OMT in ConcussionDr Kate Quinn DO
Board Certified Neuromusculoskeletal MedicineBoard Certified Family MedicineOMT
Primary Care Sports Medicine FellowTrinity Medical CenterLemak Sports Medicine and Orthopedics
Birmingham AlabamaTeam Physician Alabama State University Montgomery Alabama
Concussion in Real Time
Objectives
bull Describe current research related to concussion and manual therapy
bull Discuss relevant anatomy to concussion
bull Demonstrate and teach techniques applicable to the treatment of concussion and its associated symptoms
Current Research
Multimodal PT RCTbull Aim Determine if a combination of cervical and vestibular
physiotherapy is an effective treatment for persistent dizziness neck pain and headaches following a sports-related concussion
bull Involved 31 participants aged 12-30 bull Groups
ndash Control =rest + gradual exertionndash Treatment=multimodal PT= vestibular rehab manual therapy
neuromotor and sensorimotor retraining exercisesbull Frequency once weekly x 8 weeks or until medically cleared to
return to sportbull Results
ndash 1115 in treatment group cleared to return to sport at 8 weeksndash 114 of control group cleared to return to sport at 8 weeksndash 2 lost to follow up
Schneider K Meeuwisse W et al Cervicovestibular rehabilitation in sport related concussion a randomized controlled trial Br J Sport Med 2014481294-1298
Concussive impact of mTBI
Military model of projectile impact on helmets and affect on
Axonal damage
accumulation of β-amyloid protein in corpus collosum
Astrocyte activation
most prominent in hippocampus
Act to preserve neural tissue restrict inflammatory cell invasion
Impact location affect on gait disturbance
Temporoparietal region affected gait more
Leung L et al The WRAIR Projectile Concussive Impact Model of Mild Traumatic Brain Injury Re-design Testing and Pre-clinical Validation Annals of Biomedical Engineering 2014 42(8) 1618-1630
CONCUSSION RELATED SYMPTOMS
Anatomy
HEADACHE
Three Types of Headaches
1 Post-traumatic Headache
ndash Acute lt 3m
ndash Chronic gt 3m
Also meets classification for TENSION TYPE and MIGRAINE without aura
2 Tension Headache
3 Cervicogenic Headache
Syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck
International Headache Society Classification Subcommittee International Classification of Hedache Disorders 2nd ed Cephalgia 2004 24 (suppl1) 1-160
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Concussion in Real Time
Objectives
bull Describe current research related to concussion and manual therapy
bull Discuss relevant anatomy to concussion
bull Demonstrate and teach techniques applicable to the treatment of concussion and its associated symptoms
Current Research
Multimodal PT RCTbull Aim Determine if a combination of cervical and vestibular
physiotherapy is an effective treatment for persistent dizziness neck pain and headaches following a sports-related concussion
bull Involved 31 participants aged 12-30 bull Groups
ndash Control =rest + gradual exertionndash Treatment=multimodal PT= vestibular rehab manual therapy
neuromotor and sensorimotor retraining exercisesbull Frequency once weekly x 8 weeks or until medically cleared to
return to sportbull Results
ndash 1115 in treatment group cleared to return to sport at 8 weeksndash 114 of control group cleared to return to sport at 8 weeksndash 2 lost to follow up
Schneider K Meeuwisse W et al Cervicovestibular rehabilitation in sport related concussion a randomized controlled trial Br J Sport Med 2014481294-1298
Concussive impact of mTBI
Military model of projectile impact on helmets and affect on
Axonal damage
accumulation of β-amyloid protein in corpus collosum
Astrocyte activation
most prominent in hippocampus
Act to preserve neural tissue restrict inflammatory cell invasion
Impact location affect on gait disturbance
Temporoparietal region affected gait more
Leung L et al The WRAIR Projectile Concussive Impact Model of Mild Traumatic Brain Injury Re-design Testing and Pre-clinical Validation Annals of Biomedical Engineering 2014 42(8) 1618-1630
CONCUSSION RELATED SYMPTOMS
Anatomy
HEADACHE
Three Types of Headaches
1 Post-traumatic Headache
ndash Acute lt 3m
ndash Chronic gt 3m
Also meets classification for TENSION TYPE and MIGRAINE without aura
