I8e PS ee Millicent King Channell David C. Mason Ne LAU Belinea 7 a WONeh ere Wu thePoint,.HOW TO USE THIS BOOK OMM determines the common procedural terminology (CPT) code to be used for the OMM procedure portion of the bill. For example, the codes for treating a patient with asthma might look like this: E&M 99213 office visit of established patient. IcD-9 493.9 < asthma If, in addition to your medical management of a patient with asthma, you were to treat the cervicals, thoracics, and pectoralis minor muscle with OMM, your bill might have the following coding: E&M 99213.25 < “25 modifier" says you performed an additional procedure—in this case, OMM. CPT 98926 < represents the separate procedure of OMT to the three body regions treated (see ICD-9 codes below) IcD-9 493.9 < asthma 739.1 = somatic dysfunction of the cervicals 739.2 < somatic dysfunction of the thoracics 739.7 < somatic dysfunction of the upper extremity Remember that whether you treat one or both upper extremities, it is still con- sidered one region. The same is true of the lower extremities. It is also true that no matter how many techniques you perform on a single body region, you only bill for that body region once. Therefore, if in the above example you perform muscle energy, myofascial release, and counterstrain on the cervicals, thoraci- cs, and pectoralis minor muscle, you can still only bill for three regions. xii CONTENTS Preface Acknowledgments How to Use This Book Ankle Sprain Anxiety Arthritis (inflammatory) Arthritis (osteoarthritis) Asthma Atelectasis Bell's Palsy Carpel Tunnel Syndrome Cervical Spondylosis Cholecystitis Chronic Cough Chronic Obstructive Pulmonary Disease Colic Common Cold Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy) Congestive Heart Failure Constipation Costochondritis Depression Diarrhea Dupuytren Contracture Dysmenorrhea Dyspareunia vii xi 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 44 46 48 50CONTENTS Dysphagia Emesis Epicondylitis Erectile Dysfunction Fibromyalgia Frozen Shoulder Gastritis Gastroesophageal Reflux Disease Goiter Headache Hiccups Hypertension lleus Inflammatory Bowel Disease (Crohn's Disease or Ulcerative Colitis) Influenza Irritable Bowel Syndrome Labyrinthitis Low Back Pain Otitis Media Pelvic Inflammatory Disorder Peptic Ulcer Disease Pes Anserine Bursitis Pharyngitis Pneumonia Postconcussive Syndrome Pregnancy Premenstrual Syndrome Pyloric Stenosis Restless Legs Syndrome Rhinitis, Allergic Scoliosis Sinusitis xiv 54 56 58 60 62 66 68 70 72 14 76 78 80 82 84 88 92 94 98 100 102 104 106 108 110 112 116 118 120 122 124 126 Tachycardia Temporomandibular Joint Dysfunction Thoracic Outlet Syndrome Torticollis Urinary Tract Infection APPENDIX 1: TECHNIQUES Head OA Release Muncie Technique Galbreath Technique Auricular Drainage CV4 Hold Cervical Counterstrain—Posterior Tenderpoints Muscle Energy—Typical: C2-C7 Muscle Energy—Atypicals: AA Muscle Energy—Atypicals: OA Myofascial Release Direct—Perpendicular Stretch Myofascial Release Direct—Longitudinal Stretch HVLA—Typicals: C2-C7 HVLA~Atypicals: AA HVLA—Atypicals: OA Thoracic Counterstrain—Anterior Tenderpoints Counterstrain—Posterior Tenderpoints Muscle Energy-Fryettes Type 1 Muscle Energy Fryette’s Type 2 Myofascial Release—Perpendicular Stretch HVLA-Full Nelson HVLA-Supine Double Arm Thrust (Kirksville) 128 130 132 134 136 139 140 141 142 143 144 146 148 150 152 153 154 155 156 157 158 159 160 161 162 163 164 CONTENTSCONTENTS HVLA-Prone Double Arm Thrust (Texas) Fryette's Type 2 HVLA-Prone Double Arm Thrust (Texas) Fryette's Type 1 Myofascial Release Direct—Pectoral Traction Lymphatic—Thoracic Pump Ribs Springing Technique (Myofascial Release)—Rib Raising Muscle Energy—First or Second Rib Inhalation Dysfunction Muscle Energy—Ribs 3 to 10 Inhalation Dysfunction Muscle Energy—Ribs 11 and 12 Inhalation Dysfunction Muscle Energy—First Rib Exhalation Dysfunction Muscle Energy—Second Rib Exhalation Dysfunction Muscle Energy—Ribs 3 to 5 Exhalation Dysfunction Muscle Energy—Ribs 6 to 10 Exhalation Dysfunction Muscle Energy—Ribs 11 to 12 Exhalation Dysfunction Lumbar Counterstrain—Posterior Tenderpoints Counterstrain—Anterior Tenderpoints Myofascial Release Direct—Perpendicular Stretch Muscle Energy HVLA—Lumbar Roll Abdomen Myofascial Release—Doming of the Diaphragm Myofascial Release Direct—Collateral Ganglion Release xvi 166 167 168 169 170 172 174 176 177 178 179 180 181 182 183 184 185 186 189 190 Chapman’s Reflex Inhibition Treatment Innominate Muscle Energy—Anterior Innominate Rotation Dysfunction Muscle Energy—Posterior Innominate Rotation Dysfunction: Patient Supine Muscle Energy—Posterior Innominate Rotation Dysfunction: Alternate Prone Setup Muscle Energy—Inflare Dysfunction Muscle Energy—Outflare Dysfunction Sacrum Muscle Energy—Anterior Torsion Muscle Energy—Posterior Torsion Upper Extremity Lymphatic—Effleurage Muscle Energy—Posterior Radial Head Dysfunction (Pronation Dysfunction) Muscle Energy—Anterior Radial