Authors

Al e x a n d e r S . N i c h o l a s D O , F AAO P r o f e s s o r an d C h a i r m a n D e p a r t m e n t o f O s t e o p a t h i c M a n i p u l a t iv e Me di ci ne , P hi la de lp hi a Co ll eg e of O st eo pa t h ic Medicine, Philadelphia, Pennsylvania E v a n A. N i c h o l a s D O Associate Professor D e p a r t m e n t o f O s t e o p a t h i c M a n i p u l a t iv e Me di ci ne , P hi la de lp hi a Co ll eg e of O st eo pa t h ic Medicine, Philadelphia, Pennsylvania

Secondary Editors
Donna Balado Acquisitions Editor Kathleen H. Scogna Development Editor Keith Donnellan Managing Editor Dovetail Content Solutions E m i l i e M o ye r Marketing Manager Eve Malakoff-Klein Production Editor Stephen Druding Design Coordinator Michael Ferreira Indexer M a r yl a n d C o m p o s i t i o n , I n c . Compositor R.R. Donnelley and SonsWillard Printer

Dedication
Dr. Nick I n 1 9 7 4 , t h e a u t h o r s ' f a t h e r , N i c h o l a s S . Ni ch ol as , D O , F A A O , c ha irm an of t h e O s t e op at hi c P r i n c i p l e s a n d P r a c t i c e D e p a r t m e n t a t P h il ad el ph ia Co ll eg e of O s t e op at hi c M ed ic in e ( P C O M ) p u b l i s h e d t h e f i r s t e d i t i o n o f A t l as o f O s t e op at hi c T ec hn iq ue s . Hi s go al was t o p u t i n t o p r i n t a n u m b e r o f t h e c o m m o n l y u se d os t e op at hi c m a ni pu la t i ve t e ch ni qu es of t ha t t im e. T h e y we r e t o b e u s e d b y m e d i c a l s t u de nt s t o ref er en ce t he t ec hn iq ue s b ei ng t a ug ht in t he c l a s s r o o m a n d t o s t a n d a r d i z e t h e t e c hn iq ue s s o t h at i n t he o ra l ex am i na t i on , t h e e va lu at io n o f t h e i r wo r k c o u l d b e m o r e o b j e c t i v e l y ev al ua t e d. N i c h o l a s S . N i c h o l a s , D O , a 1 9 3 9 g r a d ua t e of K irk s vi ll e Co ll eg e of O s t e op at h y, wa s a g e n e r a l p r ac t i t i o n e r wh o a l s o s p e c i a l i zed in i nd us t r ia l a nd s po rt s m ed ic in e. He u se d o s t e o p a t h i c t e c h n i q u e s r o u t i n e l y i n h i s pr ac t i ce , a nd b ec au se of t he c li ni ca l r es ul t s , he wa s v e r y e x c i t e d t o t e a c h t h e s e t e c h n i q u e s t o m ed ic al s t u de nt s. A f f e ct io na t e l y k n own as D r. N i c k t o h i s s t u d e n t s , h e b e g a n t e a c h i ng at P CO M in 1 94 6 a nd in 1 97 4 be cam e ch ai rm a n of t h e O s t e o p a t h i c P r i n c i p l e s a n d P r a c t i ce De pa rt m en t . I n 19 74 , h e en li st ed P C O M f ac ul t y m e m b e r s t o d e v e l o p a l i s t o f t e c h n i q ue s t o in cl ud e i n t h e or ig in al ed it io n of hi s at la s. T he se f a c u l t y m e m b e r s i n c l u d e d D a v i d H e i l i g, D O , F A A O ; R ob er t E ng la nd , D O , F A A O ; M ar vi n B l u m b e r g , D O , F A A O ; J e r o m e S u l m a n, D O ; a nd K at he ri ne E n gl an d, DO . T h e s t u d e n t s b e n e f i t e d , a n d t h e i r a t t em pt s t o l ea rn t he t e ch ni qu es wer e im p ro ve d, as wa s s e e n d u r i n g P C O M e x a m i n a t i o n s . A s wo rd of t h is t ex t sp re ad , P C O M a lum ni a nd ot he r o s t e o p a t h i c p h ys i c i a n s a l s o s a w a n e e d f or t hi s t e xt a s a re vi e w an d/ or r ef e re nc e of s t a n d a r d t e c h n i q u e s f o r t h e i r p r a c t i c e s . B ec au se of i ll ne ss , Dr . Ni ck wa s a bl e t o pr od uc e o n l y t wo e d i t i o n s o f h i s wo r k . O v e r t h e ye a r s , t h e a t l a s g a v e wa y t o vi de ot ap e d em o ns t r at io ns of t e ch ni qu es an d f ur t h er e d i t e d a n d e x p a n d e d v e r s i o n s o f t h e wri t t en t e ch ni qu es . F rom t he t im e of t h e in ce pt io n of t h e a t l a s , t h e n u m b e r o f n a m e d s t yl e s of os t e op at hi c t ec hn iq ue s b ei ng t au gh t i n os t e op at hi c m e d i c a l s c h o o l s h a s g r o wn f r o m a p p r o xim a t e l y t h re e t o t wel v e d is t i nc t l y nam ed s t yl es . M a n y o f t h e s t yl e s h a v e s i m i l a r i t i e s t h at ca n le ad t o c onf u si on , wh ic h i s wh y we h av e d e c i d e d t o e x p a n d t h e o r i g i n a l v e r s i o n a nd up da t e it t o t h e pr es en t l ev el of pr ac t i ce . W e d e d i c a t e t h i s b o o k t o o u r f a t h e r , wh o wo ul d m o st l ik el y ha ve wa n t e d t o de di ca t e it t o al l o f h i s f o r m e r s t u d e n t s a n d t o a l l t h e f ut u re o st eo pa t h ic ph ys ic ia ns he t ho ug ht wou l d a p p r e c i a t e a c o m p r e h e n s i v e wo r k o n o st eo pa t h ic m an ip ul at iv e t ec hn iq ue s.

