OMT Thoracic Somatic Dysfunction

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

Thoracic Vertebral Levels

SegmentsCurvatureSP in relation to TP
Cervico-thoracic junction T1-T3 LordoticSP same level as TP
True thoracics T4-6 KyphoticSP 1/2 way between TP and one below it
True thoracics T7-9 KyphoticSP same level as TP below it
Thoraco-lumbar junction T10 LordoticSP same level as TP below it
Thoraco-lumbar junction T11 LordoticSP 1/2 way between TP and one below it
Thoraco-lumbar junction T12 LordoticSP same level as TP

Facet Orientation

Cervical Facet OrientationBUM: backwards, upward, medial
Thoracic Facet OrientationBUL: backwards, upward, lateral
Lumbar Facet OrientationBM: backwards, medial

Anatomic Landmarks

T2Sternal notch
T3 Spine of Scapula
T4 Sternal angle
T4 dermatome Nipple
Spinous process of T7 Inferior angle of scapula
T10 dermatome, L3-4 disc Umbilicus

Plane and Axis

Motion AxisPlane
Rotation VerticalTransverse
Side BendingAnterior-PosteriorCoronal


Def, – Tissue texture changes, asymmetry, ROM, tenderness
Acute TARTChronic TART
-increased moisture,
-hypertonic muscles

-Asymmetry present
-Restriction present, painful with movement
-Tenderness severe and sharp
-No edema or erythema,
-cool dry skin,
-slight tension,
-decreased muscle tone,

-Asymmetry present but with compensation
-Restriction present but decreased or no pain
-Tenderness dull, achy, burning

Barrier Concepts

physiological barrier limit of active motion
anatomical barrier limit of passive motion
restrictive barrier position through which direct techniques work through

Fryette’s law 

Fryette’s law 1neutral, side bending and rotation occur in opposite directions
Fryette’s law 2flexion/extension, side bending and rotation occur in same directions
Fryette’s law 3motion in one plane decreases motion in other planes
(ex: extension will decrease the motion of side bending)

Somatic Dysfunction Types

Type I Dysfunction Type II dysfunction
Componentneutral (no forward or backward bending; a.k.a. flexion or extension) segments. Always have Flexion or Extension Component
Segments• Group Dysfunction (three or more segments)
• Three or More Segments Have the Same Pattern
Caused byFormed gradually, usually as compensation

•can either be a dysfunctional curve, or a normal adaptation to some other asymmetry or lesion in another region
Occur as a result of trauma/abrupt twisting

-Should be treated before Type I lesions

-Found at apex or extremes of Type I curves
Rotation and Side Bending Opposite sides

Such as Side bent Right and Rotated Left
Same sides
Muscles maintained bylong paraspinal restrictor muscles
(erector spinae)
short restrictors
(rotatores brevis and intertransversari muscles)
Characteristics•May be an Adaptation
–As in scoliosis due to unequal leg length

•No exaggeration of the deformity in either extreme of flexion or extension
•The restricted (unilateral) facet acts like a pivot around which rotation occurs
•The segment will appear symmetric at some point in its sagittal range if it is flexed or extended far enough
•The lesion becomes more prominent in the direction away from its ease

Dx thoracic and lumbar segmental motion testing

Techniques Types

DirectIndirectCombined Direct and Indirect
Direct myofascial release
Muscle energy
Indirect myofascial release
position of laxity
– position through which indirect techniques work
shifted neutral
Start at laxity position, move through the restrictive barrier

OMT Thoracic Somatic Dysfunction Techniques

Thoracic Outlet Release

Thoracic Muscle Energy

Thoracic HVLA/Kirksville Crunch

  • Detailed Steps:
    • The physician stands on the opposite side of PTP
    • The patient crosses arms over chest, with side of PTP on top.
    • Place your thenar eminence of caudal hand on the PTP
    • Patient’s elbows are positioned in the examiner’s upper abdomen
    • Use your cephalad hand/forearm to lift and position the patient’s head and neck to localize to the restrictive barriers (F/E, sidebending & rotation).
    • – Type 1: Side bend away from the doc
    • – Type 2: Side bend towards the doc
    • Pt inhale/exhale
    • Exhale–>thrust A–>P

Thoracic Counterstrain

Anterior Thoracic points
AT 1
– near the episternal notchFLEX
AT 2– Near sternomanubrial junctionFLEX
AT 3-6
–On sternum at corresponding rib levelFLEX

–Knee under patient
AT 7– inferior tip of xyphoidF ST RA

–Patient seated, arm over your knee
–The arm opposite of tender point goes on knee
AT 8– halfway between xyphoid – umbilicusF ST RA

–Patient seated, arm over your knee
–The arm opposite of tender point goes on the knee
AT 9– 3/4 away from xyphoid towards umbilicusF ST RA

–Patient seated, arm over your knee
–The arm opposite of tender point goes on the knee
AT 10– 1/4 distance from umbilicus to pubic symphysisF ST RA

–Patient supine, knee up to 90 degrees
AT 11– 1/2 between umbilicus and pubic symphysisF ST RA
AT 12 – Anterior, superior surface of iliac crest, MID-axillary line!F ST RA
Posterior Counterstrain Points
Thoracic Tenderpoints
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PT1-12 MidlineExtend!
PT1-12 posterior
–Infralateral tip of spinous process

PT1-4 = just move head!

PT5-9 = pull opposite shoulder TOWARDS you

PT10-12 = Stand opposite side of tender point, pull hip towards you
PT1-12 Transverse ProcessE SA RT

PT4-9 = lift the shoulder on the side of the transverse process thats tender towards you!

PT10-12 = Lift pelvis TOWARDS the tender transverse process