OMT Patient Encounter

The OMT Patient Encounter provides High Yield information that is needed for the COMLEX Level 1, 2, and 3, Medical School, Residency, and as a practicing Physician.

Disease and OMT Quick Table

OMT Patient Encounter Techniques

Still point- CV4

• Physical exam:
  • inspection and palpation of the head and neck,
  • ophthalmoscopic exam,
  • palpation for chapman’s points,
  • auscultation of carotids.
• pt is laying down on table. doc is sitting at the head of table. Doc’s fingers are crossing.
• R hand fingers are on top of L hand fingers. the thumbs are parallel & slightly apart and the thenar eminence are upward and under the pt’s occiput.
• Assess for cranial impulse for couple of cycles (feel the flexion & extension).
• Try to feel a Still point by allowing the occiput to go into extension (by allowing you thenar eminence to go slightly toward the shoulders which encourages the occiput to go into extension).
• Hold for 15sec (by doing this you allowing it to go into extension and resisting flexion).
• assume you reached the still point. allow for another 15 sec to get the rhythmic impulse.
• and then take pt back to neutral position.
• then return the pt to neutral position and ask pt if there is any change to the sxs and ALWAYS help the pt back to the seated position

Frontal and maxillary sinuses effleurage

• Physical exam: do palpation and percussion of frontal and maxillary sinuses and transillumination
• second: doc is sitting at the head of table. pt is laying down on table.
• put thumbs on frontal sinuses and apply moderate pressure as you pull your fingers laterally. do that for frontal sinuses for 30 full secs and then move on to maxillary sinues for full 30 secs. THEN re- assess!
• re assess by palpating the sinuses with your thumbs by applying pressure and ask pt if it feels better. If the pt said it feels the same, tell them it’s ok and it will feel better w time.
• ALWAYS help the pt back to the seated position

Periauricular drainage

• Physical exam: otoscopic exam of ears, nose, and throat. palpation of lymph nodes
• pt is laying down on table. doc is sitting at the head of table and away from the side of complaint.
• doc’s hand placement is 2 fingers above ear and 2 fingers below ear.
• and roll the pt’s head toward you and include the torsional rotation to the affected ear clockwise for 10 seconds and wait for the tissue to loosen
• and then counterclockwise w deeper torsion to engage the tissue for another 10 secs.
•  then return the pt to neutral position and ask pt if there is any change to the sxs and ALWAYS help the pt back to the seated position.

Galbreath

• Physical exam: Otoscopic examination, inspection of mouth, ROM of the TMJ
• pt is laying down on table. doc is sitting at the side of head of table.
• one hand on the forehead and the other anchoring the top of mandible.
• Ask pt to slowly open wide mouth and then close and apply lateral traction for 3-5 secs then ask pt to swallow and then you slowly release.
• do that 2 more times.
• then return the pt to neutral position and ask pt if there is any change to the sxs and check the opening and closing of the mouth or do palpatory technique of the TMJ while pt opens and closes mouth and ALWAYS help the pt back to the seated position

Counterstrain- post-tender point w facilitated positional release

• Physical exam: inspection, ROM (flexion, extension, rotate L & R, sidebend L & R), and palpation of neck for tender point
• pt is laying down on table. doc is sitting at the head of table.
• palpate for a tender point with one hand when pt admits to a tender point (give it 10), cradle the occiput w the other hand. induce rotation and sidebending AWAY from that tender point.
• Ask if the tenderness is reduce to 3 and hold and put pressure down the cervical spine and hold for 3-5 secs and palpate for release of tender point.
• Once you feel the release, take the pt’s head back to neutral and reassess the tender point.
• ALWAYS help the pt back to the seated position

Spencer Technique

• Physical exam: inspection w ROM & palpation of the shoulder.
• Mnemonic: Elephants fart constantly to annoy intelligent people.
  • Elephants: Extension
  • Fart: Flexion
  • Constantly: Circumduction (with Compression)
  • To: Traction (with Circumduction)
  • Annoy: ABduction
  • Intelligent: Internal Rotation
  • People: Pumping
• pt is lateral recumbent facing the doc.
• stablize pt’s shoulder w cephilad hand and caudad hand take it to extension, do some light springing for 10 times and then muscle energy 3-5 secs and take the slack out and more muscle energy (repeat 3-5 times). at the end of this step re-assess extension.
• then take arm to flexion repeat the springing and muscle energy and reassessing.
• then do circumduction clockwise then counterclockwise 10 times each. then do circumduction w traction clockwise then counterclockwise 10 times each, at the end of circumduction here re assess of for ROM of circumduction.
• then take pt’s hand and put it on your cephalad forearm and do springing of the elbow w your caudad hand for 10 times and then do muscle energy by asking pt to push down and repeat 3-5 times. and reassess abduction.
• then do internal rotation but taking pt’s hand and putting it behind their back and keep cephalad hand to stablize the shoulder and the other arm on elbow for springing and then muscle energy by asking pt to push out and you resisting and you take the slack out by pushing elbow out of the body.
• for the last step which is traction, take pt’s arm on your caudad shoulder and do traction for 10-15 secs waiting for the tissue to release.
• you could reassess all the step at the end of the technique instead of reassessing while doing it.

