A 60-year-old woman presents to the clinic with two weeks of mid-back pain. She was recently hospitalized for acute pancreatitis and underwent a laparoscopic cholecystectomy. The back pain started during the hospitalization and is a dull ache that occurs intermittently throughout the day. Her past medical history includes hypothyroidism for which she takes levothyroxine 50 mcg daily. Her vital signs are within normal limits. On physical examination her lungs are clear to auscultation. Her abdomen is scaphoid, she has normoactive bowel sounds and no abdominal tenderness to palpation. Examination of her thoracic spine shows the transverse process at T7 is more prominent on the left and evens out with the other transverse process when she extends her back. How should the physician position themself and the patient to treat her thoracic somatic dysfunction with muscle energy?
A. Stand on her left side, keep her neutral at T7, sidebend her right and rotate her right
B. Stand on her left side, flex at T7, sidebend her left and rotate her left
C. Stand on her left side, extend at T7, sidebend her left and rotate her left
D. Stand on her right side, flex at T7, sidebend her right and rotate her right
E. Stand on her right side, extend at T7, sidebend her left and rotate her left
Scroll down for the correct answer!
The correct answer to today’s OMM Question is…
D. Stand on her right side, flex at T7, sidebend her right and rotate her right
Before we get to the Main Explanation, let’s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!
Incorrect answer explanations
The incorrect answers to today’s OMM Question are…
A. Stand on her left side, keep her neutral at T7, sidebend her right and rotate her right
While the sidebending and rotation here are correctly taking her into her barrier, she should also be flexed to fully engage her barrier.
B. Stand on her left side, flex at T7, sidebend her left and rotate her left
While flexing her at T7 is moving her toward her barrier, left sidebending and left rotation are in her direction of ease.
C. Stand on her left side, extend at T7, sidebend her left and rotate her left
Positioning her in this way would be moving her further into her somatic dysfunction (motion of ease).
E. Stand on her right side, extend at T7, sidebend her left and rotate her left
Positioning her in this way would be moving her further into her somatic dysfunction (motion of ease).
Main Explanation
Type 2 somatic dysfunctions at the thoracic spine occur in flexion or extension, and rotation and sidebending are to the same side (e.g. T6 F SR RR). Depending on the patient’s size and position, you can treat from either their left or right side. This patient’s somatic dysfunction is T7 E SL RL, so whether you stand on her left or right side, you should be flexing her at T7, sidebending her right and rotating her right.
Position the patient into their barrier by moving exactly opposite of their somatic dysfunction. As you slowly engage the barrier for 3-5 seconds, instruct the patient to gently resist by returning their head toward neutral (i.e. moving it in the direction of their freedom of motion). After each time you engage their barrier, let them rest for a few seconds while you very slowly engage the next barrier.
Major Takeaway
Type 2 somatic dysfunctions involve flexion or extension, and rotation and sidebending to the same side. In order to treat, stand on whichever side of the patient is more comfortable and move them toward their barrier.
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