OMM #25
Wed. Sept. 23, 2003 2pm
Dr. Fotopoulos
Cynthia Schlueter
Page 1 of 2
Urinary Tract Infection and Incontinence
Case Study:
A 48-year-old female has a history of repeated urinary tract infections. She also complains of urinary
incontinence when she laughs, coughs, sneezes, or jogs. She has a history of being pregnant 5 times and
delivered all 5 children vaginally. She presents today with urinary burning, urgency, supra-pubic
tenderness, and frequency of urination.
Techniques to Treat Urinary Tract Infections and Incontinence:
• Sitting-Direct-Muscle Energy 4312.11A
• Pubic Decompression 4513.11A
• Innominate Inflare/Outflare: Supine-Direct-Muscle Energy 4530.11A &4531.11A
• Superior and Inferior Mesenteric Ganglion Release Supine-Direct-Inhibition
Sitting-Direct-Muscle Energy:
Used to treat Extension dysfunctions
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Diagnosis: T4-T12 Extension - This will be restricted in forward bending, and the spinous processes
will be approximated. There will also be pain and decreased range of motion.
The physician places the heel of one hand over the lower spinous process of the dysfunctional unit.
The other hand is placed over the superior spinous process of the dysfunctional unit
The patient is forward bent to the barrier, and is then instructed to contract the dysfunctional region
against resistance. (isometric contraction or muscle energy)
The patient and physician relax force simultaneously, and the physician waits for the tissue to
completely relax. This is known as the absolute refractory period.
During the absolute refractory period, the physician forward bends the patient to next barrier and repeats
the process at least 3 times.
Pubic Decompression:
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Diagnosis: Pubic Symphysis Compression including inferior/superior shears and anterior/posterior
shears
The patient lies supine with the hips and knees approximately 10-12” apart.
The physician holds both knees together and asks the patient to try to pull the knees apart. (isometric
contraction) The arms can be wrapped around both knees, or one hand can be placed on each leg.
OMM #25
Wed. Sept 23, 2003 2pm
Dr. Fotopoulos
Cynthia Schlueter
Page 2 0f 2
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The patient gently ceases contraction and the physician simultaneously relaxes, and the process is
repeated at least three times.
The physician then spreads the knees 10-12” apart and adjusts his forearm grasp to brace the knees. The
forearm can be placed between the knees, or the physician can place a hand on each leg.
The patient is now instructed to pull the knees together while the physician holds counterforce with the
forearm brace (isometric contraction).
The physician asks the patient to relax and the adduction contraction is repeated 3 times.
Innominate Inflare:
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Diagnosis: Inflared Innominate meaning that the ASIS is closer to the umbilicus than the other ASIS.
The patient is supine and the leg on the dysfunctional is bent at the knee with the foot placed on the
table.
The physician stabilizes the pelvis by contacting the contralateral ASIS.
The knee is abducted to the innominate’s restrictive barrier and the patient is instructed to bring the
knee to midline against isometric counterforce.
The contraction is held for 3-5 seconds and then the patient relaxes.
The physician waits for the tissues to completely relax and abducts the thigh to the new restrictive
barrier and repeats at least 3 times.
In treating inflare, the knee is abducted
Innominate Outflare:
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Diagnosis: Outflared Innominate meaning that the ASIS is farther from the umbilicus than the other
ASIS.
Similar to previous technique except thigh is adducted to restricted barrier and the affected SI is
palpated and monitored
In treating outflare, the knee is adducted
Collateral Ganglion Release:
• Diagnosis: Tight tissue texture changes over anterior collateral ganglia
• With the patient supine the physician “rolls” his fingers over the linea alba.
• Direct inhibition or myofascial release is directed over the regions with tissue texture changes
until these areas release. Collater ganglion release uses direct inhibition or myofascial release.
- Pressure is applied to the area until the tissue softens or releases.