Exam I Flashcards
1
Q
Osteopathy was founded by _______ in _______ year
A
Andrew Taylor Still
1874
“flung to the breeze, the banner of osteopathy”
2
Q
Caduceus
A
Hermes wand
-military branches of medicine only
3
Q
Aesculapius
*associated with D.O’s
A
- Greek god of healing (through touch)
1. Cypress branch: strength, solidity, unwavering ethics
2. snake: extensive knowledge and prudent action
4
Q
Still opened the first college of osteopathy in
A
1892
American School of Osteopathy, Kirksville Missouri
5
Q
“Health, Disease and Patient Care”
A
- Health is natural state of harmony
- Human is perfect machine
- Healthy state exists as long as there is normal flow of body fluids and nerve activity
**rule of artery is supreme
6
Q
List the 4 principles of Osteopathic Medicine
A
- the body is a unit (mind, body, spirit)
- The body is capable of self-regulation, self-healing and health maintenance
- Structure & Function are reciprocally interrelated
- Rational treatment is based upon the understanding of the first three principles
7
Q
Disease occurs when ______ fails
A
homeostasis
- maintains internal equilibirum
- within narrow range
8
Q
Allostasis
A
Maintain stability through change
9
Q
Holistic care
A
treat person, not disease
-preventive
10
Q
Osteopathy emphasizes the inter-relationships between _______ and _______, and an appreaciation of the body’s ability to ___
A
structure and function
heal itself
11
Q
True/False: Stress is the sum of biological reactions to any adverse stimulus, physical, mental or emotional…etc. that disturbs homeostasis
A
True
12
Q
Sources of stress
A
- body (somatic/visceral)
- Genetic (age, inherited conditions)
- Emotional
- environmental
- Nutritional
13
Q
When was A.T. Still born?
A
Aug. 6, 1828
-dies at 88
14
Q
______ describes impaired or altered function of related components of the somatic system. Normally involves changes in the normal functioning of a joing.
A
Somatic dysfunction
*diagnosed by TART
15
Q
Range of mostion can be passive, with no effort, or active, requiring patient effor.
We can move a joint until we hit a restriction or a barrier. What is a barrier? What are the different types?
A
-limit to motion
Types:
- anatomic
- elastic
- physiologic
- restrictive
16
Q
_______ barrier is the limit of absolute passive motion
A
Anatomic
17
Q
_____ barrier lies between a physiologic barrier and the anatomic barrier. It represents the limit of passive ligamentous stretching and passive ROM prior to tissue disruption
A
Elastic barrier
*pushing through it will bring to absolute passive ROM
18
Q
______ barrier is the limit of ACTIVE motion
A
Physiologic barrier
19
Q
______ barrier is the functional limit that abnormally diminishes the normal physiologic range
A
Restrictive barrier
Causes:
- pain
- spasm
- edema
- bony abnormality
- fusion
20
Q
______ is the point of balance of an articular surface from which all the motions physiologic to that articulation may take place.
A
Neutral
21
Q
______ neutral is neutral position assuming no motion loss or restriction
A
Midline neutral
22
Q
_____ neutral is a a new resting neutral position which may correlate with the midpoint of the available range of active motion
A
Pathologic neutral
23
Q
When did A.T. Still “fling to the breeze the banner of osteopathy”
A
1874
24
Q
The first college of osteopathy was opened by A.T. Still in
A
1892
25
"Rule of the Artery is Supreme" suggests that
a healthy state exists as long as there is normal flow of body fluids and nerve activity
26
True/False:
The human body provides all the chemicals necessary for the needs of its tissues and organs
True
*removal of mechanical impediments allows for optimal fluid flow, nerve function and restoration of health
27
True/False: The body is a unit suggests that there is a connection between the body and the mind and that a pe rson is more than the union of the body and mind.
