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

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

3. 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

4. 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

6. FPR and Still Technique

7. 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

8. 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

9. 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

10. 2 1 3

11. 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.

12. 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

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

14. 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

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

16. 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.

17. 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

18. Still Technique-contraindications
Acute Fracture
Inflamed or infected joint

19. 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

20. 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!!

21. 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

22. Frequent Clinical Conditions
Sinus Congestion/ URI
Headaches

23. Sinusitis/ URI
Frontal sinuses
Drain by gravity
maxillary sinuses

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

25. 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.

26. 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.

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

28. 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

29. 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