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Spencer techniqu
ue with mu
uscle enerrgy treatm
ment (MET
T)– Upper extremityy
Figure 1 – e
extension Figuree 2 ‐ flexion
Figure 3 – circumduction Figuree 1 ‐ circumducttion with tractio
on
Copyrightt 2013 – New York Institute
e of Technolo
ogy College off Osteopathicc Medicine
Departmeent of Osteop
pathic Medicin ne
Figure 2 – abduction Figuree 3 ‐ adduction
Figure 4 – in
nternal rotation
n Figure 5 ‐ tractiion
Brief desscription: Traaditionally thee Spencer tecchnique uses 7 motions off the shoulderr to improve
glenohum
meral joint mo otion. The me o add an 8th m
ethod can also motion, adduction, and forr any of the
motions m
muscle energyy can be used d by having th
he patient pu sh against iso
ometric resisttance and re‐
engaging the barrier.
Physician
n position: SStanding, facinng the patient
Patient p
position: Lyinng on their sidde with the afffected shoullder up.
Hand positioning: Staabilize the scaapula with yoour cephalad hand and usee your caudadd hand to
maneuver the arm.
Techniqu
ue:
1. Sttabilize the sscapula.
2. Place the sho oulder into extension. Make sure youu go to the eend range off motion and
d do
th
his 7 times.
3. Place the sho oulder into flexion. Make
e sure you goo to the end
d range of motion and doo
his 7 times.
th
Copyrightt 2013 – New York Institute
e of Technolo
ogy College off Osteopathicc Medicine
Departmeent of Osteop
pathic Medicin ne
4. Do circumduction of the joint with the elbow flexed. Start with small circles and then
make bigger circles. Go in the clockwise direction 7 times and then counterclockwise
direction 7 times.
5. Now do circumduction with traction by extending the elbow and holding the arm near
the wrist. (Apply traction by gently pulling the arm towards the ceiling.) Start with small
circles and then make bigger circles. Go in the clockwise direction 7 times and then
counterclockwise direction 7 times.
6. Proceed to abduction by having the patient grab your cephalad forearm and then push
up on the elbow. Move the arm to its abduction barrier 7 times.
7. Next, adduct by having the patient grab your cephalad forearm and then push down on
the elbow. Move the arm to its adduction barrier 7 times. (This is an optional part of the
Spencer technique.)
8. Place the patient’s arm behind their back in order to internally rotate the arm. Be very
gently with this step. Pull the elbow towards you to induce the internal rotation. Again,
internally rotate the arm 7 times.
9. The final step is traction, place the patient’s hand on your shoulder and now grab the
upper arm with both hands. Apply traction 7 times in all directions.
10. To add muscle energy to any component of the Spencer technique, simply place the
patient in the barrier during that step of the technique and have the patient push
against you. Then re‐engage the barrier 2 more times with the patient again pushing
against isometric resistance for 3‐5 seconds. Finally, add a passive stretch before
continuing to the next step of the Spencer technique.
Models: Biomechanical, Respiratory‐Circulatory, Neurological, Metabolic‐Energy, Behavioral
Other notes: Mnemonic for remembering Spencer technique Step 1 “Shake hands with the patient,”
Step 2 “Let’s go for a walk,” Step 3 “Would you like an ice cream cone?” Step 4 “How about a tall ice
cream cone?” Step 5 “Do you like pistachio?” (Make the letter “P”), Step 6 “Don’t make me twist your
arm,” Step 7 “Let’s be friends.”
Copyright 2013 – New York Institute of Technology College of Osteopathic Medicine
Department of Osteopathic Medicine
Brief desscription: This tenderpoinnt (TP) is assocciated with thhe extensor ccarpi radialis m
muscle. The TTP is
located on
n the lateral aaspect of the elbow and iss treated by eextending, abd
ducting and ssupinating thee
forearm.
Physician
n position: SSeated
Patient p
position: Suppine
Hand positioning: Plaace one fingeer on the TP oon the lateral aspect of thee elbow.
Techniqu
ue:
Technique
e:
1.Loocalize the ttenderpoint and establissh the pain sscale.
2.Now extend,
N abduct and supinate the forearm soo that you fo old over the TP.
3.At the mobile
A e point, you want the paain to ideallyy be 0 out off 10.
4.Hold the posi
H ition for 90 sseconds.
5.Now place th
N e patient baack to neutraal and reasseess the pain before liftin
ng your fingeer off
thhe TP.
Models: Biomechaniccal
Copyrightt 2013 – New York Institute
e of Technolo
ogy College off Osteopathicc Medicine
Departmeent of Osteop
pathic Medicin ne
Brief desscription: This tenderpoinnt (TP) is assocciated with thhe coronoid. The TP is locaated on the m
medial
aspect of the cubital fo
ossa of the elb
bow and is treated by flexxing, pronating and compreessing to the
point.
Physician
n position: SSeated
Patient p
position: Suppine
Hand positioning: Plaace one fingeer on the TP oon the medial aspect of thee elbow in the cubital fosssa.
Techniqu
ue:
1. Lo ocalize the ttenderpoint and establissh the pain sscale.
2. Now maxima
N lly flex and p
pronate the forearm so that you fold over the TTP. Add
coompression down to the e TP as well.
3. At the mobile
A e point, you want the paain to ideallyy be 0 out off 10.
4. Hold the posi
H ition for 90 sseconds.
5. Now place th
N e patient baack to neutraal and reasseess the pain before liftin
ng your fingeer off
thhe TP.
Models: Biomechaniccal
Copyrightt 2013 – New York Institute
e of Technolo
ogy College off Osteopathicc Medicine
Departmeent of Osteop
pathic Medicin ne
Carpal spread – U
Upper extrremity
Brief desscription: Carpal spread oor release is useful in patie nt suffering ffrom carpal tuunnel syndrom
me, a
compresssion of the meedian nerve, aas well as pattients sufferinng from edem
ma of the hands, such as
pregnant patients. Sim
mply grasp the
e patient’s hand, extend thhe wrist and aapply pressurre over the fleexor
um while movving from medial to lateral.
retinaculu
Physician
n position: SSeated or stannding
Patient p
position: Seaated
Hand positioning: Hoold the patiennt’s hand withh the palm sidde up. Place aa thumb on eeach side of thhe
flexor retiinaculum so tthat you are o
on the carpal bones. Use t he rest of you
ur fingers to ggrasp the han
nd.
Techniqu
ue:
1. Grasp the pat
G tient’s hand and place your thumbs over the carpal bones.
2. Exxtend the paatient’s wrist.
3. Sttarting with your thumb bs medially aand while appplying presssure, move yyour thumbss out
laaterally.
4. Repeat several times until your feel tthat the flexoor retinaculu
um is less teense.
Models: Biomechaniccal and Respirratory‐Circulaatory
Copyrightt 2013 – New York Institute
e of Technolo
ogy College off Osteopathicc Medicine
Departmeent of Osteop
pathic Medicin ne