Exam 1 Flashcards
Mesomorphic
- Muscular or sturdy body build The average guy
- Mid-ranges of ROM
- Characterized by relative prominence of structures developed from the embryonic mesoderm
Ectomorphic
• Thin body build Long and linear frame (aka tall and lean) • Tend to have higher ROM • Characterized by relative prominence of structures developed from embryonic ectoderm
Endomorphic
- Heavy (fat) body build Obese, increased fatty tissue
- Tend to have lower ROM
- Characterized by relative prominence of structures developed from embryonic endoderm
Comparative Analysis
• The goal of this observation is to compare right versus left in regard to:
Symmetry
Heights
Deviation from midline
Plumb Line
- External Auditory Canal
- Acromion Process
- Greater Trochanter
- Anterior medial Malleolus
4 Tenets of Osteopathic Medicine
- The person is a unit of body, mind, and spirit
- The body is capable of self-regulation, self-healing, and health maintenance
- Structure and function are reciprocally interrelated
- Rational Treatment is based upon understanding and implementing the other 3 tenets
Somatic Dysfunction
- Impaired or altered function of related components of the somatic (body framework) system (skeletal, arthrodial, myofascial structures) and their related elements (vascular, lymphatic, and neural)
- it impairs the body to do the things listed in the tenets
- treatable using osteopathic manipulation
Osteopathic Manipulative Treatment (OMT)
- The therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction.
- OMT employs a variety of techniques including…
Osteopathic Philosophy treats the…
WHOLE PATIENT
Homeostasis
The level of well-being of an individual maintained by internal physiologic harmony that is the result of a relatively stable state or equilibrium among the interdependent body functions.
Acute Somatic Dysfunction
-Immediate or short-term impairment or altered function of related components of the somatic (body framework) system. Characterized by: • Vasodilation • Edema • Tenderness • Pain • Tissue contraction
Chronic Somatic Dysfunction
Impairment or altered function of related components of the somatic (body framework) system. Characterized by: • Tenderness • Itching • Fibrosis • Paresthesias • Tissue contraction
Diagnostic Criteria for SD
T.A.R.T
- Tissue texture abnormalities – -Asymmetry of structure or motion
- Restriction of motion
- Tenderness
Types of Tissue texture abnormalities
– Bogginess – Thickening – Stringiness – Ropiness – Firmness (hardening) – Temperature change – Moisture change
Bogginess
A tissue texture abnormality characterized principally by a palpable sense of sponginess in the tissue, interpreted as resulting from congestion due to increased fluid content.
Tone
Normal feel of muscle in the relaxed state. Contrast with:
– Hypertonicity (at the extreme = spastic paralysis) or
– Hypotonicity (aka flaccid paralysis when no tone at all).
Contraction
Normal tone of a muscle when it shortens or is activated against resistance
Contracture
Abnormal shortening of a muscle due to fibrosis. Most often in the tissue itself, often result of chronic condition. Muscle is no longer able to reach its full normal length.
Spasm
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.
Ropiness
Hard, firm, rope-like or cord-like muscle tone. Usually indicates a chronic condition.
TTC: Vascular, Sympathetic, Musculature Acute
- V: Inflamed vessel wall injury, endogenous peptide released
- 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
TTC: Vascular, Sympathetic, Musculature Chronic
- V: Sympathetic tone increases vascular constriction
- S: Vascoconstriction, hypersympathetic tone, may be regional
- M: Decreased muscle tone, flaccid, mushy, limited ROM due to contracture
Asymmetry
- Absence of symmetry of position or motion
- Dissimilarity in corresponding parts or organs on opposite sides of the body that are normally alike
- Determined by vision or palpation
Restriction of Motion
A resistance or impediment to movement
Barriers to ROM
- Anatomic Barrier - the limit of motion imposed by
anatomic structure; the limit of passive motion. - Physiologic Barrier - the limit of active motion.