Preface
O s t e o p a t h i c m e d i c i n e a s t a u g h t a n d p ra ct ic ed in t he U ni t e d S t a t e s at t he en d of t he 19 t h c e n t u r y t h r o u g h t h e b e g i n n i n g o f t h e 2 1s t c en t u r y h as un de rg on e m a n y c ha ng es . T h e e v o l u t i o n o f s c i e n t i f i c f i n d i n g s a n d u n d er st an di ng of b io lo gi c p ro ce ss es b y wh ic h t he b od y f u n c t i o n s a n d a t t e m p t s t o m a i n t a i n h ea lt h h as h ad a di re ct ef f e ct o n t h e wa y os t e op at hi c m e d i c a l c u rr i c u l a a r e d e v e l o p e d . D u r i n g o u r o s t e o p a t h i c m e d i c a l s c h o o l m at ri cu la t i on , we we r e t au gh t on l y t h re e or f o ur s e p a r a t e s t yl e s o f o s t e o p a t h i c t e c h n i qu e. S i nc e t ha t t im e , m an y ne w di ag no st ic an d t h e r a p e u t i c p r o c e d u r e s h a v e b e e n a d d ed t o t he arm am en t a ri um of o st eo pa t h ic t r ea t m e nt , a n d t h e r e ar e n o w o v e r a d o ze n i n d i v id ua l s t yl es . S om e of t h es e st yl es ar e ve r y s im i la r, a n d a s d e s c r i b e d i n t h e c h a p t e r s o f t h is a t l as , t h e y ha ve d ev el op ed b y nu an ce in t o d is t i nc t , i n d i v i d u a l l y n a m e d c a t e g o r i e s o f t e c h n iq ue . B e c a u s e o f t h e s e a d d i t i o n s a n d c h a n g es , b ot h os t e op at hi c m e di ca l st ud en t s an d p r a c t i t i o n e rs h a v e h a d a m u c h m o r e dif f ic ul t t im e t r yi n g t o le ar n an d r em em b er t he se t e c h n i q u e s , a n d p r a c t i t i o n e r s h a v e f a c ed an i nc re as in gl y c om pl ex p ro ce ss in d ec id in g wh ic h t e c h n i q u e i s c l i n i c a l l y i n d i c a t e d f o r a pa rt ic ul ar p at ie nt . T o ai d t h e s t u d y a nd p ra ct ic e, we h a v e g r a d u a l l y d e v e l o p e d a c o m p i l a t i o n of t ec hn iq ue s t ha t a re c om m on l y u se d b y o s t e o p a t h i c p h ys i c i a n s a n d t h a t a r e c l in ic al l y ef f e ct iv e. T he r es ul t of t h is ef f or t is t he A t l as of Osteopathic Techniques. A t P h i l a d e l p h i a C o l l e g e o f O s t e o p a t h i c M ed ic in e, a t r ad it io n of t e ch ni qu e a t l as g oe s ba ck t o a t l e a s t 1 9 4 9 wi t h t h e p u b l i c a t i o n o f O s t e op at hi c T ec hn iq ue s , b y S am u el R ub in st ei n, DO . I t wa s d e d i c a t e d t o t wo h i g h l y r e s p e c t e d ph ysi ci an s, O t t e rb ei n D re ss le r, D O , a nd Jo hn E i m e r b r i n k , D O . I n h i s p r e f a c e , D r . R ub in st ei n n ot ed , T he ne ce ss it y f or t h is t yp e of t e x t b o o k h a s b e c o m e i n c r e a s i n g l y a p p ar en t wit h t im e be ca us e of t h e ne ed t o h av e a v is ua l r e c o r d o f t h e v a r i o u s p h ys i c i a n a n d p a t i en t p os it io ns a nd f orc e ve ct or s a t pl a y. Ye t no ot he r e x a m p l e wa s r e a d i l y r e p r o d u c e d u n t i l N . S . N ic ho la s, D O , F A A O , p ub li sh ed hi s A t la s of Osteopathic Technique in 1974. T h r o u g h o u t o u r ye a r s o f t e a c h i n g , m an y p ra ct ic in g p h ys ic i an s h av e ask ed u s wh y t h er e we r e n o n e w e d i t i o n s o f t h e A t l a s o f O s t e op at hi c T ec hn iq ue . O ur i ni t i al an s we r wa s t ha t o t h e r t e x t s h a d b e e n p u b l i s h e d . H o wev er , t he se ref e re nc e t e xt bo ok s f oc us o n t h e p h i l o s o p h y a n d p r i n c i p l e s o f o s t e o p a t hi c m e di ca l pr ac t i ce an d in cl ud e o nl y a f ew us ef u l t e c h n i q u e s . T h e n e e d f o r a n u p d a t e d , c om p re he ns iv e a t l as of t ec hn iq ue s b ec am e i n c r e a s i n g l y c l e a r , a n d we h a v e r e s p o nd ed wit h a t e xt bo ok t ha t in cl ud es a st ra ig ht f or war d, h i g h l y o r g a n i z e d , a n d e a s i l y n a v i g a b l e com p en di um of o st eo pa t h ic t e ch ni qu es al on g wi t h t h e p h i l o s o p h y a n d p r i n c i p l e s t h a t s u p po rt t h em . T h is m a t e ri al i s in t e nd ed t o h el p s t u de nt s a n d p r a c t i t i o n e r s u n d e r s t a n d t h e r e a so ni ng be hi nd t h e pr oc ed ur es an d t he r am if ic at io ns of their use in the clinical setting. O n e o f t h e m a j o r i m p r o v e m e n t s i n t h e A t la s of O st eo pa t h ic T e ch ni qu es is t he p re se nt at io n o f m o r e t h an 1 0 0 0 c o l o r p h o t o s o f e v er y p ro ce du ra l s t e p in vo lv ed in e ac h t ec hn iq ue . T he p h o t o s f o r e a c h t e c h n i q u e a r e p l a c e d t og et he r o n t he s am e o r ad ja ce nt pa ge s, a lo ng wit h d e s c r i p t i v e t e x t , t o m a k e t h e b o o k e a s y t o u se i n t h e c li ni ca l se t t in g. T h e ne w ph ot os wer e c r e a t e d s p e c i f i c a l l y f o r t h i s a t l a s u n d er t h e di re ct io n of t h e au t h or s a nd a p rof es si on al

