Overview of Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure – Thoracic Vertebrae
Upper back and neck pain caused by certain issues with the upper spine are very common. They can be caused by changes in posture, or injuries. In some cases, problems in an internal organ, such as the heart, can create problems in the spine. For example, people experiencing chest pain from a heart problem might also have problems at the levels of T1-T5 of their spine, which concerns the upper back.
There are several manual therapy treatments that can be used to treat these issues. These treatments, often performed by osteopaths, physically manipulate the body to alleviate discomfort. Certain techniques often used involve guiding the body into more comfortable or less restricted positions. Strain-counterstrain (SCS) is one method where the patient is placed in a posture that allows a muscle to shrink, aiding the spine in returning to its proper position. Functional Positional Release (FPR) incorporates elements of SCS along with other tactics and involves applying some pressure or a twisted force. It is important to note that these are just two ways that these upper spine issues can be treated.
Anatomy and Physiology of Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure – Thoracic Vertebrae
The human spine is made up of different types of vertebrae, and one such type is the thoracic vertebrae. There are twelve thoracic vertebrae in total, labeled T1 through T12. They have a natural curve and significantly, they provide a place for the ribcage to attach.
Thoracic vertebrae are unique in that they are especially connected to the ribs. This may lead to issues if there are any rib injuries, which could affect the thoracic vertebrae as well. Thoracic vertebrae have features called costal facets, setting them apart from the other types of vertebrae, such as the neck (cervical) and lower back (lumbar) vertebrae.
Each of these thoracic vertebrae has six specific connection points (facets) that allow them to join with the ribs. T1, T11, and T12 are slightly different from the other thoracic vertebrae. For instance, T1 entirely connects with the first rib while T11 and T12 lack facets on their transverse processes, which are extensions of the vertebra where muscles attach. T12 is at the level of and connects with the first lumbar spine vertebra (L1).
The thoracic vertebrae also connect to numerous muscles, including ones like the latissimus dorsi (large back muscle), and trapezius (a large upper back and neck muscle). They are mainly supplied with blood by arteries branching from the subclavian artery (major artery in the upper chest) and the thoracic aorta (the main blood vessel carrying blood from the heart to the rest of the body). Veins surrounding the spinal canal primarily handle the removal of blood. The nervous supply to the thoracic vertebrae comes from branches of the spinal nerves.
Techniques like Strain-Counterstrain (SCS) and Facilitated Positional Release (FPR) work based on the body’s natural ability to relax. SCS works by managing muscle activity, specifically between a muscle that causes motion and its opposing muscle. By elongating a muscle, there’s an increase in muscle activity and a reflexive muscle contraction. This activity decreases when the muscle is shortened. Extending the time for muscle shortening in SCS can help bring back normal muscle function.
FPR is similar to SCS since it also works by altering muscle activity. The method of FPR rests on reducing the activity of certain motor neurons that influence the muscle function, leading to relaxation. In simpler terms, it causes the muscles to return to their relaxed state.
Why do People Need Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure – Thoracic Vertebrae
Somatic dysfunctions of the thoracic spine (the middle and upper part of your back) might need to undergo therapeutic treatments like Strain Counterstrain (SCS) or Fascilitated Positional Release (FPR). These treatments could be recommended if you’re experiencing several symptoms, such as:
- Back pain
- Chest pain
- Neck pain
- Headaches
- Issues moving your joints freely (joint hypo-mobility)
- Tightness in your connective tissue (fascial restrictions)
- Muscle problems or spasms in the area of your thoracic spine or the thoracic spine itself.
Another critical factor considered when deciding whether to perform SCS or FPR is the patient’s ability. If you have difficulties in controlling or activating your muscles and you need more help from the medical professional, both these treatment techniques, which involve gentle manipulation of your body by the medical professional, could be suitable.
When a Person Should Avoid Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure – Thoracic Vertebrae
SCS and FPR are treatments that cannot be used if a patient is unable to communicate their sensations to the doctor. Here are conditions where the usage of SCS and FPR may not be suitable:
- A recent bone break or ‘acute fracture’
- A shoulder that has moved out of place, or ‘dislocated’ – this is specific for issues related to thoracic extension, which involve movement and function of the middle part of your spine and upper body
Equipment used for Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure – Thoracic Vertebrae
The tools for this treatment include a table where the patient can either sit or lie down (this could be an exam table, an OMT – Osteopathic Manipulative Treatment – table, or a massage table), and a stool where the healthcare provider can sit.
Who is needed to perform Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure – Thoracic Vertebrae?