True
*neuromuscular skeletal system
28
True/False: OMT is commonly associated with neck and back pain
True
29
True/False: Homeostasis describes balanced rhythms of the body or the tendency of an organism to maintain internal equilibrium.
True
```
-maintains body parameters within a narrow range
(blood pressure
heart rate
temperature
pH and ionic balance)
```
*Disease occurs when one or more systems fail to maintain their part of homeostasis.
30
______-Maintaining stability through change.
Shifts homeostatic rhythms into defensive mode
Stress increases the allostatic load
Prolonged allostasis is associated with multiple disease states
Allostasis
31
Sources of stress include
1. Body (somatic/visceral)
2. Emotional (thoughts, attitudes, fears)
3. Genetic (age, inherited)
4. Nutritional
(caffeine, diet, OH)
5. Environmental
(microorganisms, toxins, sleep deprivation)
32
The bathtub model is a proposed model for managing stress. Desvribe it
```
Faucet = stress in
Drain = stress out/relief
```
33
TART
- Tissue texture
- Asymmetry
- Restriction/Range of Motion
- Tenderness
34
Static Evaluation
No motion
--multiple landmarks to highlight asymmetry
--check multiple areas
--landmarks
35
______ osteopathic techniques involve application of force directly into the restrictive barrier. Typically, one would push in the direction towards the physiologic barrier/restrictive barrier.
Direct technique
“An osteopathic treatment strategy by which the restrictive barrier is engaged and a final activating force is applied to correct somatic dysfunction.”
36
_______ osteopathic techniques involve application of force away from the restrictive barrier. Normally one would push in the direction of ease/freedom, away from the restrictive barrier
Indirect
“a manipulative technique where the restrictive barrier is disengaged and the dysfunctional body part is moved away from the restrictive barrier until tissue tension is equal in one or all planes and directions.”
37
Examples of DIrect Techniques
- soft tissue
- myofascial release
- articulation
- muscle energy
- HVLA
38
Dynamic Evaluation incorporates 4 different types of motion:
1. Transitional areas
2. Passive
3. Active
4. Dorsiflexion and Plantarflexion
Describe the transitional areas
-junctional areas where curves change
(cervicothoracic, thoracolumbar)
*more likely to have dysfunction
39
Evaluation incorporates 4 different types of motion:
1. Transitional areas
2. Passive
3. Active
4. Dorsiflexion and Plantarflexion
Describe passive motion
- physician does all the work
| - patient does not expend energy
40
What are the 3 domains of osteopathic philosphy?
1. health
2. disease
3. patient care
41
In what plane does the gravitational line run?
Coronal (Frontal)
-front and back
42
Sagittal plane
left vs. right
| --flexion and extension
43
Evaluation incorporates 4 different types of motion:
1. Transitional areas
2. Passive
3. Active
4. Dorsiflexion and Plantarflexion
Describe active motion
- patient does all the work
| - physician doesn't expend energy
44
Evaluation incorporates 4 different types of motion:
1. Transitional areas
2. Passive
3. Active
4. Dorsiflexion and Plantarflexion
Describe dorsi and plantar
--specifically for the foot
45
What are examples of indirect techniques?
- strain-counterstrain
- Still technique (direct to indirect)
- myofascial release
- functional
- facilitated positional
- osteopathy in cranial field
46
What are factors that would influence the technique used?
1. age
2. acute or chronic restriction
3. physical condition of patient
4. operator size and OMT skills
5. location of treatment
6. knowing what has previously worked/not worked
47
What monumental report changed medical education in the U.S. in 1910?
FLexner report (1910)
"Medical education in the U.S. and Canada"
-recommended that all but 31 of the nation's 153 medical schools and ALL of the DO schools be closed
48
California disaster of 1961-1962
In 1962 the voters of California voted for Proposition 22 which prohibited further licensing of DO’s.
49
______ dysfunction is impaired or altered function of related components of the somatic system. It involves not just bones and joints, but the entire body.
