Viscerosomatics and FPR and Still Technique Ann Habenicht D.O., FAAO, FACOFP Annual Family Practice Review and Reunion February 8, 2019

Viscerosomatics Paravertebral Chapman’s Reflexes Parasympathetics Occiput-C2 (Vagus) Sympathetics T1-L2-3 Ganglion Impar Chapman’s Reflexes Anterior Posterior

Viscerosomatics Paravertebral Parasympathetics Sympathetics Vagus- Cranium- first half of transverse colon Pelvic splanchnic S2-S4-second half of transverse colon thru rectum; distal ureter, bladder; prostate , testis; uterus, fallopian tubes, ovaries Sympathetics T1- L2

Viscerosomatics Chapman’s Diagnostics- Anterior EENT/neck- above 2nd rib bilateral Cardiopulmonary- 2nd to 4th Intercostals UGI- 5th- 9th bilateral LGI- along ITB GU- surrounding umbilicus; surrounding pubes and ITB

FPR and Still Technique

What is it? STILL TECHNIQUE FPR A gentle, precise localization technique Starts out as indirect, but finishes as direct Utilizes localization of all planes of motion to the balance point, or position of ease. Uses a final activating vector force through the affected tissue. The vector force should come from a part of the body that can be used as a lever for the technique. Then, finishes by returning the joint, tissue, fascia,etc. to the normal range of motion. FPR Positional technique facilitated with compression or torque quick and efficient effective

What is it? STILL TECHNIQUE FPR As the coupled vector force and the tissue motion takes the tissue past its restriction, a palpable release is appreciated. The vector force is then released and the tissue is returned to its start position. FPR Positional technique facilitated with compression or torque quick and efficient effective

Physiologic basis FPR STILL TECHNIQUE Similar to counterstrain Muscle spindles reporting length & rate of stretch Increase firing of gamma afferents in the stretched muscle Restoration of hyper-shortened muscle decreases firing compressive force/torque causes the neural feedback to rapidly normalize STILL TECHNIQUE Similar to FPR initially

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Activating Forces FPR STILL TECHNIQUE Compression Torque Traction (rarely) STILL TECHNIQUE The activating force is the vector force as it moves the tissue through its range of motion and through the area of restriction. It is articulatory in the sense that it takes the tissue through the range of motion, but is NOT a repetitive articulation.

Why use it? FPR Indications similar to counterstrain Useful for pain from disc herniations Fast- done in 3-5 seconds STILL TECHNIQUE Can be used for almost any type of dysfunction. Quick and efficient Can retreat are without complications Very gentle Can treat in SEATED and supine positions

FPR Complications and Contraindications Increased pain Increased tension Inflamed joint Infected joint

FPR-How’s it done? Put joint in a “loose pack “ position Flatten the spine Add facilitating force Position into freedom of motion or shortening of the muscle Hold for 3-5 seconds and release

FPR-Benefits Easily applied Non traumatic Efficient Ability to repeat immediately if normalization is not completely achieved

Still Technique History Richard Van Buskirk, D.O., Ph.D., F.A.A.O. discovered techniques first used and noted by A.T. Still Van Buskirk was able to “read between the lines” of technique descriptions to make the techniques function. These descriptions were from Still and from fellow D.O.s observing Still’s technique.

Still Technique-requirements Exact nature of the restriction, i.e.- exact diagnosis of the somatic dysfunction Knowledge of the normal range of motion of the affected tissue

Still Technique-contraindications Acute Fracture Inflamed or infected joint

Still Technique- How’s it done? The players The dysfunction The physician’s sensing hand- passive The physician’s operating hand-the worker The force vector- compressive or distractive- 3-5 pounds

Still Technique- How’s it done? Find the dysfunction Place sensing hand on dysfunction and localize to balance point or the pathological neutral Operating hand does all the work. Introduces the force vector through the tissue to the sensing hand Uses the force vector as a steering rod at a low-moderate velocity motion to return the tissue to normal MUST KEEP THE VECTOR FORCE FOCUSED AT ALL TIMES!!

Still Technique- looks familiar! Similar to FPR/counterstrain Initial start point Similar to HVLA Requires precise localization Similar to articulatory Puts tissue through its range of motion, but ONLY ONCE

Frequent Clinical Conditions Sinus Congestion/ URI Headaches

Sinusitis/ URI Frontal sinuses Drain by gravity maxillary sinuses

Sinusitis/URI Ethmoid sphenoid inferior chonchae Rely on ciliated cells to move mucus Increased secretions and trapped air result in pressure and pain

Sinusitis/URI Referred pain will follow path of CN V1 an V2 Forehead, cheeks, top of head Behind eyes, surrounding eyes Teeth Also referred pain to ears and neck.

Sinusitis/URI Tenderness over CN V1 and V2 as they exit via the notches will aid in the diagnosis of sinusitis. Suboccipital tenderness is found at the ipsilateral side.

Sinusitis/URI Treatment- trigeminal stim ethmoid articulation sphenopalatine decongestion lymphatic drainage thoracics thoracic inlet diaphragm

Techniques Lymphatic Drainage Techniques For The Cervicals. Soft tissue review Effleurage technique – a gentle percussive technique starting at the submental area caudad to the mandible and moving posteriorly to the submental area. This technique should help drain the lymph tissue in this area.  Facilitated Positional Release: Cervical Treatment Still Technique: Cervical Technique Posterior Atlas Muscle Energy- Oculocephalogyric

Techniques THE CRANIUM  Sinus Technique: Inhibitory Pressure Of The Three Branches Of The Trigeminal Nerve Sinus Technique: Percussion Of The Frontal And Maxillary Sinuses Sinus Technique – Nasal Bone Articulation Sinus Technique – Frontal Lift Pterygoid Fossa Decongestion Mandibular Drainage Technique for Otitis Media- Galbreath Technique