p h o t o g r a p h e r . A r r o ws a n d o t h e r a n n o t at io ns di re ct l y o n t h e p ho t o s gu id e t he r ea de r t hr ou gh t h e t e c h n i q u e s . T h e c l a r i t y o f t h e s e p h ot os an d t he ir a nn ot at io ns , c om b in ed wi t h t h ei r o r g a n i z a t i o n i n t o a n e a s y- t o - u s e f o r m a t , m ak e t hi s at la s a n ex t r em el y us ef u l t o ol i n bo t h t h e laboratory and the clinic. A l s o i n c l u d e d i n t h e a t l a s a r e t h e v a r io us d ia gn os t i c p ro ce du re s c om m on t o os t e op at hi c m e d i c i n e . T h e d e s c r i p t i o n s f o r t h e s e i nc lu de t he m usc ul osk el et al s t r uc t u ra l ex am i na t i on , r e g i o n a l r a n g e o f m o t i o n a s s e s s m e n t , la yer - b y- l a ye r p al pa t o r y ex am i na t i on , an d t he i n t e r s e g m e n t a l e x a m i n a t i o n o f t h e s p in al an d pe lv ic re gi on s. D ia gn os is is i nc lu de d s o t h e r e a d e r c a n r e l a t e t h e s p e c i f i c t r e a t m e nt t o t h e d ia gn os t i c c ri t e ri a t h at g ov er n i t s u se . T h is i s i m p o r t a n t , a s t h e p h ys i c i a n m u s t u n d er st an d t he n at ur e of t h e d ysf un ct io n a nd t h e t e c h n i q u e b e s t s u i t e d t o t r e a t i t s u c c e ssf ul l y. W e h a v e o r g a n i ze d t h i s a t l a s i n t o t wo se ct io ns : P a rt 1 , O s t e op at hi c P ri nc ip le s i n Di ag no si s, a n d P a r t 2 O s t e o p a t h i c M a n i p u l a t i v e T e ch ni qu es . T he o rd er of P ar t 1 is s im il ar t o h o w we p r e s e n t t h e m a t e r i a l t o o s t e o p a t h i c m ed ic al s t u de nt s a nd i s in k e ep in g wit h wh at we b el ie ve i s t h e m o s t a p p r o p r i a t e a n d s a f e m e t ho d of pe rf o rm in g t h e o st eo pa t h ic m usc ul osk el et al e x a m i n a t i o n . W e h a v e a r r a n g e d P a r t 2 i n wha t we co ns id er t h e cl as si ca l f orm a t , b y t e c h n i q u e st yl e , a s t h e r e a d e r s h o u l d f irs t de ci de on a s t yl e, t h en pr oc ee d t o t h e a p p r o p r i a t e c h a p t e r a n d t o t h e s p e c i f i c an at om i c re gi on wit hi n t ha t ch ap t e r. W e h o p e t h a t t h e r e a d e r wi l l f i n d t h i s us ef u l in a ll s t a ge s of os t e op at hi c e du ca t i on : u n d e r g r a d u a t e , p o s t g r a d u a t e r e s i d e n c y, an d co nt in ui ng m ed ic al e du ca t i on . W e ho pe us e of t h i s t e x t wi l l i n s t i l l m o r e c o n f i d e n c e i n p erf o rm i ng t he se t e ch ni qu es an d t h er eb y h el p r e a d e r s t o b e t t e r h e l p p a t i e n t s . A s p h ysi ci an s, we a re t r ai ne d t o u se ou r m in ds a nd h an ds , a n d a s o s t e o p a t h i c p h ys i c i a n s , we a r e f req ue nt l y rem i nd ed t h at i t is i nh er en t t o ou r pr ac t i ce t o d o s o . A s t h e s e a l o f P h i l a d e l p h i a Co ll eg e of O s t e op at hi c Me di ci ne st at es , M en s e t Manus. A . S . Ni ch ol as E . A . Ni ch ol as

