Somatic Dysfunction: Thoracic and Lumbar Spine (Screening/AGR, Long Lever, Short Lever)
Osteopathic Clinical Skills is a channel dedicated to discussing and exploring Osteopathic Clinical Skills concepts for medical students, residents, and clinicians and presenting them in an easy to understand manner.
This particular video is intended as a demonstration of the principles of Somatic Dysfunction diagnosis of the Thoracic Spine and Lumbar Spine, included screening, Area of Greatest Restriction (AGR), Long Lever segmental motion testing, and Short Lever segmental motion testing.
It is not intended as a complete instructional video and should not be considered a source of complete OMT instruction.
Instead, it should be treated as a supplement to independent learning using primary Osteopathic Manipulation instructional resources. Clinical skills are best learned and developed with support from faculty in the context of a complete Osteopathic Medical School Curriculum.
Attributions:
Many thanks to the University of North Texas Health Science Center Texas College of Osteopathic Medicine (UNTHSC - TCOM) for permitting use of the Medical Education Training (MET) facilities and equipment during the production of this video.
Additional thanks to the UNTHSC-TCOM learner and faculty volunteers who participated in this production and provided permission for the use of their image in this video.
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Great techniques when working with a person 50 to 100 lbs lighter and several inches small than the therapist. But not effective when the patient is larger than the therapist. AGR dx will be less accurate when struggling to manage the weight and size of a larger patient. I notice that all the demostrations in this series use small models. How do you manage the typical American 30-50% over ideal weight when using a sitting position. ALSO How do you manage large brested women when testing for AGR.
@OsteopathicClinicalSkills
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You make a good point, and I will make an effort to find mock patients with more diverse body types. Most of the demonstrations on this channel have the mock patients you’ve seen for two reasons: 1. Ease of demonstration for beginner learners 2. Most of the mock patients are medical students or residents All of these skills apply to larger patients, though some slight modifications may be needed depending on the size mismatch between doctor and patient. I teach many students who are of much shorter stature that become very capable at performing these treatment techniques on patients of all sizes. I will find more opportunities to showcase adaptations for more challenging size mismatches.
For an AGR screening using short lever technique, is there a method to confirm the sidebending component of the diagnosis other than deducing from Fryette's principles? Or could you only confirm via long lever sidebending?
@OsteopathicClinicalSkills
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You can also contact the transverse processes and directly translate the segment to induce sidebending. This is a short-lever type motion that looks similar to cervical spine diagnosis. Translation left = sidebending right; Translation right = sidebending left. For thoracic and lumbar spine it is a little more challenging than long lever motion testing, especially when first developing your palpatory skills, but the more you practice, the better you’ll get at it!