Thrusting techniques dysfunction

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. 

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. 

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. 

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

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

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. 

FIG. 88-10 HVLA thrusting technique for glenohumeral joint somatic dysfunction. 

FIG. 100-2 High-velocity, low-amplitude thrusting technique for a posterior fibular head somatic dysfunction. (Physician is on opposite side to allow viewing of hand positions.)... 

Treatment began with inhibition to the paravertebral muscles in the thoracolumbar region as well as muscle energy and thrusting techniques to the somatic dysfunctions. A mesenteric lift was used with good release. The Chapman s reflex points were treated. The patient was encouraged to drink several glasses of water per day and to maintain a balanced diet. 

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