Working with children from a lymphatic and fluid motion perspective

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Working with children from a lymphatic and fluid motion perspectiveSEATED OR STANDING RIB BALANCEDLIGAMENTOUS TENSION1. The child is seated or standing with thephysician behind them.2. One of the physician’s hands is placed on theanterior and posterior aspect of the rib(s) to betreated, noting that with young children that therib runs in a more horizontal plane than in olderchildren and adults. The other hand stabilizes thevertebra attached to the rib being treated.3. Using gentle pressure, the rib and itssurrounding tissue is engaged by using a pincergrasp. Then the physician brings the area intobalance by bringing the entire rib up or down,internal or external rotation, and inferior orsuperior inclination.4. Once balanced tension is achieved, the physician maintains that position until a correction of the mechanicalstrain or improvement in the tissue motion is noted.SEATED ABDOMINAL DIAPHRAGM RELEASE1. The child is seated with the physician behind them andsupporting their back with their hip or leg.2. The physicians fingers anteriorly contact the inferiorborder of the rib cage and gently hook posteriorly andsuperiorly to engage the abdominal diaphragmatic fascia.Posteriorly (see bottom picture) the thumbs are engaging thethoracolumbar junction, including the 11-12 ribs and T12-L1.3. The child is gently encouraged to slump into the fingerswhile the entire diaphragm is brought into ease or bind,whichever feels more conducive to treatment, until thepassive breathing of the child is felt easily. This is balance.4. This position is held until a release of the mechanical strain orimprovement in tissue motion is noted.Heather Ferrill DO March 2013 Convocation Page 4

Working with children from a lymphatic and fluid motion perspectiveSEATED OR STANDING THORACIC INLET MYOFASCIAL RELEASE1. The child is seated or standing with thephysician behind them.2. The physician contacts the first andsecond ribs and possibly the manubriumanteriorly, and the costotransverse junctionof T1 posteriorly. The focus of treatment ison the fascial connections of the thoracicinlet.3. The area is engaged by gently liftingsuperiorly. Balance is sought by bringingthe area into ease or bind through engagingflexion/extension, sidebending androtational barriers.4. When the breath is easily felt coming through the tissues, the position is held until a correction of themechanical strain occurs or improvement in tissue motion is noted.SEATED OR STANDING CLAVICLE BALANCEDLIGAMENTOUS TENSION1. The child is seated or standing with the physicianbehind them. The clavicle is contacted at both thesternoclavicular and acromioclavicular ends and thephysician evaluates passive motion with respiration.2. First to be addressed should be any interosseous strains.To do this, a gentle compression or distraction force alongthe long axis of the clavicle is applied. The force vectorhere can be changed to accommodate tissue response andtorsional restrictions of the clavicle.3. After the interosseous balancing is achieved, then the clavicle is balanced in relationship to the supportingstructures and attachments such as the clavipectoral fascial, and the sternoclavicular and acromioclavicularligaments. Both of these are then balanced with the respiratory motion of the first rib.4. This balanced tension system is then maintained until correction of the mechanical strain or improvement inthe tissue motion is noted.Heather Ferrill DO March 2013 Convocation Page 5

Working with children from a lymphatic and fluid motion perspectiveSEATED OR STANDING CERVICALFACILITATED POSTITIONAL RELEASE:Lower cervical, Occipito-Atlantal (OA) andAtlanto-Axial (AA) joints1. The child is seated with the physician to theside for best control of the head.2. One hand is used to monitor tissue response totreatment at the level of the dysfunctionalsegment(s). The other hand is placed on the head.3. The child’s head is gently placed in relativeflexion until the cervical spine is in a posturalneutral position.4. A gradual and gentle axial compression isapplied until there is a softening of the tissuesjust under the monitoring hand. Force used should be no more than 2.5kg.5. While maintaining the axial compression, the segment monitored is then brought into is position of ease, orinto the position of diagnosis. For example, if the diagnosis was C4FRSr, than C4 would be gently brought intoa flexion, sidebending and rotation to the right using the head as well as translational motion of the monitoringhand.6. This position is held for 3-5 seconds and then released and the area is re-assessed. This procedure can bereapplied as many times and the child allows.Heather Ferrill DO March 2013 Convocation Page 6

Working with children from a lymphatic and fluid motion perspectiveSome of my favorite resources:All techniques described above are adaptations of things I have learned from theseoutstanding physicians though direct contact or through their writing.‣ Carreiro, J. Pediatric Manual Medicine, An Osteopathic Approach. Churchill, Livingstone,Elsevier 2009.‣ Carreiro, J. An Osteopathic Approach to Children, 2 nd ed. Chruchill Livingston Elsevier, 2009.‣ Frymann, V. The Collected Papers of Viola M. Frymann, DO. Legacy of Osteopathy to Children.American Academy of Osteopathy, 1998.‣ Sergueef, N. Cranial Osteopathy for Infants, Children and Adolescents: A Practical Handbook.Churchill, Livingstone, 2007.‣ Arbuckle, B. The Selected Writings of Beryl Arbuckle DO. American Academy of Osteopathy.Heather Ferrill DO March 2013 Convocation Page 7