Head Dysfunction (Supination Dysfunction) Lower Extremity Lymphatic Pedal Pump Lymphatic—Effleurage Muscle Energy—Psoas Hypertonicity Muscle Energy—Piriformis Hypertonicity Counterstrain—Psoas Hypertonicity Counterstrain—Piriformis Hypertonicity APPENDIX 2: SPECIALIZED TESTS Cervical Spine Distraction Test (Intervertebral foraminal encroachment) 192 193 194 195 196 197 198 199 200 202 203 204 205 206 207 208 209 211 212 CONTENTSCONTENTS Compression Test (Intervertebral foraminal encroachment) Valsalva Test (Discopathy, spinal cord tumor, or any space-occupying lesion) Swallowing Test (Possible infection, osteophytes, hematoma, or tumor in the anterior portion of the cervical spine) Upper Extremity Apley's Scratch Test (Shoulder Range of Motion) Drop Arm Test (Rotator Cuff Tears, Especially Supraspinatus) Yergason’s Test (Stability of the Biceps Tendon in the Bicipital Groove) Apprehension Test (Anterior glenohumeral instability) Adson's Test (Thoracic Outlet Syndrome) (Brachial Plexus Impingement Between Middle and Posterior Scalene) Military Posture Test (Costoclavicular Syndrome Test) (Brachial Plexus Impingement Between Clavicle and First Rib) Wright's Test (Brachial Plexus Impingement Under Pectoralis Minor) Tinel's Sign at Elbow (Ulnar Nerve Entrapment) Allen's Test (Arterial Insufficiency of the Radial and Ulnar Arteries to the Hand) Finkelstein's Test (de Quervain’s Disease/Tenosynovitis) Phalen's Test (Carpal Tunnel Syndrome) Tinel’s Sign at Wrist (Carpal Tunnel Syndrome) Tennis Elbow Test (Epicondilitis) Tests for Ligamentous Stability at Elbow Lower Extremity Trendelenburg's Test (Gluteus Medius Weakness) xviii 213 214 215 216 Ot 218 219 220 221 222 293 294 225 226 207 228 229 230 Knee Exam—Anterior Drawer Test (Anterior Cruciate Ligament Tear) 232 Knee Exam—Posterior Drawer Test (Posterior Cruciate Ligament Tear) 233 Apley's Compression Test (Meniscal Tears) 234 Apley’s Distraction Test (Ligamentous Tears) 235 Lachman’s Test (Anterior Cruciate Ligament Tear) 236 McMurray’s Test (Posterior Tear of the Medial Meniscus) 237 McMurray's Test (Tear of the Lateral Meniscus) 238 Patellar Grind Test (Chondromalacia) 239 Valgus Stress (Medial Collateral Ligament Tear) 240 Varus Stress (Lateral Collateral Ligament Tear) 241 Anterior Drawer Test for Ankle Instability (Tear of anterior talofibular ligament and possibly other ligaments) 242 Lumbar Spine Straight Leg Raising Test (Sciatic Nerve Compression Due Lumbar Disk Herniation) 243 Hip Drop Test (Sidebending of the Lumbar Spine) 244 Pelvis Innominate and Sacrum ASIS Compression Test (Locate the Side of Somatic Dysfunction in the Pelvis) 246 Standing Flexion Test (Locate the Side of Somatic Dysfunction in the Pelvis) 247 Seated Flexion Test (Locate the Side of Somatic Dysfunction in the Pelvis, Especially the Sacrum) 248 Lumbosacral Spring Test (Posterior Sacral Base) 249 APPENDIX 3: SUMMARY CHARTS 251 Potential Upper Extremity Nerve Impingements 252 Potential Lower Extremity Nerve Impingements 253 CONTENTSCONTENTS Anterior Dermatomes Posterior Dermatomes Reflexes—Upper Extremity Reflexes—Lower Extremity Muscle Strength—Upper Extremity Muscle Strength—Lower Extremity Cranial Holds Cranial Diagnosis Sacral Diagnosis References Index 254 255 256 258 260 267 269 274 284 287 297 ce SRS ES SR A ST ACRONYMS AND ABBREVIATIONS atlantoaxial abdomen anterior superior iliac spine attention cranial nerve common procedural terminology cranial sacral technique cranial rhythmic impulse counterstrain fourth cerebral ventricle facilitated positional release gastroesophageal reflux disease gastrointestinal (tract) high velocity/low amplitude inflammatory bowel disease irritable bowel syndrome intercostal space iliotibial band lower extremity muscle metacarpal phalange joint muscle energy myofascial release muscles nerve nerves occipitoatlantoid osteopathic manipulative medicine osteopathic manipulative treatment progressive inhibition of neuromuscular structures posterior superior iliac spine sphenobasilar synchondrosis sacroiliac used for temporomandibular joint and temporomandibular joint dysfunction trigger point injection treatment upper extremity xxiANKLE SPRAIN & BASICS DESCRIPTION A nonphysiological stretching or twisting of the ankle joint resulting in tears of its ligaments or other soft tissue D PHYSIOLOGY AND ASSOCIATED SOMATIC KY) DYSFUNCTIONS PARASYMPATHETICS Not applicable SYMPATHETICS * Increased tone = dilated arterioles of the muscles (cholinergic and adrenergic (82), constricted arterioles of the muscles (adrenergic ct) © T10-12 —Tenderpoints ~ Tissue texture changes over transverse processes — Rotated vertebrae MOTOR * L4-S2 common fibular nerve — Impinged by posterior fibular head somatic dysfunction ‘* Tenderness and/or edema of any of the following: ~ Lateral ankle (inversion sprain) L4-S2 superficial fibular nerve © Fibularis longus muscle and tendon © Fibularis brevis muscle and tendon — Medial ankle (eversion sprain) L4~S3 tibial nerve © Flexor