Acknowledgments
T h e A t l a s o f O s t e o p a t h i c T e c h n i q u e s i s ou r ef f or t t o m ai nt ai n a h is t o ri ca l c on t i nu um of t he m a n y v a r i a t i o n s o f o s t e o p a t h i c m a n i p ul at iv e t ec hn iq ue s t ha t h av e be en us ed f o r ov er a c e n t u r y i n t h e U n i t e d S t a t e s a n d n o w i n m an y o t h er co un t r ie s. W e o bv io us l y h av e n ot i n v e n t e d a n y t e c h n i q u e s , n o r h a v e a n y b ee n nam ed af t e r us . T h e m an y os t e op at hi c p h ys i c i a n s wh o h a v e p r e c e d e d u s i n t o t hi s pr of e ss io n ha ve t a ug ht u s t he se t ec hn iq ue s, an d we h o p e t h a t t h i s m a y c o n t i n u e t h e i r l eg ac y. A f e w p h ys ic i a n s m u s t b e p a r t i c u l a r l y t ha nk e d. F ir st , we m u st r ec og ni ze o ur f at h er , N i c h o l a s S . N i c h o l a s . O v e r m a n y ye a r s of wit n es si ng hi s pa t i en t s ' o ve r whe lm in gl y po si t i ve f e e l i n g s a b o u t t h e c a r e t h e y r e c e i v e d at h is ha nd s, we co ul d n ot c ho os e a n y o t h er f orm of o c c u p a t i o n , a s t h e y j u s t s e e m e d m i n o r com pa re d t o t h e wor k h e di d. S e co nd , we m u st t ha nk D a v i d H e i l i g . O u r f a t h e r m a n y t i m e s s t at ed t ha t H ei li g was t h e m os t ab le p h ysi ci an he h ad e v e r s e e n wi t h o s t e o p a t h i c d i a g n o s i s a nd t ec hn iq ue . W e wer e lu ck y en ou gh t o k no w him a s c h i l d r e n a n d l a t e r t o b e t a u g h t b y h i m . W e t he n wo rk ed si de - b y- s id e f or m or e t h an 2 5 ye ar s, s h a r i n g i d e a s a n d t e c h n i q u e s . W e we re bl es se d t o be h is f ri en ds . W al t e r E h r e n f e u c h t e r , o u r f r i e n d a n d c ol le ag ue f or m an y yea rs , m us t al so be r ec og ni ze d, as h e h e l p e d i n d e v e l o p i n g t h e s t yl e o f t hi s a t l as a nd p ut t o p en m a n y of t h e t ec hn iq ue s i n ou r o r i g i n a l m a n u a l s a t P C O M . H i s u n d e r st an di ng of m usc le e ne rg y t ec hn iq ue was sp ec if ic al l y u s e d a s a m o d e l i n d e v e l o p m e n t o f t ha t ch ap t e r, an d hi s im p ri nt c an b e f ou nd i n o t h er c h a p t e r s a s we l l . W e m u s t t h a n k o t h e r s wh o h a v e i n f l u e nc ed u s a s ro le m o de ls , t e ac he rs , a nd p ra ct it io ne rs B e r yl A r b u c k l e , M a r v i n B l u m b e r g , A l b e rt D' A l on zo , He nr y D 'A lo nzo, F a irm a n De nl in ge r, K a t h e r i n e E n g l a n d , R o b e r t E n g l a n d , W ayne E ng li sh , R ob er t K a pp le r, A n t h on y L eo ne , P au l T . L l o yd , R o b e r t M e a l s , I d a S c h m i d t , E d war d S t il es , Jam e s S t ook e y, Je rom e S u lm an , G al en D . Yo u n g , G a l e n S . Y o u n g , a n d A b r a h am Z e ll is f o r al l of t he ir s up po rt an d h el pf ul c o m m e n t s o v e r t h r e e d e c a d e s . M o r e re ce nt l y, we ha ve ha d im p or t a nt i np ut f rom o ur f ri en ds a n d a s s o c i a t e s D e n i s e B u r n s , W i l l i a m T h om a s Cr o w, Jo hn Jo ne s, a nd Mi ch ae l K u ch er a. W e c a n n o t f o r g e t t h e m a n y u n d e r g r a d ua t e P CO M os t e op at hi c m a ni pu la t i ve m e di ci ne f e ll o ws wh o h a v e b e e n a s s o c i a t e d wi t h t h i s e f f or t . E ve r yo n e a ss oc ia t e d wit h ou r de pa rt m en t ha s h a d s o m e ef f e c t o n t h e o u t c o m e , b u t s om e sh ou ld be s in gl ed ou t f or t h ei r o ri gi na l id ea s, e d i t i n g , p h o t o l a yo u t s , a r t wo r k , a n d g ra ph ic s on t h e m an ua ls t ha t pr ec ed ed an d e ve nt ua ll y c u l m i n a t e d i n t h i s a t l a s : S a n d r a R a n i e ri -C os t a , Da ni el Cs as za r, T od d F ea t h er s, T ro y H e n n i n g , P a yc e H a n d l e r - H a l y, T h o m a s Ha l y, S h er yl L yn n O le sk i, C on ce t t a O t e ri , T a ra H e i n z - L a wl o r , D a v i d G l u s k o , D a v i d K el le r, L au re n N ot o- B el l, F ra nc is co L ab o y, S co t t P e e r e n b o o m , D a n i e l l e C a m p b e l l , R i c ha rd S l oa n, E un S t ra wse r, an d K e ll i Yo un g. S p ec ia l t h a n k s t o K yl i e J o h n s t o n - K a n z e f o r h e r wo rk on t he c ra ni al ch ap t e r. T h a n k s t o o u r o t h e r P C O M s t u d e n t s wh o p ut in t im e he lp in g wi t h t h is p ro je ct : N im i P a t e l a n d N i c h o l a s R o s s i ( m o d e l s ) ; K a t e S t o r y, A sh le y P a le se , an d A m a nd a S ch om p er t (e di t i ng ); B r a d T a i c h e r ( c o m p u t e r s k i l l s ) ; a n d P at ri ck S ot o a nd J us t i n S n yd er (m e di ca l il lu st ra t i on ). A p p r e c i a t i o n t o D o n n a B a l a d o f o r b r i ng in g t hi s po ss ib il it y t o L ip pi nc ot t W illiam s & W ilk ins a n d t h a n k s t o K e i t h D o n n e l l e n a n d B r et t Ma cN au gh t o n f o r t h ei r pr od di ng , e di t i ng , a nd

