Autonomics, SV/VS Reflexes, Chapmans

OA RELEASE/DECOMPRESSION
TECHNIQUE: Patient supine. Hands on occiput & move caudad to find occipital shelf. Apply
anterior force & cephalad traction. Pt may put chin to chest using OA to exaggerate flexion &
prevent hyperextension. Maintain position while pt holds 1 or more deep inspirations to enhance
articular release. Reassess OA motion.
TREATMENT MODEL: Occipitoatlantal decompression is a myofascial release technique that
engages continual palpatory feedback to achieve release of myofascial tissues, taking advantage
of fascias ability to change length with associated changes in energy. Additionally, it allows us to
normalize parasympathetic tone via the vagus nerve. It is indicated to treat cardiac arrhythmias
and respiratory dysfunctions, and contraindicated if fractures, open wounds, or neoplasms are
present.
BIOMECHANICS: OA dysfunction results from rotation of the occiput on its axis, causing
misalignment of the condyles in the facets of the atlas. OA decompression allows us to carry the
occipital condyles posteriorly, tense the ligaments in the region, and stretch the contracted
muscles in the occipital triangle.
OCCIPITOMASTOID SUTURE SPREAD
TECHNIQUE: Pt supine. Engage mastoid grooves (behind ears) with index fingers. Contact
occiput with middle fingers. Spread fingers (V-spread) to spread the suture. Apply gentle
cephalad traction along with the lateral spreading force. Maintain gentle pressure until desired
affect is obtained.
TREATMENT MODEL: Occipito-mastoid suture spread is a myofascial release technique that
engages continual palpatory feedback to achieve release of myofascial tissues, taking advantage
of the fascias ability to change length with associated changes in energy. Additionally, it allows
us to normalize parasympathetic tone and decrease the patients pulse by influencing the vagus
nerve. It is indicated to treat cardiac arrhythmias, and contraindicated if fractures, open wounds,
or neoplasms are present.
BIOMECHANICS: Occipitomastoid suture release physically spreads the mastoid suture,
inducing a normalizing effect on the vagus nerve and thus parasympathetic tone.
RIB RAISING
TECHNIQUE: pt supine. Place fingers 2 inches lateral of spinous processes on costotransverse
angles. Apply anterior & lateral force. Hold until release or move in cyclical motion for 30-60
seconds, moving down the spine. Reassess with rib motions.
TREATMENT MODEL: Rib raising is a myofascial release technique that engages continual
palpatory feedback to achieve release of myofascial tissues, taking advantage of the fascias
ability to change length with associated changes in energy. Additionally, it can directly normalize
sympathetic tone by applying pressure to the sympathetic ganglion, improve lymphatic return,
and encourage maximum inhalation. It is indicated in visceral dysfunction, decreased rib
excursion, and lymphatic congestion, and contraindicated in spinal or rib fracture or recent spinal
surgery.
BIOMECHANICS: Rib raising allows us to contact the costotransverse angles, which align with
the sympathetic chain ganglia. It initially produces a short-lived increase in sympathetic activity,
but provides long-lasting sympathetic inhibition to normalize sympathetic tone. It also enhances
lymphatic return and encourages inhalation.
SACRAL ROCKING
TECHNIQUE: Pt prone. Contact lumbars & move down to sacral base. Place caudad hand
underneath cephalad hand. Apply gentle pressure with rocking motion in conjunction with
respiration, extending the sacrum during inhalation (counternutation), & flexing the sacrum
during exhalation (nutation). Repeat for 30-60 seconds. Reassess with sacral landmarks.
TREATMENT MODEL: Sacral rocking is a myofascial release technique that engages continual
palpatory feedback to achieve release of myofascial tissues, taking advantage of the fascias
ability to change length with associated changes in energy. Additionally, it can directly normalize

parasympathetic tone via the sacral splanchnic nerves. Sacral rocking is indicated in
dysmenorrhea and sacroiliac dysfunction, and contraindicated in pelvic malignancy and pain.
BIOMECHANICS: Sacral rocking utilizes a rocking motion synchronous with the natural
movement of the sacrum, extension in inhalation, and flexion in exhalation, to normalize
parasympathetic tone by engaging the sacral splanchnic nerves.
CHAPMANS POINTS
TECHNIQUE: locate the Chapman point deep to the skin in the deep fascia or periosteum; it will
feel like a small, rubbery nodule, producing no pain to severe pain. Apply gentle but firm rotatory
motion to the point using the finger pad for 20-30 seconds.
TREATMENT MODEL: Treating Chapmans points utilizes myofascial release, a continuous
palpatory feedback mechanism to achieve release of the myofascial tissues. Additionally,
Chapmans points represent a type of viscerosomatic reflex, as well as lymphatic stasis
secondary to diseased, stressed, or irritated organs. They are a potential diagnostic tool that can
be used to determine key visceral dysfunctions.
BIOMECHANICS: Chapmans points represent the somatic manifestation of visceral dysfunction,
and treating them results in palpatory dissolution of the point and a decrease in pain.