- Elastic Barrier - the range between the physiologic and anatomic barrier of motion in which passive stretching occurs
before tissue disruption; aka, the area that “warms up” with stretching - Restrictive Barrier - a functional limit that abnormally diminishes the normal physiologic range.
Active vs. Passive ROM
- AROM: Patient motivated and patient must give maximum effort!
- PROM: Patient must relax fully and you must “block the linkage” of associated structures
Normal: PROM>AROM
Barrier “end feel” Characteristics
-The palpatory experience or perceived quality of motion when a joint is moved to its limit – a barrier is approached Normal end feel • Examples -Early muscle spasm -Late muscle spasm -Hard capsular -Soft capsular
Tenderness
- Discomfort or pain elicited by an osteopath through palpation.
- A state of unusual sensitivity to touch or pressure (Dorland’s).
- Pain – an unpleasant sensation induced by noxious stimuli and generally received by specialized nerve endings
Pain, Visceral Function, Visceral Dysfunction: Acute
- P: Sharp, severe, cutting
- VF: minimal somatovisceral effects
- VD: may or may not be present; if trauma is severe, it is often present
Pain, Visceral Function, Visceral Dysfunction: Chronic
- P: Dull, ache, paresthesias (tingling, burning, gnawing, itching)
- VF: Somatovisceral effects common
- VD: Often involved in somatic dysfunction
TTA, Asymmetry, Restriction, Tenderness: Acute
- Red, swollen, boggy, increased tone
- Present
- Present, painful with motion
- Sharp pain
TTA, Asymmetry, Restriction, Tenderness: Chronic
- Dry, cool, ropy, pale, decreased tone
- Present, compensation occurs
- Present, maybe not. Guarded or “Empty”
- Dull, achy pain
Tenderpoints
small discrete hypersensitive areas within myofascial structures that result in localized pain
Trigger points
mall discrete hypersensitive areas within myofascial structures - palpation causes referred pain away from site.
Somatic Dysfunctions are named for:
- Position of ease
* Aka “Where they live”
Direct vs. Indirect Techniques
- Method of action engage the restrictive barrier directly
2. Method of action involve positioning away from the restrictive barrier
Types of Direct
- MFR
- INR
- ST
- MET
- HVLA
- Visceral
Combination of Direct/Indirect
- MFR
- Still
- Percussor • PINS
Types of Indirect
- MFR
- INR
- BLT/LAS
- FPR
- Functional • Visceral
Motion has…
- DIrection: flexion, extension, sidebending, rotation
- Range: actual measurements in degrees
- Quality: smooth, ratcheting, restricted, exhibiting resistance to motion induced..
ROM - Spine
- Complicated system of articulations and bony segments (coupled motion)
- Structure and motion of spinal segments differ substantially over the entirety of spinal column
- Functional unit: two vertebrae, their associated disc, neuromuscular, and other soft tissues
- Cervical spine displays the greatest motion
Linkage
-relationship of joint mechanics with surrounding structures
Joseph Lister (1827-1912)
- Father of Antiseptic Surgery
* Reduced surgical mortality from 45% to 15%
Ingaz Semmelweiss 1818-1865
• Obstetrical clinic decreased mortality by 90%
not valuable. He thinks he can
through handwashing • Died from infection
John Snow 1813-1858
• Used epidemiology to trace source of
William Budd 1811-1880
• Used epidemiology to prove cholera came from a contaminated water source in Bristol
Germ Theory
- Replaced miasma theory
- Thucydides 460-400BC – disease spread from person to person by “seeds”
- Louis Pasteur – discredited spontaneous generation
- Robert Koch – isolated anthrax
Heroic Medicine
- “Preserve life force”
- Stimulants if the patient drowsy
- Hypnotics if the patient agitated
- Purgatives and cathartics were rampant, as well as blood letting
- “Conquer disease”
- If enough force or drugs were used, it would cast out the demons
Nils Finsen 1860-1904
• Used ultraviolet light in medicine
Wilhelm Rontgen
- First to systematically study X-rays
- Discovered by Fernando Sanfordin 1891
- X-rays used diagnostically in 1896
William Halstead
- Meticulous in surgery
* First used sterile rubber gloves in surgery 1890
Local anesthetics became popular in the ___.