i l l u s t r a t i n g , wh i c h f i n a l l y m o v e d t h i s pr oj ec t t o com pl et io n, a s wel l a s h el pi ng t o g iv e it i t s distinctive look.

W e also must thank our wives, Benita and Vicki, for their patience with us during this enterprise.

List of Tec hniques Cha pter 3 Forward Bending and Backward Bending (Flexion and Extension), Active Forward Bending and Backward Bending (Flexion and Extension), Passive Side Bending, Active and Passive Rotation, Active and Passive T1 to T4 Side Bending, Passive T5 to T8 Side Bending, Passive T9 to T12 Side Bending, Passive T9 to T12 Rotation, Active T9 to T12 Rotation, Passive Forward Bending and Backward Bending (Flexion and Extension), Active Side Bending, Active Side Bending, Passive, with Active Hip Drop Test 18 19 20 21 22 23 24 25 26 27 28

29

Cha pter 5

L1 to L5-S1 Rotation, Short-Lever Method, Prone (L4 Example) L1 to L5-S1 Side Bending, Translational Short-Lever Method, Prone (L4 Example) L1 to L5-S1 Type 2, Extension (Sphinx Position) and Flexion, Prone L1 to L5-S1 Passive Flexion and Extension, Lateral Recumbent Position L1 to L5-S1 Passive Side Bending, Lateral Recumbent Position (L5-S1 Example) T1 to T4 Side Bending, Lateral Recumbent Position (Long Lever) T1 to T4 Passive Flexion, Extension, Side Bending, and Rotation, Seated, Long-Lever Method T1 to T12 Passive Flexion and Extension, Translatory Method, Seated (T6-T7 Example) T1 to T12 Translatory Method (Passive Side Bending), Seated T1 to T12 Prone Short-Lever Method, Passive Rotation, Side Bending (Example T7) T8 to T12 Long-Lever Method, Passive Flexion and Extension, Lateral Recumbent T8 to T12 Long-Lever Method, Passive Side Bending, Lateral Recumbent Upper Ribs 1 and 2, Supine Method First Rib, Elevated, Seated Method Upper Ribs 3 to 6, Supine Method Lower Ribs 7 to 10, Supine Method Floating Ribs 11 and 12, Prone Method Occipitoatlantal Articulation (Occiput-C1), Type I Coupling Motion Atlantoaxial Articulation (C1-C2), Rotation