Somatic dysfunction
=diagnosed by TART
50
Contraindications to soft tissue
Fracture, dislocation, nerve entrapment, malignancy
51
What state was the first and lasst state to grant licensure?
Vermont (1896)
| Mississipi (1973)
52
What state was the first and last state to grant licensure?
Vermont (1896)
| Mississipi (1973)
53
Myofacial release is a direct technique that involves the fascia (CT) that unites all aspects of the body. It is manipulated to reduce bind and restriction.
What is the goal? What are the steps?
Goal: improve innate and inherent motion of the myofascial structures
Steps:
1. engage restrictive barrier with myofascial tissue
2. Tissue is loaded with a constant force and held until release occurs
54
List the indications and contraindications of myofascial release
Indications:
-fascial bind, strain or altered patterns
Contraindications:
-open wounds, recent fracture, burns, DVT, trauma
55
_______ is known as "springing technique". It applies low velocity, moderate/high amplitude technique where a joint is carried through its full motion. The therapeutic goal is to increase freedom range of movement.
Articulation
- gentle and repetitive carrying of the body part through restrictive barrier
* well tolerated in many ages
56
_______ is known as "springing technique". It is a direct technique that applies low velocity, moderate/high amplitude technique where a joint is carried through its full motion. The therapeutic goal is to increase freedom range of movement.
Articulation
- gentle and repetitive carrying of the body part through restrictive barrier
* well tolerated in many ages
57
_____ is a plan of diagnosis and treatment that relies on active patient effort through muscular contraction. The patient is moved into a position which directly engages the restrictive barrier, and then asked to gently move against a resistance made by the physician.
Muscle Energy
- isometric contraction
- active use of patient muscles
- precisely controlled position
- specific directin
- distinct counterforce
58
_____ is a plan of diagnosis and treatment that relies on active patient effort through muscular contraction. The patient is moved into a position which directly engages the restrictive barrier, and then asked to gently move against a resistance made by the physician.
**Direct technique
Muscle Energy
- isometric contraction
- active use of patient muscles
- precisely controlled position
- specific directin
- distinct counterforce
59
_____ involves high velocity, low amplitude. It engages a quick impulse or thrust to quickly break through a restrictive barrier.
*bone cracking
HVLA
“An osteopathic technique which employs a rapid therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint and that engages the restrictive barrier in one or more planes of motion to elicit release of restriction.” – ECOP
60
_____ involves high velocity, low amplitude. It engages a quick impulse or thrust to quickly break through a restrictive barrier.
* bone cracking
* *Direct technique
HVLA
“An osteopathic technique which employs a rapid therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint and that engages the restrictive barrier in one or more planes of motion to elicit release of restriction.” – ECOP
61
________ is an indirect technique that places the patient's body and specific tenderpoint in position of maximum comfort.
It considers the dysfunction to be a continuing, inappropriate strain reflex. The patient is moved to a balance point, position of ease, or away from the restrictive barrier.
Counterstrain
62
List the indications and contraindications of Counterstrain
Indications: --Tenderpoint
Contraindications: --Fracture, patients who cannot remain passive or quiet or relax.
63
A tissue texture abnormality characterized by a palpable sense of sponginess in the tissue, interpreted as resulting from congestion and causing increased fluid content
Bogginess
64
A tissue texture change characterized by a cordor ropelike feeling
ropiness
65
a palpable tissue texture abnormality characterized by fine or string-like myofascial structures
stringiness
66
List the acute effects on
1. Temperature
2. Texture
3. Moisture
4. Tenderness
5. Tension
6. Edema
7. Blood vessels
8. Erythema Test
1. Increased temp
2. boggy, rough
3. inc. moisture
4. rigid tension
5. greatest tension
6. yes - edema
7. venous congestion
8. redness lasts
67
List the chronic effects on
1. Temperature
2. Texture
3. Moisture
4. Tenderness
5. Tension
6. Edema
7. Blood vessels
8. Erythema Tes
1. slight inc. or dec.