late 1800’s
AT Still early life
• Born August 6, 1828
• Lee County, Virginia
• Parents Abraham (Abram) and
Martha Still
• Abram – Methodist Circuit Rider and Physician
• Martha – uneducated (could read), but wanted better for her kids
• Moved to Missouri in 1830’s
• Still Studied medicine and ministry from his father
AT Still 1839-1886
• 1839 Makes a rope swing to treat a headache
• 1849 Married Mary Margaret Vaughn • 1850 Took over mission in Eudora, KS
• 1855 Still studied anatomy in Indian cadavers after a cholera epidemic (With tribal permission)
• 1857 Elected to Kansas Legislature • Active in anti-slavery movement
• 1859 Mary Margaret dies leaving him with 3 children (two died within days of birth
• 1860 Marries Mary Elvira Turner
• 1861-1864 Fights in Civil War (Union) highest rank a Major
1864 Three of Still’s children die from spinal meningitis, and another one dies from pneumonia one month later
• 1864 Returns home to farm (also formulate his ideas on changes for medicine)
• 10 AM June 22, 1874 “AT Still flung the banner of osteopathy to the breeze”
• 1874 Presents his new ideas to Baker University
• 1874 Still is “read out” or formally removed from
the Methodist Church
• 1874 First “recorded” Osteopathic Treatment in Macon, Missouri
• 1875 – Still officially moves his family to Kirksville, Missouri
• Has to work as a travelling physician in rural Missouri
• 1885 – Still coins the term “Osteopathy”
• Continued to advertise as a Bone Setter until
1890
• 1886 – Still becomes busy enough to stay in Kirksville and let patients come to him
• Tries unsuccessfully to apprentice assistants
American School of Osteopathy
- 1892 – American School of Osteopathy opens
- 17 Men and 5 women
- 5 of the first students were Still’s children
- Including his youngest child, Blanche • Professors: AT Still and Dr. William Smith
- 1894 – Second class begins • 2 year course was $500
- 1895 – Enrollment was 28
- 1896 – Enrollment was 102
- 1900 – 700 Students with 18 faculty
- Largest school of healing arts in the country
- 12 or more sister schools started by graduates
What year did AT Still die? How old was he?
1917; 89
What year did Mary Elvira Still die? How long were they married?
1910; 50 years
What year was AT Still’s autobiography published? What year was Philosophy of Osteopathy published?
1897; 1899
What were the first and second state to accept DO licenses? When did Missouri accept them?
- Vermont (1896); North Dakota
2. 1897
When was American Association for Advancement of
Osteopathy (AAAO) founded? When did it become the AOA?
1897; 1901
Dr. Abraham Flexner
-in 1910 had travelled to all medical schools in US (MD & DO)
• Authored a report on the state of medical education • Harsh criticism of both MD and DO schools
• Teaching, clinical care, and investigation important
• Encouraged clinical rotations
• Many medical schools were closed or merged • 8 DO schools left after the report
• “Not one of the eight osteopathic schools is in a position to give training as osteopathy demands”
• State licensing boards began enforcing stricter requirements
When was KCU founded?
1916
What two big things happened in 1916?
- AOA revoked ban on teaching pharmacology at DO schools
• Despite Dr. Still’s opposition
–in 1929, AOA allows teaching of pharmacology under “Comparative Therapeutics”
-KCU was founded
Influenza Pandemic
-1917-1918
• 30 million died worldwide in 6 months
• 50-100 million died 1918-1920 • 3-5% of world’s population
• 500 million people infected
• Possibly a more virile strain
• Possibly a weakened victim • Post World War I
• Osteopathic care - 0.25 % death rate
• Medical/Osteopathic care - 10% death rate
DOs were labeled a cult in ___
1922; AMA told MDs not to associate with them
What happened to the Kirksville school in 1926?