37 38 39 40 42 43 44 46 47 48 49 50 54 55 56 57 58 60 62

Atlantoaxial (C1-C2), Supine, with Flexion Alternative C2 to C7 Articulations, Short-Lever Translatory Effect, Type II Motion C2 to C7 Articulations, Long-Lever Method, Type II Motion (e.g., C3SRRR or SLRL) Pelvis on Sacrum (Iliosacral), Anteroposterior Rotation, Supine, Long Lever (Leg Length) Sacroiliac Joint and Pelvic Dysfunctions, Pelvic (e.g., Innominate Rotation, Shear, InflareOutflare), Standing Flexion Test Sacroiliac Joint and Pelvic Dysfunctions, Pelvic (Innominate) or Sacral, Seated Flexion Test Sacroiliac Joint Motion, Pelvis on Sacrum (Iliosacral Dysfunction), Anteroposterior Rotation Prone, Long Lever Sacroiliac Joint Motion, Pelvis on Sacrum (Iliosacral Dysfunction), Inflare-Outflare Prone, Long Lever Sacroiliac Joint Motion, General Restriction, Prone, Short Lever Sacroiliac Joint Motion, General Restriction or Anteroposterior Rotation, Supine, Short Lever

63 64 65 66

67 68

69

70 71

72

Cha pter 7

Traction, Supine Forward Bending (Forearm Fulcrum), Supine Forward Bending (Bilateral Fulcrum), Supine Contralateral Traction, Supine Cradling with Traction, Supine Suboccipital Release, Supine Rotation, Supine Supine, Forefingers Cradling Thumb Rest, Supine Coupling with Shoulder Block, Supine Lateral Traction, Seated (Example: Left Cervical Paravertebral Muscle Hypertonicity, Fascial Inelasticity, and Others) Sitting Traction (Example, Using Right Knee) Head and Chest Position, Seated Prone Pressure Prone Pressure with Two Hands (Catwalk) Prone Pressure with Counterpressure Side Leverage, Lateral Recumbent Bilateral Thumb Pressure, Prone Trapezius, Inhibitory Pressure, Supine Upper Thoracic with Shoulder Block, Lateral Recumbent

81 82 83 84 85 86 87 88 89 90

91 92 93 94 95 96 97 98 99 100

Cha pter 8 Supine Cradling Thoracic Inlet and Outlet, Seated Steering Wheel Prone Bilateral Sacroiliac Joint with Forearm Pressure, Supine Prone Interosseous Membrane, Seated Supine Leg Traction 118 119 120 121 122 123

124

Cha pter 9

AC1 AC2 to AC6 AC7 (Sternocleidomastoid Muscle) AC8 PC1 Inion PC1 and PC2 PC3 to PC7, Midline PC3 to PC7, Lateral AT1 and AT2 AT1 to AT6 AT3 to AT4, Alternative Technique AT7 to AT9 AT 9 to AT12 PT1 to PT4, Midline PT1 to PT6, Midline PT7 to PT9, Midline PT4 to PT9, Lateral PT4 to PT9, Lateral PT9 to PT12 Anterior Rib, Exhaled and Depressed, AR1 and AR2

136 138 139 140 142 143 144 145 147 148 149 150 151 153 154 155 156 157 158 160

Cha pter 10

Trapezius Muscle Spasm (Long Restrictor): Post Isometric Relaxation Left Sternocleidomastoid Spasm (Acute Torticollis): Reciprocal Inhibition Left Sternocleidomastoid Contracture (Chronic): Post Isometric Relaxation Cervical Range of Motion: Oculocervical Reflex Occipitoatlantal (C0-C1) Dysfunction, Example: CO ESLRR, Post Isometric Relaxation Occipitoatlantal (C0-C1) Dysfunction, Example: CO FSLRR, Post Isometric Relaxation Atlantoaxial (C1-2) Dysfunction, Example: RL, Post Isometric Relaxation C2C7 Dysfunction, Example: C3-FSRRR, Post Isometric Relaxation T1T4 Dysfunction, Example: T4-ESRRR, Post Isometric Relaxation T1T6 Dysfunction, Example: T4-FSRRR, Post Isometric Relaxation T5T12 Dysfunction, Example: T8 ESRRR, Post Isometric Relaxation Right First Rib, Inhalation Dysfunction: Respiratory Assist, Seated Right First Rib, Inhalation Dysfunction: Respiratory Assist, Supine Right Ribs 1 and 2, Inhalation Dysfunction: Post Isometric Relaxation to Relax Scalene Muscles, Seated Right Ribs 1 and 2, Inhalation Dysfunction: Post Isometric Relaxation to Relax Scalene Muscles, Supine Right Ribs 2 to 6, Inhalation Dysfunction: Respiratory Assist Right Ribs 7 to 10, Inhalation Dysfunction: Respiratory Assist Right Ribs 11 and 12, Inhalation Dysfunction: Respiratory Assist Right Ribs 1 and 2, Exhalation Dysfunction: Contraction of Scalene Muscles Mobilizes Dysfunctional Ribs

