25. OMM | Lab 3 Prep Lecture: Thoracic MET for Type I and Type II Anterior Thoracic CS

What are the key mechanical features of a Type I thoracic somatic dysfunction?

Neutral mechanics; sidebending and rotation occur in opposite directions; flexion/extension absent; often involves multiple vertebrae.

What is an example diagnosis of a Type I thoracic dysfunction?

T8 NSRRL (Neutral, Sidebent Right, Rotated Left).

What is the mechanism of action of MET?

Direct, active technique; stimulates Golgi tendon organ reflex to relax muscle.

According to Fryette’s 3rd principle, what happens if you improve motion in one plane?

Motion improves in all three planes.

What is the general sequence of steps for thoracic/lumbar MET?

"1. Take patient to restrictive barrier (all 3 planes)

2. Patient resists toward freedom (~10% effort) for 3-5 sec

3. Relax 1-2 sec

4. Advance to new barrier

5. Repeat 3-5 times

6. Add passive stretch at end

7. Reassess TART."

In Type I MET (example: T8 NSRRL), what is the correct patient position and physician setup?

Pt seated: L hand behind head/neck, R hand grasps L elbow (R forearm parallel to floor). Physician stands opposite side of rotation, R hand under axilla grasps L upper arm, L hand palpates T8-T9.

In Type I MET for T8 NSRRL, how are the barriers engaged?

Physician pushes down on pt’s left shoulder to engage left sidebending barrier; rotates shoulders to the right to engage right rotation barrier.

In Type I MET for T8 NSRRL, what instructions are given to the patient?

Patient is instructed: 'Turn shoulders to the left' while physician resists.

What are the key mechanical features of a Type II thoracic somatic dysfunction?

Flexion or extension present; sidebending and rotation are in the same direction.

What is an example diagnosis of a Type II thoracic dysfunction?

T8 ESRRR (Extended, Sidebent Right, Rotated Right).

What is the regional difference in localizing Type II MET?

T1-T4 localized via head/neck; T5-T12 localized via trunk/shoulders.

What is the sequence of steps for MET in Type II dysfunctions?

Same as Type I: barrier → resist 3-5 sec → relax 1-2 sec → reposition → repeat → reassess.

Describe patient position and physician setup for T8 ESRRR (Type II MET, lower thoracic).

Pt seated at table edge, arms folded (R over L). Physician stands opposite side of rotation. L arm crosses pt’s elbows, hand on R shoulder. R hand monitors T8-T9, torso flexed to barrier.

How are barriers engaged in T8 ESRRR (Type II MET)?

Physician localizes to left sidebending and left rotation barriers; pt instructed 'Sit up and turn right' while physician resists.

Describe the sequence for T4 ESRRR (Type II MET, upper thoracic).

Pt seated. Physician stands at side. L hand monitors T4-T5, R hand flexes head/neck to barrier. Physician sidebends and rotates head/neck left. Pt instructed: 'Extend head/neck and turn right' against resistance. Hold 3-5 sec, relax 1-2 sec, reposition into new barriers (SB L → Rot L → Flex), repeat 3-5x, reassess.

What are the general principles of counterstrain?

"1. Identify tender point (ask 'Is this tender?')

2. Establish pain scale (10/10)

3. Passively position pt for maximal pain relief (goal 0/10, accept ≤3/10)

4. Hold 90 sec while monitoring

5. Slowly return to neutral

6. Reassess tenderness

7. Remove monitoring finger."

What does the acronym f-F stand for in counterstrain setup?

Flexion (fine-tune with sidebending and/or rotation).

What does the acronym F St Ra stand for in counterstrain setup?

Flex, Sidebend toward, Rotate away.

What is the location of counterstrain point AT1?

Midline/lateral to episternal notch

What is the patient position for treating AT1?

Flex to dysfunctional level

What is the setup/acronym for treating AT1?

f-F

What is the location of counterstrain point AT2?

Midline/lateral to manubrium-sternum junction (angle of Louis)

What is the patient position for treating AT2?

Flex to level

What is the setup/acronym for treating AT2?

f-F

What is the location of counterstrain point AT3-AT6?

On sternum @ corresponding costal levels

What is the patient position for treating AT3-AT6?

Flex to level, fine-tune SB/Rot

What is the setup/acronym for treating AT3-AT6?

f-F

What is the location of counterstrain point AT7?

Inferior xiphoid tip or 1/4distance xiphoid→umbilicus

What is the patient position for treating AT7?

Pt seated

What is the setup/acronym for treating AT7?

F St Ra

What is the location of counterstrain point AT8?

