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OPP #1 > 7- Direct Osteopathic Treatment Techniques > Flashcards

7- Direct Osteopathic Treatment Techniques Flashcards

0
Q

What are examples of Direct Techniques?

A 
Soft tissue techniques
Direct myofascial release
muscle energy technique
articulatory technique
High velocity, low amplitude (HVLA) technique
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1
Q

What is the difference between direct and indirect techniques

A

Direct techniques take area toward the restrictive barrier for treatment.

Indirect techniques take the area AWAY from the restrictive barrier for treatment

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2
Q

What are examples of indirect techniques?

A

strain/counterstrain and indirect myofascial release

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3
Q

What is Still’s technique?

A

involve initially taking the joint away from the restrictive barrier (indirect) then a secondarily progressing motion toward the restrictive barrier.

INDIRECT, then DIRECT

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4
Q

Are myofascial releases direct, indirect, or combined techniques?

A

It’s a combined technique. Myofascial release can be direct or indirect.

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5
Q

What do you look for when performing soft tissue techniques

A

The last T in TART:

TISSUE TEXTURE CHANGE

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6
Q

What structures are considered soft tissue?

A

Muscles, Tendons, Ligament and Fascia

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7
Q

Why do we perform soft tissue?

A

Preparation of the soft tissue achieves improved articular motion!

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8
Q

What are the benefits of applying soft tissue techniques?

A
  • Relaxes hypertonic (contracted or fully inflammed) muscles & reduces spasm/tension
  • Stretches & increases elasticity of short fascial structures
  • Enhances circulation to myofascial structures
  • Improves fluid dynamics (reduces/moves edema/lymphedema)
  • Improves somato-somatic and vicerosomatic reflex activity
  • IMproves local and systemic immune response
  • Tonic stimulation by stimulating the stretch reflex in hypotonic (non-active muscles).
    Identifies areas of restricted motion, sensitivity and tissue textrure change
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9
Q

What does ROPY feel like when referring to soft tissue?

A

Feels like a rope

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10
Q

What does boggy feel like when referring to soft tissue?

A

Feels fluid filled

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11
Q

What are the two types of contradindications?

A

Relative contraindication and absolute contraindication

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12
Q

What are relative contraindications for soft tissue techniques?

A

1) Severe osteoporosis

2) Acutely inured muscles/tendons/ligaments (microtears within 24-48 hours can cause infection)

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13
Q

What are Absolute Contraindications for soft tissue techniques?

A
  • Fracture/dislocation
  • Serious vascular compromise (DVT/blood clot)
  • Over opened wounds/sites of localized infection (cellulitis, abscess, septic arthritis, osteomyelitis)
  • Areas of localized malignancies (malignant tumors/cancer)
  • Severe bleeding disorders
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14
Q

What are the basic osteopathic soft tissue principles?

A
  1. Patient comfort comes first
  2. Apply technique to exposed skin
  3. Clinician body mechanics is important
  4. Always gentle force, low amplitude and increase over time
  5. Always superficial to deep
  6. Stroke towards the heart when possible.
  7. Rate of application: 1-2 seconds on; 1-2 seconds off
  8. good discomfort
  9. Do not let hands slide or create friction
  10. Do not compress musculature against bone
  11. Continue technique until desired effect is achieved
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15
Q

When do you know you are done with the soft tissue technique?

A

When the excursion of the soft tissues have reached a maximum improvement AND PLATEAUED at that level.

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16
Q

What are some examples of soft tissue techniques?

A

Stretching of tissues longitudinally (with the fibers)
Kneading or cross fiber stretching of tissues
Deep Pressure
Effleurage, petrissage, tapotement
Stroking of tissues
creating waves of movement to move fluids (e.g. pedal pump)

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17
Q

What is Fascia?

A
  • Fibroelastic connective tissue
  • Compartmentalizes muscle masses & organs
  • Forms sheaths around nerves and vessels
  • connects bone to bone, muscle to muscle, and forms tendinous bands/pulleys
  • Continuous throughout the body
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18
Q

Can fascia be injured?

