The Use of Seated Facet Release in...

The Use of Seated Facet Release in Children• Karen M. Steele, DO, FAAO

• Professor Emerita, West Virginia School of Osteopathic Medicine

• Former AAO President

Outline of lab

• Pedigree

• Basic Principles

• Diagnosis and treatment with SFR• Lumbar

• Thoracic

• Cervical

• First rib

• Questions

• Recognitions

One of the technique approaches used by Andrew Taylor Still

“Tell them your pedigree, child” “Adopted” into the Still family September 10, 2009

3With permission of Mrs. Roberta Still, widow of Richard H. Still, Jr, DO

Basic Principles of SFR

4

• Child is seated, either on the treatment table on the parent’s lap

• Practitioner stands or sits behind the child

• Practitioner gently guides child into the position which matches the force within the restricted facet joint, then maintains gentle continuous compressive force at the facet, while moving the facet against the barrier

• The child is kept upright during the entire treatment, necessitating the perfect balance of forces at the restricted facet

• Children do not sit quietly. Move with the child while maintaining the force balanced on the restricted facet

Basic Principles of SFR

• First make a proper diagnosis. Determine if SFR is indicated and nothing else is contributing to the child’s problem that needs medical or surgical attention.

• Indications & Contraindications• Indications

• Facet joint restriction

• Contraindications• Joint inflammation

• Fracture

• Severe osteoporosis

• Bony malignancy

5

Basic Principles of SFR: a different paradigmNot based on Fryette’s Laws of physiologic motion…

…but rather of facets restricted in opening or closing

6

Pocket Manual of OMT 2010

Pocket Manual of OMT 2011 By permission, WVSOM

Basic principles of SFR: Lumbar spine

The child may be seated on the table or on the parent’s lap. Bring the child’s back near you.

Place the child’s hands in their lap

7

© 2015

© 2015

© 2015


• Gently guide the child into lumbar extension, by pushing anteriorly in the mid-lumbar area.

• Place your other hand on their shoulder

© 2015


• Place knuckles over facets to be tested/treated, keeping the wrist straight and the elbow extended

By permission, WVSOM

© 2015


• Localize the knuckles of one hand over the restricted facet and provide an anterior force into the facet to be tested

• Place the other hand on the child’s shoulder and provide slight downward and medial compression into the facet to be tested

• Hyperextend the lumbar facets over your knuckles, individually

• Note motion characteristics during extension (facet closing) and recoil to neutral (facet opening)

© 2015


• To treat the lumbar spine with SFR, exaggerate lumbar extension while pushing anteriorly into the restricted facet with your knuckles

• With your hand on the child’s shoulder, compress across the torso into the restricted facet and also compress inferiorly into the restricted facet. This provides localization in all 3 planes of restriction

• Pull the child into exaggerated extension while maintaining all forces localized to the facet being treated.

• Gently allow recoil at that facet by slightly reducing the forces into the facet

• Repeat this procedure until the facet moves freely in flexion and extension

© 2015

Basic principles of SFR: Thoracic spine

• Sit/stand behind the seated child. Have the child come close to the edge of the table and rest their hands on their lap.

• Place your ipsilateral forearm anterior to the child’s shoulder and your contralateral thumb on the facet to be palpated

© 2015© 2015


• Place your torso into lumbar extension and have the child lean back onto your abdomen

• Provide inferior and medial force into the facet to be tested with your ipsilateral forearm and enough anterior force with your palpating thumb to be able to perceive facet movement.


© 2015

Basic principles of control of the seated patient: Thoracic spine• Control the child’s ipsilateral

shoulder by pinning it between your forearm and torso

• Pull the child into rotation and side bending toward you while maintaining all forces localized to the facet being tested



© 2015


• Palpate each facet joint with the thumb while inducing rotation and side bending toward you at that facet joint with your forearm on their shoulder

• Movement into the facet is controlled by your torso and lumbar movements, while holding the forces on the child’s torso constant


© 2015

Basic principles SFR: Thoracic spine

• To treat the thoracic spine with SFR, exaggerate thoracic side bending and rotation at that facet level while pushing the facet anteriorly with your abdomen to induce extension at the facet to be treated. This provides localization in all 3 planes of restriction

• For a very young child, you can control side bending and rotation with your hand on their shoulder