Lymphatics
SUBOCCIPITAL DIAPHRAGM RELEASE
TECHNIQUE: Pt supine. Place finger pads beneath occiput & apply anterior & lateral force for 3060 seconds.
TREATMENT MODEL: Suboccipital diaphragm release is a myofascial release technique that
engages continuous palpatory feedback to achieve release of myofascial tissues. It also opens
the suboccipital diaphragm, opening myofascial pathways, increase differentials to augment fluid
flow beyond normal levels, and mobilize targeted tissue fluids into the lymphatic system. It also
causes normalization of parasympathetic tone via the vagus nerve.
BIOMECHANICS: The anterior & lateral force applied to the suboccipital region opens the
suboccipital diaphragm, stretches the obliquus capitis inferior & superior, and the rectus capitis
posterior minor, freeing up restrictions to lymphatic flow. It can also normalize parasympathetic
tone via the nearby vagus nerve.
THORACIC INLET/OUTLET DIAPHRAGM RELEASE
TECHNIQUE: pt is supine. Place index finger on clavicle (or supraclavicular fossa) & place thumb
on 1st rib. Assess rotation & translation. Treat directly or indirectly for 30-60 seconds, using
patient inhalation to take inlet further into barrier or ease.
TREATMENT MODEL: Thoracic inlet diaphragm release is a myofascial release technique that
opens myofascial pathways, increase differentials to augment fluid flow beyond normal levels,
and mobilize targeted tissue fluids into the lymphatic system.
BIOMECHANICS: Release of the thoracic inlet diaphragm engages the upper thoracics, ribs,
clavicle, scalenes, pectoral muscles, and the pre-tracheal fascia, and enhances lymphatic
drainage from the head & neck to thoracic duct.
DOMING OF THE DIAPHRAGM

TECHNIQUE: Pt is supine. Place thumbs or thenar eminence inferior to pts lower coastal margin
& xiphoid process with thumbs pointing cephalad. Pt takes a deep breath & exhales. On
exhalation, follow the diaphragm inward, permitting the thumbs to move posteriorly. On
inhalation, resist the motion & follow more posteriorly & cephalad on exhalation. Repeat for 3 to
5 respiratory cycles.
TREATMENT MODEL: Doming of the diaphragm is a lymphatic technique that opens myofascial
pathways, increase differentials to augment fluid flow beyond normal levels, & mobilize targeted
tissue fluids into the lymphatic system. It is indicated for lymphatic congestion distal to the
diaphragm, and contraindicated if there are drainage lines, IV lines, hiatal hernia, fracture, or
malignancy present.
BIOMECHANICS: Doming of the diaphragm engages the patients natural breathing cycles to
free lymphatic flow restrictions. It engages the diaphragm itself, which attaches to the lower ribs,
the upper lumbars, and the xiphoid process.
PRE-SACRAL FASCIA/PELVIC DIAPHRAGM RELEASE
TECHNIQUE: pt is supine. Ask pt to lift hips & place monitoring hand on sacrum. With other
hand, place fingers & thumb downward in lower abdominal region above pubic ramus. Assess
motion in rotation, superior & inferior glide & translation. Apply forces directly or indirectly for
20-30 seconds & follow fascial creep to new barrier. Reassess motions
TREATMENT MODEL: Pelvic diaphragm release is a lymphatic technique that opens myofascial
pathways, increase differentials to augment fluid flow beyond normal levels & mobilize targeted
tissue fluids into the lymphatic system. It is indicated to enhance lymphatic drainage & relieve
venous congestion in the lower abdomen, pelvic region & lower extremities, and is
contraindicated in the presence of abdominal incision, acute ischemic bowel disease, or
obstruction.
BIOMECHANICS: Release of the pelvic diaphragm engages the pre-sacral fascia and frees
lymphatic flow for improve lymphatic & venous drainage. It engages the levator ani muscles, the
pubococcygeus & illiococcygeus, and the coccygeus muscles.
POPLITEAL DIAPHRAGM RELEASE
TECHNIQUE: pt supine with legs extended. Place medial hand on medial aspect of popliteal
fossa & grasp lateral aspect with lateral hand. Palpate for fascial restrictions in cephalad/caudad,
& medial/lateral planes. Engage the tissues with an anterior force through the fingertips while
engaging fascial barriers until resistance is met. Apply anterior & lateral pressure to open
popliteal fossa & hold for 30 seconds. Reassess planes.
TREATMENT MODEL: Release of the popliteal diaphragm is a combined myofascial release
technique, engaging the myofascial tissues and allowing for active release of those, and a
lymphatic technique, opening the myofascial pathways, increase differentials to augment fluid
flow beyond normal levels, & mobilize targeted tissue fluids into the lymphatic system. It is
indicated to improve lymphatic flow & venous drainage from the lower extremities & to release
fascial restrictions of the popliteal fossa.
BIOMECHANICS: Popliteal fossa release engages the fascia and tendons surround the posterior
knee, including those of the hamstring, inserting on the proximal tibia (biceps femoris,
semimembranosus & semitendinosus).
PLANTAR FASCIA RELEASE
TECHNIQUE: Pt supine. Cross thumbs making an X, with thumb pads over the area of concern
(tarsal to distal metatarsal) at the plantar fascia. Apply an inward force vectored distal & lateral
& continue until restrictive barrier is met. Reassess components of dysfunction (TART).
TREATMENT MODEL: Release of the plantar fascia is a myofascial release technique, engaging
the myofascial tissues and allowing for active release of fascia. It also opens the plantar fascia
diaphragm, opening the myofascial pathways, increase differentials to augment fluid flow beyond
normal levels, & mobilize targeted tissue fluids into the lymphatic system. It is indicated to
improve lymphatic flow & drainage, and in cases of plantar fasciitis & rigid pes planus.