halicus longus muscle and tendon © Flexor digitorum longus muscle and tendon © Tibialis posterior muscle and tendon — Posterior ankle L4—S3 tibial nerve © Soleus muscle and tendon ‘© Gastrocnemius muscle and tendon ¢) OTHER SOMATIC DYSFUNCTIONS + Pes planus (inferior/dropped cuboid, navicular, cuneiform bones, or proximal metatarsal bones) © Posterior and inferior fibular head (with inversion sprain) * Anterior tibia on talus ANKLE SPRAIN TREATMENT 2-MINUTE TREATMENT © Lower extremity—strain-counterstrain for tenderpoints of associated muscle and tendons CS 739.6 5-MINUTE TREATMENT * Lower extremity—direct MFR stretching of associated muscles 739.6 * Lower exttemity—iymphatic drainage of ankle edema: gentle effleurage 739.6 * Lower exttemity—posterior fibular head: CS, ME, and/or HVLA 739.6 EXTENDED TREATMENT * Lower extrernity—anterior tibia on talus: articulatory technique 739.6 © Lower extremity—pes planus; CS and/or HVLA 739.6ANXIETY & BASICS DESCRIPTION An acute or chronic fearful emotion often with associated physical symptoms wD PHYSIOLOGY AND ASSOCIATED SOMATIC KY) DYSFUNCTIONS PARASYMPATHETICS * Increased tone = increased acid secretion, nausea, vomiting, diarrhea * Vagus nerve ~ 0A, AA, C2 © Tenderpoints 6 Tissue texture changes over cervical pillars © Rotated vertebrae — Compression of occipitomastoid sutures as well as Occipitoatlantoid joint SYMPATHETICS Increased tone = tachycardia, constipation, increased sensitivity to acid © T1-14 (cardiac) and/or T5-L2 (gastrointestinal) — Tenderpoints — Tissue texture changes over transverse processes — Rotated vertebrae * Celiac ganglion—fascial restriction © Superior mesenteric ganglion—fascial restriction © Inferior mesenteric ganglion—fascial restriction MOTOR * C2-C7 (levator scapulae, scalene, upper trapezius, posterior cervical musculature) —Tenderpoints ~ Tissue texture changes over cervical pillars ~ Rotated vertebrae “ 0) OTHER SOMATIC DYSFUNCTIONS * Pectoralis minor tenderpoints and hypertonicity * Inhalation dysfunctions of ribs 1 and 2 ANXIETY it TREATMENT A ay DY 2-MINUTE TREATMENT * Head—OA release 739.0 is ) 5-MINUTE TREATMENT t © Cervical—FPR 739.1 * Rib—FPR to inhalation dysfunction of first and second rib 739.8 BY) EXTENDED TREATMENT # Head—abnormal cranial strain pattern: treat strain 739.0 ~ Vault hold ~CV4 hold © Cervical —C2-C7: MER, FPR, and/or HVLA 739.1 * Upper extremity—pectorales minor: MER, ME, and/or CS 739.7 Thoracic—ME, MFR, and/or HVLA 739.2 * Lumbar—ME, MFR, and/or HVLA 739.3 * Abdomen—ganglion restriction: MFR 739.9 * Abdomen/other/viscerosomatic—Chapman's reflex at ITB 739.9 Intestine (peristalsis) Colon © UMDNJ 2007 (continued) 5ANXIETY (acidity) Stomach (peristalsis) Gallbladder ) Celiac ganglion “A> Umbilicus Superior mesenteric Inferior ganglion mesenteric ganglionARTHRITIS (INFLAMMATORY) & BASICS DESCRIPTION There are many rheumatologic conditions that can lead to arthritis; the correct diagnosis will direct the appropriate medical management of the patient with joint pain. These recommendations may be helpful to follow during the workup and after the disease has been identified. D PHYSIOLOGY AND ASSOCIATED SOMATIC KY) DYSFUNCTIONS PARASYMPATHETICS Not applicable i>) SYMPATHETics * Increased tone = dilated arterioles of the muscles (cholinergic and adrenergic (52), constricted arterioles of the muscles (adrenergic «) © T5-T7—upper extremity —Tenderpoints = Tissue texture changes over transverse processes ~ Rotated vertebrae © T10-L2—lower extremity —Tenderpoints ~ Tissue texture changes over transverse processes — Rotated vertebrae MOTOR © C4-T1—upper extremity — Tenderpoints — Tissue texture changes over cervical pillars. —Rotated vertebrae © L1-S3—lower extremity ~Tenderpoints — Tissue texture changes over transverse processes — Rotated vertebrae @) OTHER SOMATIC DYSFUNCTIONS * Any joint may be affected depending on the nature of the rheumatolagic condition. Synovitis, bursitis, or generalized edema may accompany the arthritis and may respond to lymphatic drainage techniques. © Sacroilitis is common with some rheumatic diseases. The sacrum, innominates, and lumbar spine should be assessed for somatic dysfunction in these individuals. Compensatory findings or overuse syndromes of areas not affected by arthritis should also be evaluated. ARTHRITIS (INFLAMMATORY) TREATMENT Caution: Inflammatory arthritis my lead to joint instability as @ result of ligamentous laxity, therefore, avoidance of HVLA techniques to the upper cervical spine is recommended. 