Facilitated Positional Release OMM

How to screen for area of greatest restriction

This is just another screening tool, it is optional on the practical

What are the basic principles of FPR?

1) Region of dysfunction placed in a neutral position

2) Facilitating force applied (compression, torsion, or traction)

3) Body part moved into position of ease

4) Held for a few seconds (3-5 secs)

5) Passive return to neutral

Cervical Spine Superficial FPR

Example: Right Suboccipital HypertonicityTechnique:

1. With the right hand, support the occipital and upper cervical regions of the patient’s head.

2. With the left hand on the patient’s head, neutralize the cervical spine by applying slight flexion to the anteroposterior curve.

3. Add an activated caudad force (about 1 lb) through the axial plane. Continue to apply force until the force is felt under your fingers supporting the occiput and cervical spine.

4. While maintaining compression, position the patient’s head and cervical region toward extension with right side bending and right rotation.

• Side bending and rotation towards the hypertonic muscles.

5. Continue to move until maximal reduction of tissue and muscle tension is achieved.

6. Hold this position for 3 to 5 seconds and then slowly release the compression while returning to neutral.

7. Reassess to compare with the original diagnosis.

Flexion of Cervical Spine FPR

Patient position: Supine upon the treatment table.

Physician position: Sitting at the head of the table.

Example: C4 F SᵣRᵣTechnique:

1. With the right hand, support the cervical region.

2. With the left hand on the patient’s head, neutralize the spine with slight flexion.

3. With the left hand, apply an axial compression force (~1 pound). While maintaining compression, position the head into flexion, right side bending, and right rotation.

• Side bending and rotation towards the freedoms.

4. Continue to move until maximal reduction of tissue and muscle tension is achieved.

5. Hold this position for 3 to 5 seconds and then slowly release the compression while returning to neutral.

6. Reassess to compare with the original diagnosis.

Extension of Cervical Spine FPR

Patient position: Supine upon the treatment table. For C4-C8, they should be slightly off the table

Physician position: Sitting at the head of the table.

Example: C4 E SᵣRᵣTechnique:

1. With the left hand, support the cervical region.

2. With the right hand on the patient’s head, neutralize the spine with slight flexion.

3. With the right hand, apply an axial compression force (~1 pound). While maintaining compression, position the head into extension, left side bending, and left rotation.

• Side bending and rotation towards the freedoms.

4. Continue to move until maximal reduction of tissue and muscle tension is achieved.

5. Hold this position for 3 to 5 seconds and then slowly release the compression while returning to neutral.

6. Reassess to compare with the original diagnosis.

Superficial Thoracic Paravertebral Hypertonicity FPR

Patient position: Seated

Physician position: Standing on left side of patient (side of hypertonic muscles)

Example: Left Thoracic HypertonicityTechnique:

1. With the right hand, monitor the area of hypertonic muscle.

2. With the left forearm, place it on the patient’s left shoulder.

3. With the left hand, place it on the patient’s right shoulder.

4. Instruct the patient to sit up straight to neutralize the kyphotic curve of the spine (induce extension).

5. Physician’s left forearm applies a caudad and posterior axial compression force, which side bends left and extends the thoracic area.

• Side bend towards the side of hypertonicity.

6. Continue to move until maximal reduction of tissue and muscle tension is achieved.

7. Hold this position for 3 to 5 seconds and then slowly release the compression while returning to neutral.

8. Reassess to compare with the original diagnosis.

Thoracic Flexion FPR

Instruct pt to drop their head forward when you add flexion

Thoracic Extension FPR

Lumbar Soft Tissue FPR

Lumbar Flexion FPR

Add internal rotation by moving around in your chair and then add compression at the knee before holding for 3-5 seconds

Lumbar Extension FPR