8- Indirect Osteopathic Treatment Techniques

Question 0

What are the contraindications for myofascial release?

Answer 0

Absolute:

- Absence of somatic dysfunction
- Lack of patient consent and/or cooperation

Relative:

- Patients w/ fractures
- Open wounds
- Acute thermal injury, soft tissue or bony infarctions,
- Abscesses
- Deep venous thrombosis  (threat of embolism), anticoagulation, disseminated or focal neoplasm
- Recent post-operative states over the site of proposed treatment (wound dishiscence)
- Aortic aneurysm

Question 1

What the indications for myofascial release?

Answer 1

Treating somatic dysfunctions involving myofascial or other connective tissues

Question 2

What is the proposed mechanism for myofascial release?

Answer 2

Fascia is capable of changes in length (plasticity and elasticity), with associated changes of energy content (hysteresis)

Myofascial Release provides peripheral neuroflexive alterations in muscle one and neural facilitation. In part, by its influence on mechanoreceptors.

Application of MFR allows for connective tissue creep (plastic changes) which are associated with release of energy. This may include heat, electromagnetic, and piezoelectric changes.

External forces applied to fascia facilitate restoration of normal structure and function

• Tensegrity principles coupled with fascial bioelectric (piezoelectric) properties influence the anatomical and physiological responses of tissues applied manipulative forces

Question 3

How is a strain/counterstrain technique diagnosed?

Answer 3

having a somatic dysfunction with an associated myofascial tender point

Question 4

What does the anterior tenderpoint correlate with?

Answer 4

Spinal somatic dysfunction

Question 5

Where are tenderpoints typically located?

Answer 5

near bony attachment of tendons, ligaments or the belly of osme muscles.

Question 6

How do you know a tenderpoint when you feel it?

Answer 6

small, tense, endomatous areas in the soft tissue, which are about the size of a fingertip.

Question 7

What are indications for a strain/counterstrain?

Answer 7

• Acute or chronic somatic dysfunctions
• Somatic dysfunctions with a neural component like a hyper-shortened muscle
• As primary treatment or in conjunction with other approaches
• Somatic dysfunctions in any area of the body

Question 8

What are contraindications for a strain/counterstrain?

Answer 8

Absolute:

- Absence of somatic dysfunction
- Lack of patient consent and/or cooperation

Relative:

- Patient who cannot voluntarily relax
- Severely ill patient
- Vertebral artery disease (cervical)
- Severe osteoporosis

Question 9

What are safety and efficacy for selected indirect techniques?

Answer 9

Post-treatment reaction
- Pain, most often in antagonist muscles, several hours after treatment, usually self limited and well-tolerated by patients

Reactions associated with patient position

- Avoid positions that do not relieve pain
- Avoid positions that cause discomfort, dizziness, panic and/or neurogenic pain, such as upper cervical hyper rotation and hyperextension
- Use caution when treating the cervical spine in a patient with rheumatoid arthritis or any other rheumatological conditions, segmented or ligamentous instability

Question 10

How do you diagnosis for strain/counterstrain technique?

Answer 10

• Patient history and observation and body habitus are evaluated
• Once an area of potential dysfunction is determined, then specific tissue location are evaluated for presence of TENDERNESS and TISSUE TEXTURE abnormalities (increased tension)

Question 11

How do you treat strain/counterstrain?

Answer 11

• Do a relevant/appropriate structural (including orthopedic) exam
• Localize the tender point
• Establish tenderness assessment with a pain scale
• Place patient passively in position that results in greatest reduction (>70% with a goal of 100%(
  - FINE TUNE the position with small arcs of movement
• Maintain position for 90 seconds while continuously monitoring the point
• Slowly return patient passively to neutral position
• Retest for tenderness at tender point.

Question 12

How do you treat for:
Anterior points? 
Posterior points?
Midline point?
A very lateral point?

Answer 12

Anterior points = flexion
Posterior point = extension
Midline point = flexion or extension
VeryLateral point = More side bending and rotation required

Question 13

What is a god sign of myofascial relaxation to a strain/counterstrain technique?

Answer 13

The presence of a therapeutic pulse

Question 14

What is the goal of a Facilitated Positional Release (FPR)?

Answer 14

Decrease tissue hypertonicity (excessive tone)

Question 15

What is the proposed mechanism for Facilitated positional release (FPR)?

Answer 15

• (by Korr) Behavior of lesioned segment initiated/maintained by increased gain in gamma motor neuron activity of that segment
• (by Bailey) - In appropriate high “gain-set” of muscle spindle –> changes characteristic of somatic dysfunction
• (by Carew) - shortening the muscle “more than intended” causes decrease in spindle output, lowering the afferent excitatory input to the spinal cord via la fibers.
• FPR may affect the gamma loop

Question 16

What are the indications for a facilitated positional release (FPR)?

Answer 16

• Acute or chronic somatic dysfunctions
• Somatic dysfunctions with a neural component like a hyper-shortened muscle
• As primary treatment or in conjunction with other approaches
• Somatic dysfunctions in any area of the body

Question 17

What are contraindications for Facilitated Positional Release (FPR)?

Answer 17

Absolute:

• Absence of somatic dysfunction
• Lack of patient consent and/or cooperation

Relative:

• Patient who cannot voluntarily relax
• Severely ill patient
• Vertebral artery disease (Cervical)
• Severe osteoporosis

Question 18

What are safety and efficacy considerations for facilitated positional release (FPR)?

Answer 18

Complications and precautions:

• Post-treatment reaction
  
  • Pain, most often antagonist muscles, several hours after treatment, usually self limited and well-tolerated by patients
• Reactions associated with patient position
  
  • Avoid positions that do not relieve pain
  • Avoid positions that cause discomfort, dizziness, panic and/or neurogenic pain such as upper cervical hyper rotation and hyperextension
  • Avoid extreme forward bending of the thoracolumbar spine in osteoporotic patients
  • Use caution when treating the cervical spine in a patient with rhumatological conditions, segmental or ligamentous instability

Question 19

What criteria do you use to diagnosis the use of facilitated Positional Release (FPR)?

Answer 19

• Muscle hypertonicity
• Segmental somatic dysfunction
• T A R T

Question 20

What are the treatment options for facilitated positional release (FPR)?

Answer 20

• Tissue texture change treatment

- Intervertebral motion restriction treatment

Question 21

How do you perform the Tissue Texture change treatment for a facilitated positional release?

Answer 21

Physician places the patient’s musculature in a relaxed position
- the A-P spinal curve of the treatment area is flattened (places the region of the spine into a position of ease of motion, which shortens and softens associated muscle)

Applies a facilitating force (like compression, torsion, or a combination of the two)

Position is held for 3-4 seconds, then released

Patient is reevaluated.

Question 22

What is the method for an intervertebral motion restriction treatment for a facilitated positional release?

Answer 22

• Segmental diagnosis is made
• The A-P spinal curve of the treatment area is flattened
• Physician places vertebra into a position that allows freedom of motion in all planes
• A facilitating force is applied. This may be compression, torsion, or a combination of the two.
• The position is held for 2-3 seconds then released.

Patient is re-evaluated