2-MINUTE TREATMENT © MER to area of subjective complaint or objective findings 5-MINUTE TREATMENT + Lymphatic effleurage to affected areas EXTENDED TREATMENT © Strain-counterstrain to tenderpoints encountered BILLING BY REGION TREATED © Head/cranial somatic dysfunction 739.0 © Cervical somatic dysfunction 739.1 © Thoracic somatic dysfunction 739.2 * Lumbar somatic dysfunction 739.3 Sacral somatic dysfunction 739.4 Innominate somatic dysfunction 739.5 © Lower extremity somatic dysfunction 739.6 © Upper extremity somatic dysfunction 739.7 © Rib somatic dysfunction 739.8 * Abdominal/viscerosomatic dysfunction 739.9ARTHRITIS (OSTEOARTHRITIS) & BASICS DESCRIPTION A noninflammatory degenerative joint disease of any joint in the body, commonly of hands, knees, hips, and spine. It is identified by joint space narrowing, articular derangement as a result of cartilaginous breakdown, and calcium deposition based on Wolff law associated with pain, stiffness, tenderness, joint effusion, crepitus, and reduced range of motion. i. PHYSIOLOGY AND ASSOCIATED SOMATIC DYSFUNCTIONS PARASYMPATHETICS Not applicable SYMPATHETICS © Increased tone = dilated arterioles of the muscles (cholinergic and adrenergic 52), constricted arterioles of the muscles (adrenergic a) © T5-T7—upper extremity —Tenderpoints. ~ Tissue texture changes over transverse processes ~ Rotated vertebrae © T10-L2—lower extremity — Tenderpoints ~ Tissue texture changes over transverse processes — Rotated vertebrae MOTOR © C4-T1—upper extremity = Tenderpoints — Tissue texture changes over cervical pillars. — Rotated vertebrae © L1-S3—lower extremity —Tenderpoints — Tissue texture changes over transverse processes — Rotated vertebrae @ OTHER SOMATIC DYSFUNCTIONS * Any joint may be affected. History of trauma or repetitive use may localize. * Cervical, thoracic, lumbar, and sacral arthritis may lead to foraminal or central canal stenosis with the expected associated findings. + Hands (especially thumbs), knees, and hips are especially prone to osteoarthritis because of gravitational forces and overuse. © Examine patient for compensatory findings or overuse syndromes of areas not affected by arthritis, 10 ARTHRITIS (OSTEOARTHRITIS) TREATMENT Note: Treatment should be focused on the restoration and maintenance of function of affected joints, This should include preventive health of the surrounding joints through exercise prescription, postural education, ergonomic evaluation, and recommendations. 2-MINUTE TREATMENT © MER to areas of subjective complaint or objective findings I) 5-MINUTE TREATMENT © WNiFR, ME, or HVLA to areas above and below affected joints bY EXTENDED TREATMENT #h © Strain-counterstrain to tenderpoints encountered Ergonomic evaluation and recommendations * Postural education * Exercise prescription BILLING BY REGION TREATED © Head/cranial somatic dysfunction 739.0 * Cervical somatic dysfunction 739.1 © Thoracic somatic dysfunction 739.2 * Lumbar somatic dysfunction 739.3 © Sacral somatic dysfunction 739.4 © Innominate somatic dysfunction 739.5 # Lower extremity somatic dysfunction 739.6 © Upper extremity somatic dysfunction 739.7 © Rib somatic dysfunction 739.8 # Abdominal/viscerosomatic dysfunction 739.9 11a SM A ASTHMA & BASICS DESCRIPTION A disorder of the tracheobronchial tree characterized by mild to severe obstruction to airflow. The clinical hallmark is wheezing, but cough may be the predominant symptom. | PHYSIOLOGY AND ASSOCIATED SOMATIC KY. DYSFUNCTIONS PARASYMPATHETICS * Increased tone = increased volume of secretions and relative bronchiole constriction © Vagus nerve = 0A, AA, C2 © Tenderpoints © Tissue texture changes over cervical pillars © Rotated vertebrae — Compression of occipitomastoid sutures as well as occipitoatlantoid joint SYMPATHETICS * Increased tone = decreased secretions and bronchiole dilation e247 —Tenderpoints — Tissue texture changes over transverse processes Rotated vertebrae MOTOR * C3-C5 (phrenic nerve to the diaphragm; dysfunction as a result of decreased excursion and overuse) © Tenderpoints ® Tissue texture changes over cervical pillars * Rotated vertebrae a ¢) OTHER SOMATIC DYSFUNCTIONS * Cranial extension dysfunction * Scalenes—tenderpoints and hypertonicity * Sternocleidomastoid—tenderpoints and hypertonicity © Inhalation or exhalation dysfunction of ribs * Flattened diaphragm * Thoracolumbar dysfunction (diaphragm attachment) 12 TREATMENT A hh Hy 2-MINUTE TREATMENT © Thoracic—seated ME 739.2 * Abdomen/other/viscerosomatic—Chapman’s reflex for lung 739.9 5-MINUTE TREATMENT © Upper extrernity—pectoralis minor: CS, MFR, and/or pectoralis traction (for lymphatic treatment) 739.7 © Thoracic—HVLA 739.2 BY EXTENDED TREATMENT * Head—decreased CRI: CV4 hold 739.0 * Head—vagus: OA release 739.0 * Head—sphenopalatine ganglion stimulation 739,0 © Cervical—C2, C3-C5: MFR, FPR, and/or HVLA 739.0 © Cervical—scalenes: CS and/or ME 739.1 © Thoracic—MFR 739.2 © Rib dysfunction—ME 739.8 © Rib raising 739.8 * Abdomen—diaphragm =Doming technique 739.9 — Thoracolumbar junction: ME, MFR, HVLA 739.2, 739.3 13ATELECTASIS & BASICS DESCRIPTION A condition in which the lung, in whole or in part, is collapsed or without air and the alveoli are collapsed. It implies some blockage of a bronchiole or bronchus, which can be within the airway (foreign body, mucus plug), from the wall (tumor, usually squamous cell carcinoma), of compressing from the outside (tumor, lymph node), DD PHYSIOLOGY