Percussion Hammer Techniques

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Percussion Hammer Techniques

• Jerry Haman, D.O.

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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.

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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

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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.

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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.

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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.

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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.

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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.

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Sternal Angle

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

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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.

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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.

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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.

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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.

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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.