184 185 186 187 188 190 192 193 194 196 198 200 201

202

203 204 205 206

208

Cha pter 11

Occipitoatlantal (C0C1, OA) Dysfunctions, Example: OA, F/E/or N-SLRR Atlantoaxial (C1C2, AA) Dysfunction, Example: C1 RL C2 to C7 Dysfunctions, Example: C4 FSLRL, Short-Lever, Rotational Emphasis C2 to C7 Dysfunctions, Example: C5 ESRRR, Long-Lever Rotational Emphasis C2 to C7 Dysfunctions, Example: C5 NSLRL, Short-Lever Technique, Side-Bending Emphasis T1 to T12 Dysfunctions, Example: T4 FSLRL, Supine T1 to T12 Dysfunctions, Example: T9 ESRRR, Supine T1 to T8 Dysfunctions, Example: T2 FSLRL, Supine Over the Thigh T3 to T8 Dysfunctions, Example: T6 FSRRR, Prone T1 to T4 Dysfunctions, Example: T2 FSRRR, Prone (Long Lever) T8 to T12 Dysfunctions, Example: T9 ESRRR, Seated (Short Lever) T8 to T12 Dysfunctions, Example: T10 ESRRR, Seated (Long Lever) Right First Rib Inhalation Dysfunction, Seated Left First Rib Inhalation Dysfunction, Supine Left Rib 6 Inhalation Dysfunction, Supine Left Rib 8 Exhalation Dysfunction, Supine Right Ribs 11 and 12 Inhalation Dysfunction, Prone Right Ribs 11 and 12 Exhalation Dysfunction, Prone L1 to L5 Dysfunctions, Example: L5 NSLRR, Lateral Recumbent (Long Lever) L1 to L5 Dysfunctions, Example: L4 FRRS, Lateral Recumbent (Long Lever)

278 280 281 282 283 284 286 288 289 290 291 292 293 294 295 296 297 298 299 300

Cha pter 12 Right: Suboccipital Muscle Hypertonicity C2 to C4 Dysfunction Example: C4 FSRRR T4 to T12 Dysfunctions Example: T6 ESRRR Right-Sided Trapezius Muscle Hypertonicity Left First Rib Dysfunction, Posterior Elevation: Nonrespiratory Model, Soft-Tissue Effect Left Seventh Rib, Inhalation Dysfunction L1 to L5 Dysfunctions Example: L3 NSLRR L1 to L5 Dysfunctions Example: L4 FSRRR Left-Sided Erector Spinae Muscle Hypertonicity Left Posterior Innominate Dysfunction Left Anterior Innominate Dysfunction 334 335 336 337 338 339 340 341 342 343

344

Cha pter 13

Occipitoatlantal (C0C1, OA) Dysfunction, Example: C0 ESRRL, Seated Atlantoaxial (C1C2) Dysfunction, Example: C1 RL, Supine C2 to C7 Dysfunction, Example: C4 ESRRR, Supine T1 and T2 Dysfunctions, Example: T1 ERRSR, Seated T1 and T2 Dysfunctions, Example: T2 FRLSL, Supine T3 to T12 Dysfunctions, Example: T5 NSLRR, Seated First Rib Dysfunction, Example: Right, Posterior, Elevated First Rib (Nonphysiologic, Nonrespiratory) First or Second Rib, Example: Left, First Rib Exhalation Dysfunction, Seated First Rib, Example: Right, First Rib Exhalation Dysfunction, Seated L1 to L5 Dysfunctions, Example: L4 NSRRL, Supine L1 to L5 Dysfunctions, Example: L3 ESRRR, Lateral Recumbent Innominate Dysfunction, Example: Right Anterior Innominate, Modified Sims Position Innominate Dysfunction, Example: Right Posterior Innominate, Modified Sims Position Elbow: Radial Head, Pronation Dysfunction Elbow: Radial Head, Supination Dysfunction Acromioclavicular Joint, Example: Right Distal Clavicle Elevated Acromioclavicular Joint, Example: Right, Proximal Clavicle Elevated (Distal Clavical Depressed) Cha pter 14

349 350 351 352 353 354

355 356 357 358 359 360 361 362 363 364

365

Occipitoatlantal (C0C1, OA) Dysfunction, Example: C0-C1 ESLRR Atlantoaxial (C1C2, AA) Dysfunction, Example: C1 RR Atlantoaxial (C1C2) Dysfunction, Example: C1 Right, Lateral Translation C2 to C7 Dysfunction, Example: C4 ESRRR T1 and T2 Dysfunctions, Example: T1 FSRRR Anterior Cervical Fascia, Direct Technique T3 to L4, Example: T12 ESLRL T8 to L5, Example: L5 FSRRR with Sacral Tethering First Rib Dysfunction, Example: Left, Posterior, Elevated First Rib (Nonphysiologic, Nonrespiratory) Dysfunction of the Respiratory Diaphragm and/or Exhalation Dysfunction of the Lower Ribs Clavicle: Left Sternoclavicular Dysfunction (Direct Method) Shoulder: Spasm in the Teres Minor Muscle (Direct Method) Shoulder: Glenohumeral Dysfunction Forearm and Elbow: Ulnohumeral and Radioulnar Dysfunctions Wrist: Carpal Tunnel Syndrome Hypertonicity of the External Hip Rotators and Abductors of the Femur (Example: Piriformis Hypertonicity and Fibrous Inelasticity) Knee: Posterior Fibular Head Dysfunction Knee: Femorotibial Dysfunctions, Example: Sprain of the Cruciate Ligaments

