COMT Techniques for the Upper Extremity

COURSE DESCRIPTION

Clinical Orthopedic Manual Therapy (COMT) for the Upper extremity covers the major clinical orthopedic assessment and treatment techniques for the upper extremity. This course is a 2-day hands-on workshop.

Day one begins with palpation assessment and soft tissue manipulation and stretching of the muscles of the shoulder joint complex and the deeper muscles of the anterior forearm. As a part of this, we discuss and workshop guidelines for proper body mechanics when performing soft tissue manipulation of the muscles of the upper extremity; you will learn how the upper extremity can be worked deeply with little effort. We also introduce the technique of pin and stretch. We continue with special orthopedic assessment tests and postural examination for conditions of the upper extremity.

Day two begins with application of the principles of body mechanics and deep pressure soft tissue manipulation to work the muscles of the shoulder girdle. We then begin Arthrofascial Stretching (AFS): Soft Tissue Joint Mobilization for all the joints of the upper extremity. AFS is the only effective means of stretching specific nonaxial hypomobilities of the upper extremity joints. We then conclude the day with advanced neural inhibition stretching techniques, including Contract Relax (PNF/PIR), Agonist Contract (the basis for AIS), and Contract Relax Agonist Contract stretching techniques.

Clinical treatment strategy and planning as well as precautions and contraindications are also covered. These manual therapy skills will empower you to do effective clinical orthopedic work. Throughout this hands-on workshop, Dr. Joe Muscolino reinforces the underlying mechanisms for each of the assessment and treatment techniques, encouraging critical reasoning skills.

Clinical Orthopedic Manual Therapy for the Upper Extremity is part of the COMT Regional Approach Certification. The other hands-on workshops in this series cover the neck, thoracic spine / ribcage, low back / pelvis, and lower extremity.

COURSE OBJECTIVES

After attending this workshop, the participant will be able to:

Explain and demonstrate the principles of using core body weight and larger muscle groups for efficient body mechanics.
Perform orthopedic assessment tests for the upper extremity to determine the ability to safely perform deep soft tissue manipulation, stretching, and Arthrofascial Stretching (AFS) – Soft Tissue Joint Mobilization.
Explain the fundamental concepts of stretching and apply these concepts to the musculature of the upper extremity.
Demonstrate how to stretch each of the functional muscle groups of the upper extremity.
Explain and demonstrate how to stretch each of the muscles of the upper extremity in all three cardinal planes.
Explain the physiologic basis for and demonstrate how to perform contract relax (CR; also known as PIR/PNF) stretching, agonist contract (AC) stretching, and contract relax agonist contract (CRAC) stretching techniques.
Explain the physiologic basis for and demonstrate how to perform Arthrofascial Stretching (AFS, Grade IV joint mobilization) of the upper extremity.

CONTENT OUTLINE

Following is the usual time line for this workshop. Note: This time line is often adjusted as needed based on the needs of the particular group.

DAY ONE:

Introductions: 30 min

Introduction to the content of the class
Introduction of instructor and workshop participants to each other

Palpation assessment, soft tissue manipulation, and stretching: 90 min

Supraspinatus, infraspinatus, teres minor, teres major, serratus anterior, pectoralis minor, subscapularis

Break: 15 min

Orthopedic assessment: Thoracic outlet syndrome (TOS) 45 min

Assessment tests for TOS: Adson’s, Eden’s, and Wright’s tests
Pin and stretch for pectoralis minor supine
Pectoralis stretch with client/patient prone, therapist sitting on client’s/patient’s buttocks or low back [if cushioned] and stretch the anterior abdominal wall stretch

Orthopedic assessment: Tennis elbow and Golfer’s elbow 60 min

Active ROM, Passive ROM, Manual resistance (with no motion) to agonists, and manual resistance to antagonists – to assess mover muscle-tendon units (strain, tendinitis), antagonist muscle tendon-units, and ligamentous joint capsule complex (sprain) / bony degeneration
Tennis elbow – protocol: warm up, ice massage, deep work, iced again

UE-f14-07C-A05171-copy Lunch: 60 min

Orthopedic assessment: Carpal Tunnel Syndrome (CTS) 60 min

(Fascial spreading to palm)
Flexor Pollicis Longus, Flexor Digitorum Superficialis, Flexor Digitorum Profundus

Orthopedic assessment: Pronator teres 30 min

Palpation, assessment, soft tissue manipulation, stretching

Orthopedic assessment: De Quervain’s tenosynovitis 30 min

Finkelstein’s test
Palpation of abductor pollicis longus and extensor pollicis brevis

Break: 15 min

Orthopedic assessment: Frozen shoulder 60 min

Range of motion assessment
Application of stretching

Review: 45 min

Question and answer
Discuss treatment strategy

DAY TWO:

Introductions: 30 min

Question and answer over material from Day 1

Deep soft tissue manipulation: 60 min

Work deep to the scapula with the client prone (work contralateral scapula)

Break: 15 min

Arthrofascial Stretching (AFS): Soft Tissue Joint Mobilization
Overview of Arthrofascial Stretching (AFS, Grade IV joint mobilization): 30 min

Explain concept of pinning a bone and moving adjacent bone relative to it
Convex and concave kinematics
Discuss steps of AFS (place pin, bring to tension, mobilize)
Hold for less than a second, 3-5 oscillations
Soft tissue pull to trap underlying bone
Contraindications…
Use hands in concert
Utilize body mechanics

Workshop AFS: 105 min

Fingers (MCP and IP joints)
Glenohumeral joint (glides anterior, posterior, superior inferior, and axial distraction/traction)
Shoulder girdle (seated or side-lying)

Lunch: 60 min

Workshop AFS: 90 min

Radioulnar joints
Elbow joint
Wrist

Break: 15 min

Advanced stretching: Contract relax and Agonist contract 105 min

Discuss principles of advanced neural inhibition stretching
Golgi tendon organ reflex
Reciprocal inhibition reflex
Muscle spindle reflex
Workshop contract relax stretch (pectoralis musculature seated and rhomboids prone)
Workshop agonist contract stretch (pectoralis musculature seated, rhomboids seated)
Workshop contract relax agonist contract stretch

Review and paperwork: 30 min

Question and answer
Fill out evaluation forms
Hand out Certificates

WORKSHOP PARTICIPANTS SHOULD BRING

1. Massage table with face cradle
2. Stool
3. Bolster and pillow
4. Sheets and face cradle cover
5. Loose-fitting short-sleeved shirt
6. Water-based lotion
7. Soft foam cushion (approx. 6×10 inches) or bath towel