2 Tension Headache
3 Cervicogenic Headache
Syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck
International Headache Society Classification Subcommittee International Classification of Hedache Disorders 2nd ed Cephalgia 2004 24 (suppl1) 1-160
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Objectives
bull Describe current research related to concussion and manual therapy
bull Discuss relevant anatomy to concussion
bull Demonstrate and teach techniques applicable to the treatment of concussion and its associated symptoms
Current Research
Multimodal PT RCTbull Aim Determine if a combination of cervical and vestibular
physiotherapy is an effective treatment for persistent dizziness neck pain and headaches following a sports-related concussion
bull Involved 31 participants aged 12-30 bull Groups
ndash Control =rest + gradual exertionndash Treatment=multimodal PT= vestibular rehab manual therapy
neuromotor and sensorimotor retraining exercisesbull Frequency once weekly x 8 weeks or until medically cleared to
return to sportbull Results
ndash 1115 in treatment group cleared to return to sport at 8 weeksndash 114 of control group cleared to return to sport at 8 weeksndash 2 lost to follow up
Schneider K Meeuwisse W et al Cervicovestibular rehabilitation in sport related concussion a randomized controlled trial Br J Sport Med 2014481294-1298
Concussive impact of mTBI
Military model of projectile impact on helmets and affect on
Axonal damage
accumulation of β-amyloid protein in corpus collosum
Astrocyte activation
most prominent in hippocampus
Act to preserve neural tissue restrict inflammatory cell invasion
Impact location affect on gait disturbance
Temporoparietal region affected gait more
Leung L et al The WRAIR Projectile Concussive Impact Model of Mild Traumatic Brain Injury Re-design Testing and Pre-clinical Validation Annals of Biomedical Engineering 2014 42(8) 1618-1630
CONCUSSION RELATED SYMPTOMS
Anatomy
HEADACHE
Three Types of Headaches
1 Post-traumatic Headache
ndash Acute lt 3m
ndash Chronic gt 3m
Also meets classification for TENSION TYPE and MIGRAINE without aura
2 Tension Headache
3 Cervicogenic Headache
Syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck
International Headache Society Classification Subcommittee International Classification of Hedache Disorders 2nd ed Cephalgia 2004 24 (suppl1) 1-160
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Current Research
Multimodal PT RCTbull Aim Determine if a combination of cervical and vestibular
physiotherapy is an effective treatment for persistent dizziness neck pain and headaches following a sports-related concussion
bull Involved 31 participants aged 12-30 bull Groups
ndash Control =rest + gradual exertionndash Treatment=multimodal PT= vestibular rehab manual therapy
neuromotor and sensorimotor retraining exercisesbull Frequency once weekly x 8 weeks or until medically cleared to
return to sportbull Results
ndash 1115 in treatment group cleared to return to sport at 8 weeksndash 114 of control group cleared to return to sport at 8 weeksndash 2 lost to follow up
Schneider K Meeuwisse W et al Cervicovestibular rehabilitation in sport related concussion a randomized controlled trial Br J Sport Med 2014481294-1298
Concussive impact of mTBI
Military model of projectile impact on helmets and affect on
Axonal damage
accumulation of β-amyloid protein in corpus collosum
Astrocyte activation
most prominent in hippocampus
Act to preserve neural tissue restrict inflammatory cell invasion
Impact location affect on gait disturbance
Temporoparietal region affected gait more
Leung L et al The WRAIR Projectile Concussive Impact Model of Mild Traumatic Brain Injury Re-design Testing and Pre-clinical Validation Annals of Biomedical Engineering 2014 42(8) 1618-1630
CONCUSSION RELATED SYMPTOMS
Anatomy
HEADACHE
Three Types of Headaches
1 Post-traumatic Headache
ndash Acute lt 3m
ndash Chronic gt 3m
Also meets classification for TENSION TYPE and MIGRAINE without aura
2 Tension Headache
3 Cervicogenic Headache
Syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck
International Headache Society Classification Subcommittee International Classification of Hedache Disorders 2nd ed Cephalgia 2004 24 (suppl1) 1-160
