By Lee Jarvis and Katie Ryan.
The book Principles of Osteopathy by Dain Loren Tasker, DO was originally published in 1903. Although this was not the only Osteopathic publication of this time, what is worthy of noting is that it has an extensive number of photographs of manual Osteopathic applications. In some cases, the subjects in these photographs had anatomy illustrations drawn directly on them in ink. It is for this reason that we endeavour to further illustrate Tasker’s work with our own explanations and illustrations. In this series we not only intend to reveal the mechanics of the technical applications relative to the patient, but just as importantly we hope to show how the operator generates leverage safely and effectively.
The following description and series of images is taken from the book Principles of Osteopathy pages 423-425. Specifically, these words and images are from the section titled “Kyphosis in the Dorso-Lumbar Region”. Kyphosis dorso-lumbar refers to a flexed/convex curvature occurring at the dorsal-lumbar junction (DL). In this case the author has chosen to use the word “Dorsal” to describe what we more commonly now call the “Thoracic”.
Above is the original and unedited image. We can see that the patient sits on a stool and the practitioner stands behind the patient. The wrists are grasped bilaterally and the arms are lifted into the position seen above.
Tasker’s goal is to stretch the thorax, lumbar, and abdomen to reduce the anterior/flexed curvature of the DL junction. Tasker notes that this movement should not be carried too far due to the significant leverage and ability to produce more than the desired effect, a potential for injuring the patient.
A fixed point at created at the DL by placing the foot on a lower rung of the stool, bending the knee until it touches the DL, and then bringing the patients body posteriorly over the practitioner’s knee.
In addition to creating a fixed point at DL, the pelvis is fixed to the stool. Using the stool to maintain the position of the pelvis helps the practitioner to direct the force from their knee into DL rather down into the pelvis and hip regions.
The arms, bent at a 90-degree angle and drawn posterior, are used as long levers to pull thoracic spine into extension.
This leverage allows the practitioner to engage the anterior muscles of the trunk (what CAO students and grads might call the Anterior Line). Utilizing the arms as such is beneficial to the treatment in several ways as it addresses the forward pull on the spine of the Pectoral muscles through the ribs and clavicle as well as the Serratus Anterior through the ribs and scapular attachments. The abdominal muscles are also lengthened reducing their pull on the ribs through muscular and fascial attachments between inferior border of the ribs, Costal Chondral Cartilages, and Xiphoid Process, down to the superior border of the pelvis.
Drawing the anterior aspect of the ribs upwards unifies the rib cage through muscular and ligamentous attachments and allows it to act on (pull on) the thoracic and lumbar spine.
The upper limbs are abducted and drawn posterior causing the Scapulae to approximate into a retracted position and opening the anterior aspect of the upper and middle ribs.
The retraction of the scapulae lengthens the serratus anterior muscle and lifts the ribs on the front of the body.
The abduction of the upper limbs and drawing the arms posterior creates an oblique line of pull into the pectoralis and causes them to lengthen, again pulling on the ribs, sternum, and clavicles.
The spine is moved into extension above and below the fixed point over DL. The dual pointed arrow indicates this occurring through the usage of the practitioner’s knee at DL, the arms, as well as the fixation and weight of the pelvis.
In this image you can see that the fixed point at DL directs force up into the thoracic spine; the weight of the body and the practitioner’s knee also directs the extension force down into the lumbar spine stopping at the pelvis fixed point created by the stool. The spinal extension increase the distance between the rib cage and pelvis and thus causes the abdominal musculature to elongate reducing their downward pull on the lower ribs.
As always, the effectiveness of this method depends on the knowledge, skill, and willingness to practice of the practitioner. We hope the reader finds this explanation both informative and useful.