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Percussion Hammer Techniques

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The next percussion area of the knee is at the head of the fibula. ... Percussion hammer head is directly up against and perpendicular to the right ... – PowerPoint PPT presentation

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Title: Percussion Hammer Techniques


1
Percussion Hammer Techniques
  • Jerry Haman, D.O.

2
Evaluating the Knee
  • In examining the knee, we use the patella as a
    center and the tibial tuberosity should bisect
    the patella in the midline.
  • If it lays in one direction or the other from the
    midpoint of the patella, it is not bisecting the
    center of the patella and we have dysfunction in
    that knee.

3
Treating the Knee
  • The knee should be percussed at the end of the
    ilio-tibial band as it attaches to the distal end
    of the femur.
  • Monitoring hand - placed on the opposite side of
    the knee medially.
  • The next percussion area of the knee is at the
    head of the fibula.
  • Monitoring hand - over the opposite side of the
    knee

4
Evaluating the Ankle
  • To evaluate
  • Place your thumb on the anterior surface of the
    ankle and your index and third finger
    posteriorly.
  • Compare the medial and lateral malleolus to see
    if they are in the same plane. If not, the one
    that is closer to the table is the dysfunctional
    side.

5
Treating the Ankle
  • To treat the ankle, treat the lateral malleolus,
    even if the dysfunctional side is medially.
  • In treating the ankle
  • Percussion hammer - placed at the superior
    surface of the lateral malleolus (superior
    surface of the distal end of the fibula.)
  • Monitoring hand placed on the medial side of
    the ankle.
  • In severe ankle problems both lateral and medial
    malleolus are treated.

6
Evaluating the Hip
  • To evaluate the hip the patient should be supine
    grasping the feet and ankles.
  • You externally and internally rotate the lower
    extremities to test for restrictions regardless
    of the side of the hip which has the dysfunction.
  • Subtle motion in testing.

7
Treating the Hip
  • To treat the hip you will treat the right
    trochanter.
  • Percussion hammer - placed over the right
    trochanter even if the restriction is on the left
    side.
  • Monitoring hand - across the patient and the left
    trochanter.
  • Percussion hammer head is directly up against and
    perpendicular to the right trochanter during
    treatment.
  • Palpating hand is across the pelvis on the left
    trochanter.

8
Sacro-Iliac
  • Use your normal mode of diagnosis to determine
    the dysfunction with the sacrum.
  • Rule of Thumb
  • Treating below the diaphragm - monitoring hand is
    on the hip
  • Treating above the diaphragm - monitoring hand is
    on the shoulder.

9
Treating the Sacro-Iliac
  • To treat this area the patient is placed in a
    lateral recumbent position.
  • The percussion hammer is placed over the area of
    the sacrum with the restriction.
  • The monitoring hand is on the hip.

10
The Spine
  • Diagnose the somatic dysfunction of the spine in
    your normal manner of diagnosing.
  • Remember
  • In treating below the diaphragm your monitoring
    hand is on the hip.
  • In treating above the diaphragm your monitoring
    hand is on the shoulder.

11
Treating the Spine
  • In treating the patient, the patient is in a
    lateral recumbent position.
  • Find the restriction and then percuss
    perpendicular to the spinous process of the area
    of somatic dysfunction until you feel a release.
  • The monitoring hand - placed on the shoulder.
  • Note treat up to C7 in this manner

12
Companion Vertebrae
  • C1 and L5, C2 and L4, C3 and L3 are considered
    companion vertebrae.
  • If you have a prominent problem at L3 and it will
    not release go up to and treat the C3 area and
    often times the L3 area will release.
  • In the mid-dorsal area from T1-T8 there are no
    companion vertebrae.

13
The Scapula
  • In testing the left shoulder, your right hand is
    on the patients right shoulder.
  • Check for restrictions in the shoulder girdle.
  • Restrictions in the scapula restrict the motion
    of the upper four or five ribs.

14
Treating the Scapula
  • To treat the scapula, the percussion hammer is
    placed on the midpoint of the spine of the
    scapula.
  • The monitoring hand is on the shoulder.
  • In raising left arm, place hand under elbow and
    raise arm.
  • Keep in horizontal plane to shoulder.

