Thrusting techniques

Most thrusting techniques are direct techniques in that the dysfunctional unit is placed into at least one of its restrictive barriers to motion and the physician thrusts through that barrier. The techniques are considered passive because the physician provides the treating force and the patient remains passive. 

The best known of all manipulative techniques are the high-velocity, low-amplitude thrusting techniques. In these techniques, the physician positions the patient in such a way that the restricted joint is placed into its restrictive barrier(s) to motion. The physician then quickly applies a small to moderate amount of force to the joint in such a way as to move it through the barriers. Improved joint motion should result very quickly. 

Functional techniques can be described as low-force, non-thrusting techniques for the treatment of vertebral motion restrictions that utilize indirect positioning to create a gradual release of restrictive tensions at the dysfunctional segment. 

Historically, the use of functional techniques can be dated back to A. T. Still. It is noted that Harold Hoover, DO, one of the early pioneers in the use of functional methodologies, was using the techniques learned from the teachings of Still. Over time, these functional techniques lost popularity in favor of thrusting techniques. The schools found the thrusting techniques easier to teach, and most practitioners found that patients more readily accepted these methods and looked forward to hearing the "popping" sound that was created. 

This section describes the application of high-velocity, low-amplitude thrusting techniques to correct somatic dysfunctions of the cervical spine. The vertebra may be placed into one or all of its barriers to motion. Frequently with this technique, however, only one plane of motion is addressed. When this motion restriction is corrected, the other planes of restriction respond as well. After placing the vertebra into its restrictive barrier, the physician applies a rapid, gentle force through a very short distance to pass through the barrier. 

FIG. 32-1 High-velocity, low-amplitude thrusting technique for somatic dysfunction of the occipitoatlantal joint. 

Once the acute inflammation has subsided, some tissue tension will still remain. Range of motion will improve but may still be limited. The patient may now be treated with appropriate osteopathic manipulative techniques to the injured area or wherever somatic dysfunction is found. Muscle energy, counterstrain, lymphatic drainage techniques, cranial, and facilitated positional release techniques may be used judiciously. Thrusting techniques should not be used until the soft tissues are no longer boggy and warm. If necessary, they may be used to correct stubborn somatic dysfunctions with firm barriers to motion. 

This chapter describes high-velocity, low-amplitude thrusting techniques for treating somatic dysfunctions of the thoracic spine by region-upper, middle, and lower spine. For most of the techniques, the patient is supine a variation is iiiustrated in which the patient is seated. 

F I G. 4 3 -1 High-velocity low-amplitude thrusting technique for upper thoracic somatic dysfunction. 

FI G. 43 - 2 Hand placement for mid-thoracic high-velocity low-amplitude thrusting technique. 

FIG. 43-5 Alternative thrusting technique for thoracic spine somatic dysfunction, patient supine. 

Treatment consisted of stretching of the paravertebral muscles on the left and muscle energy techniques to help stretch those muscles. The two somatic dysfunctions were treated with muscle energy and high-velocity, low-amplitude (HVLA) thrusting technique with resolution. 

FIG. 54-1 Hlgh elocity low mplitude thrusting technique for the lumbar spine. 

H igh-velocity, low-amplitude thrusting techniques may be applied to the pelvic and sacral articulations. There should be soft tissue preparation as for any other area. 

FIG. 66-1 HVLA thrusting technique for a posterior iiiac somatic dysfunction. 

FIG. 66-4 HVIA thrusting technique for restriction of pubic symphysis. 

The sacrum frequently becomes restricted in its motion at the sacroiliac articulation. Thrusting techniques may be used to create motion at this articulation. 

FIG. 66-5 HVLA thrusting technique for anterior sacral flexion dysfunction. 

There are two direct methods used to move the rib articulations rib-raising techniques, which are articulatory, and thrusting techniques, which are generally high-velocity, low-amplitude. Each has its own special applications as described here. 

Note As with high-velocity, low-amplitude thrusting techniques of the thoracic spine, flexion of the spine down to the segment of dysfunction may be necessary for rib dysfunctions lower in the thorax. Flexion is achieved by the physician grasping and cradling the patient behind the shoulders with his nonlocalizing hand and then flexing the patient to create localization down to the necessary point. 

R.T. was treated with osteopathic manipulation. He received soft tissue myofascial techniques to the neck and upper back. The somatic dysfunctions were treated with facilitated positional release techniques, as was the first rib. The T3-4 somatic dysfunction was also treated with high-velocity, low-amplitude thrusting technique. 

The two major goals of osteopathic manipulation of the upper extremity are to restore function and to prevent motion loss. The upper extremity is generally considered one unit when treating with articulatory or thrusting techniques. Each restricted joint must be returned to normal function. 

CHAPTER 88 ARTICULATORY THRUSTING TECHNIQUES FOR THE UPPER EXTREMITIES... 

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