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Multimodal PT RCTbull Aim Determine if a combination of cervical and vestibular
physiotherapy is an effective treatment for persistent dizziness neck pain and headaches following a sports-related concussion
bull Involved 31 participants aged 12-30 bull Groups
ndash Control =rest + gradual exertionndash Treatment=multimodal PT= vestibular rehab manual therapy
neuromotor and sensorimotor retraining exercisesbull Frequency once weekly x 8 weeks or until medically cleared to
return to sportbull Results
ndash 1115 in treatment group cleared to return to sport at 8 weeksndash 114 of control group cleared to return to sport at 8 weeksndash 2 lost to follow up
Schneider K Meeuwisse W et al Cervicovestibular rehabilitation in sport related concussion a randomized controlled trial Br J Sport Med 2014481294-1298
Concussive impact of mTBI
Military model of projectile impact on helmets and affect on
Axonal damage
accumulation of β-amyloid protein in corpus collosum
Astrocyte activation
most prominent in hippocampus
Act to preserve neural tissue restrict inflammatory cell invasion
Impact location affect on gait disturbance
Temporoparietal region affected gait more
Leung L et al The WRAIR Projectile Concussive Impact Model of Mild Traumatic Brain Injury Re-design Testing and Pre-clinical Validation Annals of Biomedical Engineering 2014 42(8) 1618-1630
CONCUSSION RELATED SYMPTOMS
Anatomy
HEADACHE
Three Types of Headaches
1 Post-traumatic Headache
ndash Acute lt 3m
ndash Chronic gt 3m
Also meets classification for TENSION TYPE and MIGRAINE without aura
2 Tension Headache
3 Cervicogenic Headache
Syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck
International Headache Society Classification Subcommittee International Classification of Hedache Disorders 2nd ed Cephalgia 2004 24 (suppl1) 1-160
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Concussive impact of mTBI
Military model of projectile impact on helmets and affect on
Axonal damage
accumulation of β-amyloid protein in corpus collosum
Astrocyte activation
most prominent in hippocampus
Act to preserve neural tissue restrict inflammatory cell invasion
Impact location affect on gait disturbance
Temporoparietal region affected gait more
Leung L et al The WRAIR Projectile Concussive Impact Model of Mild Traumatic Brain Injury Re-design Testing and Pre-clinical Validation Annals of Biomedical Engineering 2014 42(8) 1618-1630
CONCUSSION RELATED SYMPTOMS
Anatomy
HEADACHE
Three Types of Headaches
1 Post-traumatic Headache
ndash Acute lt 3m
ndash Chronic gt 3m
Also meets classification for TENSION TYPE and MIGRAINE without aura
2 Tension Headache
3 Cervicogenic Headache
Syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck
International Headache Society Classification Subcommittee International Classification of Hedache Disorders 2nd ed Cephalgia 2004 24 (suppl1) 1-160
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
CONCUSSION RELATED SYMPTOMS
Anatomy
HEADACHE
Three Types of Headaches
1 Post-traumatic Headache
ndash Acute lt 3m
ndash Chronic gt 3m
Also meets classification for TENSION TYPE and MIGRAINE without aura
2 Tension Headache
3 Cervicogenic Headache
Syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck
International Headache Society Classification Subcommittee International Classification of Hedache Disorders 2nd ed Cephalgia 2004 24 (suppl1) 1-160
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Anatomy
HEADACHE
Three Types of Headaches
1 Post-traumatic Headache
ndash Acute lt 3m
ndash Chronic gt 3m
Also meets classification for TENSION TYPE and MIGRAINE without aura
2 Tension Headache
3 Cervicogenic Headache
Syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck
International Headache Society Classification Subcommittee International Classification of Hedache Disorders 2nd ed Cephalgia 2004 24 (suppl1) 1-160
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
HEADACHE
Three Types of Headaches
1 Post-traumatic Headache
ndash Acute lt 3m
ndash Chronic gt 3m
Also meets classification for TENSION TYPE and MIGRAINE without aura
2 Tension Headache
3 Cervicogenic Headache
Syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck
International Headache Society Classification Subcommittee International Classification of Hedache Disorders 2nd ed Cephalgia 2004 24 (suppl1) 1-160
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Three Types of Headaches
1 Post-traumatic Headache
ndash Acute lt 3m
ndash Chronic gt 3m
Also meets classification for TENSION TYPE and MIGRAINE without aura
2 Tension Headache
3 Cervicogenic Headache
Syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck
International Headache Society Classification Subcommittee International Classification of Hedache Disorders 2nd ed Cephalgia 2004 24 (suppl1) 1-160
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Physiology- Cervicogenic HA
bull Suboccipital nerveoccipital region
bull C2 spinal nerveoccipital Parietal temporal frontal and periorbital
bull C3 dorsal ramusfrontotemporal occipital and periorbital
Biondi Cervicogenic Headache A review of diagnostic and treatment strategies JAOA 2005 105 (4s2)
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
NECK PAIN- CERVICAL ANATOMY
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
C2
C3
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Involved Anatomy
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Connection between Rectus Capitus Posterior Major Obliquus Capitus Minor AA Myodural Bridge and C1-2 Cervical Dura
Rodeghero and Smith Role of Manual Physical Therapy and specific exercise intervention in the treatment of a patient with cervicogenic headaches Journal of Manual and Manipulative Therapy 2006 14(3)m 159-167
Pontell ME Scali F Marshall E Enix D The obliquus capitis inferior myodural bridgeClin Anat 2013 May26(4)450-4 doi 101002ca22134 Epub 2012 Jul 26
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
DIZZINESS
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Vestibular System Orientation
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
TREATMENT CONSIDERATIONS
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
CONTRAINDICATIONS TO MANIPULATIONOMT
bull Skull fracture
bull Increased intracranial pressure
bull Suspected or documented intraextra cranial hemorrhage
bull Suspected or confirmed cervical fracture
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Osteopathic Exam Findingsbull Dependent on patient
bull Frequently havebull Dominant or primary restriction in body
bull Tissue with cellular feartrauma
bull Reduced CRI
bull Cranial strain pattern present
bull Brain restriction
bull Bony motion and sutural restrictions of cranium
bull Sacral motion restrictions
Bruno Chikly MD DOGreenman amp McPartland Cranial findings and iatrogenesis from craniosacral manipulation in
patients with traumatic brain syndrome JAOA 95(3) 182-192
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Quinnrsquos Treatment Approachbull Complete thorough MSKNeuro Exambull Treat as soon as possible
ndash So strain patterns do not have a chance to organizeengrain themselves
bull Use techniques tolerable to patientndash Indirect treatment modalities (MFR LAS soft tissue
counterstrain lymphatic Still OCF etc)
bull Treat dominant lesion in bodyndash Osteopathic structural screen positionmechanism of injury
bull Address cellular fearbull Treat cranium brain spinal cordbull Balance autonomics
bull Let body rest 1-2 days to 1 week and then rechecktreat residual restrictions
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Bamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Treating Cellular Fear
bull Palpate a solidwall like barrierndash Move hand parallel to body at interface
bull Patient exaggerates what they feel
bull Doc- provide reassurancesafe space
bull Continue to move through interfaces until hand on patientrsquos body and get ldquostill pointrdquo
bull Physical signs of sympathetic discharge=ndash Shaking trembling tremor micromovements
perspiring deep breathing tachycardia nostril flaring pupil dilation hypervigilance muscular tension
ndash If these dominate SLOW DOWN AND BACK OFFReference-Bruno Chikly MD DO
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Video of Locating Cellular Fear
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Video of Treating Cellular Fear