BIOMECHANICS: Plantar fascia release loosens the plantar fascia, which attaches to the
calcaneus & the heads of the metatarsal bones. Loosening of the fascia opens the plantar fascia
diaphragm, allowing for drainage of edematous fluid & relief of tension & pain.
PECTORAL TRACTION
TECHNIQUE: Pt supine with hips & knees flexed & feet flat on table. Place finger pads inferior to
pts clavicles at anterior axillary fold. Slowly & gently lean backward, causing hands & fingers to
move cephalad into axilla. Pull cephalad during inhalation & resist during exhalation. Repeat for
3-5 breath cycles. Reassess rib motions near pectoralis muscles.
TREATMENT MODEL: Pectoral traction is a lymphatic technique designed to open myofascial
pathways, increase differentials to augment fluid flow beyond normal levels & mobilize targeted
tissue fluids into the lymphatic system. It is indicated for lymphatic congestion, upper extremity
edema, & respiratory impairments, & is contraindicated in the presence of pacemakers &
metastatic cancer.
BIOMECHANICS: Pectoral traction augments thoracic range of motion via stretching of the
pectoralis minor, which originates on ribs 3, 4, & 5, & inserts on the coracoid process. This
improves lymphatic return.
THORACIC PUMP
TECHNIQUE: Pt supine with head to one side, hips & knees flexed & feet flat on table. Stand at
head of table with 1 foot in front of other. Place thenar eminences inferior to pts clavicles with
fingers spreading out over upper rib cage (or over sternum for women). Increase pressure on
anterior rib cage during exhalation & add a vibratory motion at 2 compressions per second.
Continue applying pumps for 30-60 seconds throughout breathing cycle for 5-6 cycles. Reassess
with rib motions.
TREATMENT MODEL: The thoracic pump is a lymphatic technique designed to open myofascial
pathways, increase differentials to augment fluid flow beyond normal levels & mobilize targeted
tissue fluids into the lymphatic system. It is indicated for infection, fever, & lymphatic
congestion, and contraindicated in the presence of fractures, osteoporosis, severe dyspnea, &
malignancy of the lymphatic system.
BIOMECHANICS: The thoracic pump accentuates negative intrathoracic pressure, increases
lymphatic return, loosens mucus plugs via vibration, and potentially stimulates the autoimmune
system.
PEDAL PUMP
TECHNIQUE: Pt supine with heels of feet on table. Stand at food of table with one foot behind
the other for balance. Grasp plantar surface of feet at distal metatarsals and plantarflex foot to
neutral. Apply cephalad pressure in rhythmic fashion at 2 per second for 30-60 seconds.
Reassess tissue texture changes in legs & check for improvement of edema.
TREATMENT MODEL: The pedal pump is a lymphatic technique designed to open myofascial
pathways, increase differentials to augment fluid flow beyond normal levels & mobilize targeted
tissue fluids into the lymphatic system. It is indicated for lymphatic congestion & fever, and
contraindicated in the presence of deep vein thrombosis, lower extremity strain, or recent
abdominal surgery.
BIOMECHANICS: The pedal pump accentuates negative intraabdominal pressure, increases
lymphatic return, and increases endothelial nitrous oxide, which has an anti-inflammatory effect.
It also uses the pumping motion to improve edema.
SPLENIC PUMP/STIMULATION
TECHNIQUE: Pt supine. Stand at left side of patient and abduct pts left arm 90 degrees. Exert a
gentle traction. Place left hand on lower costal cartilages overlying the spleen, with fingers
following the intercostal spaces. Exert pressure directly toward the center of the pts body,
springing the ribs inward. Spring at 2 per second for 30-60 seconds. Reassess with rib motions.
TREATMENT MODEL: The splenic pump is a lymphatic technique that opens myofascial
pathways, increases differentials to augment fluid flow beyond normal levels & mobilize targeted

