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OS1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Somatic Dysfunction

A

Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, myofascial

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2
Q

Disease is

A

the result of anatomical abnormalities followed by physiological discord

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3
Q

Who exploded the pseudomotor (ANS) impact of somatic dysfunction

A

Irvin Korr

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4
Q

Acute somatic dysfunction

A

Immediate or short term impairment or altered function of related components of the somatic (body framework) system

Characterized by: vasodiliation
edema
tenderness
pain
tissue contraction
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5
Q

Chronic somatic dysfunction

A

impairment or altered function of related components of the somatic (body framework) system

Characterized by:
tenderness
itching
fibrosis
paresthesias
tissue contraction
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6
Q

Bog/ Bogginess

A

Wet, spongy ground

To sink in as if in a bog

Tissue texture abnormality characterized by a palpable sense of sponginess in the tissue, interpreted as resulting from congestion due to increased fluid content

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7
Q

Tone

A

Normal feel of muscle in the relaxed state

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8
Q

Hypertonicity

A

extreme= spastic paralysis

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9
Q

Hypotonicity

A

flaccid paralysis when no tone at all

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10
Q

Contraction

A

normal tone of a muscle when it shortens or is activated against resistance

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11
Q

Contracture

A

abnormal shortening of a muscle due to fibrosis.

Most often in the tissue itself, often result of chronic condition.

Muscle no longer able to reach its full normal length

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12
Q

Spasm

A

Abnormal contraction maintained beyond physiologic need. Most often sudden and involuntary muscular contraction that results in abnormal motion and is usually accompanied by pain and restriction of normal function

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13
Q

Ropiness

A

hard, firm, rope-like

chronic condition

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14
Q

Elastic barrier

A

the range between physiologic and anatomic barrier of motion in which passive stretching occurs before tissue disruption; aka the area that warms up with stretching

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15
Q

Restrictive barrier

A

a functional limit that abnormally diminishes the normal physiologic range

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16
Q

Barrier “end feel”

A

placatory experience or perceived quality of motion when a joint is moved to its limit- a barrier is approached normal end feel

bone to bone (elbow)
Soft tissue approx (knee flex0
Tissue stretch (ankle dorsiflex)

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17
Q

Examples of Restricted ROM and abnormal end feel

A

early muscle spasm
late muscle spasm
hard capsular
soft capsular

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18
Q

early muscle spasm

A

protective spasm after injury

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19
Q

late muscle spasm

A

chronic spasm, think chronic tissue change

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20
Q

hard capsular

A

frozen shoulder

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21
Q

soft capsular

A

synovitis (swelling of knee after injury

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22
Q

Tenderpoints

A

small discrete hypersensitive areas within myofascial structures that result in localized pain

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23
Q

Trigger point

A

small discrete hypersensitive areas within myofascial structures- palpation causes referred pain away from site

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24
Q

According to Osteopathic practices and principles which of the following do we treat?

a. symptoms
b. illness
c. pain
d. psychosocial causes of disease
e. the patient

A

e. the patient

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25
Q

A 22 A 22-yo female c/o rt. ankle pain after “twisting” her ankle playing tennis yesterday. Passive motion testing reflects diminished dorsiflexion with an empty end-feel. Which barrier description is associated with this finding?

a. bony
b. ligamentous
c. tissue approximation
d. tendinous
e. guarding

A

e. guarding

patient resists touching end point

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26
Q

ROM Planes

A

Sagittal
-flexion/ extension

Frontal (coronal)
-sidebending

Horizontal (transverse)
-rotation

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27
Q

fibrous joint

A

skull articulations

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28
Q

cartilaginous joint

A

discs between vertebrae

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29
Q

Synovial

A

6 types

extremities

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30
Q

End Feel of range of motion

5

A 
elastic
abrupt
hard
empty
crisp
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31
Q

elastic end feel

A

like a rubber band

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32
Q

abrupt end feel

A

osteoarthritis or hinge joint

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33
Q

hard end feel

A

somatic dysfunction

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34
Q

empty end feel

A

stops due to guarding

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35
Q

Crisp end feel

A

involuntary muscle guarding as a pinched nerve

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36
Q

Static

A

maximal ROM a joint can achieve with an externally applied force

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37
Q

Dynamic

A

ROM an athlete can produce and speed at which he/she can produce it

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38
Q

Functional unit

A

two vertebrae, their associated disc, neuromuscular, and other soft tissues

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39
Q

coupled motion

A

consistent association of a motion along or about one axis, with another motion about or along a second axis. the principle motion cannot be produced without the associated motion occurring as well