2. thin, smooth
3. dry
4. slight inc, ropy, stringy -tension
5. present; less tender
6. no edema
7. neovascularized
8. redness fades fast
- -red reflex
68
_______ is an indirect technique in which the fascia is manipulated to reduce bind and restriction. Its goal is to improve the innate and inherent motion of the myofascial structures.
Myofascial release
69
What are the steps of Myofascial release?
-dysfunctional tissues are guided along the path of least resistance until free movement is achieved
70
What are the indications/contraindications of myofascial release (MFT)?
Indications
--Fascial bind, strain, or altered patterns. Takes time to develop this skill.
Contraindications
--Open wounds, recent fracture, burns, deep vein thrombosis, traumatized tissue.
71
________ is a patient passive, indirect technique. It is a system of indirect myofascial release treatment developed by Stanley Shiowitz.
Facilitated positional release
Steps:
1. diagnose
2. flatten the curve
3. add a compressive force
4. place into position of ease
5. hold for 3-5 seconds
6. release and return to neutral
72
List the indications and contraindications of Facilitated positional Release
Indications: --myofascial or articular dysfunction
Contraindications: --joint instability, severe herniation, severe strain/sprain
73
A specialized technique based on the theory of inherent motility and mobility of the skull, spine, and nervous cord in conjunction with the fluctuation of CSF (cerebrospinal fluid).
Cranial
*Usually indirect -- some use it directly
74
A technique that is both direct AND indirect all in one motion
It is a specific, non-repetitive articulatory method that is indirect then direct
Still
--Specific - Not a “shotgun” technique
--Non-repetitive - One treatment/motion should be effective
--Articulatory – Finishes into the barrier
75
Steps to Still technique
1. Diagnose
2. Move to Position of Ease
3. Exaggerate
4. Apply Force Vector
5. Articulatory Movement
6. Release Force Vector
7. Return to Neutral
8. Retest
76
When was the AOA founded?
1897 – Founding of the American Association for the Advancement of Osteopathy….. American Osteopathic Association (AOA)(1901)
77
List the 6 foundation schools
```
Kirksville - 1892
Los Angeles - 1896
Des Moines - 1898
Philadelphia - 1899
Chicago - 1900
Kansas City - 1916
```
78
List the 6 foundation schools
```
Kirksville - 1892
Los Angeles - 1896
Des Moines - 1898
Philadelphia - 1899
Chicago - 1900
Kansas City - 1916
```
*Kansas CIty - ony osteopathic opened after Flexner until 1969
79
During the influenza epidemic, the mortality for flu patients treated by DOs was 0,25% compared to traditional medical care (33%).
True
*death rate due to pneumonia: 10%
80
Not until what event were DOs allowed to serve as physicians in the armed forces?
Not until the Vietnam War (1966)
81
Osteopathic Hospital in OK
1944 (OK osteopathic hospital)
82
OSU College of Osteopathic Medicine was established in
1972-- Oklahoma College of OSteopathic Medicine and Surgery
I988 - OSU college of osteopathic medicine
83
Landmarks
```
C7 – vertebral prominens
T1 – first rib
T3 – spine of scapula
T7 spinous process – inferior angle of scapula
L4 – iliac crest
```
84
Planes:
1. Sagittal
2. Coronal
3. Transverse
1. left vs. right; flexion and extension
2. ant. vs. posterior; abduction, adduction
3. superior vs. inferior; internal and external rotation
85
Gravitational line
-static evaluation
“Viewing the patient from the side, an imaginary line in a coronal plane which, in the theoretical ideal posture, starts slightly anterior to the lateral malleolus, passes across the lateral condyle of the knee, the greater trochanter, through the lateral head of the humerus at the tip of the shoulder to the external auditory meatus; if this were a plane through the body, it would intersect the middle of the third lumbar vertebra and the anterior one third of the sacrum. It is used to evaluate the A-P (anterior-posterior) curves of the spine.”