• Repeat this procedure until the facet moves freely in flexion and extension

© 2015

© 2015

Basic principles of SFR: Typical cervical spine

• Stand behind the seated child, with their hands resting in their lap

• Have the child drop their forehead into your ipsilateral hand

• Have the child lean back onto your abdomen

© 2015

© 2015


• Place the contralateral thumb on the ipsilateral facet joint to be tested

• Induce ipsilateral cervical side bending and rotation with the forehead hand, while palpating at each facet level with the contralateral thumb


By permission, WVSOM© 2015


• To treat the cervical spine with SFR, stabilize the facet to be treated with the thumb at that level and exaggerate side bending and rotation at the facet to be treated


• Repeat this procedure until the facet moves freely in flexion and extension © 2015

Basic principles of SFR: Rib 1

• Make the diagnosis of elevated or depressed rib 1 in the usual manner.

• Have the patient seated with their hands in their lap

• Stand behind the patient and place the ipsilateral hand over the first rib to be treated.

By permission, WVSOM© 2015

Basic principles of treatment SFR: Rib 1

• Have the child drop backwards against your abdomen, and drop their forehead into your contralateral hand, as you did for cervical treatment.

• Press inferiorly on the restricted first rib with your ipsilateral hand to stabilize it.

© 2015


• To treat the first fib with SFR, maintain a stabilizing inferior pressure on the rib to be treated

• From flexion, take the child’s head to contralateral side bending and rotation, allowing the head to rest in your hand and the child to rest on your abdomen

• Using your hand on the forehead, localize a distraction force into the restricted costo-transverse facet

• Maintain downward pressure on the first rib and anterior and upward distraction into the restricted facet with your abdomen

• All planes of force are localized at the restricted facet

© 2015


• Maintain your distraction force into the restricted costo-transverse facet from your hand on the forehead, as well as downward pressure on the first rib and anterior and upward pressure into the restricted facet with your abdomen

• Rotate the child’s head away from the restricted rib, still maintaining a distraction force

© 2015

© 2015


• Maintain your downward pressure on the first rib and anterior and upward pressure into the restricted facet with your abdomen

• Extend the child’s neck while still maintaining all other forces at the restricted costo-transverse facet

© 2015


• Maintain your downward pressure on the first rib and anterior and upward pressure into the restricted facet with your abdomen

• Side bend the child’s neck, now creating compression at the restricted costo-transverse facet with the hand on the forehead, while still maintaining all other forces at the restricted facet © 2015


• Finally, while still maintaining your downward pressure on the first rib and anterior and upward pressure into the restricted facet with your abdomen, allow the head to gently fall forward into flexion

• You will commonly feel/hear an articulation

• Recheck rib 1 motion in the usual manner

© 2015

Basic principles of SFR: Alternative control of torso for upper thoracic and Rib 1 SFR treatment

• Have the child put their hand behind their neck so that their arm is at about a 90° angle

• Place your arm under their triceps area and grasp the arm against your torso

• As before, pull the child back against your abdomen and create a lumbar lordosis so that you can create an upward and forward force into the facet being treated

• This will require more lordosis on your part, as your are localizing to the upper thoracic and first rib areas

© 2015

© 2015


• Maintaining the forces from the abdomen into the treated facet, induce a lateral pressure from your arm through the child’s arm and into the restricted facet

• Translate the child either toward or away from the restricted facet


• Repeat this procedure until the facet moves freely © 2015

Thank you to my models:

Mason – 4 yo

Joanna – 9 yo

Ellie the elephant – 2 yo

Brendan – 13 yo

Thank you most of all to Dr. Richard Still, who mentored me in my early years and later welcomed me into his home and family during the last few years of his life. His wish was that this treatment approach be carried forth in its most pure and unadulterated form for the benefit of future generations of osteopaths, osteopathic physicians and patients.

With permission of Mrs. Roberta Still,Widow of Richard H. Still, Jr, DO

References

• Beatty D, Li TS, Steele K, Comeaux Z, Garlitz J, Kribs J, Lemley WL. A Pocket Manual of OMT 2nd Edition. Lippincott Williams & Wilkins, Baltimore. 2011.

The Use of Seated Facet Release in...

Documents

Transcript of The Use of Seated Facet Release in...