Stiles - American Academy of Osteopathy

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� Stiles’ AGR for THORACIC AND UPPER BODY: � The operating hand is on the patient’s shoulder. � Fingers of the sensing hand are on the thoracic paraspinal tissues. � Introduce sidebending with the operating hand. Listen for ease and restriction. Transfer the operating hand to the other shoulder. Again compress to produce sidebending and listen for ease or restriction. � Now on the relatively restricted side reintroduce sidebending. Next introduce flexion and anterior rotation and then extension and posterior rotation. Determine which position feels more restricted. � Maintaining the position of restriction, press each thoracic segment anteriorly and diagonally toward the side of ease with the sensing hand listening for the “hard end-feel.” Test each segment in turn. The segment with a “hard end-feel” will be an AGR (key dysfunction). � If there is no single segment that possesses this hard end-feel but instead the whole paraspinal area medial to the scapula has a relative restriction, the AGR is likely to be in the arm on that side. Screen the arm for dysfunction at its joints. � Move the sensing hand laterally over the area of the mid-thoracic rib angles on the side of restriction. Again use the operating hand to introduce sidebending. Is the sense of restriction greater than or less than the sense of restriction along the spine? If worse, screen the ribs in the same fashion as the paraspinals.
� Stiles’ AGR for LOWER HALF OF THE BODY: � For the lower half of the body start with a standing flexion test. Are the lumbar paravertebral muscles symmetrical? Does one PSIS ride superior? � Next perform a seated flexion test. Does the lumbar spine show asymmetry of motion and/or muscle volume? Does one PSIS ride superior? Is the PSIS shift stronger for seated than standing flexion? If so look to the lumbar spine, innominates, and/or sacrum for the SGR. � If the lumbar paravertebral muscles demonstrate asymmetry in both standing and seated flexion use the same test as that performed for the thoracic spine (sidebending from the shoulder). Is one side of the lumbar spine restricted? Can you localize a segment that has a diagonal hard end-feel when the regional restriction is maximized? � Now use the same sidebending to test the sacrum. Is sacrum restricted? Did one PSIS ride superior in the seated flexion test? Evaluate sacral mechanics. � If the PSIS rides superiorly on the same side in both standing and seated flexion, it suggests that the pelvis may be the area of greatest restriction. Likewise compression from the shoulder may lateralize restriction to the pelvis. Evaluate for the nature of the restriction. � If the standing flexion PSIS shift is stronger than the seated, look to the leg on that side. An additional clue that it might be the leg: diffuse unilateral paravertebral muscle tightness.
Page 1 and 2: Richard L. Van Buskirk, DO, PhD, FA
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Page 7 and 8: “The principle used and taught by
Page 9 and 10: � Over the years the idea of a
Page 11 and 12: � Speece and Crow identify four m
Page 13: � Stiles’ AGR for CERVICAL: �
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Page 19 and 20: � Treatment involves stacking eac
Page 21 and 22: � Key dysfunctions are found at
Page 23 and 24: � The Still-Laughlin Technique tr
Page 25 and 26: � That being said, the Still-Laug
Page 27: ii. Holding each segment in neutral

Stiles - American Academy of Osteopathy

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