2c Flashcards
What level is the first spine that sticks out dominantly in the neck?
C7
What level is the PSIS?
S2
What level is the Angle of Louis?
T4
What level is the xiphoid process?
T9
What is the Angle of Louis?
Where manubrium and sternum meet
Umbilicals level
L3-L4 interspace
Greater trochanter is same level as what?
Pubic Symphysis
Define “Somatic Dysfunction”
Impaired or altered function of related components of the somatic (bodywork) system including the skeletal, arthrodial, and myofascial structures and their related vascular, lymphatic, and neural elements
Is Somatic Dysfunction treatable with OMT?
Yes
What is the Soma?
Skeletal
Arthrodial
Myofascial
What are the neural, vascular, and lymphatic elements?
Related to Soma
What is the most important part of TART?
None; depends on which model or treatment you intend to use but Restriction is key
TTA
Tissue Texture Abnormality (TTC)
Can we measure Sensitivity in TART?
Yes; STAR
3 things to use for “Tenderness”
- Biomechanical
- Counterstrain TPs
- Travell trigger points
3 things to use for “Asymmetry”
- Postural Model
- Axial somatic dysfunction
- Appendicular somatic dysfunction
Restricted Motion 2 things
- Zink Fascia = regions
2. AGR = segments
3 things for “Tissue Texture Change”
- Acute-Chronic
- Neurological
- Congestion (fluid changes)
Can tenderness be specific?
Yes
Restriction on Motion 4 benefits
- Helps identify tissue type of dysfunction
- Allows naming articular dysfunction
- Allows positioning for direct or indirect methods
- Patten aids in “Differential Diagnosis”
What is a Somatic Dysfunction Barrier?
Freedom in one area and restriction in another
Patter of barrier can show what?
Position that patient was in when injury/dysfunction occurred
Paired elements bilaterally restricted shows what?
Probably inflammation/pathlogical as opposed to somatic dysfunction
Passive Motion gives what feel?
“End” feel
T5 somatic dysfunction shows what?
T5 moving on T6
What is useful in defining barriers?
End feel
Anatomic barrier
Limit of PASSIVE motion
Physiological Barrier
Limit of ACTIVE motion
Elastic Barrier
Range between physiological and anatomical barrier of motion in which passive ligamentous stretching occurs before tissue disruption
What is a Restrictive Barrier
Functional limit that abnormally diminishes the normal physiological range
Name the 4 barriers for a single direction
- Physiological
- Elastic
- Anatomical
- Restrictive
What is a Capsular Pattern
Barriers abrupt in BOTH paired directions - can’t reach normal physiological barriers
What is a pathologic barrier?
A restriction of joint motion associated with pathological change of tissues (osteophytes)
Difference between Somatic Dysfunction and Capsular Dysfunction
Somatic = 1 barrier Capsular = both directions of pair are restricted
Which Fryette is for a Group Curve?
Type 1
What does a Type 2 single segment do?
Rotates into intended concavity
What is Physiological Motion of the Spine related to ?
Fryette
If it doesn’t return to normal, what do we have?
Dysfunction, not physiological motion
3 things with Fryette Type 1
- May not be symptomatic
- May need to treat if wish to rehabilitate posture
- Often treat the apex of curve
3 things with Fryette Type 2
- Often symptomatic (sclerotomal innervation)
- Biomechanical from extreme flexion or extension
- May be involved in viscerosomatic of somatovisceral reflexes
Which type is more common? Does it still have TART?
Type 1; yes
How is pain characterized in Type 2?
Deep, dull, achy
What is the Nociceptive Model?
Noxious stimulus of somatic dysfunction
What does noxious stimulus of somatic dysfunction lead to?
- Local biochemical “sensitizing soup”
- Activation of spinal reflexes
- Activation of sympathetics
What is the process of a Spinal Cord Nocifensive Reflex?
- Skeletal muscle activity (shortened)
- Maintained shortening
- Connective tissue reorganized in shortened form
4 Muscle Fascia Responses
- Acute = contraction
- Chronic = contracture
- Segmentl facilitation
- Pain-spasm-pain response
Do changes occur both in spinal cord and periphery? What does it affect?
Yes; local somatic dysfunction found and response to treatment
What 3 effects occur from Sympathetic Activation?
- Visceral effects
2. Immune effects
What 6 things do we see in sympathetic activation?
- Vasoconstriction of vessles to skin and segmental viscera
- Activation of sweat glands in skin (acute and early chronic)
- Activation of sympathetic responses to end-organs
- Central sensitization: higher pain perception and response
- Release of (nor)epinephrine and cortisol
- Reduced immune function (direct and secondary)
2 examples of Noxious stimulus
- Repetitive strain
2. Injury
What does a noxious stimulus initiate?
Production of “biochemical sensitizing soup”
6 examples of sensitizing soup
- Cytokines
- Histamine
- Interleukins
- Prostaglandins
- Substance-P
- Bradykinin
What does sensitizing soup lead to?
- Hyperalgesia
- Inflammation
- Edema
What horn is the soup associated with?
Dorsal
Tissue Texture Change can help in what?
Choosing direct vs indirect OMT
What does Hysterisus mean?
After compression, how quickly do tissues return to non-compressed state
What blend do we see in tissue texture?
Blend of physiological processes: biochemical-autonomic-trophic
What does TTA permit?
Physiological diagnosis
Do acute and chronic associate just time?
No; different palpatory diagnostic criteria
What is acute associated with?
Biochemical - autonomic (sympathetic)
What is chronic associated with?
Autonomic (sympathetic) functional changes
What is very chronic associated with?
Sympathetic + trophic changes
What are bradykinins?
Histamine
Does acute vs chronic have a physiological meaning?
Yes
Acute needs what kind of OMT? (IMPORTANT)
Indirect OMT = acute
Chronic needs what kind of OMT? (IMPORTANT)
Direct OMT = chronic
3 things with acute
- Pain
- Edema
- Muscle contraction
2 things with Chronic
- Fibrosis
2. Muscle contracture
Difference between contraction and contracture
Contraction wound healing where wound edges are pulled together, contracture is abnormal contraction of a muscle
What is mechanotransruction?
Change of biochemical kinetics
What can speed healing in mechanotransduction?
Titrated mechanical force to integrins or venous stasis pumps)
Biomechanics can reduce and modulate what?
- Musculoskeletal function
- Nociception/pain
- Homeostasis/physiologiy modulation in all systems
What does touching do?
Pain reduction impacting biopsychosocial mechanisms
Somatic Dysfunction can do what for the models?
Give somatic clues that can be linked to each model
Asymmetry used in what?
- Postural model
2. Zink fascial pattern for either postural or respiratory-circulatory
Restriction in motion related to what?
- Biomechanical model with AGR
2. Biomechanical model with flexion tests or pelvic sideshift test
Tenderness interprets what?
TTC of physiology for key lesion in any of the models
T>R in what?
Neurological-autonomic model
Tenderness often used in what?
Counterstrain