Spring technique- rib raising: myofascial release

• Physical exam: inspection & palpation of rib motion (check the excursion of the pt by placing the hands on the ribs as pt inhales and exhales), auscultation.
• pt is laying down on table. doc is sitting at the side of table. use the pads of the fingers about 2 inches lateral to the spinous processes.
• Use elbows to dip down to create the leverage and pull the tissue laterally for 10-15 secs to feel the release of tissue.
• then slowly return the pt.
• then slide hands caudad and do the same thing. you could ask pt to put their arm across their chest for the side you are treating
• reassess by checking the excursion of the pt by placing the hands on the ribs as pt inhales and exhales (thumbs on midline and ask pt to inhale and exhale and check symmetry)
• ALWAYS help the pt back to the seated position

Lymphatic Effleurage (Elbow)

• Physical exam: inspection w ROM & palpation of elbow.
• it’s ok to manipulate the joint above or below the affected area.
• effleurage help mobilize fluid and bring healing fluids like WBC
• pt is lateral recumbent w affected side up. your hands encircle upper side of shoulder and apply perpendicular pressure and apply lateral traction w thumbs from each side while moving cephalad.
• then take out both hands and place them on a more caudad area and do the same lateral traction and move cephalad.
• that leads to milking the fluid out of the arm and prompts the return of the healing fluids. and repeat until you get to the point of tenderness.
• then re assess the tenderness and ROM of elbow

Myofascial wrist retinaculum (transverse carpal ligament) release

• Physical exam: inspection w ROM & palpation of wrist, Tinel’s & Phalen’s exam. Painful passive Arc test
• extended pts wrist by applying traction and hold of the thumb and last digit w your hands and apply lateral traction to the wrist w your both thumbs until softening of tissue occur.
• traction should be applied for 30 secs.
• reassess w phalen and ask pt if the feel better
• another type of technique is applying the lateral traction to the forearm, up and down the forearm.

Myofascial release direct perpendicular stretch

• Physical exam: inspection w ROM and palpation of thoracic
• Pt is prone. Doc is opposite of dysfunction.
• Use the thenar of both hands to place on the side of dysfunction and apply pressure perpendicular and lateral traction for 3-5 secs when done.
• move down and do the same. check at flexion/ext, sidebending, rotation
• re assess for tenderness while pt is laying down and palpate for tissue texture changes
• ALWAYS help the pt back to the seated position

Muscle energy

• Physical exam: inspection w ROM and palpation of the lumbar spine areas
• pt is sitting up, not facing the doc who is standing on the side opposite to the dysfunctional side. and doc’s hand is on the dysfunctional side. the hand of dysfunctional side is on the opposite shoulder which should be stablized w opposite hand of the doc.
• then ask pt to flex forward until you feel the segment moving then have the pt rotate and sidebend away from the seg until you find the barrier and ask pt to move against doc’s resistance and count out loud to 5 secs and then take out the slack (by adding additional rotation and sidebending) and then count for another 5secs and then again take out the slack and then count for the third time the 5 secs out loud.
• reassess by asking the pt to sit up again and palpate the region then ask pt to bend forward and backward and then sidebend to R & L then rotate head and shoulders L & R.

ME and torsion RonR or L on L

• Physical exam: inspection & palpation of the sacrum & pelvis
• pt is lateral recumbent w axis facing up
• if ROR, pt would be lying on left decubitus position w the R side up.
• if LOL, pt would be lying on R decubitus position w L axis side up.
• the doc should stand facing pt and hips & knees flexed 90 degrees. help pt rotate shoulders to both face upwards.
• Place your hands under ankles and lift feet toward the ceiling and ask pt to push feet back down to the table while you count to 5 secs out loud..
• take slack out then count to 5 then take slack out and count 5 for the third time.
• then Ask pt to lay down on stomach and re ASSESS the sacrum and do spring test and then help pt back to seated position

ME piriformis hypertonicity

• Physical exam: inspectionw ROM & palpation of hip & lumbar spine.
• pt lay down on back, bend the leg up, stablize the opposite hip by holding it w your celaphad hand and you caudad hand is on the bended knee which you are internally rotating it.
• by pushing the knee inward until you get to the barrier. then ask pt to push knee out and count 3 secs out loud then take off the slack by more internal rotation of the knee then repeat the 3 secs and then again take out the slack.
• lastly take pt to neutral and then passively take pt to the new barrier to reassess then extend that leg and check if the leg has less external rotation

Lymphatic Effleurage (Knee)

• Physical exam: inspectionw ROM & palpation of knee ant and post drawer tests, varus & valgus stress testing, meniscal testing, apley compression or distraction or mcmurray
• pt lay down. you sit on the side of injury and lift the left and put it the ankle on your shoulder. your hands encircle the upp ext and start very up and massage toward the cephalad direction
• then move your hands caudad and milk celphald until you get to the area of dysfunction.
• you could repeat from starting upwards again.
• reassess pt if there is decrease in pain, see if change to edema, also could check ROM and ant and post drawer test

Functional Technique

• Physical exam: inspectionw ROM & palpation of ankle, drawer testing
• the bottom hand is holding the ankle to moniter the injury of the tissue and then top hand is the moving hand to check the motion abnormality.
• hold the tissue feel it to release and then check another area with the same hand placements. make sure elbows are straight
• then reassess by keeping the bottom hand as it is and the top hand should be moved the the distal part of achilles to move ankle to check ROM