Direct vs Indirect Flashcards
Vertebral Segment
Single vertebrae
Vertebral Unit
2 adjacent vertebrae and their associated elements
Associated elements of vertebral unit
- Ligamentous
- Intervertebral disk
- Arthrodial
- Muscular
- Neural
- Vascular, including lymphatics
How do we name vertebral motion?
In relation to segment below and for movement of a point on the anterior/superior portion of the vertebral body
What does the posterior component refer to? Anterior?
Prominent transverse process; less prominent
Fryette 3rd Law of Motion
When one motion is introduced, it reduces the amount of the other motions
What are atypical vertebrae
Do NOT follow Fryette’s rules due to their anatomy
What is AT Still’s birthday? Where was he born?
August 6th, 1828 - Virginia
AT Still’s letters after his name. Where did he study medicine?
MD, DO - Kansas City School of Physicians and Surgeons
AT Still’s dad’s professions
Farmer, physician, and minister
What are the 3 atypical vertebrae?
- OA - occiput on atlas (C0 on C1)
- AA - atlas on axis (C1 on C2)
- Sacrum
What are all techniques based off of?
The Barrier Concept
What does The Barrier Concept describe? Contain?
Describes motion in a joint or in a tissue in ONE plane; contains neutral point along with barriers
What do we have in SD in relation to Barrier Concept?
Additional barriers and pathological neutral
Barrier defines what?
Limit of motion
What makes up normal joint motion and barriers to that motion?
- Balance point - O
- Physiological barrier - PB
- Anatomical barrier - AB
What is the balance point?
Midline between physiologic barriers
What can be altered by warm up?
PB
When does tissue disruption occur?
Beyond the AB
What is a Restrictive Barrier?
Change in ROM
What happens because of a RB?
Pathologic neutral (asymmetric point of balance)
What makes up somatic dysfunction and barriers to motion?
- O - balance point
- PB
- AB
- RB
- SD
Full definition of Restrictive Barrier
A functional limit within the anatomical ROM, which abnormally diminishes the normal physiologic range
What is another term for the ROM?
Quantity; tissue motion
What is the Quality of motion?
Endfeel
What is the Endfeel of motion?
Perceived as an anatomic or physiologic barrier as approached
What is Endfeel used for?
Describe osteopathic manipulative procedures
How do we tell what the tissues are doing?
Based on what our hand FEEL
3 examples of “End Feel” descriptions
Firm, rubbery, boggy
Diagnosis with TART
- What you feel
- What you see
- How it responds to motion testing
- Tender?
Is TART equal?
No; some more equal than others depending on which technique to choose
What skill is needed for to define Barrier Mechanics?
Restriction in Motion
What is the Manipulative Description?
- Your goal?
- Which technique?
- How much?
- How often?
How do we choose the right technique?
- Initial positioning
2. Find activating force
Definition of “Direct Treatment”
A manipulative technique where the restrictive barrier is engaged; the dysfunctional body part is moved into the restrictive barrier until tissue tension is localized in all planes and directions, then an activating force is used to either move through the barrier or release the barrier in increments
3 main points with Direct Treatment
- Position in restrictive barrier
- Localize in all planes
- Utilize activating force
Definition of “Indirect Treatment”
A manipulative technique where the restrictive barrier is disengaged; the dysfunctional body part is moved away from the restrictive barrier until tissue tension is equal in one or all planes and directions
3 main points with Indirect Treatment
- Position in direction of freer motion
- Balance tension on all sides, hold
- Released via inherent forces
Definition of inherent force?
Using the body’s natural tendency to seek homeostasis, inherent force is the rhythmic activity in all tissues that work to improve the hydrodynamics and bioenergetics factors around the restricted tissues and articulations
Direct engages what? What about its Activating Forces?
Restrictive (pathological) barrier; its activating forces vary
Indirect engages what?What about its Activating Force?
Moves away from restrictive barrier to a point of ease (new pathological neutral); the activating force is the inherent force of the body
6 Direct Techniques
- Direct Myofascial Release (D-MFR)
- Articullatory (ART)
- Muscle Energy (ME or MET)
- Soft Tissue (ST)
- High Velocity, Low Amplitude (HVLA)
- Direct Osteopathic Cranial Manipulative Medicine (OCMM)
6 Indirect Techniques
- Counterstrain (CS)
- Indirect balancing
- Faciliated Postural Release (FPR)
- Balanced Ligamentous Tension (BLT)
- Osteopathic Cranial Manipulative Medicine (OCMM)
- Indirect Myofascial Release (I-MFR)
What is the “Combined Technique”
First INDIRECT, then direct
3 Activating Forces in Direct Technique
- Operator induced
- Patient activated
- Inherent force
Activating Force in Indirect Technique
- Inherent forces
Describe Soft Tissue Treatment. What is its Activating Force?
Direct. Directed toward tissues other than skeletal or arthrodial elements, which involves lateral/linear stretching, deep pressure, traction and/or separation of muscle origin and insertion while monitoring tissue response and motion changes by palpation
Activating Force: intermittent engagement and release of the restricted tissues
Describe Direct Muscle Energy Technique. What is its Activating Force?
Patient voluntarily moves their body from a precisesly controlled position against a controlled resistance applied by the physician
Activating Force: patient induced
Describe Indirect Counterstrain. What is its Activating force?
A treatment form in which a tender point is monitored for continual palpatory feedback as the patient is positioned to a “point of ease” and held for 90 seconds to achieve release of myofascial tissues; the patient is passively returned to the “normal” position.
Activating Force: inherent force
Describe Indirect Myofascial Release. What is its Activating Force?
A treatment form which engages continual palpatory feedback to achieve release of myofascial tissues; with indirect MFR the myofascial tissues are moved to the balance point or “point of ease” in ALL planes of motion until a tissue release occurs.
Activating Force: inherent
Describe the Still Technique. Activating Force?
Combined. Indirect-Direct. A technique where the initial movements are indirect; as the technique is completed the movements change to direct forces
Activating Force: 1) the inherent release within the soma and 2) the physician’s slow, gentle force through the restrictive barrier