1/2 distance xiphoid→umbilicus

What is the patient position for treating AT8?

Pt seated

What is the setup/acronym for treating AT8?

F St Ra

What is the location of counterstrain point AT9?

3/4 distance xiphoid→umbilicus

What is the patient position for treating AT9?

Pt seated

What is the setup/acronym for treating AT9?

F St Ra

What is the location of counterstrain point AT10?

1/4distance umbilicus→pubic symphysis

What is the patient position for treating AT10?

Supine, hips/knees flexed; knees pulled toward, ankles toward

What is the setup/acronym for treating AT10?

F St Ra

What is the location of counterstrain point AT11?

1/2 distance umbilicus→pubic symphysis

What is the patient position for treating AT11?

Same as AT10

What is the setup/acronym for treating AT11?

F St Ra

What is the location of counterstrain point AT12?

Ant. superior iliac crest @ midaxillary line

What is the patient position for treating AT12?

Same as AT10

What is the setup/acronym for treating AT12?

F St Ra

Why does AT1 require less flexion and AT2 require more flexion?

Because of their relative locations: AT1 is higher (needs less flexion), AT2 is lower (needs more flexion).

In counterstrain for AT7-AT9, how does sidebending and rotation depend on the tender side?

If tender on left: sidebend left and rotate right. If tender on right: sidebend right and rotate left.

In counterstrain for AT10-AT12, how is sidebending and rotation achieved?

Sidebending toward is achieved by pulling ankles toward physician; rotation away is achieved by pulling knees toward physician.

What is the counterstrain setup acronym associated with AT1?

f-F

What is the counterstrain setup acronym associated with AT2?

f-F

What is the counterstrain setup acronym associated with AT3-AT6?

f-F

What is the counterstrain setup acronym associated with AT7?

F St Ra

What is the counterstrain setup acronym associated with AT8?

F St Ra

What is the counterstrain setup acronym associated with AT9?

F St Ra

What is the counterstrain setup acronym associated with AT10?

F St Ra

What is the counterstrain setup acronym associated with AT11?

F St Ra

What is the counterstrain setup acronym associated with AT12?

F St Ra

A 19-year-old wrestler presents with chest wall tenderness. Palpation reveals a tender point located on the sternum at the level of the fourth rib. Which counterstrain setup is most appropriate?

A. Flex to dysfunctional level, fine-tune with sidebending and/or rotation (f-F)
B. Patient seated; flex, sidebend toward, rotate away (F St Ra)
C. Supine, hips/knees flexed; knees and ankles pulled toward physician (F St Ra)
D. Extend to dysfunctional level with sidebending toward, rotate away
E. Extend to dysfunctional level with sidebending away, rotate toward

A

• Why A is correct: AT3–AT6 tender points are on the sternum. Treatment is flexion at dysfunctional level, fine-tuned with SB/Rot as needed.

• Why B is wrong: That setup (F St Ra) is for AT7–AT9.

• Why C/D/E are wrong: Incorrect for AT4 location; they describe lower thoracic or extension-based positions.

A 21-year-old male presents with abdominal pain after strenuous exercise. On palpation, you find a tender point halfway between the xiphoid process and the umbilicus, lateral to the midline. Which counterstrain position is correct?

A. Flex to dysfunctional level (f-F)
B. Patient seated; flex, sidebend toward, rotate away (F St Ra)
C. Supine, hips/knees flexed; knees and ankles pulled toward physician (F St Ra)
D. Neutral with sidebending and rotation opposite
E. Extension with sidebending and rotation away

B

• Why B is correct: AT8 (halfway between xiphoid and umbilicus) uses seated F St Ra positioning.

• Why C is wrong: That describes AT10–AT12.

• Why A/D/E are wrong: Flex-only (f-F) applies to AT1–AT6; extension setups not used for anterior thoracic CS.

A 19-year-old wrestler is found to have a tender point ¾ of the distance between the xiphoid process and umbilicus, within the rectus abdominis. Which of the following is the correct counterstrain acronym and position?

A. f-F; flex to dysfunctional level, fine-tune with SB/Rot
B. F St Ra; patient seated, flex, sidebend toward, rotate away
C. F St Ra; supine, hips and knees flexed, knees/ankles toward physician
D. Extension; seated with head/neck extended
E. Neutral; rotate left, sidebend right

B

• B is correct: This is AT9 (¾ distance between xiphoid and umbilicus). AT7–AT9 are treated seated with F St Ra.

• C is wrong: Supine F St Ra is for AT10–AT12, not AT9.

• A: f-F is AT1–AT6.

• D/E: Not used for anterior thoracic CS.