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40
Q

Linkage

A

by linking multiple structures together you will get increased ROM

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41
Q

Four natural curves of the spine

A

Cervical: lordosis
Thoracic: kyphosis
Lumbar: lordosis
Sacral: kyphosis

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42
Q

First woman DO

A

Jeanette Bowles

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43
Q

What happened in 1910 that changed the face of medical education for MDs and DOs?

A

Abraham Flexner produced the Flexner report with harsh criticism of medical education in the US.

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44
Q

Founder of osteopathy

A

AT Still

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45
Q

3 of AT Stills children die

A

1864

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46
Q

Day AT Still flung the banner of osteopathy

A

June 22, 1874

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47
Q

First school of osteopathy opened

A

1892

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48
Q

KCU established

A

1916

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49
Q

Spanish flu

A

1917-1918

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50
Q

DOs could serve in the military

A

1957

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51
Q

California referendum (DOs can turn tin degrees for MD degrees)

A

1961-1974

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52
Q

Four Tenets of osteopathic medicine

A

Four Tenets of Osteopathic Medicine

  1. The mind, body & spirit are a unit.
  2. The body is capable of self- regulation, self-healing, and health maintenance.
  3. Structure and function are reciprocally interrelated.
  4. Rational treatment is based upon understanding & implementing the other 3 tenets.
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53
Q

Acute

  • vascular
  • sympathetic
  • musculature
A

V: inflamed vessel wall injury, endogenous peptide release

S: local vasoconstriction overpowered by local chemical release, net effect is vasodilation

M: local increase in tone, muscle contraction, spasm- mediated by increase spindle activity

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54
Q

Chronic

  • vascular
  • sympathetic
  • musculature
A

V: sympathetic tone increases vascular constriction

S: vasoconstriction, hypersympathetic tone, may be regional

M: decreased muscle tone, flaccid, mushy, limited ROM due to contracture

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55
Q

Acute

  • Pain
  • Visceral Fxn
  • Visceral Dysfunction
A

P: sharp, severe, cutting

VF: minimal somatoviseral effects

VD: may or may no be present; if trauma is severe it is often present

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56
Q

Chronic

  • pain
  • Visceral Fxn
  • Visceral Dysfunction
A

P: Dull, ache, paraesthesias (tingling, burning gnawing, itching)

VF: somatovisceral effects common

VD: often involved in somatic dysfunction

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57
Q

Acute

  • TTA
  • Asymmetry
  • Restriction
  • Tenderness
A

T: Red, swollen, boggy, increased tone
A: present
R: Present, painful w/ motion
T: Sharp pain

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58
Q

Chronic

  • TTA
  • Asymmetry
  • Restriction
  • Tenderness
A

T: Dry, cool, ropy, pale, decreased tone
A: present, compensation occurs
R: present, maybe not guarded
T: dull, achy pain

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59
Q

Temperature receptors

A

Deep in the hand

Dorsal back of hand has thinner skin, better for temp palpation

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60
Q

Touch receptors

A

Concentrated in the pads of the fingers (not the tips)

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61
Q

Sagittal

A

Front and back bending

Flex leg at hip, Leg extension

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62
Q

Frontal (coronal

A

Side bending

Shoulder abduction, shoulder adduction (not horizontal)

