Practical Video for OB: Special Considerations

00:01 Articulatory technique for the thoracic cage and the spine So with pregnancy, there's a lot of hypertonicity of the muscles that could potentially restrict motion of the spine and the ribcage.

00:13 So to try to optimize motion of the thoracic spine and the ribcage, what we could do is articulatory technique to gently try to mobilize the spine and the ribs.

00:21 So first to mobilize the spine, what we wanna do is to find the spinous processes, then we get our thenar eminence on the ipsilateral side from where we're standing.

00:31 My arms are gonna drape across the shoulders, and what I wanna do is to gently sidebend and at the same time, translate the spine laterally away from me.

00:40 and so as I move down, I'm gently articulating the thoracic spine finding regions of restriction, areas that might be a little bit tighter, we might work a little bit longer and so here in the thoracolumbar spine, I feel like it's a little bit tighter, so I'm just kind of gently encouraging more motion here as I move lower, I could go ahead and move in to the lumbar spine Here you might just have to do a little bit more sidebending to get the translation to that level.

01:05 and so we're gonna go up and down the thoracolumbar spine and if there's areas of restriction, we're just gonna mobilize it a little bit more.

01:13 Now if we wanna mobilize the ribcage, what we're gonna do is we're gonna induce rotation so I'm gonna have the patient bring her head up and place it on her shoulder, this gives me a leverage to kind of hold on the arm, and now I could apply a little bit of rotation.

01:26 As I rotate, my thenar eminence is now on the opposite side along the rib angles, just a little bit medial to the rib angles on the opposite side.

01:35 Now I'll put my thenar eminence there and just add a little bit of extra rotation when I reach that endpoint.

01:41 So here we're just mobilizing the ribs on the opposite side from where I'm standing and we could go down all the way down the ribcage and almost into the lumbar spine and make that a little bit more of a fascial stretch with some articulation so we go up and down the ribcage in this fashion.

02:01 And then once we've completed that, we could reassesed the area, I would definitely do both sides, to try to mobilize the spine and treat the spine the ribs bilaterally.

02:14 Thoracic spine articulatory technique So what we wanna do here with the patient seated, is to try to address any musculoskeletal complaints and issues in the posterior aspect of the spine, the thoracic spine and also the ribcage.

02:28 What we're going to do is to contact the ribcage just medial to the rib angles with our fingers and we are going to leverage and extend a little bit over our fingers so in order to do that, we're gonna have the patient's arms placed over our shoulder and I'm gonna place my fingers along the rib angles here and so I'm going to slowly lean back and extend the patient over my fingers pulling a little bit superior and towards me and feeling for the ribs to move a little bit more on the thoracic spine so this is a rib raising technique also to try to mobilize the ribcage.

03:07 So this is a good technique to perform especially with pregnancy to try to articulate the ribcage, get more expansion in the thoracic cage, increase thoracic compliance.

03:18 We could also try to articulate the ribs with the arms crossed, if you're more comfortable, you could place the elbows on your shoulder and do the same things.

03:27 There's a way to also articulate the thoracic spine directly We could keep the arms crossed like this, I'm gonna slide my arm underneath and hold on to the opposite shoulder, I'm gonna have the patient lean forward and that creates a fulcrum over my hand.

03:40 I'm gonna articulate the thoracic spine now with my thenar eminence on the same side of the thoracic spine so I'm gonna contact just medial to the thoracic spine on my side and create a transitory force.

03:55 And as I create a transitory force, I could also use my other arm to create a little bit of extension over my head and so we kind of walk our way down the thoracic spine If there's an area that's more restricted, we could articulate that area a little bit more and then once we finish articulating up and down the thoracic spine, we could bring her back and then slowly recheck the musculature and the ribcage to see if there is decreased somatic dysfunction in the area.

04:23 Cervical myofascial release So to promote cervical myofascial release, what we want to do is to first assess the cervical muscles to see if there is any hypertonicity We're gonna stand on the opposite side from where we wanna treat, so here we're treating the left side here What we wanna do is to take our fingers and contact those cervical paraspinal muscles and then we're gonna apply anterior traction and as I pull the muscles superiorly, it's gonna start to loosen up the muscles If I don't stabilize the head when I pull, the whole head's gonna turn so what I do with my other hand is I stabilize the head by the forehead and my other hand grasp the posterior musculature and just kinda leans back You don't want to lean back and pull too quickly, myofascial should be done slowly and you can move up and down the cervical spine and even down into the trapezius muscles to try to get a good stretch.

05:16 You hold this stretch until you feel a release and then you come back and then afterwards, you could reassess to see if the muscles are a little bit more relaxed.

05:26 Thoracic inlet release So it's important to address any somatic dysfunctions around the thoracic inlet to make sure that we treat any muscle hypertonicities, restrictions here and remember the thoracic inlet is also the region for terminal lymphatic drainage, so we're gonna contact the posterior aspects of the first ribs with our thumbs, want to place our fingers around the clavicles and my pinky kinda reaches around to the shoulders We're going to find the freedom of motions in the thoracic inlet so we're gonna check side bending by pushing down towards the feet and see which way the thoracic inlet likes to sidebent towards so here it likes to sidebend to the left.

06:04 I'm gonna hold back and stack the freedoms so now I'm gonna check rotation and here the thoracic inlet likes to rotate to the right and then when I check a little bit of flexion, and extension and here the thoracic inlet likes to go into extension so I'm holding all three freedoms and I'm gonna apply a little bit of a lateral traction by the first rib opening up the inlet and try to decrease some of the muscle tension here.

06:30 So you're gonna match the tension underneath your fingers, you're gonna hold it until you start to feel the tissues start to soften a little bit more and once you feel that tissue release, you could bring the hends back and then reassess to see if there's improved mobility and motion in the thoracic inlet.