AND ASSOCIATED SOMATIC i) pysFunctions PARASYMPATHETICS * Increased tone = increased secretions and relative bronchiole constriction Vagus nerve = 0A, AA, C2 © Tenderpoints © Tissue texture changes over cervical pillars. © Rotated vertebrae — Compression of occipitomastoid sutures as well as occipitoatiantoid joint SYMPATHETICS = Increased tone = decreased secretions and bronchiole dilation °12-17 ~Tenderpoints ~ Tissue texture changes over transverse processes ~ Rotated vertebrae MOTOR © C3-C5 (phrenic nerve to the diaphragm; dysfunction as a result of decreased excursion and overuse) —Tenderpoints — Tissue texture changes over cervical pillars — Rotated vertebrae z OTHER SOMATIC DYSFUNCTIONS i + Rib dysfunction « Diaphragm restriction 14 ATELECTASIS |) : TREATMENT ; ty 2-MINUTE TREATMENT * Thoracic pump 739.8 * Pedal pump 739.6 5-MINUTE TREATMENT «© Rib raising 739.8 * Abdomen—diaphragm =Doming technique 739.9 —Thoracolumbar junction: ME, MFR, HVLA 739.2, 739.3 = Costochondral margin and xyphoid process: CS, MFR 739.8 EXTENDED TREATMENT © Thoracic—MER 739.2 « Rilb dysfunction—ME 739.8 © Cervical—C2, C3-C5: MFR, ME, and/or FPR 739.1 * Head—vagus: OA release and/or V spread 739.0 © Abdomen and other viscerosomatic refleres—Chapman’s reflex for lung 739.9 15SS ih RESTS BELL'S PALSY & BASICS DESCRIPTION ‘A form of unilateral facial paralysis resulting from damage, trauma, ot entrapment at stylomastoid foramen of one of the facial nerves (CN Vil), 2) PHYSIOLOGY AND ASSOCIATED SOMATIC kW. pysFUNCTIONS PARASYMPATHETICS * Because the parasympathetic fibers to the lacrimal gland and the submandibular gland separate from CN Vil prior to exiting the stylomastoid foramen, these functions should be unaffected. However, irritation of the nerve may reflexively cause dysfunction of these glands, stimulating secretion from the submandibular, sublingual, and lacrimal glands, as well as the mucous membranes of the nasopharynx and hard and soft palates, © Facial nerve (CN Vil) — Cranial dysfunctions, especially of the temporal bones — Compression of occipitomastoid sutures SYMPATHETICS * Inhibit secretion from the submandibular, sublingual, and lacrimal glands, as well as the mucous membranes of the nasopharynx and hard and soft palates oT1-14 ~Tenderpoints = Tissue texture changes over transverse processes ~ Rotated vertebrae MOTOR * CN Vil—muscles of facial expression including frontalis and orbicularis oculi, muscles of the nasolabial folds, labial muscles, buccal muscles, posterior belly of the digastric muscles, and the platysma will all be paralyzed on the affected side. @) OTHER SOMATIC DYSFUNCTIONS © Somatic dysfunction of temporal bones © Posterior digastric muscle © TMJ—medial pterygoid muscles, glossal muscles, hyoid muscles, and fascial restrictions * Sternocleidomastoid hypertonicity (due to attachment to temporal bone) © Any cervical dysfunction * Lymphatic congestion of lymph nodes: preauricular and postauriculay, submaxillary and submental, supraclavicular 16 BELL'S PALSY TREATMENT 2-MINUTE TREATMENT # Head—Galbreath technique (mandibular drainage) 739.0 | 5-IMINUTE TREATMENT + Head—cranial dystunction (especially temporal dysfunction): vault hold/cranial treatment 739.0 BY EXTENDED TREATMENT * Head—OA release 739.0 * Head—compressed occipitomastoid suture: V spread 739.0 * Head—decreased CRI: V4 hold 739.0 © Cervical—FPR, ME, and/or MFR 739.1 * Thoracic—T1—T4: ME, MFR, and/or HVLA 739.2 * Head-—TMU: direct inhibition or CS to restricted muscle 739.0 * Abdomen—respiratory diaphragm: doming 739.9 © Head—PINS technique 739.0 * Cemvical—PINS technique 739.1 17CARPAL TUNNEL SYNDROME & BASICS DESCRIPTION Often a painful peripheral neuropathic condition of the hand and wrist accompanied by paresthesias and weakness in the distribution of the median nerve distal to the wrist. Caused by compression of the median nerve as it passes through the carpal tunnel. i) PHYSIOLOGY AND ASSOCIATED SOMATIC » DYSFUNCTIONS PARASYMPATHETICS Not applicable SYMPATHETICS * Increased tone = dilated arterioles of the muscles (cholinergic and adrenergic (2), constricted arterioles of the muscles (adrenergic cx) °15-17 — Tenderpoints ~ Tissue texture changes over transverse processes ~ Rotated vertebrae MOTOR © Median nerve (C5-T1)—distal to the wrist innervates the opponens pollicis muscle, superficial head of flexor pollicis brevis muscle, and first two lumbricles. Dermatomal pattem—palmar surface, distal first digit, second, third, and lateral half of fourth digit. — Displaced carpal bones — Edema of the distal upper extremity é) OTHER SOMATIC DYSFUNCTIONS * Hexor retinaculum (transverse carpal ligament) restriction * Interosseous membrane tenderpoints and fascial restrictions * Carpal bones: lunate and capitate anterior displacement Note: Rule out cervical radiculopathy and thoracic outlet syndrome. 