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63
Q

Transverse

A

Head rotation
Horizontal adduction
Horizontal abduction

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64
Q

Fascial Anatomy

A

These connective tissue layers are composed of collagen fibers (and occasionally also elastin fibers) in an amorphous matrix of hydrated proteoglycans which mechanically links the collagen fiber networks in these structures

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65
Q

Fascia is

A

a complete system with blood supply, fluid drainage & innervations
-largest organ system in the body

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66
Q

Fascia is composed of

A

irregularly arranged fibrous elements of varying density

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67
Q

Fascia function

A

involved in tissue protection & healing of surrounding systems

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68
Q

Fascia is not:

A

tendons
ligaments
aponeuroses

69
Q

Omnipresent

A

it belts each muscle, vein, n nerve and all the organs of the body

There is myofascialarthrodial continuity throughout the body

70
Q

Continuity of Fascia

A

Perimysium (Fascia) –> Peritendium –> periosteum

71
Q

Pannicular Fascia

A

Outermost layer of fascia derived from somatic mesenchyme & surrounds entire body with exception of the orifieces; outer layer is adipose tissue & inner layer is membranous & adherent, generally to the outer portion

72
Q

Axial & Appendicular Fascia

A

aka investing layer

Internal to the pannicular layer; fused to the panniculus and surrounds all of the muscles, the periosteum of bone & peritendon of tendons

73
Q

Fascia Layers

A

Pannicular Fascia
Axial & Appendicular Fascia
Meningeal Fascia
Visceral Fascia

74
Q

Meningeal Fascia

A

Surrounds the nervous system, includes the dura

75
Q

Visceral Fascia

A

Surrounds the body cavities (pleural, pericardial, and peritoneum)

76
Q

Fascia FXN

A

Omnipotent
Provides for mobility and stability of the musculoskeletal system
1) elastic as well as contractile
2) supports and stabilizes, helping to maintain balance
3) it assists in the production and control of motion and the interrelation of motion of related parts
4) Many of the body’s fascial specializations have postural functions in which stress bands can be demonstrated

77
Q

Contractile

A

Myofibroblasts

78
Q

Healing

A

Macrophages

Mast cells

79
Q

Percentages

A

Approximately 20% of cutaneous high-threshold mechanoreceptors supplying the skin also have receptive fields in the subcutaneous tissue… the loose fascia

Stretch receptors for muscles & proprioception (balance)

  • only 25% in the muscle
  • 75% consists of free endings in fascia

80% of the C fibers are polymodal

Liquid crystal-like properties
-Piezoelectricity

80
Q

Viscoelastic material

A

any material that deforms according to rate of loading and deformity

81
Q

Stress

A

is the force that attempts to deform a connective tissue structure

82
Q

Strain

A

is the percentage of deformation of a CT

83
Q

stress-strain curve can

A

shift with loading of tendon

During cyclic loading of tendon, the stress- strain curve gradually shifts to the right

84
Q

Hysteresis

A

The difference between the loading and unloading characteristics represents energy that is lost in the connective tissue system; this energy loss is termed hystereresis

85
Q

Creep

A

Connective tissue under a sustained, constant load (below failure threshold) will elongate (deform) in response to the load

86
Q

Bind

A

a palpable restriction of connective tissue mobility

87
Q

Fascial Sweater

A

Fascial restrictions in one area of the body, will create connective tissue restrictions (pulls) at a distance away from the site of the initial restriction. The result is abnormal myofascial & joint mobility

88
Q

Newton’s Third Law

A

When two bodies interact, the force exerted by one is equal in magnitude and opposite in direction to the forces exerted by the other

89
Q

Hooke’s Law

A

The strain (deformation) placed on an elastic body is in proportion to the stress (force) placed upon it.

