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SCIENTIFIC KINESIOLOGY MANEUVERS AND CARE
Scientific Kinesiological maneuvers consist of the
following therapeutic hands on care:
Mono and Poly Point Maneuvers
Cervical, Thoracic and Lumbar Stretching Maneuvers
Cervical, Thoracic and Lumbosacral Manual Traction Maneuvers
Origin and Insertion Maneuvers
Basic Pressure Techniques
MONO Ė POINT AND POLY Ė
When considering monopoint and poly point
maneuvers one must first understand the relationship
between motor points, trigger points and areas where these points
happen to coincide topographically. Motor points are defined as that
point at which a motor nerve enters a muscle. Further, that point
wherever, if galvanic stimulation is applied, it will cause a
contraction of a corresponding muscle.
A Trigger Point is defined as that point or
particular spot on the body on which pressure or other stimulus will
give rise to specific sensations or symptoms.
Glogowsky and Wallraff, conducted biopsy
examinations on 20 patients, with trigger point, and related that,
histologically the were characterized by a waxy degeneration of the
muscle fibers, destruction of fibrils, increase in number and
agglomeration of nuclei of muscle fibers, and fatty infiltrations.
Brendstrup et al (1957) conducted 12
symmetrical biopsy examinations from chronic ďfibrocysticĒ areas in
the sacrospinales muscles of patients operated upon for herniated
discs. They found interstitial mucinous edema containing acid
mucopolysaccharides and accumulation of mast cells, which are
considered the origin of the mucopolysaccharide ground substance.
In 1959, Erwin advanced the theory that
trigger points can be located in any peripheral tissue. He classified
them as into levels as follows:
Superficial layer of deep fascia
Deep layer of deep fascia
He believed that the most frequent locations are
at levels 3,4 then 5, followed by level 7 the Ligaments. The least
frequent levels were 1 and 2.
In 1971 Glyn reported that during the early
phase of the pain syndrome, pain may be due to ďpain Ė producingĒ
metabolites (see muscular splinters) released into the connective
tissues, and if not immediately leached out of the area, these
substances could perhaps produce the local irritation, which in turn
may result in the cellular damage and the release of intracellular
cathepsins, possibly from mast cells or from connective tissue
Hackett reported that Gutstein believed that
the trigger point is initiated by a localized sympathetic predominance
which is associated first with changes in the H+ ion (see muscular
splinters) concentration and calcium and sodium balance in the tissue
fluids, and generally also with vasoconstriction and hypoxia. These
altered circulation dynamics trigger (trigger point) impulses in pain
endings and proprioceptors. The referral distribution of pain and
sensory disturbance, or its anatomic pathways do not follow the normal
dermatomal patters. They generally follow a scleratomal
Travell studied trigger points with precision
and identified the topographic location of these points. Trigger
points have been found at the level of the skin and at projections of
the posterior articular bony structures by an axial pressure. These
latter points in the dorsal and lumbar vertebrae are called
Trousseauís apophyseal point in cases of neuralgia. In any case,
these apophysial trigger points coincide topographically with motor
points. Thus axial stimulation of these points aids in diagnosis
(Trigger point) and result in treatment of contracted musculature
Other areas have also been identified as
combination motor-trigger points. Generally, these points are
bilaterally along the posterior superior border of the trapezius
muscle, along the superior, medial and inferior surface of the
scapula. These points have also been found along the apophysial
joints of the spine, bilaterally near the lateral border of the second
to third sciatic notch, over the tissues near the Ischeal tuberosities,
medially below the illiac crest, medially and just superior to the
greater trocanters of the femurs, medially over the adductors of the
upper thigh, bilaterally about the knee joint, just central above the
tissues over the belly of the Gastrocnemius muscle and bilaterally
about the ankle just inferior to the medial and lateral malleoli.
To locate trigger points and perhaps motor
points which coincide first palpate for trigger points with physical
stimulation. Pulsating or tetanizing sine with ultrasound or galvanic
stimulation can be applied to locate hot trigger points. Note any
reproduction of pain responses.
During the early phase of pain responses
motor and sensory effects may be found in the scleratome
distributions. After several weeks, there is also involvement of the
Monopoint Kinopractic maneuvers are defined
as the diagnosis of/and at times the treatment of the combined motor
trigger point with axial pressure of usually one digit or the thumb of
the physician. Polypoint Kinopractic maneuvers are defined as the
diagnosis of and treatment of multiple motor-trigger points
simultaneously with multiple fingers applying the pressure.