370 371 372 373 374 375 376 377

378 379 380 381 382 383 384

385 386 387

Gastrocnemius Hypertonicity, Direct Method Ankle: Posterior Tibia on Talus Foot and Ankle, Example: Left Calcaneus Dysfunction, the Boot Jack Technique Foot Dysfunction: Metatarsalgia Foot: Plantar Fasciitis, Direct Method

388 389 390 391

392

Cha pter 15 Occipitomastoid Suture Pressure Alternating Pressure, Left Second Rib Singultus (Hiccups) Rib Raising Colonic Stimulation Splenic Stimulation Sacral Rock Gastric Release Hepatic Release Gallbladder Kidney Release 398 400 402 404 405 406 407 408 409 410

411

Cha pter 16

Anterior Cervical Arches: Hyoid and Cricoid Release Cervical Chain Drainage Technique Mandibular Drainage: Galbreath Technique Auricular Drainage Technique Alternating Nasal Pressure Technique Submandibular Release Trigeminal Stimulation Technique Maxillary Drainage: Effleurage Frontal Temporomandibular Drainage: Effleurage Thoracic Inlet and Outlet: Myofascial Release, Direct or Indirect, Seated, Steering Wheel Technique Thoracic Inlet and Outlet: Myofascial Release, Direct, Supine Miller Thoracic (Lymphatic) Pump Miller Thoracic (Lymphatic) Pump, Exaggerated Respiration Thoracic (Lymphatic) Pump, Side Modification Thoracic (Lymphatic) Pump, Atelectasis Modification Pectoral Traction: Pectoralis Major, Pectoralis Minor, and Anterior Deltoid Anterior Axillary Folds: Pectoralis Major and Anterior Deltoid Muscles Doming the Diaphragm Rib Raising: Bilateral Upper Thoracic Variation

416 417 418 419 420 421 422 424 425

426 427 428 429 430 431 432 433 434 436

Marian Clark Drainage Mesenteric Release, Small Intestine Mesenteric Release, Ascending Colon Mesenteric Release, Descending Colon Presacral Release, Direct or Indirect Ischiorectal Fossa Release, Supine Ischiorectal Fossa Release, Prone Pedal Pump (Dalrymple Technique), Supine Pedal Pump (Dalrymple Technique), Prone Variation Hip, Indirect LAS/BLT, Supine Popliteal Fossa Release, Supine

437 438 440 442 444 445 446 447 448 449

450

Cha pter 17

Shoulder Girdle: Spencer Technique Stage 1Shoulder Extension with Elbow Flexed Shoulder Girdle: Spencer Technique Stage 2Shoulder Flexion with Elbow Extended Shoulder Girdle: Spencer Technique Stage 3Circumduction with Slight Compression and Elbow Flexed Shoulder Girdle: Spencer Technique Stage 4Circumduction and Traction with Elbow Extended Shoulder Girdle: Spencer Technique Stage 5AAbduction with Elbow Flexed Shoulder Girdle: Spencer Technique Stage 5BAdduction and External Rotation with Elbow Flexed Shoulder Girdle: Spencer Technique Stage 6Internal Rotation with Arm Abducted, Hand Behind Back Shoulder Girdle: Spencer Technique Stage 7Distraction, Stretching Tissues, and Enhancing Fluid Drainage with Arm Extended Hip Girdle: Spencer Technique Stage 1Hip Flexion Hip Girdle: Spencer Technique Stage 2Hip Extension Hip Girdle: Spencer Technique Stages 3 and 4Circumduction Hip Girdle: Spencer Technique Stages 5 and 6Internal and External Rotation Hip Girdle: Spencer Technique, Stages 7 and 8Abduction and Adduction Elbow: Radioulnar Dysfunction, Long Axis, Pronation Dysfunction (Loss of Supination), Muscle Energy, HVLA Elbow: Radioulnar Dysfunction, Long Axis, Supination Dysfunction (Loss of Pronation), Muscle Energy, HVLA Right Anterior Innominate Dysfunction: HVLA with Respiratory Assistance, Leg-Pull Technique

456 457

458

459 460

461

462

463 464 465 466 467 468

469

470

471

C2 to C7, Articulatory, Type 2 Motion T1 to T4, Articulatory, Side Bending

472

473

Cha pter 18 Cranial Vault Hold Fronto-occipital Hold Sacral Hold Decompression of the Occipital Condyles Occipitoatlantal Decompression Compression of the Fourth Ventricle Interparietal Sutural Opening (V-Spread) Sutural Spread (V-Spread, Direction-of-Fluid Technique) Venous Sinus Drainage Unilateral Temporal Rocking Example: Left Temporal Bone in External or Internal Rotation Frontal Lift Parietal Lift 481 482 483 484 485 486 488 489 490 492 493