90
Q

Wolff’s Law

A

Bone will develop according to the under stresses placed upon it

This concept extends to fascia too

91
Q

Somatic dysfunction includes

A

impaired or altered function of:

  • skeletal
  • arthroidal
  • myofascial structures
  • related vascular
  • lymphatics
  • neural element
92
Q

Sherrington’s law

A

When a muscle receives a nerve impulse to contract, its antagonists, receive, simultaneously, an impulse to relax

93
Q

Transition Zones of the Spine

A

Zone 1: OA, C1, C2
Zone 2: C7, T1
Zone 3: T12, L1
Zone 4: L5, Sacrum

94
Q

Soft Tissue Technique Defined

A

A system of diagnosis and treatment directed toward tissues other than skeletal or arthrodial elements

95
Q

ST Indictations & Treatment Goals

A

T Goal: stretch and increase the elasticity of shortened myofascial structures to return symmetry and to improve local tissue nutrition, oxygenation and removal of metabolic wastes to normalize tissue texture

A Goal: return symmetry & normalize tone

R Goal: Set the fascia free to normalize ROM

T Goal: Normalize neurologic activity (pain, guarding & proprioception) and Improve abnormal somato-somatic and somato-visceral reflexes

96
Q

ST Indications

A

Diagnostically
- to identify areas of restricted motion, tissue texture changes, and sensitivity

Feedback about tissue response to OMT

Improve local and systemic immune response

Provide a general state of relaxation

Enhance circulation to local myofascial structures

Provide a general state of tonic stimulation

97
Q

ST Relative Contraindictions

A

Individual techniques may be contraindicated in specific situations such as:

Severe osteoporosis

Acute Injuries

98
Q

ST Relative Contraindictions

-severe osteoporosis

A

-prone pressure techniques may be contraindicated in the the thoracocostal region, but lateral recumbent techniques could be easily applied

99
Q

ST Relative Contraindictions

-Acute Injuries

A

Direct techniques that stretch acutely injured muscles, tendons, ligaments or joint capsules may do additional damage to these structures, or increase the amount of pain the patient experiences and are therefore contraindicated

100
Q

ST Absolute Contraindications

A

1) Fracture of dislocation
2) Neurologic entrapment syndromes
3) Serious vascular compromise
4) Local malignancy
5) Local infection (cellulitis abscess, septic arthritis, osteomyelitis
6) Bleeding disorders

101
Q

Principles of ST Technique

A

1) patient comfort
2) Physician comfort
- to minimize energy expenditure
3) Initially, the applied forces are very gentle and of low amplitude. The force is applied rhythmically, typically 1 or 2 seconds of stretch followed by a similar time frame releasing that stretch
4) As the soft tissues are palpated responding to the technique, the applied forces can be increased to increase the amplitude of the technique. The rate of application typically remains the same
5) The applied forces should be comfortable for the patient. Some patients experience some discomfort, but it is recognized by the patient as a good discomfort
6) DO NOT allow your hands to create friction by sliding across or rubbing the skin. The physician’s hand should carry the skin and subcutaneous tissues in applying the activating force
7) The technique is continued until the desired effect is achieved. This typically means that the amplitude of excursion of the soft tissue has reached a maximum and has plateaued at that level

102
Q

Stretch

A

Parallel traction

Increase distance between origin and insertion (parallel with muscle fibers)’

Taffy pull

103
Q

Knead

A

perpendicular traction

Repetitive pushing of tissue perpendicular to muscle fibers

Bowstring

104
Q

Inhibition

A

Push and hold perpendicular to the fibers at the musculotendinous part of hypertonic muscle

hold until relaxation of tissue

105
Q

MFR defined

A

A system of diagnosis and treatment first described by AT. Still and his early students, which engages continual placatory feedback to achieve release of myofacial tissue

106
Q

INR (integrated neuromuscuoloskeletal release)

A

A treatment system in which combined procedures are designed to stretch & reflexively release patterned soft tissue & joint related restrictions

107
Q

INR techniques

A

Breath holding
Prone/Supine simulated swimming & pendulum arm swing maneuvers
R/L Cervical rotation
Isometric limb & neck movements against the table
Patient evoked movement from cranial nerves (eye, tongue, jaw)

108
Q

Indications for MFR

A

Somatic dysfunction
-Almost all soft tissue or joint restriction

When HVLA (high velocity low amplitude) or Muscle energy is contraindicated
-consider indirect MFR