A

Yes! It’s tissue, so it can.

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19
Q

hat happens when fascia is injured.

A

it can affect structures since it connects muscle to muscle and tendon.

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20
Q

What is the function of fascia?

A 
Protect
Posture
Coordinate muscle action/smooth contraction
Aids circulation
assists lymphatic drainage
promote homeostasis
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21
Q

What are some extra activating forces for myofascial release?

A 
INherent
Respiratory force (breathing in and out)
Patient cooperation
Physician guided force
Springing/vibration
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22
Q

What are the steps of performing a myofascial release?

A
  • Contact tissue/area where restriction or tightness is perceived.
  • Engage the tissue by pressing into it
  • Drag the myofascial tissue superior/inferior, medial/lateral, clockwise/counterclockwise and perceive which direciton is most restricted.
  • Stack these motionstwoard the restrictive barrier, hold this position until the tissue releases under your hand
  • Recheck!
23
Q

What is an articulatory technique?

A

Clinician repetitively takes the part of the body being treated directly TO the restrictive barrier

  • Improves physiological motion
  • Low velocity, mod-high amplitude (displacement)
  • Long lever technique - although can be short lever also
24
Q

What are some examples of articulation?

A
  • Rib raising (short lever)
  • Spencer technique for the Glenohumeral joint of the shoulder (long lever)
  • Glenohumeral joint gliding (short lever)
25
Q

What are indications for Articulatory technique?

A
  • Post-operative patients (esp. knee or hip replacements)
  • Elderly patients suffering from osteoarthritis or osteoporosis
  • Where more invasive techniques are contraindicated
26
Q

Define Muscle Energy Technique

A

The patient’s muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed physician counterforce

27
Q

What are indications for muscle energy techniques?

A
  1. Relax hypertonic muscles
  2. Address joint restrictions
  3. Stretch tight fascial planes.
  4. Alter neural reflex relationships
  5. To address muscular contractures
  6. Can be used where more forceful methods cannot be used
28
Q

What is the muscle energy treatment flow?

A
  1. Diagnose SD
  2. Position joint to the restrictive barrier
  3. Patient instructed to move away from restrictive barrier- creating an isometric force
  4. Operator resists patient movement for 3 to 5 seconds.
  5. Patient instructed to relax- operator simultaneously relaxes
  6. Joint is taken further towards the restrictive barrier

Repeat steps 3-6 until improvement is achieved
Recheck diagnosis

29
Q

When do you stop the contraction-relaxation cycle for muscle energy treatment flow?

A

UNTIL NO FURTHER IMPROVEMENT IS FELT.

Known by:

  1. patient’s body telling the operator when the treatment is done
  2. Usually 3-5 cycles is enough
    c. Re-check to see if you have made a difference
30
Q

True or false: In a muscle energy treatment, the counterforce is an isometric contraction?

A

True

31
Q

True or false: In a muscle energy treatment, the patient’s force should be greater than the operator/physician’s force.

A

False; the physician’s force and the patient’s force should be the same.

32
Q

How much force should be used for cervical muscles?

A

Ounces of force

33
Q

How much force should be used for large muscles?

A

pounds of force

34
Q

Once you have resisted the final isometric contraction in the cycle of a muscle energy treatment, what must you do?

A

Approach the barrier one last time prior to coming out of the treatment position!!

35
Q

TQ: How many cycles do you perform in a muscle energy treatment?

A

AS MANY AS IT TAKES until NO further improvement is noted (usually 3-5 cycles, but may be more).

36
Q

What body parts can you apply muscle energy techniques to?

A

long muscles or small muscles to improve joints

37
Q

For muscle energy, if a patient’s T4 is rotated and sidebent to the left, which way is the restricted motion?

A

Restrictive barrier is rotation and sidebending to the RIGHT

38
Q

Which direction is muscle energy treatment taken in relation to the barrier? Which direction does the isometric contraction occur in relation to the barrier?

