E1 Flashcards
Symptom exacerbation: C Spine flexion
Flexion
+disc herniation
+posterior muscle injury
+hypertonicity
Symptom exacerbation: T Spine flexion
Flexion
+posterior paraspinal muscles
+shoulder girdle muscles
+disc herniation
Symptom exacerbation: L Spine flexion
Flexion
+disc herniation
+lumbar pvm
+lumbosacral ligaments
Sequence of Examination
- Screen
+asymmetry
+spinal curve abnormalities
+regional ROM abnormalities - Scan
+layer by layer palpating - Segmental Definition
+segmental (spine) motion testing
Motion terminology (planes)
- Sagittal: flexion/extension (transverse coronal axis)
- Coronal: sidebending (anterior-posterior axis)
- Horizontal: rotation (vertical axis)
Symptom exacerbation: C spine extension
Extension
+facet joint disease
+anterior muscle injury
+hypertonicity
Symptom exacerbation: C spine rotation
Rotation
+splenius capitis and cervicis
+sternocleidomastoid
Symptom exacerbation: C spine sidebending
Sidebending
+trapezius
+levator scapulae
Symptom exacerbation: T spine extension
Extension
+facet joint disease
Symptom exacerbation: T spine sidebending
Sidebending
+intercostal muscles
+serratus anterior
Symptom exacerbation: T spine rotation
Rotation
+abdominal obliques
Symptom exacerbation: L spine extension
Extension \+spondylolisthesis \+facet syndrome \+spinal stenosis \+psoas
Symptom exacerbation: L spine sidebending
Sidebending
+lateral abdominal wall
+IT band
Symptom exacerbation: L spine rotation
Rotation \+discogenic pain \+abdominal obliques \+iliolumbar ligaments \+piriformis syndrome
Mid-gravity line
EAM–>Odontoid Process of C2–>Greater Tuberosity of Humerus–>Middle of L3–>Sacral Promontory–>Greater Trochanter of Femur–>Just behind patella–>Just anterior to lateral malleolus
Direct techniques
Engage motion barriers
e.g. Muscle energy, soft tissue, direct myofascial release, articulatory, HVLA
Name the barriers
Anatomic, physiologic, elastic, restrictive, pathologic
Anatomic barrier
Final limit to motion limited by bone and ligaments
“The point past which disruption occurs”
Limited especially by ligaments and bone contour
Physiologic barrier
Soft tissue tension that limits voluntary/active motion; further motion toward the anatomic barrier can be induced passively
“As far as you can go by yourself”
Maintained by Golgi receptors, muscle spindles, and Pacinian receptors
Elastic barrier
Range between the physiologic and anatomic barriers in which passive stretching occurs before tissue disruption
Determined by the capsules and ligaments around a joint
**determines passive ROM
Restrictive barrier
Functional limit that decreases the physiologic range; OMM is okay
Techniques for pain
Counterstrain
Soft tissue
Indirect technique
Techniques for edema
Muscle energy
Myofascial release
Lymphatic techniques
Techniques for muscle spasm
Muscle energy
Counterstrain
Techniques for fascia
Myofascial release (direct or indirect)
Techniques for joint surface
HVLA
Somato-somatic dysfunction
Dysfunction in one somatic structure provokes muscle hypertonicity in a related location
Mode: segmental facilitation
Example: quadriceps strain causing L2, L3, L4 group dysfunction via reflex paraspinal muscle hypertonicity
Somato-visceral dysfunction
Dysfunction in one somatic structure reflexly provokes hypersympathetic/parasympathetic response in segmentally related viscera
Mode: segmental facilitation
Example: occipito-Atlantal dysfunction causing bradycardia via a reflex vagal hyperparasympathecotonia to the conduction system of the heart
Viscero-somatic dysfunction
Organ causing reflex hypertonicity of musculature
Mode: sympathetic visceral afferents
Example: ulcerative colitis causing hypertonicity of paravertebral musculature at T10-L2 spinal levels
Viscero-visceral dysfunction
Reflex effects that one viscus (organ) has on another
Mode: spinal cord modulation of ANS reflexes
Example: increased intraocular pressure provoking slowing of the heart rate via trigeminal parasympathetic afferents
Types of muscle contraction
Isotometric, concentric isotonic, eccentric isotonic, isolytic
Isometric contraction
Muscle contracts but origin/insertion distance remains static
**most common contraction in muscle energy techniques
Concentric isotonic contraction
Muscle contractile force remains constant while proximal and distal attachments approximate
**used to increase strength in muscles that are reflexly weakened by somatic dysfunction
Eccentric isotonic contraction
Muscle contraction remains constant as proximal and distal attachments are permitted to separate
**used to strengthen weak muscle
Isolytic contraction
Patient contracts muscle against resistance, but physician overcomes force
**lengthens muscles
First part of neuron table
H 1-5
S 5-9
L/G 6-9
P 5-11
Second part of neuron table
SI 9-11
C/R 8-2
K/U 10-1
B 10-1
Third part of neuron table
O 9-10 T 9-10, 1-2 U 10-1 C P 1-2
Organs with preganglionic neurons in sacrum
C, B, T, C
Colon, bladder, testicle, cervix
S2-S4
A.T. Still lifetime
1828-1917 (died at 89)
Year Still broke with allopathic medicine
1874 – “flew the osteopathic banner to the breeze”
When did Still found the American School of Osteopathy? When are DMU and PCOM founded? GA PCOM?
October 3, 1892 – Kirksville, MO
1898
1899
2005
First four principles of osteopathy
- The body is a unit
- Structure and function are reciprocally related
- The body possesses self-regulatory mechanisms
- The body has the inherent capacity to defend and repair itself
(1953 in Kirksville)
Steps of layer by layer palpating
Observation (skin color, temperature, etc)
Superficial fascia (elasticity of skin, turgor [swelling], tension, thickness, mobility, quality)
Deep palpation (contact periaxial tissues of spinal column – muscle turgor, tension, thickness, shape, irritability)
Bone (contour and motion)
Tissue texture changes–acute
Skin-warm, moist, erythematous
Soft tissues-boggy edema, acute congestion
Muscles-increased tone, spasm ropiness
Mobility-ROM may be normal, but sluggish
Tissue texture changes–chronic
Skin-cool, pale
Soft tissues-doughy, stringy, fibrotic, thickened, contracted
Muscles-decreased tone, flaccid, mushy, decreased ROM
Mobility-ROM decreased, but quality is normal
Date and founder of first chiropractic school
1898 – D.D. Palmer (former student of Still’s)
What happened in 1941?
Penicillin introduced by Fleming
Casualties greatly reduced in WWII
California debacle
1962-many DOs give up licenses to become MDs
1974-Supreme Court rules against allopathic takeover; DOs reinstated with full licensure
Where are the angles of the ribs?
In a line parallel to the medial scapular border
What ligament attaches to the ILA of the sacrum?
Sacrotuberous ligament
What ligament is superior to the PSIS?
Iliolumbar