When counterstain may be difficult secondary to a patient’s inability to relax

109
Q

Contraindications of MFR

Absolute

A

Lack of patient consent

Absence of Somatic Dysfunction

110
Q

Contraindications of MFR

Relative

A

1) Infection of soft tissue or bone
2) Fracture, Avulson, or dislocation
3) Metastatic disease
4) Soft tissue injuries: thermal, hematoma, or open wounds
5) Post-op patient with wound dehiscence
6) Rheumatologic condition involving instability of cervical spine
7) DVT or Anticoagulation therapy

111
Q

Activating Forces

A

Inherent Forces
Respiratory Cooperation
Patient Cooperation

112
Q

Inherent Forces

A

Using the body’s PRM (primary respiratory mechanism)

113
Q

Respiratory Cooperation

A

Refers to a physician directed, patient performed, inhalation or exhalation or a holding of the breath to assist with the manipulative intervention

114
Q

Patient Cooperation

A

The patient is asked to move in specific directions to aid in mobilizing specific areas of restriction

115
Q

MFR Treatment Endpoint

A

1) A three dimensional release is often palpated as:
- warmth
- softening
- increased compliance/ROM
2) The continuous application of activating forces no longer produce change
3) When finished, recheck of the tissue demonstrates symmetry

116
Q

Muscular or sturdy body build

A

Mesomorphic

Mid-ranges of ROM

Characterized by relative prominence of structures developed from the embryonic mesdorm

117
Q

Thin body build

A

Ectomorphic

  • Long and linear frame
  • Tend to have higher ROM
  • Characterized by relative prominence of structure developed from embryonic ectoderm
118
Q

Heavy (Fat) body build

A

Endomorphic

  • obese, increased fatty tissue
  • tend to have lower ROM
  • characterized by relative prominence of structures developed from embryonic endoderm
119
Q

Which body habitus is associated with an excess of mesoderm

A

Mesomorph

120
Q

Yellow skin color

A

Jaundice

Live disease

121
Q

Redness skin color

A

Erythema

Inflammation

122
Q

Blue skin color

A

Cyanosis

  • Reynaud’s disease
  • Children with Tetralogy of Fallot exhibit bluish skin during episodes of crying or feeding
123
Q

Blackness skin color

A

Necrosis

124
Q

Pale skin color

A

May indicate anemia

125
Q

Spanish Flu

A

1917-1919
1 in 4 persons in US became ill with the flue
- increased susceptibility to pneumonia
-1 in 4 soldiers died
-500,000 deaths
-osteopathic physicians reported only 160 deaths during the period (just 10 attributed to pneumonia)
-Based on extrapolation of the mortality only 73,500 deaths from DOs

11,118 influence cases, 513 pneumonia

  • osteopathic care= 0.486%
  • medial/osteopath= 1.08 death rate
126
Q

Lymph

A

clear yellow fluid composed of proteins, salts, fats, lymphocytes, clotting factors, bacteria and viruses

127
Q

Lymphatic Development

A

Begins during 5th week of gestation

Develops from the mesdoerm

Immature at birth
-lymphoid tissue increases until puberty to mature, but lymphoid tissue regresses

128
Q

Liver

A

Gate keeper of hepatic-biliary pancreatic venous and lymphatic drainage

Pressure sensitive organ

1/2 of the bodies lymph is found here

Clears bacteria

129
Q

Lymphatic Channels perfuse what?

