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. 

Sacral wobble is an articulatory technique that mobilizes the sacroiliac joint and helps improve gait mechanics and parasympathetic tone in the large intestine and genitourinary systems. With the patient prone, the physician stands ipsilateral to the sacroiliac joint to be treated. The physician contacts the posterior superior iliac spine and along the iliac portion of the sacroiliac joint with his or her hypothenar eminence of one hand as close to the joint as possible. The opposite thenar eminence contacts the superior aspect of the sacrum near the sulcus. The hand on the sacrum alternates with the hand on the innominate with applying an anteriorly directed force into the barrier to achieve the “wobble.” These impulses should be short and quick. Sacral wobble should be performed bilaterally.