18 CARPAL TUNNEL SYNDROME TREATMENT 2-MINUTE TREATMENT © Upper extremity—flexor retinaculum: MFR 739.7 =) 5-MINUTE TREATMENT « Upper extremity —carpal bone: ME, HVLA 739.7 + Thoracie—HVLA 739.2 EXTENDED TREATMENT « Cervical —C5-T1: FPR, MFR, and/or HVLA 739.1 Thoracic—FPR, MFR, and/or ME 739.2 © Upper extremity—interosseous membrane: C5, MFR 739.7 192 aE St EER CERVICAL SPONDYLOSIS ec BASICS DESCRIPTION A.condition of the intervertebral disks and the surrounding boney vertebrae in the cervical spine that most likely is caused by degenerative changas. |, PHYSIOLOGY AND ASSOCIATED SOMATIC . DYSFUNCTIONS PARASYMPATHETICS Not applicable SYMPATHETICS * Increased tone = dilated arterioles of the muscles (cholinergic and adrenergic 62), constricted arterioles of the muscles (adrenergic cx) * 71-15 ~Tenderpoints ~ Tissue texture changes over transverse processes — Rotated vertebrae MOTOR * CI-C8—nerve roots, spinal accessory nerve (CN Xi): levator scapula, fongus capitis, longus col, scalenes, splenius, sternocleidomastoid, rectus capitis ~Tenderpoints ~ Tissue texture changes aver cervical pillars — Rotated vertebrae ) OTHER SOMATIC DYSFUNCTIONS © Scalene hypertonicity, tenderpoints, and restricted motion ® Inhalation dysfunction of ribs 1 and 2 © Clavicle somatic dysfunction * Pectoralis minor hypertonicity, tenderpoints, and restricted motion * Levator scapulae hypertonicity, tenderpoints, and restricted motion Rhomboid hypertonicity, tenderpoints, and restricted motion * Teres major, teres minor, and latissimus dorsi tenderpoints and hypertonicity (posterior axillary region) 20 CERVICAL SPONDYLOSIS TREATMENT DY 2-MINUTE TREATMENT Le * Head—OA release 739.0, 739.1 © Ribs 1-2—FPR 739.8 ) 5-MINUTE TREATMENT A Cervical FPR and/or MFR 739.1 { J EXTENDED TREATMENT * Thoraci—ME, FPR, and/or MFR 739.2 © Upper extremity—pectoralis minor: CS, ME 739.7 * Cervical—scalene muscles: ME, CS 739.1 * Ribs 1-2—ME, HVLA 739.8 * Upper extremity—levator scapulae: C5, ME 739.7 * Upper extremity—shomboid: CS, ME 739.7 © Upper extremity—clavicle: MFR, ME 739.7 7 © Upper extremity—posterior axillary region tenderpoints and hypertonicity: CS 739.7 21CHOLECYSTITIS & BASICS DESCRIPTION Inflammation of the gallbladder D PHYSIOLOGY AND ASSOCIATED SOMATIC KW. DYSFUNCTIONS PARASYMPATHETICS ® Increased tone = contraction of gallbladder and bile ducts © Vagus nerve ~ OA, AA, C2 © Tenderpoints © Tissue texture changes over cervical pillars © Rotated vertebrae — Compression of occipitomastoid sutures as well as occipitoatlantoid joint SYMPATHETICS * Increased tone = relaxation of gallbladder and bile ducts ° 15-19 —Tenderpoints — Tissue texture changes over transverse processes ~ Rotated vertebrae * Celiac ganglion restriction MOTOR + C3-C5 (phrenic nerve to the diaphragm; dysfunction as a result of diaphragm irritation) = Tenderpoints ~ Tissue texture changes over cervical pillars — Rotated vertebrae ¢) OTHER SOMATIC DYSFUNCTIONS © Diaphragm—restriction of gross motion and at all attachments * Mid and lower rib dysfunction as a result of splinting * Celiac ganglion restriction © Left thoracic duct fascial restriction © Cisterna chyli fascial restriction 22 CHOLECYSTITIS TREATMENT 2-MINUTE TREATMENT © Thoracic—seated ME 739.2 5-MINUTE TREATMENT * Rib dysfunction —ME 739.8 * Abdomen—celiac ganglion: MFR 739.9 * Rib raising 739.8 EXTENDED TREATMENT © Head—vagus: OA release 739.0 * Cervical—C2; C3-C5: MFR, FPR, and/or HVLA 739.1 © Thoracic—T5-T9: MFR and/or HVLA 739.2 Abdomen—cisterna chyli and thoracic duct (lymphatic) 739.9 © Abdomen—diaphragm attachments (costal margins, T12/L1, xyphoid): MFR 739.9 * Abdomen—diaphragm: doming 739.9 * Abdomen—liver pump 739.9 * Abdomen/other/viscerosomatic—Chapman’s reflex for gallbladder and liver 739.9 Stomach (acidity) Stomach (peristalsis) Gallbladder Celiac ganglion’ > Umbilicus Superior mesenteric Inferior ganglion mesenteric ganglionCHRONIC COUGH & BASICS DESCRIPTION Cough recalcitrant to medical management for infection, gastroesophageal reflux disease, allergies, or reactive airway disease Fe) PHYSIOLOGY AND ASSOCIATED SOMATIC i) DYSFUNCTIONS PARASYMPATHETICS © Increased tone = thinning of secretions and relative bronchiole constriction © Facial nerve (CN Vil) © Vagus nerve = OA, AA, C2 © Tenderpoints © Tissue texture changes over cervical pillars © Rotated vertebrae ~ Compression of occipitomastoid sutures as well as occipitoatlantoid joint SYMPATHETICS * Increased tone = thickened secretions and bronchiole dilation °12-17 — Tenderpoints ~ Tissue texture changes over transverse processes — Rotated vertebrae @) OTHER SOMATIC DYSFUNCTIONS * Stemocleidomastoid—tenderpoints and hypertonicity © Scalenes—tenderpoints and hypertonicity * Anterior cervical tenderpoints © Anterior cervical fascial restriction © Rib dysfunctions © Thoracic outlet dysfunction ® Thoracoabdominal diaphragm dysfunction * Cranial dysfunctions 24 CHRONIC COUGH TREATMENT Y 2-MINUTE TREATMENT i © Cervical—anterior cervical fascia: MFR 739.1 ee I) 5-MINUTE TREATMENT + Cervical—ME, HVLA 739.1 + Thoracic—HVLA 739.2 By EXTENDED TREATMENT ié # Cervical—C, FPR, and/or