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Table Time Treat that cellular fear
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Cerebellar Anatomy
Adapted from Sobottas Textbook and Atlas of Human Anatomy 1908
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Treating the Cerebellum
bull Patient prone
bull Doc seated at head of table
bull Hands just below superior nuchal ridge on either side of inion
bull Start at midline and then move laterally frac12 finger width for eachnuclei
bull Layer by layer palpationbull Follow where it wants
to go (indirect release)
Bruno Chikly MD DO
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Treatment of Thoracolumbar spine and sacrum
bull Patient Supine
bull Doc At side of table caudad hand under sacrum cephlad hand under vertebra
ndash Balance sacrum (SuperiorinferiorrotationSB)
ndash Move cephlad hand anterior and superior towards patientrsquos eyes (position of ease)
ndash Maintain balance point until release
Ligamentous Articular Strain Osteopathic Techniques for the Body C Speece and WT Crow 2001
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Bamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
CV4
bull ldquoEnhances tissue and fluid motion and restores flexibility of autonomic responserdquo
bull Doc place thenar eminences POSTEROMEDIAL to occipitomastoid suturesndash Encourage extension as occiput moves into extension
ndash Resist flexion (take up slack with extension and hold there)
ndash Continue until Still Point
Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70Atlas of Osteopathic Techniques Nicholas and Nicholas 2nd ed P 564
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
So back to my playerhelliphellip
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Studies related to manual medicine and headache
bull Anderson and Sensical A comparison of osteopathic treatment and relaxation for tension-type headaches Headache 2006 461273-1280
bull Bronfort et al Efficacy of spinal manipulation for chronic headache A systematic review Journal of Manipulative and Physiological Therapeutics 2001 24(7) 457-466
bull Hanten et al The effectiveness of CV4 and resting position techniques on subjects with tension-type headaches Journal of Manual and Manipulative Therapy 1999 7(2) 64-70
bull Jull et al A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache SPINE 200227(17)1835-43
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Studies related to manual medicine and neck pain
bull Miller et al Manipulation or Mobilisation for neck pain Cochrane Database of Systematic Reviews 2010 Issue 1
bull Miller et al Manual therapy and exercise for neck pain A systematic review Manual Therapy 2010 15 334-354
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Studies related to manual medicine and vestibular dysfunction
bull Berkowitz Application of Osteopathy in the Cranial Field to Successfully treat vertigo A case series JAAO 2009 19(3)27-32
bull Schenk et al Cervicogenic Dizziness A case report illustrating orthopaedic manual and vestibular physical therapy comanagement Journal of Manual and Manipulative Therapy 2006 14(3) E56-68
bull Collins and Misukanis Chiropractic management of a patient with post-traumatic vertigo of complex origin Journal of Chiropractic Medicine 2005 432-38
bull Lystad et al Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness a systematic review Chiropractic amp Manual Therapies 2011 1921
bull Fraix Marcel Osteopathic Manipulative Treatment and Vertigo A Pilot Study PM R 2010 2612-618
bull Fraix et al Use of SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness J Am Osteoapath Assoc 2013113(5)394-403
bull Galm et al Vertigo in patients with cervical spine dysfunction Eur Spine J 1998 755-58
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
Proposed considerations by Philippe Druelle DO - Canada
bull Normalize somatic dysfunction outside of the head especially upper T spine
bull Target OA and AA foramen lacerum course of carotid artery
bull Treat posterior fossa and brainstem thalamus
bull Normalize ventricles
If recent start peripherally at sacrum
Short frequent treatments lt10-15min then increase after 1 week if improved
QuestionsBamastatesportscom
QuestionsBamastatesportscom