tissue fluids into the lymphatic system. It is indicated for infectious disease, and contraindicated
for infectious mononucleosis, splenomegaly, & splenic neoplasm.
BIOMECHANICS: The splenic pump facilitates bringing toxins & other antigens into close
contact with the macrophages of the liver & allows the spleen to screen & remove damaged cells
in circulation.
EFFLEURAGE/PETRISSAGE
TECHNIQUE: For effleurage, lightly massage/stroke the skin. For petrissage, deeply massage the
muscles, kneading, wringing, & skin-rolling. Always begin proximally on the limb, and apply a
distal to proximal motion, and continue for 30-60 seconds.
TREATMENT MODEL: Effleurage & petrissage are lymphatic techniques that open myofascial
pathways, increase differentials to augment fluid flow beyond normal levels & mobilize targeted
tissue fluids into the lymphatic system. These are indicated in lymphatic congestion and edema,
and contraindicated in breast cancer malignancy, skin breakdown, & fracture.
BIOMECHANICS: Effleurage & petrissage actively mobilize fluids superficially & deeply,
respectively. They open the diaphragms and maximize fluid motion back to the lymphatic
system.

OMT for the Shoulder

SPENCERS TECHNIQUE EXTENSION
TECHNIQUE: Pt lateral recumbent. Stand facing pt. With cephalad hand, bridge the shoulder to
lock out the AC joint & scapulothoracic motion. Place fingers on the spine of the scapula & thumb
on the anterior clavicle. With caudad hand, grasp the pts elbow. Move the shoulder into
extension to the barrier. Instruct the pt to attempt to flex the shoulder against resistance for 3-5
second and repeat 3-5 times. Perform a final stretch & reassess shoulder extension.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: The extension component of Spencers technique engages the anterior fibers
of the deltoid (lateral clavicle to deltoid tuberosity) & coracobrachialis (coracoid process to mid
humerus). These provide the patients activating force in flexion.
SPENCERS TECHNIQUE FLEXION
TECHNIQUE: Pt lateral recumbent. Stand facing pt. With caudad hand, reach over & bridge the
shoulder to lock out the AC joint & scapulothoracic motion. Place fingers on anterior clavicle &
heel of hand on spine of scapula. With other hand, take pts shoulder into flexion. Instruct the pt
to attempt to extend the shoulder against resistance for 3-5 second and repeat 3-5 times.
Perform a final stretch & reassess shoulder flexion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: The flexion component of Spencers technique engages the latissimus dorsi
(proximal humerus to inferior border of scap) and teres major (lower lateral border & inf angle of
scapula to proximal humerus), which are hypertonic. These provide the patients activating force
in extension.
SPENCERS TECHNIQUE CIRCUMDUCTION WITH COMPRESSION & ELBOW FLEXED
TECHNIQUE: Pt lateral recumbent. Stand facing pt. With cephalad hand, bridge the shoulder to
lock out the AC joint & scapulothoracic motion. Place fingers on spine of scapula & thumb on
anterior clavicle. With other hand, take pts elbow & take shoulder into abduction. Move pts arm
through full circumduction with slight compression. Make larger & larger circles, increasing range
of motion. Repeat 15-30 seconds in each direction.

TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: The circumduction with compression component of Spencers technique
moves through the patients barriers in circumduction. There is no specific muscle energy
activation for this step, but during fine-tuning, it may be feasible to implement it in a portion of
the restricted arc.
SPENCERS TECHNIQUE CIRCUMDUCTION WITH TRACTION & ELBOW EXTENDED
TECHNIQUE: Pt lateral recumbent. Stand facing pt. Abduct pts shoulder with elbow fully
extended. With caudad hand, grasp the pts wrist & exert vertical traction. With cephalad hand,
brace the shoulder. Move pts arm through full circumduction with traction, making larger
concentric circles, increasing range of motion. Repeat for 15-30 seconds in each direction.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: The circumduction with traction component of Spencers technique moves
through the patients barriers in circumduction. There is no specific muscle energy activation for
this step, but during fine-tuning, it may be feasible to implement it in a portion of the restricted
arc.
SPENCERS TECHNIQUE ADDUCTION WITH EXTERNAL ROTATION
TECHNIQUE: Pt lateral recumbent. Flex pts arm to allow elbow to pass in front of chest wall.
Rest pts wrist against your forearm, & adduct shoulder to edge of restrictive barrier. Instruct pt
to lift elbow against resistance for 3-5 seconds 3-5 times. Reassess adduction.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: The adduction component of Spencers technique engages the middle fibers of
the deltoid (acromion & spine of scap to deltoid tuberosity) & supraspinatus (supraspinous fossa
to greater tubercle). These provide the patients activating force in abduction.
SPENCERS TECHNIQUE ABDUCTION WITH ELBOW FLEXED
TECHNIQUE: Pt lateral recumbent. Brace shoulder, and grasp pts elbow. Instruct pt to grasp
your forearm. Abduct shoulder to edge of restrictive barrier. Have pt adduct against resistance
for 3-5 seconds 3-5 times.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: The abduction component of Spencers technique engages the middle fibers of
the deltoid (acromion & spine of scap to deltoid tuberosity) & supraspinatus (supraspinous fossa
to greater tubercle). These provide the patients activating force in adduction.
SPENCERS TECHNIQUE INTERNAL ROTATION ARM ABDUCTED, HAND BEHIND BACK
TECHNIQUE: Pt lateral recumbent. Brace shoulder with cephalad hand, and grasp pts elbow.
Abduct to 45 degrees & internally rotate to 90 degrees. Place the dorsum of the pts hand in the
small of the back. Gently pull pts elbow forward into internal rotation to the barrier. Instruct pt to
pull elbow backward against resistance 3-5 seconds 3-5 times. Reassess internal rotation gently.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.

BIOMECHANICS: The internal rotation component of Spencers Technique engages infraspinatus

(infraspinous fossa to lesser tubercle) & teres minor (lower lateral border & inferior angle scap to
medial humerus). These provide the patients activating force in external rotation.
SPENCERS TECHNIQUE DELTOID MFR/TRACTION
TECHNIQUE: Pt lateral recumbent. Abduct the pts shoulder & place hand & forearm on your
shoulder. With fingers interlaced, position hands just distal to acromion process. Scoop the pts
shoulder inferiorly, squeezing the deltoid between palms. Continue for 15-30 seconds.
TREATMENT MODEL: Spencers Technique for the deltoid is a myofascial release technique,
which engages continual palpatory feedback to achieve release of myofascial tissues, taking
advantage of the fascias ability to change length with associated changes in energy.
BIOMECHANICS: The deltoid component of Spencer Technique loosens the deltoid and distracts
the tissues, enhancing fluid drainage.
*Spencer Technique is indicated in adhesive capsulitis, bursitis, tenosynovitis & arthritis.
SCAPULOTHORACIC ARTICULATION
TECHNIQUE: Pt lateral recumbent. Place cephalad hand over pts right shoulder, anchoring the
clavicle with the webbing of the thumb/index finger. Contact the superior medial angle of the
scapula at the insertion of the levator scapula & rhomboids with your finger pads. Place caudad
hand under the patients right arm & place finger pads at inferior medial scapular border at
inferior aspect of scapula. Add a gentle compression into the tissues to gain access & controls of
the scapulothoracic articulation & its related myofascial components. Take the scapula inferior &
superior & assess restriction. Place in direct or indirect position for 30 seconds. Reassess in all
planes.
TREATMENT MODEL: Scapulothoracic articulation is a myofascial release technique that
engages continual palpatory feedback to achieve release of myofascial tissues, taking advantage
of the fascias ability to change length with associated changes in energy.
BIOMECHANICS: Scapulothoracic articulation engages the levator scapula and rhomboids, in an
attempt to loosen myofascial and muscular restrictions for increased range of motion of the
scapula.