When considering a patient, one must realize
that muscular pain proper may prolong or produce the suffering in these
patients. Palpation of the muscles may reveal the presence of some
contracted fasciculi, with painful induration and trigger point, which
induces referred pain. Palpation may be carried out in relaxed muscles,
but it is good to complete it by palpating contracted muscles against
The treatment of muscular spasticity lies in
the realm of Kinopractic stretching techniques as illustrated with a
full explanation of their procedure as follows:
Stretching Cervical Kinopractic Techniques
The patient is supine with their head rotated to the left. The
physician stands at the right side of the table with his right hand
extended over the temporal bone area. The physician paces the thenar
eminence of his left hand just below the mastoid process of the left
side. A gently springing pressure exerted downward over the temporal
bone by the right hand accompanies the stretching of local tissues.
Reverse the procedure for stretch of the contralateral musculature.
The patient is in the supine position with his head at 0
degrees Neutral. The physicianís right ad cups t patentís chin
gently. The physicianís left hand cups the patientís occipital area
with their thumbs in a natural position. The maneuver is performed as
follows: Gradually traction the head cephalad with both hands. Next
take the occipital and upper cervical vertebrae through their range of
motion springing where tension appears; expect the release to be
gradual. Then raise the head superiorly and gently flex the mid and
lower cervical areas in a springing motion.
The patient is in the supine position with their head facing
the physician. The physician stands at the patients left side. The
physician stabilizes the right shoulder of the patient with his left
hand and hooks the tips of his right fingers about the lateral mass of
the neck. The physicianís left hand stabilizes the shoulder while
they pull (stretches) the muscles of the cervical area toward him then
releases them by a gentle, slow, rhythmic and elastic movement.
Reverse the procedure for stretch of the contralateral musculature.
The patient is either sitting on a table or stool with
the physician facing the patient. The physician places the patientí
frontal bone against his chest. The physician now cups the posterior
cervical area with his hands and fingers. The physician then draws
the patient toward them. An exaggeration of movement is produced
anteriorly and superiorly with a gentle springing motion. Next, the
patientís head is turned to the side and lateral flexion is produced.
This is done bilaterally. The technique is known for its
excellent results with the geriatric patient.
The patient is in the supine position. The physicianís
thumb and forefinger of the left hand cup the posterior cervical area,
with the palm cupping the occiput. The physicianís right hand is
placed over the temporal and frontal regions and places the head into
slight flexion and rotation against the thumb. This motion is very
slight. The pressure (stretch) is relaxed slowly and reapplied gently
and slowly. This is done bilaterally.
THORACIC STRETCHING TECHNIQUE:
The patient is sitting with his arms crossed in front of his
chest and his thumbs hooked in each of his anti-cubital fosse. The
physician is standing facing the patient. The physician then places
his fingers under the patientís forearms and over the transverse
processes of the thoracic vertebrae. The patient is drawn toward the
physician and a superior lifting of the patientís forearms
accomplishes gentle springing and a downward pressure exerted through
The patient I placed in the right lateral recumbent position.
The physician stands facing the patient at the side of the table. The
physicianís right forearm is slipped under the patientís upper left
arm with his fingertips on the region supero-lateral to the spinous
processes. The physicianís left hand stabilizes the shoulder, as the
fingertips of the right hand are pulling toward the physician in a
gentle springing maneuver to stretch the local tissues.
The patient is in the prone position. The physician stands at
the side of the table facing the patient. The physician places his
right hand over the patientís left calf; his left had is placed with
is fingers forward, anterior to the contracted thoracic paraspinal
musculature. The physician affects a gentle springing motion
anteriorly and superiorly with is left hand.
LUMBOSACRAL STRETCHING TECHNIQUE
patient is supine with his thighs drawn up and flexed upon his abdomen
with his legs on his thighs. The physician stands to either side
grasping the patientís knees, springing gently downward through the
patient is supine with his legs drawn up and his feet on the table.
The physician, standing on the right side of the table, contacts the
patientís knees by his right hand and pulls toward him so that the
left hand can reach across the patient and under the opposite side.
As the physicianís left hand holds its position, the patientís knees
are pushed with the right hand toward the opposite side. This, of
course, can be done to the opposite side, by reversing the procedure.
patient is prone and the physician stands on the left and exerts a
gentle deep pressure with his left hand in the right lumbar area on
the right paravertebral musculature. The physicians right hand, which
is placed under the right anterior superior iliac spine is gently
pulling with counter-leverage and springing with the left hand.
patient is prone. The physician stands at the side of the table
facing the patient. The physician places his right and on the area of
the left floating rib. The physicianís left hand crosses and
contracts the crest of the ileum. The physician separates his hands
in a gentle springing (Quadrates Lumborum) motion.
patient is prone and the right lower limb remains extended as the
physician brings it across the popliteal space of the left lower
limb. The physicianís right hand holds the position of the lower
extremities while the left hand produces a gentle springing motion
inferiorly and laterally in the lumbar and pelvic regions. Having the
physician on the other side of the table can reverse this stretching
CERVICAL TRACTION TECHNIQUE
BILATERAL FOREARM TECHNIQUE: The patient is in the supine position.
