OMM Techniques (II)

RIB COUNTERSTRAIN
Anterior Rib (Exhalation Dysfunction)
Location
o Rib 1: located just below the medial end
of the clavicle (right off costal sternal junction)
o Rib 2: located 6-8cm lateral to the sternum at the angle of Louis
o Ribs 3-6: located along the mid-axillary line on the corresponding rib
Technique
o Rib 1/2
Patient is supine
Use hand contralateral to the side
treating to monitor tenderpoint
Flex head, sidebend and rotate
TOWARDS
Hold for 120 seconds
o Ribs 3-6
Patient is seated upright
Lower table as much as possible
Put leg CONTRALATERAL to the side
of the tenderpoint on the table and
drape patients arm over the leg
Put other arm behind the patient
(helps rotate the patient)
Ask patient to put legs completely on
the table towards the side of the
tenderpoint (knees bent)
Flex head (and trunk slightly),
sidebend and rotate trunk TOWARDS
Hold for 120 seconds

Posterior Rib (Inhalation

Dysfunction)

you are

Location
o Angle of the corresponding rib
Technique
o Rib 1
Patient is seated upright
Lower table as much as possible
Put leg CONTRALATERAL to the
side of the tenderpoint on the
table and drape patients arm over
the leg
Put other arm behind the patient
(helps rotate the patient)
E SART (head)
Hold for 120 seconds
o Rib 2-6
Patient is seated upright
Lower table as much as possible
Put leg IPSILATERAL to the side of
the tenderpoint on the table and
drape patients arm over the leg
Put other arm behind the patient
(helps rotate the patient)
Ask patient to bend leg ipsilateral to
tenderpoint and place foot under opposite leg
F (head) SARA (trunk)
Hold for 120 seconds

ALTERNATING PRESSURE

Technique
o Patient is supine
o Find rib 2 anteriorly
o Find T2 posteriorly
o Find spine of scapula and move
slightly superior to it
o Apply alternating anterior and
posterior pressures (holding each
for 5 seconds)
o Repeat for a total of 30 seconds
Purpose
o Rib raising to the heart
o Normalizes sympathetics to the
heart
KNEE COUNTERSTRAIN
Lateral Collateral Ligament/Meniscus
Technique
o Find lateral collateral ligament
Palpate the fibular head &
move superior
LCL runs from femoral condyle
to fibular head
o Patients leg should be hanging off
side of table
o Flex patients knee, abduct, & externally rotate
o Hold for 90 seconds

Medial Collateral Ligament/Meniscus

Technique
o Find medial collateral ligament
Palpate tibial tuberosity
Move medially along joint line
o Pt leg should be hanging off side of
table
o Flex patients knee, adduct, &
internally rotate
o Hold for 90 seconds
TENSOR FASCIAE LATAE
COUNTERSTRAIN
Technique
o Find tensor fasciae latae
Move 2 fingers inferiorly from ASIS
& 2 fingers laterally
Have pt internally rotate leg to
confirm finger placement
o Put table as low as possible
o Put foot up on table & place pts leg on top
o Flex & abduct hip
o Hold for 90 seconds
IT BAND COUNTERSTRAIN

Technique
o Find IT band
Place fingers on greater trochanter &
move inferiorly
o Put table as low as possible
o Put foot on table & place pts leg on top
o Flex & abduct hip
o Hold for 90 seconds

PIRIFORMIS COUNTERSTRAIN
Technique
o Place fingers on greater trochanter &
move posteriorly to find piriformis
o Put table as low as possible
o Put foot on table & place pts leg on your
leg
o Flex, abduct, & externally rotate hip
o Hold for 90 seconds
INTEROSSEOUS MEMBRANE MYOFASCIAL
RELEASE
Technique
o Find tibia & fibula interosseous
membrane located between bones
o Motion test membrane (medial/lateral,
superior/inferior,
clockwise/counterclockwise)
o Place membrane in ease/barrier & hold 30
seconds
o Reassess for tissue texture changes
INNOMINATE HVLA
POSTERIOR
o Technique
Pt is lateral recumbent w/ affected side up
Place hand on L5/S1 & ask pt to flex hip/knee until you feel a
gap/space
Ask pt to straighten bottom leg
Stabilize torso w/ cephalad arm by laying along pts arm (elbow should be by pts shoulder)
w/ caudad forearm, give anterior & superior force on innominate (fist should be towards
you)

ANTERIOR
Technique
Pt is lateral
recumbent
w/ affected
side up
Place hand
on
flex hip/knee until you feel a gap/space
straighten bottom leg
o

