52: Manual Medical Approach to the Lower Extremity - Klock Flashcards
principles of osteopathic medicine
- The human being is a dynamic unit of function.
- The body possesses self-regulatory mechanisms that are self-healing in nature.
- Structure and function are interrelated at all levels.**
- – [Normal body structure promotes normal body function/Improving the functionality of the body will promote good health/Truing up the frame of the body will allow it to function more efficiently] - Rational treatment is based on these principles.
what does “truing up” the frame of the body do?
- Promotes normal arterial circulation.
- Promotes normal venous and lymphatic return.
- Improves the health of the tissues.
- Decreases the wear-and-tear on the joints from normal use.
- Decreases the wear-and-tear on the joints from extraordinary use.
define somatic dysfunction
- impaired or altered function of related components of the somatic system or body framework
key indicators that somatic dysfunction is present ***
TART
tenderness
asymmetry of motion and position
restriction of motion
texture changes of the tissues
We describe/document SD by position and motion characteristics
The position of a body part as determined by …
– palpation (described in relation to other body structures or landmarks).
– The directions into which the body part moves freely.
acute v. chronic SD
Acute: Redness, Swelling, Tenderness, Pain
Chronic: Tenderness, Itching, Ropiness, Paresthesias (altered sensation)
Both: tissue contraction/increased tension
what is a restrictive barrier? how do you identify it?
- Asymmetry of joint motion caused by restrictive barriers indicates a problem exists.
- Often times it is somatic dysfunction.
- These barriers are often caused by muscular strains.
- Strained muscles are often tighter than normal and restrict joint motion.
jones tender point
- The injury is often due to over-stretching resulting in a strain.
- A strained muscle will typically have a tender point in a specific location along its’ length
the limit of passive motion =
the limit of active motion =
anatomic barrier
physiologic barrier
elastic barrier = The range between the physiologic and anatomic barrier in which passive ligamentous stretching occurs
the hallmark of SD
restrictive barrier
- Functional limit within the anatomic range of motion that abnormally diminishes the normal physiologic range of motion.
if the following m are tight .., psoas hamstrings popliteus gastrocnemius soleus
Reduced hip extension Reduced knee extension Reduced knee extension Reduced ankle dorsiflexion Reduced ankle dorsiflexion
what do you do for muscle strain?
- Can’t be made normal by just stretching.
- To establish a lasting lengthening of strained muscles:
- —Resolve the strain.
- —Allow the muscle to reach a normal length by normal use.
- —Stretch the muscle
what is OMM?
- The intent is to restore symmetry of position and motion, to improve body function and restore health.
- OMM is to be integrated into management of the whole patient
describe indirect OMM
The body part is moved away from the restrictive motion barrier.
It is placed in a position where tissue tension is decreased and equal in one or all planes and directions.
The physician holds and directs the body part until a tissue release is noted
describe counterstrain
- Dysfunction is considered to be a continuing, inappropriate strain reflex.
- The reflex is inhibited by putting slack in the area of strain in the muscle:
- – Find a tender point in the strained muscle.
- – Position the muscle so that the tenderness is 75-100 % relieved.
- – Hold the position for 90 seconds.
- The circuit is broken and the strain is “erased.”
describe indirect myofascial release
The muscle/connective tissues are carried away from the restrictive barrier.
A force is applied and maintained until a release is observed
describe direct OMM
The body part is taken to the restrictive barrier.
The physician guides and moves the body part through the restrictive barrier to motion.
describe muscle energy (isometric technique)
The patients muscles are actively used on request:
- – The patient is asked to push…
- – From a precisely controlled position…
- – Against a distinctly executed physician counterforce .
- – An equal counterforce in this case
describe LVMA low velocity moderate amplitude
A joint is carried through its full motion.
The activating force a repetitive springing motion or repetitive movement of the joint through the restrictive barrier
body interconnectivity: body –>
foot –> ankle –> knee –> hip –> innominate –> SI joint –> sacrum –> spine