The physician stands at the head of the table facing the patient. The
physician crosses his forearms and places them under the patientís head
with his fingers over the patientís Clavicular area. The physician then
slowly increases pressure through flexion.
SITTING TRACTION TECHNIQUE: The patient is sitting with the physician
standing behind and to the left side of the patient. The physician
places his right foot on a stool behind the patient with his right elbow
resting on his right thigh. The physicianís right hand sustains the
occiput with his thumb and forefinger while the left hand sustains the
forehead. Gently elevating the right thigh and knee and then slowly
releasing them produce the traction technique.
SITTING LATERAL TRACTION: The patient is sitting on a stool or bench
with the physician behind, and at the side of the patient. The
physician places his right hand around the side of the patients face
resting on the patientís mandible. The physicianís finger, one back
toward the patient occiput, drawing the patient head over to the
physicians chest. The physicians opposite hand is placed on the
patients far shoulder and gentle traction is applied to the head in a
cephalad direction with counter-traction downward on the shoulder.
Reverse the procedure for traction of the contralateral side.
SUPINE LATERAL TRACTION TECHNIQUE: The patient is lying in the supine
position. The physician stands at the side and head of the table. The
physician places his left had on the patientís frontal bone, and his
other hand on the lateral aspect of the cervical spine along the
articular facets. The physician applies pressure on e frontal bone
inferiorly, laterally and slightly caudal ward while the other hand
stretches the musculature o the cervical area medially ad superiorly.
Reverse the procedure for traction of the contralateral side.
SUPINE LOWER CERVICAL TECHNIQUE: The patient is lying in the supine
position. The physician is standing at the head of the table. The
patientís head is allowed to rest on a pillow free of the palms of the
palms of the physicianís hands. The physicianís fingers are close to
the cervical spine bringing anterior pressure bilaterally with slight
traction through the arms of the physician.
is sitting with his hands clasped behind his neck. The physician stands
behind the patient with his/her forearms under the patientís axillae,
while his/her hands are grasping the patientís wrists reinforcing the
patientís hands. The physicianís arms and hands simply maintain this
position, while the patients, entire trunk is gently extended, rotated
and laterally flexed.
LUMBAR BELT TRACTION
is sitting astride the table near one end with his arms extended and
placed forward so that his hands grasp the side of the table. Thus, the
back is held in a slight forward inclination. The physician holds his
right hand against the lumbar vertebrae and produces a gentle foreword
springing motion while the physicians left hand draws gently back on the
patients belt or a towel placed around the patients abdomen.
PETRISAGE: This method of tissue softening is just a simple kneading
of the soft tissues.
EFFLEURAGE: a gentle stroking of the tissues utilizing the fingers and
palms of the hand practices this method. Begin effleurage at the
iliac crests, working cephalad up the erector spinae to the shoulders
and back down to the iliac crests using approximately 15 to 20
strokes/min. In the beginning stages patients report a sedative
effect, which after a prolonged period can become quite stimulating.
PINCEMENT: The patient is in the prone position. The physician
stands on the side of the table at a right angle to the patient. Use
a digital and thumb contact grasping the skin and superficial fascia
and lightly pinching in a circular motion. This has a stimulating and
toning effect upon the superficial muscles and breaking up any
superficial fascial adhesions. Action is 30 to 40 times/min.
ROULEMENT: The patient is in the prone position. The physician
stands on the side of the table facing cephalad. Grasp the skin
between the thumbs and digits at the spinal base and roll the skin
cephalad towards the cervicals. Repeat procedure several times to
receive a relaxing effect.
TAPOUTMENT: The patient is in the prone position. The physician
stands on the side of the table facing cephalad. This technique may
be accomplished with the sides of the little finger and/or and. This
procedure is done extremely rapidly with the wrists held loose and the
fingers bent slightly.
CUPPING: The patient is in the prone position. The physician stands
at a right angle to the patient, facing cephalad. This procedure
always follows Tapoutment. Your contact is digital with the hands
pronated and cupped. Begin at the base of the spine working cephalad.
Scott D. Neff, DC DABCO
DABFE FFABS FFAAJTS as a dedication to the medical students of our
"Why does this magnificent applied
science which saves work and makes life
easier, bring us little happiness? The simple answer runs, because we
have not yet learned to make sensible use of it." Albert Einstein 1931
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