Kirksville College of Osteopathy and Surgery formed by merging ASO and Andrew Taylor Still College of Osteopathy and Surgery
When was the student loan fund established and the osteopathic seal?
1931
When did the first inspection/approval of osteopathic hospitals for internships happen? how many?
1936; 18 hospitals–81 programs
Requirements in 1938
Required 1 year undergraduate studies, 2 years in 1940, 3 years in 1954, in 1960 - >70% required advanced degrees
When/what was the lowest osteopathic college enrollment?
556 students in 1945
When were osteopathic residencies approved?
1947; 71 positions approved, 37 filled
Cline Committee
-1955
• AMA inspects many osteopathic colleges
• Medical education comparable, but the facilities inadequate
• Recommends removal of the “cult” label
What could DOs so in 1964?
DOs enter AMA approved internships and residencies
- Oklahoma State University first free- standing, state funded osteopathic college in ___
- Michigan State University affiliated in ___
1972; 1971
The California Incident
- 1961: A California public referendum prohibited the granting of new licenses to DOs in the state.
- DOs who agreed to the change were able to obtain an MD degree by attending 12 Saturday classes and paying $65
- 85% of practicing DO’s traded in their DO degrees for MD degrees.
- not recognized outside the state of California
The College of Osteopathic Physicians and Surgeons (COPS) was…
- converted to an allopathic medical school
- COPS conversion with few curriculum changes demonstrated the equality of the two programs
- Merger of the California Medical Association with the California Osteopathic Association
- A year later Proposition 22 passed and abolished the osteopathic licensing board
California Supreme Court ruled that licensing of DO’s in that state must be resumed
1974
opening of the College of Osteopathic Medicine of the Pacific
1977
When/what was the last state to grant licensure to DOs?
1973; Mississippi
When were DOs accepted for residency training in Canada by ___ and ___?
1986; University of Alberta and University of Calgary
How many DOs schools are there today and how many Dos are there in the U.S.?
- 33 schools; 48 teaching locations; 27,512 students
- 102,137 DOs in the US (56% in primary care)
Military Service
-1917: Profession mounts effort to gain federal recognition and rights to serve in the military
• Supported by Teddy Roosevelt • Vetoed by William C. Gorgas (threatens to withdraw all MDs)
-1941: DOs still not serving in military
• Hospitals not granting DOs privileges • Rapid increase of DO hospitals in US
-1957: DOs are allowed to serve
-1963: DOs accepted as equal to MDs
-1966: Secretary of Defense, Robert McNamara directs Army, Navy, and Air Force to accept DOs that volunteer as officers
Harry J. Walter
first commissioned DO into the armed forces
Military DO Service: 1967, 1969, 1977, 1983
- 1967 – DOs drafted as medical officers
- 1969 – Nearly 200 DOs serving in Vietnam War
- 1977 – Association of Military Osteopathic Physicians and Surgeons (AMOPS) formed
- 1983 – Rear Admiral Louis H. Eske, DO first flag officer in the medical corps of military service
Lieutenant General Ronald R. Blank, DO
1996-2000 – Past Surgeon General of the Army
What percentage of active medical officers are DOs?
10%
Women in Osteopathy
- 1892 – AT Still supported equality for females in medicine
- First class included 5 women (one was his daughter, Blanche)
- Jeanette Bolles, DO – first woman to receive the DO degree
- Vice president of AAAO
- 1920’s – female DOs increase
- Osteopathic Women’s National Association (OWNA)
Louisa Burns (1870-1958)
- Teacher from Indiana
- Had spinal meningitis
- Treated successfully with osteopathy
- Published several books
- Worked in histology and postulated the connective tissue model of somatic dysfunction
- Louisa Burns award for research still exists
Mamie Johnston 1889-1986
- First Graduate from KCCOS (KCU)1917
- Medical curriculum changed to 4 years the next year, so she went back to complete another year.
