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.
Table Of Contents
Thoracic Vertebral Levels
Segments | Curvature | SP in relation to TP | |
Cervico-thoracic junction | T1-T3 | Lordotic | SP same level as TP |
True thoracics | T4-6 | Kyphotic | SP 1/2 way between TP and one below it |
True thoracics | T7-9 | Kyphotic | SP same level as TP below it |
Thoraco-lumbar junction | T10 | Lordotic | SP same level as TP below it |
Thoraco-lumbar junction | T11 | Lordotic | SP 1/2 way between TP and one below it |
Thoraco-lumbar junction | T12 | Lordotic | SP same level as TP |
Facet Orientation
Cervical Facet Orientation | BUM: backwards, upward, medial |
Thoracic Facet Orientation | BUL: backwards, upward, lateral |
Lumbar Facet Orientation | BM: backwards, medial |
Anatomic Landmarks
T2 | Sternal 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 | Axis | Plane |
Flexion/Extension | Transverse | Sagittal |
Rotation | Vertical | Transverse |
Side Bending | Anterior-Posterior | Coronal |
TART
Def, – Tissue texture changes, asymmetry, ROM, tenderness |
Acute TART | Chronic TART |
-Edema, -erythema, -boggy, -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, -flaccid, -ropy, -fibrotic -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 1 | neutral, side bending and rotation occur in opposite directions |
Fryette’s law 2 | flexion/extension, side bending and rotation occur in same directions |
Fryette’s law 3 | motion 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 | |
Component | neutral (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 | Single-segment |
Caused by | Formed 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 by | long 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
Direct | Indirect | Combined Direct and Indirect |
Direct myofascial release HVLA Muscle energy | Counterstrain Indirect myofascial release MFR, INR BLT/LAS FPR | |
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 outlet is between the clavicle and 1st rib
- bilateral myofascial release where you put all the restrictions together (F/E, SB/R)
- NOTES: – Can be done as a direct or indirect technique
Thoracic Muscle Energy
Thoracic HVLA/Kirksville Crunch
- 6 Steps of HVLA:
- 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 notch | FLEX |
AT 2 | – Near sternomanubrial junction | FLEX |
AT 3-6 | –On sternum at corresponding rib level | FLEX –Knee under patient |
AT 7 | – inferior tip of xyphoid | F ST RA –Patient seated, arm over your knee –The arm opposite of tender point goes on knee |
AT 8 | – halfway between xyphoid – umbilicus | F 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 umbilicus | F 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 symphysis | F ST RA –Patient supine, knee up to 90 degrees |
AT 11 | – 1/2 between umbilicus and pubic symphysis | F ST RA |
AT 12 | – Anterior, superior surface of iliac crest, MID-axillary line! | F ST RA |
Posterior Counterstrain Points
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PT1-12 Midline | Extend! |
PT1-12 posterior –Infralateral tip of spinous process | E SA RA 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 Process | E 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 |