OMT for the Elbow & Forearm

POSTERIOR RADIAL HEAD MUSCLE ENERGY
TECHNIQUE: Pt seated. Stand in front of and to side of pts dysfunctional arm. Grasp the pts
hand in handshake position, contacting the palmar aspect of the distal radius with index finger.
With other hand, contact the posterolateral aspect of the radial head, cupping the forearm.
Supinate the pts forearm until the edge of restriction is reached. Instruct the pt to try to pronate
against a counterforce. Hold for 3-5 seconds & tell pt to stop & relax. Repeat 3-5 times. Reassess
range of motion of radius.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for a posterior radial head is a pronation dysfunction. Since it is
direct, the pt attempts to pronate in response to a supinating counterforce, engaging pronator
teres (medial epicondyle & ulnar head to lateral radius) & pronator quadratus (distal ulna to
distal radius).
ANTERIOR RADIAL HEAD MUSCLE ENERGY
TECHNIQUE: Pt seated. Standing in front of the pt, grasp the pts hand on the side of
dysfunction, contacting the dorsal aspect of the distal radius with the thumb. With other hand
palm up, rest thumb against the anterior & medial aspect of the radial head. Pronate the pts
forearm to the barrier. Instruct pt to try to supinate against counterforce. Hold 3-5 seconds & tell
pt to stop & relax. Repeat 3-5 times. Reassess range of motion of radial head.

TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for an anterior radial head is a supination dysfunction. Since it
is direct, the pt attempts to supinate in response to a pronating counterforce, engaging the
supinator (lateral epicondyle to lateral radius).
ANTERIOR RADIAL HEAD HVLA
TECHNIQUE: Pt seated. Stand facing pt. Hold the hand of the dysfunctional arm as if shaking
hands. Place thumb of opposite hand anterior to radial hand. Rotate forearm into pronation until
barrier. Carry forearm into slight flexion & pronation while maintaining thumb pressure over
anterior radial head, thrusting through barrier.
TREATMENT MODEL: HVLA is a direct and passive technique, direct meaning I put the pt into
the barrier, and passive meaning the pts muscles are not actively used. This technique employs
a rapid, therapeutic force of brief duration that travels a short distance within the anatomic
range of a joint. It engages the restrictive barrier to elicit release of restriction.
BIOMECHANICS: HVLA for an anterior radial head releases disrupting periarticular or articular
adhesions at the radial head, and restores it to a more neutral position.
POSTERIOR RADIAL HEAD HVLA
TECHNIQUE: Pt seated. Stand facing pt. Hold the hand of the dysfunctional arm as if shaking
hands. Place thumb of opposite hand posterior to radial head. Rotate forearm into supination
until barrier. Carry forearm into extension & supination while maintaining thumb pressure over
posterior radial head, thrusting through barrier.
TREATMENT MODEL: HVLA is a direct and passive technique, direct meaning I put the pt into
the barrier, and passive meaning the pts muscles are not actively used. This technique employs
a rapid, therapeutic force of brief duration that travels a short distance within the anatomic
range of a joint. It engages the restrictive barrier to elicit release of restriction.
BIOMECHANICS: HVLA for an posterior radial head releases disrupting periarticular or articular
adhesions at the radial head, and restores it to a more neutral position.
INTEROSSEOUS MEMBRANE MFR
TECHNIQUE: Pt seated. Stand facing pt. Palpate the affected forearm over the interosseous
membrane & note any evidence of taut, fibrous band, pain or ease-bind tissue elasticity
asymmetry. Place thumb over anterior dysfunctional aspect of interosseous membrane with palm
& fingers encircling forearm. Monitor cephalad & caudad, translation, & clockwise &
counterclockwise motion. Treat directly or indirectly & hold for 20-60 seconds.
TREATMENT MODEL: Myofascial release engages continual palpatory feedback to achieve
release of myofascial tissues, taking advantage of the fascias ability to change length with
associated changes in energy.
BIOMECHANICS: Interosseous membrane myofascial release loosens the membrane seated
between the radius and ulna, freeing restrictions for increased range of motion and decreased
pain.

