied with hands to “bowstring” the muscles. ■ Repeat to softening of muscles throughout the lumbar region. ■ Recheck. |
Abdominal diaphragm MFR | ■ Contact either with fingers spread over lower ribs laterally or anteroposteriorly diaphragm MFR with hands at subxiphoid and thoracolumbar junction. ■ Assess rotation with sidebending and flexion/extension. ■ Use all 3 planes to approach barrier (direct) or position of ease (indirect). ■ Add respiratory cooperation to assist in release. ■ Hold 20-60 s or until release is felt. ■ Recheck. |
Pelvic diaphragm MFR | ■ Posterior contact is low on the sacrum and coccyx with fingers toward contralateral ischial tuberosity. ■ Anterior contact is across and slightly above the pubic symphysis. ■ Assess rotation with sidebending and flexion/extension. ■ Use all 3 planes to approach barrier (direct) or position of ease (indirect). ■ Hold until release is felt. ■ Recheck. |
Sacroiliac articulation | ■ Use pelvic compression test to assess sacroiliac motion. ■ Contact is on the patient’s flexed knee and hip with mild compression to engage the femur into the acetabulum. ■ The hip is externally rotated and circumducted into straightened position, maintaining compression. ■ Then, the hip is internally rotated and circumducted into straightened position, maintaining compression. ■ Repeat the technique 4-5 times until motion improves. ■ Repeat on opposite side. ■ Recheck. |
Frog-leg sacral release | ■ Contact is on sacrum with fingers at the base and palm at apex. ■ Patient’s hips and knees are flexed with feet together ■ Sacrum is taken to point of ligamentous balance with respiratory assistance. ■ As patient holds breath in most useful phase, she lets her knees fall to the sides and straightens out legs to rotate innominates. ■ As patient straightens her legs, inferior traction is applied to the sacrum. ■ Repeat 3-5 times, until sacral motion is significantly more symmetrical. ■ Recheck. |
Posterior innominate muscle energyb | ■ Leg on side of dysfunction is extended off side of table. ■ Contact is on ipsilateral thigh and contralateral ASIS. ■ Thigh is extended to restrictive barrier of the innominates. ■ Patient’s effort is to pull knee toward ceiling for 3-5 s. ■ After relaxation, innominate is taken to new barrier and forces are repeated 3-5 times. ■ Return to neutral and recheck. |
Anterior innominate muscle energyb | ■ Leg on side of dysfunction is flexed at knee and hip. ■ Contact is on ipsilateral PSIS and ischial tuberosity with patient’s knee against chest. ■ Leg is flexed to restrictive barrier of the innominates. ■ Patient’s effort is to push knee against physician’s chest for 3-5 s. ■ After relaxation, the innominate is taken to new barrier and forces repeated 3-5 times. ■ Return to neutral and recheck. |
Pubic symphysis decompression | ■ Hips and knees flexed with feet together. ■ Knees are hugged together and patient attempts to pull them apart for 3-5 s while the physician provides isometric counterforce. ■ Patient ceases force, and knees are rocked side to side 3 times. ■ These steps are repeated 2 more times. ■ Then, patient’s knees are spread apart to fist-width and patient attempts to pull them together for 3-5 s while physician provides counterforce or blocks with fist. ■ Patient ceases force, and knees are rocked side to side 3 times. ■ Knees are then spread to 2-fist width and steps repeated. ■ Knees are then spread to forearm width and steps repeated. ■ Recheck. |
Compression of the fourth ventricle | ■ Contact medial to the occipital-mastoid suture with thenar eminences. ■ Encourage the occipital motion in extension phase while resisting flexion until a still point is reached. ■ Allow the cranial rhythmic impulse to return to normal before disengaging. |