- Graduated in 1918
- 1919 – joined KCU faculty
- Taught gynecology and pediatrics • Retired 1981 (yep! At 92!)
- In 1940 Johnston science hall (KC campus) was opened and named after her
Barbara Ross-Lee
• First Female Dean of a medical college (MD OR DO) • 1993-2001 Ohio University – Heritage College of
Osteopathic Medicine
• First osteopathic physician to win Robert Wood Johnson Health Policy Fellowship
• 2001 VP of New York Institute of Technology Health Sciences and Medical Affairs
• 2002 Dean of New York College of Osteopathic Medicine
• (Elder) Sister to Diana Ross
In the 1940s, what percentage of DO applicants were women? Currently, how many women graduate from DO schools?
- 5%
- 51% women; 49% males (2007-2009)
- 56% of DOs in active practice greater than 10 years are women
National Osteopathic Women Physicians Association established (NOWPA)
-1988
In 1998, what percentage of total enrollment in osteopathic medical schools were minorities? 2009-2010?
- 25%
- 40% of osteopathic medical student enrollees minority
Marcelino Oliva 1935-2011
- Cuban born
- Graduate of KCU!!
- President of Florida Osteopathic Medical association 1971-1975
- First minority AOA president in 1988-1989
William G. Anderson (1927-)
• Associate dean KCOM (now AT Still University)
• Big in the Civil Rights Movement • Seen here with Martin Luther
King, Jr.
• AOA president 1994-1995
• AOA board of trustees for 20 years
What does “soft tissue” entail?
Living tissues of the body other than bone. – Fascia – Muscles – Organs – Nerves – Vasculature – Lymphatic
Fascial Anatomy
Generally speaking, these connective tissue layers are composed of collagen fibers (and occasionally also elastin fibers) in an amorphous matrix of hydrated proteoglycans (PGs), which mechanically links the collagen fiber networks in these structures.
Fascia is not
- Tendons
- Ligaments
- Aponeuroses
Fascia is
• A complete system with blood supply, fluid drainage & innervations
– Thus, fascia comprises the largest organ system in the body • Composed of irregularly arranged fibrous
elements of varying density
• Fn: Involved in tissue protection &
healing of surrounding systems
Pannicular Fascia
Outermost layer of fascia derived from somatic mesenchyme & surrounds entire body with exception of the orifices; outer layer is adipose tissue & inner layer is membranous & adherent, generally, to the outer portion
• Axial & Appendicular Fascia (aka investing layer)
• Meningeal Fascia
• Visceral Fascia
Axial & Appendicular Fascia
Internal to the pannicular layer; fused to the panniculus and surrounds all of the muscles, the periosteum of bone & peritendon of tendons
Meningeal Fascia
Surrounds the nervous system; includes the dura
Visceral Fascia
Surrounds the body cavities (pleural, pericardial & peritoneum
What are the four types of fascia layers?
- Pannicular
- Axial and Appendicular
- Meningeal fascia
- Visceral
Omnipotent aspect of fascia
-Provides for mobility and stability of the
musculoskeletal system
Omnipresent aspect of fascia
it’s everywhere
Omniscient aspect of fascia
•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
Viscoelastic Material
Any material that deforms according to rate of loading and deformity
Stress-Strain
- Stress is the force that attempts to deform a connective tissue structure.
- Strain is the percentage of deformation of a connective tissue.
Hysteresis
- The difference between the loading and unloading characteristics represents energy that is lost in the connective tissue system; this energy loss is termed hysteresis.
- Stretching connective tissue into its’ plastic deformational range will bring about a lengthening of the tissue.