A

Perfuse all tissues of the body except

  • epidermis
  • endomysium
  • bone marrow
  • select portions of peripheral nerves
130
Q

Lymphatic Vessels

A

1) Composed of endothelium that lacks a basement membrane
- which allows fluid, protein, bacteria, cellular debris, emulsified fats, to readily enter

2) superficial or deep
3) One way lymphatic valves ensure unidirectional flow
4) Superficial lymphatic vessels typically follow the course of the veins
5) Deep lymphatic vessels typically follow the course of the being but may be compressed by arterial pulsations

6) Larger vessels have smooth muscle
- under sympathetic control (fight or flight vs rest & digest)
- increase sympathetic tone
- decrease peristalsis
- increases congestion

7) Small vessel distension –> activation of endothelial cell contractile fibers

131
Q

Thoracic Duct

A

1) Drain the majority of the body

2) Empties into the venous system at the junction of the
- left internal jugular vein
- left subclavian vein

3) Cisterna Chyli
- Dilated collecting sac in the abdomen where the lymphatic trunks draining the lower half of the body merge
- Ascends from the collecting sac as the thoracic duct into the thorax

132
Q

Right Lymphatic Duct

A

Drains

  • right side of the head, neck and thorax
  • right upper limb

Empties into the venous system at the junction of the

  • right internal jugular vein
  • right subclavian vein

You are doing a technique in a certain area, where would it drain to (thorax or right)

133
Q

35-60% of the drainage through the thoracic duct is associated with

A

respiration

134
Q

Mechanisms of Flow

A

Interstitial Fluid Pressure
- Increased by

1) increased arterial pressure
2) increased capillary permeability
3) decreased oncotic pressure
4) increased interstitial fluid protein

135
Q

Lymphatic pumps

A

1) intrinsic pump –> pressure gradients
- large vessel distension= smooth muscle contraction
- small vessel distension= activation of endothelial cell contractile fibers

2) Extrinsic pump= direct pressure on lymphatic vessels
- thoracic diaphragm
- pelvic diaphragm

136
Q

Thoracic Duct

A

The major lymphatic vessel of the body, which drains lymph from the entire body except the upper right quadrant and returns it to the venous system via the thoracic inlet

137
Q

Thoracic inlet

A

junction of the thoracic duct with the venous system

138
Q

Thoracic outler

A

Thoracic outlet syndrome= compression of the arteries, veins and/or nerves of the upper extremities by the clavicle, first rib or scalene muscles (covered later in the curriculum)

139
Q

Sibson’s Fascia

A

Suprapleural membrane

The thoracic duct travels cephalic through Sibson’s fascia to the level of C7 then U-turns to the thoracic inlet

140
Q

Lymphatic Treatment: Indications

A

1) acute somatic dysfunction
2) sprains (ligament), strain (muscle or tendon)

3) Edema, tissue congestion or lymphatic / venous stasis
- Mild CHF
- COPD
- Asthma

4) Pregancy
5) Certain infections
6) Inflammation
7) Pathologies with significant venous &/or lymphatic congestion

141
Q

Lymphatics: Contraindications

Relative

A

1) Cancer

2) Certain Infections, caution with:
- Overwhelming bacterial infections
- Risk of dissemination (abscess, osteomyelitis)
- Chronic infections with risk of reactivation
- Consider use of antibiotics first to reduce chance of septic spread

3) Circulatory Disorders
- venous obstruction
- embolism
- hemorrhage

4) Coagulopathies
- Anticoagulants

5) Osseous fracture, dislocation or osteoporosis

142
Q

Lymphatics: Contraindications

Absolute

A

1) Anuria- failure of the kidneys to produce urine
- if the patient is not on dialysis
- the kidneys must be functional to process the extra fluid

2) Necrotizing fasciitis in the treatment area
3) Patient unable to tolerate the treatment
4) Patient does not desire treatment

143
Q

Principles of Diagnosis

A

1) Indications and risk-to-benefit ratio
2) Central myofascial pathways
3) Fluid pumps
4) Spinal involvement
5) Peripheral/ regional pathways

144
Q

Principles of Diagnosis

1) Indications and risk to benefit ratio

A

History & physical exam- swelling, shortness of breath, areas of puffiness, bogginess infection or tissue trauma

Is lymphatic treatment indicated

Does the patient have any contraindications

145
Q

Principles of Diagnosis

2) Central myofascial pathways

A

Assess transition zones for compensated and uncompensated fascial patterns

146
Q

Principles of Diagnosis

3) Fluid pumps

A

Assess muscular and fascial diaphragmatic functions that may limit lymphatic flow