The doctor who specializes in osteopathic medicine is the only one qualified to carry out these specific medical techniques correctly. Osteopathic medicine focuses on treating your body as a whole, not just specific parts or symptoms. So, this type of doctor has special training that allows them to perform these techniques safely and effectively.
Preparing for Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure – Thoracic Vertebrae
Before starting any treatment, the doctor will talk with the patient about the advantages and disadvantages, as well as other possible treatment options. This is to make sure the patient understands what’s happening and agrees to the treatment plan, which is known as giving ‘informed consent.’
Looking closely at the mid-back region, known as the ‘thoracic spine,’ is a very important step before treatment starts. The doctor will examine the patient visually, ask about their level of pain, and test the strength and flexibility of their muscles. They’ll also look for any painful spots, also known as ‘tender points,’ and any irregularities in the way the body’s internal structures are functioning, referred to as ‘somatic dysfunction.’ These assessments are done to make sure that the treatment is tailored correctly to the patient’s specific needs and to ensure the greatest chance of success.
How is Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure – Thoracic Vertebrae performed
SCS and FPR revolve around indirect techniques, which work by putting you, the patient, in a comfortable position away from the source of your discomfort or restriction.
In SCS, the first step involves identifying a tender point (TP), sometimes referred to as Jones tender points. For the part of your spine that runs down your chest, there are 12 front TPs (AT1-12), 12 back TPs (PT1-12), and 4 side TPs (LAT5-8). Each TP aligns with a different part of the spine; for example, AT1 links to the T1 bone in the spine.
For the front TPs 1-8, you would lie on your back, and the healthcare provider would sit at your head. For AT 9-12, you’d still be on your back, but the healthcare provider would stand to your side. The TPs have different locations. For instance, AT1 is located at the indentation between your collarbones, while AT2-8 are located in a line down your breastbone. The healthcare provider would then gently move your head towards your chest. AT9-12 reside near your belly button and above your hip bone.
To reach these, the healthcare provider would bend your knees and prop them up on their leg. Then, they would cross your further leg over the other to induce a leaning and turning action away from the TP. The side TPs are located at the gristly bit at the front of the rib that corresponds to that part of the backbone. Here, you’d sit up, and the provider would be behind you, rotating you towards their leg and away from the TP. The back TPs are located at the ends of the spine bones that stick out at the side. You would lie face down, and the healthcare provider would stand on the side opposite to the TP. For the upper TPs, they would pull your shoulder back on the same side as the TP, and for the lower TPs, they would pull your hips back on the same side as the TP.
Upon identifying a TP, the healthcare provider would ask you to rate your discomfort at the TP on a scale of 1 to 10. They would further adjust your position based on the location of the TP until your pain decreases to 3 out of 10 or less. Once achieved, they would maintain this position for 90 seconds, then gently return you to a neutral position.
Before starting FPR treatment on the spine running down your chest, a diagnosis of the spine using Fryette’s principles is vital. These principles state that a curved group is typically neutral, rotated, and leans in different directions. Alternatively, if a single backbone isn’t functioning well, it’s usually flexed or extended, rotated and leaning to the same side. Since FPR is indirect, you would be placed away from the restrictive barrier and into the direction of the diagnosis.
You’d sit straight to reverse the natural curve of your spine running down your chest, with the healthcare provider standing behind you. You would cross your arms, and the healthcare provider would rest their forearm on the opposite shoulder of where the TP is located. They would use their other hand to monitor the concerned backbone. Once you both have the correct position, they would move you into your diagnosis and apply a compressive force on the shoulder where their forearm rests for 3 to 5 seconds.
Possible Complications of Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure – Thoracic Vertebrae
Spinal cord stimulation (SCS) and Frequency Percussion Response (FPR) are techniques that don’t involve surgery and are safe when done properly. After these treatments, some patients may feel a bit sore in their muscles, have a headache, or feel a little dizzy. Healthcare providers will let their patients know they might feel sore for a few days after the treatment.
What Else Should I Know About Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure – Thoracic Vertebrae?
Neck and upper back pain caused by problems in the mid-back (thoracic spine) is pretty common. However, there aren’t many treatment options that don’t involve medication. Two options available include ‘SCS’ and ‘FPR’, which can provide quick relief. Additionally, if you visit a doctor who practises osteopathy, they will consider your overall health, not just the specific area causing pain.
These doctors don’t just treat the mid-back. They also address any problems that might occur throughout the body’s movement system, including issues in the neck (cervical), lower spine (lumbar), hip (pelvic), and tailbone (sacral) areas. This comprehensive treatment approach can lead to a longer-lasting, more effective outcome.