Creep
Connective tissue under a sustained, constant load (below failure threshold), will elongate (deform) in response to the load.
Ease
- The direction in which the connective tissue may be moved most easily during deformational stretching.
- Palpated as a sense of tissue “looseness”, or laxity or greater degree of mobility.
“Fascial Sweater”
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.
Sherrington’s Law
When a muscle receives a nerve impulse to contract, its antagonists receive simultaneously an impure to relax
Compensatory Patterns
- Common (80%): L/R/L/R
- Uncommon (20%): R/L/R/L
Transition Zones of the Spine
- OA, C1, C2
- C7, T1
- T12, L1
- L5, Sacrum
Transverse Restrictors
- Tentorium Cerebelli
- Thoracic Inlet Thoracolumbar Diaphragm
- Pelvic diaphragm
Stretch
increase distance between the origin and insertion
Knead
Repetitive pushing of tissue perpendicular to muscle fibers
Inhibition
- Push and hold perpendicular to the fibers at the musculotendinous part of hypertonic muscle.
- Hold until relaxation of tissue
Inherent Forces:
using the body’s PRM (primary respiratory mechanism)
Respiratory Cooperation
Refers to a physician directed, patient performed, inhalation or exhalation or a holding of the breath to assist with the manipulative intervention.
Patient Cooperation
the patient is asked to move in specific directions to aid in mobilizing specific areas of restriction
T.J. Ruddy, DO
“Ruddy’s Rapid Rhythmic Resistive Duction” 1914 – first published article – 1950’s Closed his EENT practice to focus on OMM
-Eye and cervical spine treatment
-Used rapid, repetitive contractions 1-2 per second
against resistance
Fred L. Mitchell, Sr., DO - 1959 Graduate Chicago
- Wrote about Muscle Energy Technique as early as 1948
- 1950’s-1960s taught courses with Paul Kimberly, DO entitled “The Pelvis and its Environs”
- 1970 taught a course in Iowa to 6 students (5 of whom became osteopathic college faculty)
- Fred Mitchell, Jr., DO has developed and amplified MET
Muscle Energy is:
-Voluntary contraction of patient Restrictive Barrier Varying levels of intensity muscle - In a precisely controlled direction -Varying levels of intensity -Against a distinctly executed counterforce -Active Technique = Patient contributes the corrective force - Direct Technique – positioned to the restrictive barrier **Patient's motion is away from the barrier**
Isometric contraction
Contraction of a muscle with no change in distance between the origin and insertion
Concentric isotonic contraction
Contraction of a muscle with
approximation of origin and insertion
Eccentric isotonic contraction
Contraction of a muscle with
separation of origin and insertion
“Isolytic” contraction
– NON- PHYSIOLOGIC
-Attempted concentric contraction, with an external force causing separation of origin and insertion
Post-Isometric Relaxation
Most common form of MET
-Muscle contraction increased tension in GTO
inhibition of muscle contraction
Joint mobilization using muscle force
- Restoration of motion to the articulation results in a gapping, or reseating of the distorted joint relations with reflex relaxation of the previously hypertonic musculature.
- Maximal muscle contraction that can be comfortably resisted by the physician
Respiratory assistance
- The muscular forces involved in these techniques are generated by the simple act of breathing. This may involve the direct use of the respiratory muscles themselves, or motion transmitted to the spine, pelvis, and extremities in response to ventilation motions. The physician usually applies a fulcrum against which the respiratory forces can work
- Exaggerated respiratory motion.
Oculocephalogyric reflex
• These eye movements reflexively affect the cervical and truncal musculature as the body attempts to follow the lead provided by eye motion
-Exceptionally gentle force
Reciprocal inhibition
- When a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of that muscle’s antagonistic group
- Think ounces not pounds of pressure
- *Ipsilateral–same side**
Crossed extensor reflex
- This form of muscle energy technique uses the learned cross pattern locomotion reflexes engrammed into the central nervous system. When the flexor muscle in one extremity is contracted voluntarily, the flexor muscle in the contralateral extremity relaxes and the extensor contracts.