MFR 739.1 * Thoracic—thoracic outlet release: MFR or ME 739.2 * Diaphragm = Doming technique 739.9 — Thoracolumbar junction: FPR, ME, MFR, HVLA 739.2, 739.3 © Head—OA release 739.0 ‘© Rib dysfunction—ME or HVLA 739.8 25,a CHRONIC OBSTRUCTIVE PULMONARY DISEASE & BASICS DESCRIPTION Used to describe emphysema (the destruction of interalveolar septa) and chronic bronchitis (increased mucus production and chronic cough). Characterized by airflow reduction that is not fully reversible with bronchodilators. DD PHYSIOLOGY AND ASSOCIATED SOMATIC 7! DYSFUNCTIONS PARASYMPATHETICS © Increased tone = thinning of secretions and relative bronchiole constriction * Vagus nerve — OA, AA, C2 © Tenderpaints © Tissue texture changes over cervical pillars SYMPATHETICS * Increased tone = thickened secretions and bronchiole dilation -12-17 © Tenderpoints © Tissue texture changes aver transverse processes © Rotated vertebrae MOTOR * C3-C5 (phrenic nerve to the diaphragm as a result of decreased excursion and overuse) ~ Tenderpoints ~ Tissue texture changes over cervical pillars — Rotated vertebrae g) OTHER SOMATIC DYSFUNCTIONS * Scalene hypertonicity and tenderpoints * Sternocleidomastoid hypertonicity and tenderpoints * Pectoralis minor hypertonicity and tenderpoints * Serratus anterior hypertonicity and tenderpoints * Inhalation-type rib dysfunctions © Thoracic inlet diaphragm dysfunctions * Flattened diaphragm with decreased excursion 26 CHRONIC OBSTRUCTIVE PULMONARY DISEASE TREATMENT 2-MINUTE TREATMENT * Head—OA release 739.0 © Cervical —MFR 739.1 © Thoracic—MFR 739.2 =) 5-MINUTE TREATMENT + Thoracic—ME or HVLA 739.2 * Rilb—ME or HVLA 739.8 + Addomen—diaphragm: doming technique 739.9 , » EXTENDED TREATMENT © Thoracolumbar—MER and ME 739.2, 739.3 © Cervical—ME, HVLA, or FPR 739.1 * Cervical—scalene: C5, MFR, or ME 739.1 * Cervical—stemocleidomastoid: CS, MFR, or ME 739.1 * Upper extremity-—pectoralis minor: CS, MFR, or ME 739.7 # Thoracic—serratus anterior: CS, MFR, or ME 739.2 Thoracic inlet—MFR 739.2 * Abdomen/otheriviscerosomatic—Chapman's reflex for lung 739.9 27COMMON COLD & BASICS DESCRIPTION Inflammation of the nasal passages and upper airway secondary to respiratory viruses 2) PHYSIOLOGY AND ASSOCIATED SOMATIC KD) pysFuNCTIONS PARASYMPATHETICS * Increased tone = significantly increased secretions of nasal, lacrimal, and submandibular glands * Facial (CN Vil), glossopharyngeal (CN IX)—cranial dysfunction * Vagus nerve (CN X) — OA, AA, C2 © Tenderpoints © Tissue texture changes aver cervical pillars © Rotated vertebrae ~ Compression of accipitomastoid sutures as well as occipitoatlantoid Joint SYMPATHETICS * Increased tone = vasoconstriction and slight secretions of nasal, lacrimal, and submandibular glands °Tt-17 ~Tenderpoints — Tissue texture changes over transverse processes — Rotated vertebrae MOTOR * C3-C5 (phrenic nerve to the diaphragm; irritation because of lung proximity) —Tenderpoints ~ Tissue texture changes over cervical pillars ~ Rotated vertebrae * Oculomotor (CN Ill, CN Vil, CN IX, CN X)—cranial dysfunction ¢) OTHER SOMATIC DYSFUNCTIONS © Eustachian tube dysfunction * Cranial dysfunction * Lymphatic congestion of lymph nodes: preauricular and postauricular, submaxillary and submental, supraclavicular * Anterior fascial restriction of the cervical region down into sternum with fesulting tenderpoints © Rib dysfunction 30 COMMON COLD TREATMENT Ty 2-MINUTE TREATMENT © Head—periauricular drainage technique 739.0 ; Head—supraorbital (CN V1), inforbital (CN V2), mental (CN V3): nerve stimulation 739.0 © Head—Galbreath technique (mandibular drainage) 739.0 5-MINUTE TREATMENT * Head—sphenopalatine ganglion stimulation 739.0 * Head-—cervical (OA, AA, C2): MFR, FPR, or HVLA 739.1 * Head-—Muncie technique 739.0 © Head—nasion gapping 739.0 EXTENDED TREATMENT © Thoracic—left thoracic duct: lymphatic 739.2 # Head—vagus: OA release 739.0 * Cervical—anterior cervical: MFR 739.1 # Abdomenvother—sternum: CS, MFR 739.8 * Thoracie—ME, MER, and/or HVLA 739.2 Rib dysfunction—ME 739.8 «© Rib raising 739.8 * Abdomen—diaphragm — Doming technique 739.9 —Thoracolumbar junction—ME, MFR, HVLA 739.2, 739.3 © Abdomen/other/viscerosomatic—Chapman’s reflex for ear andfor sinuses 739.9 31Ss nu UR Ce i eS STIR REISS COMPLEX REGIONAL PAIN SYNDROME (REFLEX SYMPATHETIC DYSTROPHY) & BASICS DESCRIPTION ‘A complex of signs and symptoms related to hypersympatheticatonia of one or more extremities characterized by pain, erythema, and edema, Commonly fallowing trauma to the affected limb classically after a crush injury, but also after surgery or other injury )’ PHYSIOLOGY AND ASSOCIATED SOMATIC y. DYSFUNCTIONS PARASYMPATHETICS Not applicable. Unopposed sympathetic tone to extremities key to this disease process. SYMPATHETICS * Increased tone = dilated arterioles of the muscles (cholinergic and adrenergic £2), constricted arterioles of the muscles (adrenergic «) © T5-T7—upper extremity —Tenderpoints — Tissue texture changes over transverse