OMT for the Wrist & Hand

WRIST ADDUCTION/ULNAR DEVIATION POST ISOMETRIC RELAXATION
TECHNIQUE: pt seated. Standing in front of the pt, abduct the pts wrist to the barrier. Instruct
pt to adduct wrist against counter force. Hold for 3-5 seconds, stop & relax & repeat 3-5 times.
Reassess wrist motion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.

BIOMECHANICS: Muscle energy for an abduction requires a patient activating force that
engages the abductor of the wrist, flexor carpi radialis (medial epicondyle to base of 2 nd & 3rd
metacarpals).
WRIST ABDUCTION/RADIAL DEVIATION POST ISOMETRIC RELAXATION
TECHNIQUE: pt seated. Standing in front of the pt, adduct the pts wrist to the barrier. Instruct
pt to abduct wrist against counter force. Hold for 3-5 seconds, stop & relax & repeat 3-5 times.
Reassess wrist motion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for an adduction dysfunction requires a patient activating force
that engages the adductor of the wrist, flexor carpi ulnaris (medial epicondyle to pisiform, hook
of hamate & base of 5th metacarpal).
WRIST FLEXION DYSFUNCTION POST ISOMETRIC RELAXATION
TECHNIQUE: pt seated. Standing in front of the pt, Extend the pts wrist to the barrier. Instruct
pt to flex wrist against counterforce. Hold 3-5 seconds, stop & relax, & repeat 3-5 times.
Reassess wrist range of motion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for a flexion dysfunction requires a patient activating force that
engages the flexors of the wrist, flexor carpi ulnaris (medial epicondyle to pisiform, hook of
hamate & base of 5th metacarpal) & flexor carpi radialis (medial epicondyle to base of 2 nd & 3rd
metacarpals).
WRIST EXTENSION DYSFUNCTION POST ISOMETRIC RELAXATION
TECHNIQUE: pt seated. Standing in front of the pt, Flex the pts wrist to the barrier. Instruct pt
to extend wrist against counterforce. Hold 3-5 seconds, stop & relax, & repeat 3-5 times.
Reassess wrist range of motion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for an extension dysfunction requires a patient activating force
that engages the extensors of the wrist, extensor carpi radialis longus (lateral distal humerus to
dorsal base of 2nd metacarpal), extensor carpi radialis brevis (lateral epicondyle to dorsal base of
3rd metacarpal), & extensor carpi ulnaris (lateral epicondyle to base of 5 th metacarpal).
WRIST DORSAL CARPAL DYSFUNCTION
TECHNIQUE: pt seated. Standing in front of the pt, grasp the pts wrist with thumbs on the
dorsal aspect of the wrist. Place the thumb over the displaced carpal bone & reinforce with the
other thumb. Wrap other fingers around palmar surface. Carry out a simple whipping motion,
maintaining pressure over the displaced carpal bone.
TREATMENT MODEL: HVLA is a direct and passive technique, direct meaning I put the pt into
the barrier, and passive meaning the pts muscles are not actively used. This technique employs
a rapid, therapeutic force of brief duration that travels a short distance within the anatomic
range of a joint. It engages the restrictive barrier to elicit release of restriction.
BIOMECHANICS: HVLA for carpal dysfunction restores the carpal bones to a neutral position if
they are dorsally displaced. This is done by slightly extending the pts wrist & using the whipping
motion to provide momentum through the displaced bone. (Most often the lunate)
WRIST CARPAL TUNNEL RELEASE