- Think ounces not pounds of pressure
- *Contralateral–opposite side**
Isokinetic strengthening
- Where asymmetry of range of motion exists, there is also the potential for asymmetry in muscle strength. If there is shortening of an antagonist muscle, attend to that first.
- Once this is accomplished, further restoration of strength can be accomplished through the use of an Isokinetic contraction.
- Typically concentric contractions are used, where the muscle is permitted to shorten, but at a controlled slow rate.
- Sustained gentle pressure (10 to 20 lb of pressure)
Isolytic lengthening
- It is postulated that the vibration used here has some effect on the myotatic units in addition to mechanical and circulatory effects
- Maximal Contraction that can be comfortably resisted by the physician (30 to 50 lb of pressure)
Using muscle force to move one region of the body to achieve movement of another bone or region
- For some dysfunctions, it is often more effective to move one body structure by moving another body structure adjacent to it. Muscular force is used to move the first structure and that body part’s response to the muscle force is transmitted to yet another part of the body.
- Sustained gentle pressure (10 to 20 lb of pressure)
Isometric vs. Isotonic
- Both use careful positioning
- IM uses light to moderate contraction, IT uses hard to maximal contraction
- IM uses unyielding counterforce, while IT counterforce permit controlled motion
- Both use relaxation after contraction
- Both use repositioning
Muscle energy techniques are used to
- balance muscle tone
- strengthen reflexively weakened musculature
- improve symmetry of articular motion
- enhance the circulation of body fluids (blood, lymph, and interstitial fluid)
- Lengthen a shortened, contractured, or spastic muscle group
- Versatile to use in combination with other osteopathic manipulative techniques
ME: Sequence of Technique
- The physician positions the body part to be treated, at the position of initial resistance.
- The patient is instructed in the intensity, duration, and direction of the muscle contraction.
- The physician directs the patient to contract the appropriate muscle(s) or muscle group.
- The physician uses counterforce in opposition to and equal to the patient’s muscle contraction.
- The physician maintains forces until an appropriate patient contraction is perceived at the critical articulation or area. This generally takes 3 to 5 seconds.
- The patient is directed to relax while the physician simultaneously matches the decrease in patient force.
- The physician allows the patient to relax and senses the tissue relaxation with his or her own proprioceptors.
- 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.
- Steps 1 to 8 are repeated three to five times until the best possible increase in motion is obtained.
- The physician reevaluates the original dysfunction.
Factors Influencing Successful Muscle Energy-Patient
-Contract too hard
-Contract in the wrong
direction
-Sustain the contraction for too short a time
-Do not relax appropriately following contraction
Factors Influencing Successful Muscle Energy-Operator
Not controlling the joint position in relation to the barrier movement
Not providing the counterforce in the correct direction
Not giving accurate instructions
Moving to a new joint position too soon after the patient stops contracting
Articulatory Approach is also called…
Springing techniques
- gentle and repetitive motions through the restive barrier
- applicable with the restive barrier in the joint or periarticular tissues
Articulatory Techniques are well tolerated by…
-Arthritic patients
-Elderly or frail
-Critically ill or post-operative patients
-Infants or very young patients
-Patients unable to cooperate
with instructions
Steps of Articulatory Technique
- The physician should also be in a position of comfort.
- The physician moves the affected joint or body part through its range of motion until the
restrictive barrier is engaged. - A gentle but firm force is applied carrying the body part a short distance through the restrictive barrier.
- 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
- 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
- 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
- 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
MET vs. ART
- Both are direct techniques
- Activating force in MET is patient muscle contraction, and in ART it is physician directed motions
- Patient Cooperation: required for MET, and relaxation for ART
- Goal: alleviate SD for both