A

Treatment is taken DIRECTLY to the barrier (restriction). Isometric contraction occurs in the OPPOSITE direction to the barrier.

39
Q

True or false: Muscle brought to stretch at a barrier causes the muscle spindles to activate.

A

True!

40
Q

What are the three major Neurophysiological Concepts o Muscle Energy Techniques?

A
  1. Post-isometric relaxation theory
  2. Golgi tendon organ inhibitory effects theory
  3. Muscle Fatigue Theory
41
Q

Which neurophysical concepts of muscle energy technique is the most popular? What does it theorize?

A

Post Isometric Relaxation - The refractory period of an action potential is why you can stretch further towards the barrier (

42
Q

What is the Golgi Tendon Organ (GTO) theory of post-isometric relaxation?

A

Once you contract, motor neurons are activated and tendon tension threshod reached. GTO is activated which INHIBITS the motor neuron activity, thus reducing muscle tension.

43
Q

What are contraindications to Muscle Energy Techniques?

A
  • Individuals unwilling or unable to follow verbal directions
  • Internal bleeding
  • Post-surgical patient
  • Initially following a myocardial infarction
  • In areas where there is an acutely injured muscle
44
Q

What are two types of High-velocity/low amplitude techniques?

A
  1. Direct technique

2. Short Lever technique

45
Q

What is a HVLA (High velocity/low amplitude) technique?

A

A technique using rapid, therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint and ENGAGES the restrictive barrier in one or more planes of motion to elicit release of restriction

46
Q

Why do we perform HVLA techniques?

A

To fix joint restriction

47
Q

Why do we want to fix a joint restriction?

A

Joint has asymmetrical motion due to tight myofascial tieeues around it. THere might even be small inclusions in the joint space that restrict motion (meniscoids). These result in asymmetrical pressures on the joint that cause motion changes. Often, asymmetrical pressure on the joint cause motion changes above and below.
Because joint restriction can cause pain, inflammation of tissues, and decreases in synovial fluid, gapping of the joint allows you to reestablish proper position and tensions around the joint

This result is an immediate motion gains and pain reduction.

48
Q

What are the steps to HVLA techniques?

A
  1. Identify the barrier via diagnosis
  2. Bring the joint to the barrier - reverse the somatic dysfuntion diagnosis (ex. if restriction is in sidebending and rotation left, take the joint into that direction).
  3. Take all slack out of area
  4. Position carefully/fine tune
  5. Use relaxation/distractor technique
  6. Apply thrust in a specific direction (HVLA) without letting off barrier.
  7. Recheck!
49
Q

What is the noise heard in HVLA steps?

A

It’s a HARMLESS release of nitrogen gas that is sealed in joint fluid.

50
Q

Is it important to hear a pop when you do a HVLA?

A

No. Caviation is not critical in correction.

51
Q

What are the benefits of HVLA?

A

Immediate release of pain and freedom of motion

52
Q

TQ: What is the most widely accepted theory for the effectiveness of HVLA thrusts?

A

Gapping of the joint causes release of gas which results in improved motion and gapping will cause a SUDDEN muscle stretch

53
Q

What are the three theories for the mechanism of action for HVLA?

A
  1. Gapping of the joint causes release of gas that will result in improved motion and gapping will cause a sudden muscle stretch.
  2. Meniscoid inclusions repositioned in the joint allowing free ROM
  3. Causes golgi tendon organ activation
54
Q

What are contraindications for HVLA techniques?

A

Osteoporosis and arteriosclerosis

55
Q

What are indications for HVLA techniques?

A

Acute injuries like Disc herniations, muscle spasm

56
Q

What has research shown about HVLA techniques?

A
  • An increase in average joint space of 1.2 mm
  • Muscles rich with mechanoreceptors provide feedback to the spinal cord when STRETCHed to inhibit nociceptors (pain receptors)

OPP #1 (8 decks)

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