OMM #12 (PTR)
Thur 1/30/03 11am
Turner Slicho, PDF
S. Linsteadt
Proscribe Samera Kasim
Page 1 of 5
Sternum - Diagnosis and Treatment
Additional comments aside from the ppt. are in italics.
I. Objectives
a. Correctly diagnose motions of the sternum
b. Treatment of the sternum utilizing:
i. Myofascial release (direct and indirect)
ii. Direct springing techniques
II. Anatomy
a. The sternum has three parts:
i. head (manubrium)
ii. body (gladiolus)
iii. tail (xiphoid process)
b. Angle of Louis
i. 2nd rib attaches
ii. this is a very important landmark
III. Sternal Motion
a. Upon deep inhalation:
i. entire sternum glides superiorly
ii. caudal (inferior) end moves anteriorly
b. Upon exhalation:
i. entire sternum glides inferiorly
ii. Caudal (inferior) end moves posteriorly
c. Motion at the sternal angle allows anterior and posterior motion
i. The sternum makes a tent like motion with the angle of louis being
the hinge.
Sternal Motion
ii. Note that sidebending is named for the direction that the superior
portion wants to go.
OMM #12 (PTR)
Thur 1/30/03 11am
Turner Slicho, PDF
S. Linsteadt
Proscribe Samera Kasim
Page 2 of 5
IV. Sternal dysfunction: Etiology
a. Trauma
i. seatbelts
ii. air bags
b. Poor posture
i. rolled shoulders resultant of bad posture contribute to sternal
dysfunction.
c. Disease entities
i. COPD, reactive airway disease
ii. pneumonia
d. Surgery where the sternum is split in half
V. Screening
a. Watch the pt breath; Have patient seated comfortably and breathing
normally
b. Note any gross abnormalities or scars
i. pectus excavatum
ii. pectus carnii
iii. pseudoarthrosis
iv. post-thoracotomy
1. these pts will have a scar down the middle of their chest.
Sometimes the surgeon does not do a good job of
realigning the sternum which leads to dysfunction.
c. Note motion during inhalation/exhalation
d. does the sternal angle move?
i. It should move some
VI. Motion testing, general
a. Movement of the sternum is very subtle. The qaulity of motion should be
monitored vs. the quantity.
b. Pt should be laying supine
c. Diagnose all four planes of motion:
i. flexion/extension about a transverse axis
ii. rotation about a vertical axis
iii. sidebending about an anteroposterior axis
iv. superior/inferior glide of the entire sternum
VII. Motion testing for the manubrium:
a. Sagittal plane: (FB/BB)
i. place one thumb on the superior border of the manubrium
ii. place the other thumb just above the angle of Louis
iii. Spring
iv. If there is easier movement on the superior end, there is BB
somatic dysfunction
OMM #12 (PTR)
Thur 1/30/03 11am
Turner Slicho, PDF
S. Linsteadt
Proscribe Samera Kasim
Page 3 of 5
v. If there is easier movement on the inferior end, there is FB somatic
dysfunction.
b. Check rotation
i. place thumb on each lateral border of the manubrium
ii. spring
iii. Motion testing: manubrium
iv. If pushing on the Left is easier, it’s L rotated Somatic dysfxn
v. Pushing on the Right is easier, it’s R rotated somatic dysfxn
c. Check sidebending
i. place fingers on superior and inferior lateral borders on opposite
sides of manubrium
ii. spring medially
Motion testing: manubrium

Check sidebending


place fingers on
superior and inferior
lateral borders on
opposite sides of
manubrium
spring medially
iii.
iv. remember, this is named for the way the superior portion likes to
go.
VIII. Motion testing: gladiolus
a. Sagittal motion
i. Place one thumb just below the angle of Louis
ii. place other thumb on inferior border of gladiolus just above the
xiphoid process
iii. spring
iv. be very careful not to press on the xiphoid. Painful!!
b. Check rotation
i. place thumb on each lateral border of the manubrium
ii. spring
c. Check sidebending
i. place fingers on superior and inferior lateral borders on opposite
sides of gladiolus
ii. spring medially
iii. remember that the angle of louis is a very important landmark. It’s
the superior border of the gladiolus.
IX. Naming somatic dysfunction
OMM #12 (PTR)
Thur 1/30/03 11am
Turner Slicho, PDF
S. Linsteadt
Proscribe Samera Kasim
Page 4 of 5
a. named according to the same principles used to name vertebral somatic
dysfunction
b. named by the movement of an imaginary dot on the anterosuperior surface
of the bone of reference
c. named for the preferred way of motion
X. Techniques (3)
a. Direct - Articulatory, Springing
i. Dx: Generalized sternal hypomobility
1. note that this isn’t for a particular dysfunction. It’s for
generalized immobility of the sternum.
ii. Pt is supine or sitting
iii. Dr places one hand over angle of Louis
iv. Dr places other hand over mid thoracic spine as counterforce
v. Sternum is sprung rhythmically
vi. This technique breaks through restriction at the angle of louis or
intercoastal restriction.
vii. The Kimberly manual also shows this technique with the hand
placed horizontally across the chest.
viii. Always remember to recheck what you have done to see if there is
improvement.
b. Supine Direct Articulation
i. Dx: Generalized sternal hypomobility
1. you will generally not see hypermobility problems because
there are so many attachments to the sternum which lead to
it’s stability.
ii. Pt is supine
iii. Dr places one thumb superior and one thumb inferior to the angle
of Louis
iv. Each of the two elements is alternately sprung in a rhythmic
fashion straight posteriorly
c. Myofascial release
i. Pt lies supine with doc placing entire palm of one hand along the
entire length of the sternum (fingers pointing toward the xiphoid,
heel on manubrium)
ii. doc applies gentle, firm pressure (with superior hand) and moves
the sternum in the direction of preference in FB/BB, R/L Rotation,
R/L Sidebending and holds at the point of balance
iii. the lower hand can be thought of as the “plastic hand”
iv. this can be a direct or indirect technique depending on what you
prefer. Indirect was used in class.
v. Make sure that you’re applying enough pressure so that you’re
“holding” the sternum in your hand and not just contacting the
skin.
OMM #12 (PTR)
Thur 1/30/03 11am
Turner Slicho, PDF
S. Linsteadt
Proscribe Samera Kasim
Page 5 of 5
vi. Remember to stack all 3 planes on each other. Once you have
found the FB/BB dysfunction, hold it in that plane while checking
for R/L rotation, etc.
vii. Use deep breaths to aid the release. Have the pt breath and feel
for the point in the respiratory cycle where a maximum point of
ease is felt.
viii. Have the pt hold their breath at this point as long as they can.
Release will be felt just before they must take a breath. You will
become better at feeling when this point is with practice.