L5/S1 & ask pt to

Ask pt to

Stabilize torso w/ cephalad arm by

laying along pts arm (elbow should be
by pts shoulder)
w/ caudad forward give force down
femur (fist should be away from you)
PIRIFORMIS MUSCLE ENERGY
FAIR TEST
o Flex, adduct, internally rotate hip
o Positive = pain
Technique
o Pt is supine
o Cross affected leg over other leg w/ knee
bent
o Stabilize ASIS w/ cephalad hand
o Pull pts knee toward you & have pt
contract against (adduct) for 3-5 seconds
o W/ each relaxation bring further into barrier
o Repeat 3 times

PSOAS MUSCLE ENERGY

THOMAS TEST
o Have pt bend unaffected leg & bring into chest
o Positive = other hip flexes
Technique
o Pt is prone
o Flex knee & lift w/ hand (can wedge your
bent knee under pts leg for more
stability)
o Ask pt to push down (towards table) for
3-5 seconds
o w/ each relaxation bring further into
barrier (can bring further up on your
o Repeat 3 times

leg) physicans force is upward

SACRAL MYOFASCIAL RELEASE

Technique
o Pt is supine
o Ask pt to lift hips & place your
caudad hand on sacrum
o Place cephalad forearm on ASIS
closest to you & place fingers
on opposite ASIS
o Squeeze ASISs together to gap
the posterior SI joints (allowing
for more motion of the sacrum
to relieve dysfunction)
o Rock sacrum back & forth, feel
for counternutation/nutation w/
inhalation/exhalation
o Can either accentuate or restrict
dysfunction
o Hold for 30 seconds
BALANCED LIGAMENTOUS TENSION
Posterior Fibular Head
o Technique
Pt is seated on the table
Hold leg up w/ knee slightly
bent
Contact fibular head w/ cephalad hand & hold foot w/
caudad hand
Pull leg inferiorly & invert foot
Push fibular head posteriorly further into dysfunction
Find position w/ least amount of tension
Hold for 30-60 seconds or until release
Bring back to neutral &
reassess

Cruciate Ligament Sprain/Strain

(ACL/PCL)
o Technique
Pt is seated on table w/ leg straight
Place hands around knee & push
downwards toward table
Compress knee by bringing hands
together
Assess distal femur & proximal tibia
separately
Internally/externally rotate to find
ease
Hold for 30-60 seconds to find ease
Bring back to neutral & reassess
Posterior Tibia on Talus
o Technique
Pt is seated on table w/ leg straight
Contact distal tibia & apply
downward force toward table
(induces posterior force)
Internally/externally rotate to find ease (least amount of tension)
Can also fine tune w/ foot
Hold for 30-60 seconds or until release
Bring back to neutral & reassess

LOWER EXTREMITY COUNTERSTRAIN

Quadratus Lumborum
o Technique
Pt is prone
Tender point: start at bottom of 12th
& move down lumbars to ilium (ask
about tenderness while moving
down)
Extend, Adduct, externally rotate
hip
Hold for 90 seconds
High Ilium Flare Out
o Technique
Pt is prone
Tender point: ILA
Extend & Adduct at hip
Hold for 90 seconds

rib

Gluteus Medius
o

Technique
Pt is prone
Tender pt: Find ASIS &
follow curvature posteriorly
PL4 = lateral
PL3 = more posterior &
superior
Extend, Adduct,
externally/internally rotate
hip
Hold for 90 seconds

Popliteus
o Technique
Pt is prone
Tenderpoint: find fibular
move posteriorly &
Hold leg slightly superior
Flex & internally rotate leg
Hold for 90 seconds
Flexion Calcaneus Quadratus
Plantae
o Technique
Pt is prone
Tenderpoint: anterior
aspect of calcaneus on
surface of foot
Plantarflex the foot
Hold for 90 seconds

head &
medially
to ankle

plantar

UPPER EXTREMITY COUNTERSTRAIN

Supraspinatus
o Technique
Pt is supine
Tenderpoint: above spine of scapula
(midline of supraspinatus)
Flex, abduct, externally rotate
shoulder
Hold for 90 seconds
Long Head of Biceps
o Technique
Pt is supine
Tenderpoint: bicipital groove
(anterior/proximal part of long head
biceps)
Flex, Abduct, internally rotate the
shoulder
Hold Pts arm slightly superior to wrist
Move pts fingers to outside of face (bending the elbow)
Use your body to elbow toward pt (provides internal rotation)
Hold for 90 seconds

Pec Minor
o Technique
Pt is supine
Tenderpoint: inferior & medial to
coracoid process
Stand on opposite side of
tenderpoint
Place pts arm across their torso
Pick up shoulder & pull medially &
caudad
Hold for 90 seconds
Medial Epicondyle
o Technique
Pt is supine
Tenderpoint: at/near the medial
epicondyle on anterior side
Flex, adduct, & pronate at elbow (looks like
snake head)
Hold for 90 seconds
Dorsal Wrist
Extensor Carpi Radialis
o Technique
Pt is
supine
Tenderpoint:
dorsal surface of
2nd
metacarpal
Grasp pts hand around thumb
Extend, abduct wrist

Hold for 90 seconds