147
Q

Principles of Diagnosis

4) Spinal involvement

A

After treatment of the central pathways and diaphragms other somatic dysfunction that interferes with respiration should be assessed

-Thoracic, rib, sternal dysfunction, cranial base, C3-5

148
Q

Principles of Diagnosis

5) Peripheral/ Regional Pathways

A

Evaluation of terminal lymphatic drainage sites +/- other local tissues for the presence of congestion and excess fluid in the interstitium

149
Q

Principles of Lymphatic Treatment

A

1) Remove impediments to lymphatic flow
2) Enhance mechanisms involved in respiratory-circulatory homeostasis
3) Extrinsically augment the flow of lymph and other immune system elements
4) Further mobilize lymphatic fluids from local or regional tissues that would benefit from decongestion

150
Q

Principles of Lymphatic Treatment

-Focus on

A

Focus on treatments that interact with lymph formation and/or flow

  • improve local tissue motion to enhance lymph formation
  • reduce myofascial restriction to improve lymphatic flow
  • creation of external forces to act as extrinsic pumps for lymphatic fluid mobilization
  • Enhance of respiratory mechanisms to maximize venous and lymphatic return
151
Q

Treatment Technique Order

Lymphatics

A

Goal 1
-Open myofascial pathways at transition areas of the body

Goal 2
-Maximize normal diaphragmatic motions

Goal 3
- Increase pressure differentials or transmit motion to pump or augment fluid flow beyond normal levels

Goal 4
-Mobilize targeted tissue fluids into the lymphaticovenous system

152
Q

Muscle Energy is

A

Voluntary contraction of patients muscle

  • in a precisely controlled direction
  • varying levels of intensity
  • Against a distinctly executed counter source

Active technique
-patient contributes the corrective force

Direct technique
-positioned to the restrictive barrier

Patients motion is away from barrier

153
Q

Isometric contraction

A

Contraction of a muscle with no change in distance between the origin and insertion

154
Q

Concentric isotonic contraction

A

Contraction of a muscle with approximation of origin and insertion

155
Q

Eccentric isotonic contraction

A

Contraction of a muscle with separation of origin and insertion

156
Q

Isolytic contraction

A

Non-physiologic

Attempted concentric contractions with an external force causing separation of origin and insertion

157
Q

Isometric vs Isotonic

A

Isometric

1) careful positioining
2) light to moderate contraction
3) unyielding counterforce
4) relaxation after contraction
5) repositioning

Isotonic

1) careful positioning
2) hard to maximize contraction
3) counterforce permits controlled motion
4) relaxation after contraction
5) repositioning

158
Q

Muscle Energy -Indications

A

Muscle energy techniques are used to

1) balance muscle tone
2) strengthen reflexively weakened musculature
3) improve symmetry of articular motion
4) enhance the circulation of body fluids (blood, lymph)
5) length a shortened, contractured, or spastic muscle group

Versatile to use in combination with other osteopathic manipulative techniques

159
Q

Muscle energy- sequence of Technique

A

1) The physician positions the body part to be treated, at the position of initial resistance
2) The patient is instructed in the intensity, duration and direction of the muscle contraction
3) The physician directs the patient to contract the appropriate muscle(s) or muscle group
4) The physician uses counterforce in opposition to and equal to patients muscle contraction
5) The physician maintains forces until an appropriate patient contraction is perceived at the critical articulation or area (3-5 sec)
6) The patient is directed to relax while the physician simultaneously matches the decrease in patient force
7) The physician allows the patient to relax and sense the tissue relaxation with his or her own proprioceptors
8) The physician takes up the slack permitted by the procedure. The slack is allowed by the decreased tension in the tight muscle, allowing it to be passively lengthened
9) Step 1-8 repeat 3-5 times until the best possible increase in motion is obtained
10) The physician reevaluates the original dysfunction