processes ~ Rotated vertebrae * T10-12—lower extremity — Tenderpoints — Tissue texture changes aver transverse processes — Rotated vertebrae MOTOR © C4-T1—nerve roots, upper extremity ~Tenderpoints —Tissue texture changes over cervical pillars ~ Rotated vertebrae * L1-S3lower extremity — Tenderpoints — Tissue texture changes over transverse processes — Rotated vertebrae ™ OTHER SOMATIC DYSFUNCTIONS © Upper and lower extremity lymphedema and fascial strains * Compensatory findings for antalgic gait or overuse syndromes of areas not directly atfected by complex regional pain syndrome 32 COMPLEX REGIONAL PAIN SYNDROME TREATMENT oa | 2-MINUTE TREATMENT © Thoracic—ME 739.2 * Lumbar—ME 739.3 + 5-MINUTE TREATMENT iy © Cervical—ME, FPR, MFR, or HVLA 739.1 E © Thoracic—FPR, MFR, or HVLA 739.2 aa) © Lumbar—FPR, MFR, or HVLA 739.3. © Sacrum—ME 739.4 5 EXTENDED TREATMENT + Upper extremity-—MFR, ymphatic 739.7 Lower extremity—MIFR, lymphatic 739.6 «© Rib raising 739.8CONGESTIVE HEART FAILURE & BASICS DESCRIPTION A dysfunction of the cardiac pump that results in insufficient blood flow to meet the metabolic requirements of the body oD PHYSIOLOGY AND ASSOCIATED SOMATIC 7) DYSFUNCTIONS PARASYMPATHETICS Increased tone = bradycardia © Vagus nerve — OA, AA, C2 © Tenderpoints ¢ Tissue texture changes over cervical pillars © Rotated vertebrae — Compression of occipitomastoid sutures as well as occipitoatlantoid joint SYMPATHETICS © Increased tone = tachycardia Ts ~Tenderpoints ~ Tissue texture changes over transverse processes ~ Rotated vertebrae MOTOR © C3-C5 (phrenic nerve to the diaphragm; irritation because of lung proximity) ~—Tenderpoints — Tissue texture changes over cervical pillars — Rotated vertebrae ¢) OTHER SOMATIC DYSFUNCTIONS * Dependent extremity edema Rib dysfunction Flattened diaphragm * Scalene hypertonicity and tenderpoints * Pectoralis minor hypertonicity and tenderpoints CONGESTIVE HEART FAILURE TREATMENT 2-MINUTE TREATMENT * Lower extremity—pedal pump 739.6 PY 5-MINUTE TREATMENT « Rib raising 739.8 sy EXTENDED TREATMENT * Head—vagus: OA release or V spread 739.0 * Head—decreased CRI: CV4 hold 739.0 * Abdomen—diaphragm ~Doming technique 739.9 —Thoracolumbar junction: ME, MFR, HVLA 739.2, 739.3 © Thoracic—MFR 739.2 « Rib dysfunction —ME 739.8 * Cervical—C2, C3-C5: MFR, ME, and/or FPR 739.0 « Lower extremities and upper extremities—effleurage 739.6, 739.7 * Cervical—scalenes: CS or ME 739.0 © Upper extremity—pectoralis minor: CS or MFR 739.7 © Abdomenvother/viscerosomatic—Chapman's reflex for heart 739.9 35CONSTIPATION & BASICS DESCRIPTION Infrequent or incomplete bowel movements D PHYSIOLOGY AND ASSOCIATED SOMATIC KW. DYSFUNCTIONS PARASYMPATHETICS ‘* Increased tone = increased peristalsis * Vagus nerve — OA, AA, C2 © Tenderpoints © Tissue texture changes over cervical pillars © Rotated vertebrae ~ Compression of occipitomastoid sutures as well as occipitoatlantoid joint * Pelvic splanchnics = Sacral dysfunctions ~ Innominate dysfunctions SYMPATHETICS * Increased tone = decreased peristalsis o 152 —Tenderpoints — Tissue texture changes over transverse processes — Rotated vertebrae * Superior and inferior mesenteric ganglia — Fascial restrictions @) OTHER SOMATIC DYSFUNCTIONS * Thoracoabdominal diaphragm dysfunction * Pelvic diaphragm dysfunction 36 CONSTIPATION TREATMENT ay *)) 2-MINUTE TREATMENT » Sacrum—sacral rocking 739.4 * Abdomen— Umbilicus Superior mesenteric Inferior ganglion mesenteric ganglion Intestine (peristalsis) UMDNJ 2007 42A DIARRHEA & BASICS DESCRIPTION ‘Abnormally high frequency and volume of bowel movements. May have functional, inflammatory, or infectious etiology. 2) PHYSIOLOGY AND ASSOCIATED SOMATIC KY) pysFUNCTIONS PARASYMPATHETICS * Increased tone = increased peristalsis * Vagus nerve —0A, AA, C2 © Tenderpoints © Tissue texture changes aver cervical pillars © Rotated vertebrae ~ Compression of occipitomastoid sutures as well as occipitoatlantoid joint * Pelvic splanchnics $254 — Sacroiliac dysfunctions SYMPATHETICS * Increased tone = decreased peristalsis © TS-12 ~Tenderpoints — Tissue texture changes over transverse processes — Rotated vertebrae © Celiac ganglion—fascial restriction © Superior mesenteric ganglion—fascial restriction * Inferior mesenteric ganglion—fascial restriction é) OTHER SOMATIC DYSFUNCTIONS * Associated rib dysfunctions * Thoracoabdominal diaphragm dysfunction © Pelvic diaphragm dysfunction 44 DIARRHEA TREATMENT_ 2-MINUTE TREATMENT * Thoracic—MFR 739.2 * Lumbar—MFR 739.3 5-MINUTE TREATMENT © Thotacic—ME or HVLA 739.2 © Lumbar—ME or HVLA 739.3 * Abdomen—collateral ganglia release 739.9 * Head—OA release 739.0 sy) EXTENDED TREATMENT # Head—V spread 739.0 © Cervical—FPR and/or HVLA 739.1 © Ribs—ME or HVLA 739.8 © Rib raising 739.8 * Sacrum—ME 739.4 * Innominate—ME 739.5 Abdomen/other/viscerosomatic—Chapman’s reflex 739.9 Stomach (acicity) Stomach (peristalsis) Gallbladder Celiac ganglion (A> Umbilicus Superior mesenteric Inferior ganglion mesenteric ganglion