15
The Diaphragm
  • To diagnose a restriction in the diaphragm, you
    run your hand down along the right rib cage and
    if you run into a small concavity, that is the
    area where the percussion hammer goes.
  • The palpating hand goes over to the left side
    across the body.
  • The patient is treated in a supine position.

16
Evaluating the Wrist
  • To diagnose the wrist
  • Hold the arm out and do a subtle motion testing.
  • Feel for restrictions in the wrist.
  • You can hold the wrist and block the ulna and
    radius to check for motion.

17
Treating the Wrist
  • To treat the wrist
  • You place the percussion hammer on the distal
    radius
  • The palpating hand monitors on the opposite side
    of the wrist

18
Acromio-Clavicular Joint
  • If you find a dysfunction at the
    acromioclavicular joint, you place the percussion
    hammer perpendicular to the joint so that it is
    on top of the joint over the side of the
    dysfunction.
  • Your monitoring hand is on the opposite AC joint.
  • For example If you are percussing on the right
    AC joint, your palpating hand is over the left AC
    joint.

19
Acromio-Clavicular Joint
  • When you are working with a dysfunction in the
    left shoulder, you have to stand in front of the
    patient so you are actually looking into the
    patient.
  • If you are treating the right shoulder, you sit
    behind or stand to the left of the patient so you
    are in front of them when you are percussing left
    and palpating right.
  • The palpating hand is placed across to the
    opposite side.

20
Third Cervical Vertebra
  • Remember the sub-occipital triangle inserts
    around C3.
  • A portion of the dural attachments to C3.
  • Diagnose C3 as you
  • would any other cervical
  • area.

21
Third Cervical Vertebra
  • To treat C3
  • You want the piston to be perpendicular to C3.
  • The palpating hand is on the vertex.
  • The patient is in a lateral recumbent position.

22
The Base of Cranium
  • Diagnose the occiput as you normally would.
  • You will treat the base of the head or occipital
    dysfunction by treating the insertion of the
    deltoid on the right arm side.
  • Your palpating hand is on the back of the occiput.

23
Sphenoid and Frontal Bones
  • Diagnose the sphenoid and frontal bones as you
    normally would.
  • To Treat
  • Place the percussion hammer on arm at left
    deltoid insertion.
  • Your palpating hand is on the greater wings or
    frontal area depending on the area of
    restriction.
  • When treating the sphenoid, if it becomes too
    painful stop.

24
The Parietal Bone
  • Examine the parietals by observing which
    ossification center is closer to the table.
  • The ossification center that is closer to the
    table is the one which the hammer is placed.
  • The palpating hand is over the metopic suture.
  • The first three fingers should be placed over the
    metopic suture for monitoring.

25
Sternal Angle
  • Palpate along the sternum from the xyphoid up to
    find a hard spot on the sternum.
  • Locate sternal angle

26
Sternal Angle
  • To treat
  • You will percuss so that the piston is
    perpendicular to that point on the sternum.
  • Your palpating hand is on the vertex of the
    skull.
  • This is an extremely sensitive area of the head
    and should always be treated last.

27
Foot Cuboid
  • The majority of foot problems are a result of the
    cuboid bone.
  • To Treat place the hammer directly against the
    cuboid bone and your monitoring hand is
    underneath on the plantar fascia opposite this
    cuboid.

28
Foot Navicular
  • Another area to treat on the foot is directly
    over the navicular bone.
  • The monitoring hand is underneath the navicular
    bone on the plantar fascia.

29
Care of the Percussion Hammer
  • The hole in the front of the percussion hammer
    needs oil approx. every 6 weeks.
  • A few drops of 3 in 1 oil is recommended.
  • The motor in the gear box needs to be taken care
    of once a year.
  • If you are uncomfortable handling the motor, an
    electrical motor company who deals in small
    motors should be able to wash it, clean it, and
    adjust it.

30
Care of the Percussion Hammer
  • The shaft of the percussion hammer needs fine
    grease occasionally.
  • Very fine grease is used such as the greases for
    electric motors of electric saws.
  • Packing grease has been the best type of grease
    to hold the heat that develops in the handle.
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