160
Q

Factors Influencing Successful Muscle Energy-Patient

A

1) Contract too hard
2) Contract in the wrong
direction
3) Sustain the contraction for too short a time
4) Do not relax appropriately
following contraction

161
Q

Factors influencing Successful Muscle Energy- Operator

A

1) Not controlling the joint
position in relation to the
barrier movement

2) Not providing the counterforce
in the correct direction

3) Not giving accurate
instructions

4) Moving to a new joint position
too soon after the patient stops
contracting

162
Q

Muscle Energy- Contraindiciations

A

1) Local fracture

2) Local dislocation

3) Moderate‐to‐severe segmental instability in the cervical spine

4)  Evocation of neurologic symptoms or signs on rotation of the neck.

5) Low vitality

6) Situations that could be worsened by muscle activity
- Post‐surgical patient ‐ internal bleeding may be caused
- Immediately following myocardial infarction
- Recent eye‐surgery – use of Oculocephalogyric reflex

7) Unable/unwilling to follow verbal commands

8) Muscle energy has been shown to cause
- Tendon avulsion (with inappropriate force in an 85 year old man)
- Rib fracture (in a patient with osteoporosis)
- Anterior chamber intraocular hemorrhage (in a patient just post cataract removal and lens implant surgery)

163
Q

Articulatory Approach description

A

Springing techniques

Low velocity/ high amplitude

Direct techniques

164
Q

Articulatory Approach

A

1) Gentle and repetitive motions through the restrictive barrier to restore physiologic motion

2) Applicable with the restrictive barrier is in the joint or periarticular tissues

3) Can be applied to vertebral as well as extremity somatic
dysfunction

4) May be used ona single joint, or an entire region

165
Q

Articulatory Technique Indications

A 
Well tolerated by
1)  Arthritic patients
2)  Elderly or frail
3) Critically ill or post‐operative
patients
4)  Infants or very young patients
5)  Patients unable to cooperate with instructions
166
Q

Steps of Articulatory Technique

A
  1. The physician should also be in a position of comfort.
  2. The physician moves the affected joint or body part until the restrictive barrier is engaged.
  3. A gentle but firm force is applied carrying the body part a short distance through the restrictive barrier.
  4. This force is applied rhythmically, typically 1 or 2 seconds of stretch followed by a similar time frame releasing that stretch. The joint is permitted to return to a point
    just short of its restrictive barrier
  5. As the patient responds to the technique, the restrictive barrier will shift position
    within the physiologic range of motion. For each cycle of the applied technique, reengage the restrictive barrier and carry the affected body part a short distance further through that new barrier to normal motion.
  6. The applied forces should be comfortable for the patient. Some patients experience
    some discomfort, but it is recognized by the patient as a “good discomfort.”
  7. The technique is continued until the location of the restrictive barrier reaches a
    plateau; that is, no further increase in range of motion can be achieved by
    continuing the technique, or until full physiologic range of motion has been
    restored to the joint(s) being treated.
167
Q

Articulatory Technique – Contraindications

Relative

A

Relative
- Vertebral artery compromise
( Avoid combination of rotation and extension in the cervical spine)

168
Q

Articulatory Technique – Contraindications

Absolute

A 
1) Local fracture or dislocation
2)  Neurologic entrapment syndromes
3)  Serious vascular compromise
4)  Local malignancy
5)  Local infection (e.g., cellulitis, abscess, septic arthritis, osteomyelitis)
6)  Bleeding disorders
169
Q

Muscle Energy Technique vs Articular Technique

A

Muscle Energy Technique
-Direct Technique
- Activating force: Patient muscle contraction 3‐5 times, 3‐5 seconds
- Patient Cooperation: Required (Active Technique)
- Goal: Alleviate Somatic
Dysfunction

Articular Technique
- Direct Technique
- Activating Force: Repetitive
physician directed motions
- Patient Cooperation: Relaxation (Passive Technique)
- Goal: Alleviate Somatic
Dysfunction

OS1 (2 decks)

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