TECHNIQUE: Pt seated. Standing in front of the pt, place the pts hand palm up. Place thumbs
over medial & lateral eminences of the carpal region & wrap fingers around dorsal aspect of
hand contacting the dorsal carpal region. Exert tension on the carpal region, especially the flexor
retinaculum, by pressing the thumbs into the volar surface of the base of the hand & pushing the
thumbs apart, while dragging the skin & superficial fascia with the thumbs. Maintain pressure for
20-60 seconds.
TREATMENT MODEL: Myofascial release engages continual palpatory feedback to achieve
release of myofascial tissues, taking advantage of the fascias ability to change length with
associated changes in energy.
BIOMECHANICS: MFR for the carpal tunnel stretches the flexor retinaculum which overlies the
carpal tunnel. This relieves pressure on the tunnel and the structures running through it, namely
the median nerve.
WRIST CARPAL TUNNEL RELEASE
TECHNIQUE: Pt seated. Standing in front of the pt, place the pts hand palm up. Place thumbs
over medial & lateral eminences of the carpal region & wrap fingers around dorsal aspect of
hand contacting the dorsal carpal region. Exert tension on the carpal region, especially the flexor
retinaculum, by pressing the thumbs into the volar surface of the base of the hand & pushing the
thumbs apart, while dragging the skin & superficial fascia with the thumbs. Maintain pressure for
20-60 seconds.
TREATMENT MODEL: Myofascial release engages continual palpatory feedback to achieve
release of myofascial tissues, taking advantage of the fascias ability to change length with
associated changes in energy.
BIOMECHANICS: MFR for the carpal tunnel stretches the flexor retinaculum which overlies the
carpal tunnel. This relieves pressure on the tunnel and the structures running through it, namely
the median nerve.
CLAVICLE ABDUCTION DYSFUNCTION MUSCLE ENERGY
TECHNIQUE: Pt supine. Monitor at the distal end of the clavicle (acromioclavicular joint). Pull
pts arm inferiorly & ask pt to pull arm superiorly for 3-5 seconds 3-5 times. Reassess clavicular
motion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for a clavicle abduction dysfunction requires the patients
activating force to be one of abduction, which engages the trapezius (occiput to lateral clavicle)
& levator scapulae (C1-C4 to medial border of scap).
CLAVICLE ADDUCTION DYSFUNCTION MUSCLE ENERGY
TECHNIQUE: Pt supine. Monitor at the distal end of the clavicle (acromioclavicular joint). Pull
pts arm superiorly & ask pt to push arm inferiorly 3-5 seconds 3-5 times. Reassess clavicular
motion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for a clavicle adduction dysfunction requires the patients
activating force to be one of adduction, which engages the latissimus dorsi (inferior angle of scap
to humerus), pectoralis major (medial clavicle greater tubercle of humerus)
CLAVICLE FLEXION DYSFUNCTION MUSCLE ENERGY

TECHNIQUE: Pt supine & slightly off table to assess full range of flexion. Monitor at the distal
end of the clavicle (acromioclavicular joint). Push arm down to retract scapula & have pt pull
back into flexion for 3-5 seconds 3-5 times. Reassess clavicular motion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for a clavicle flexion dysfunction requires the patients
activating force to be one of flexion, which engages the serratus anterior (ribs 8-9 to anterior
medial border scap).
CLAVICLE EXTENSION DYSFUNCTION MUSCLE ENERGY
TECHNIQUE: Pt supine & slightly off table to assess full range of flexion/extension. Monitor at
the distal end of the clavicle (acromioclavicular joint). Pull arm up to protract scapula & have pt
pull back into extension for 3-5 seconds 3-5 times. Reassess clavicular motion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for a clavicle extension dysfunction requires the patients
activating force to be one of extension, which engages the rhomboid minor (SP C6-7 to medial
border scap), & rhomboid major (SP T1-4, medial border scap).
CLAVICLE INTERNAL ROTATION DYSFUNCTION MUSCLE ENERGY
TECHNIQUE: Pt is supine. Monitor distal end of clavicle at AC joint. Take pt into external rotation
to barrier & have them internally rotate for 3-5 seconds 3-5 times. Reassess clavicular motion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for a clavicle internal rotation dysfunction requires the
patients activating force to be one of internal rotation, which engages the subscapularis
(subscapular fossa to lesser tubercle).
CLAVICLE EXTERNAL ROTATION DYSFUNCTION MUSCLE ENERGY
TECHNIQUE: Pt is supine. Monitor distal end of clavicle at AC joint. Take pt into internal rotation
to barrier & have them externally rotate for 3-5 seconds 3-5 times. Reassess clavicular motion.
TREATMENT MODEL: Muscle energy is a direct and active technique, direct meaning I put the
pt into the barrier, and active meaning the pts muscles are actively used. This post-isometric
technique uses the muscles refractory state after muscle contraction to allow passive stretching
further into the barrier.
BIOMECHANICS: Muscle energy for a clavicle external rotation dysfunction requires the
patients activating force to be one of external rotation, which engages the intraspinatus
(infraspinatus fossa to greater tubercle) & teres minor (axillary border of scapula to greater
tubercle)