Manual Of Osteopathic Technique

MANUAL OF Osteopathic Technique ALAN STODDARD M.B., B.S., D.O., D.Phys.Mcd COt/sultDIII itt Physical kledicjne Brook HospiUll, Lollt/Oll HUTCHINSON MEDICAL Lolldoll PUBLICATIONS HUTCHINSON MEDICAL PUBLICATIONS LTD /78-202 Great Portlalld Srreel, Lolldoll WI London Melbourne Sydney Auckland Bombay Toronto Johannesburg New York * First pllhlished October 1959 Second Impressioll Jalluary 1961 Tltird Impression (Rel·jsed) NOI'ember 1962 FOllr,It Impressiol/ March 1964 Fiffl, Impression Fehrllllf), /966 Sixth Imp"ss;o" AUKllst 1969 [ C I FI C TECHN IQUES 225 FIG. 140 Now rotale the lorso 10 the right by pushing her right shoulder backwards ilh your right hand. Keep the lumbar spine in extension to increase facel apposiJion locking in Ihe apophyseal joints down to and including the lumbo-sacral facets. The lumbar spine and sacrum are now working as a unit and provide a solid basis for an adjustment of the right sacro-iliac joint. The operator should now lean well over the patient so that he can apply a thrust to the posterior superior iliac spine in a forward direction. The operator's elbow points away from the pelvis so that his forearm can be dirccled in the plane of the joint. \\ (4) FOrll'ard-rotatioll Lesioll all the Left. FtG. 1 40 I n order to create a backward torsional adjustment of the left saero­ iliac joint, have Ihe patient lying on her back and stand on her right side, and in order to create sidebending to the left place the patient's pelvis well to yourside of the plinth, place her left shoulder well to the other side of the plinth and do the same with her feet, thus forming a concavity to the left in the lumbar spine. Then ask the patient to clasp her hands behind her head, bringing her elbows together. Thread your left hand through her left arm from left to right so that you can push your forearm across her chest and you can rest your left hand on the plinth just near her right a.illa. This leverage enables you to rotate the trunk to the right and to p 226 ATLAS OF T E C H N I Q U E S FIG. 141 bring the lumbar spine into flexion. This has a facet-locking effect on the left row of lumbar joints. By arranging your forces accurately the lumbar spine and sacrum become a unit and now a thrust on the patient's left innominate through the anterior superior iliac spine (covered with a thin cushion for comfort) will force the sacro-iliac to move. All the above techniques are designed to free sacro-iliac joints which are locked in rotation, but sometimes they require gapping in the hori­ zontal plane. (5) Tecllllique for Gapping. FIG. 1 4 1 A very simple method for doing this i s to have the patient o n the side comfortably arranged with the upper knee slightly flexed and the back at SAC RO-ILIAC JOINTS : S P E C I F I C T E C H N IQUES 227 FIG. 142 right angles with the plinth. Then place your forearm on her pelvis just below the iliac crest, reinforce your forearm with the other hand and then apply a vertical thrust through the pelvis. This will have a gapping effect on both sacra-iliac joints but especially on the upper of the two. (6) Reverse Gapping Gapping in the reverse direction can be achieved with the patient supine and applying a thrllst to each anterior superior iliac spine. To obtain the maximum effect, cross your arms and thrust on opposite iliac spines, and as these places are sensitive it is just as well to use small cushions for the purpose. (7) Gapping on the Right. FIG. 142 To gap the right sacra-iliac joint place the patient on the left-hand side, stand facing her and allow her right leg to hang over the side of the table, 228 ATLAS OF T E C H N IQ U ES knee extended. Feel for tension developing over the right sa