86
True/False: Posture is both static and dynamic
True
Static – alignment of body mass with respect to gravity
Dynamic – alignment constantly adjusts to individuals changing postural demands
87
Evaluates the patients ability to move through an axes of motion.
It checks an area – Eg. Cervical spine.
Segmental: specific – Eg. C7
Regional motion
88
Closing a joint space
Flexion
89
Opening a joint
Extension
90
segmental motion that creates a convexity or concavity. Linked with sidebending.
Translation
91
TART examples
1. Tissue texture changes – The T’s
Tone, temperature, tenderness, turgor
2. Asymmetry
A static finding via palpation or observation
3. Range/Restriction of Motion
passive and active motion test
quantity, quality, and end point
4. Tenderness
Is the patient hurting anywhere?
92
TART: tissue texture changes
Inspection – surface markings, scars, bruises
1. Color – inflammation, infection, decreased blood flow
2. Temperature – cool or hot
Skin drag – perspiration, oiliness, dryness, swelling
3. Texture – rough, smooth
4. Turgor – how much elasticity is in skin. Affected by age, conditions, and hydration
5. Friction rub – do both sides become equally red?
93
Vertebrae anatomy:
```
Vertebral body
Vertebral foramen
Pedicle
Transverse process
Articular process
Superior and inferior articular facets
Lamina
Spinous process
```
* Articular processes (facets): two superior and two inferior facets for articulation with adjacent vertebrae.
* Body: the weight-bearing portion of a vertebra that tends to increase in size as one descends the spine.
* Intervertebral foramen (foramina): the opening formed by the vertebral notches that is traversed by spinal nerve roots and associated vessels.
* Lamina (laminae): paired portions of the vertebral arch that connect the transverse processes to the spinous process.
* Pedicle: paired portions of the vertebral arch that attach the transverse processes to the body.
* Transverse foramina: apertures that exist in transverse processes of cervical vertebrae only and transmit the vertebral vessels.
* Transverse processes: the lateral extensions from the union of the pedicle and lamina.
* Spinous process: a projection that extends posteriorly from the union of two laminae.
* Vertebral foramen (canal): a foramen formed from the vertebral arch and body that contains the spinal cord and its meningeal coverings.
* Vertebral notches: superior and inferior semicircular features that in articulated vertebrae form an intervertebral foramen (two semicircular notches form a circle).
94
Functional Spinal Unit
- 2 adjacent vertebrae
- IVD
- shared ligaments
- facet joints
- monoarticular muscles
95
Axis of Motion
1. x - horizontal
2. y - vertical
3. z- anteroposterior
1. X - flexion, extension
- sagittal plane
2. Y - rotation
- -transverse plane
3. Z - sidebending
- -coronal plane
96
Translation describes motion along an axis or in a plane. It is named by the direction of movement.
For example, movement of vertebrae to the left along the x axis refers to ____ translation
Left translation
--left convexity, right concavity
97
During Flexion, spinous processes move _____.
Apart
- -facets open
- -superior and anterior gliding of inferior facets
98
During extension, spinous processes move _______
closer
- -close facets
- -inf. and post. gliding of inferior facets
99
Rotation left or right is named for facing of_____ surface of the vertebral body
Anterior surface
(where vertebral body is facing)
--transverse processes follow vertebral body by moving posterior
* bicycle handles
* coupled with sidebending
100
Sidebending (lateral flexion) refers to the direction of movement of what vertebrae?
superior surface of superior vertebrae
--right sidebending: right facets close; left facets open
101
List the Superior facet orientations
**BUmBLe BuM
1. Cervical
- -Backward (post.)
- - Up (superior)
2. Thoracic
- -Backward
- -Lateral
3. Lumbar
- -Backward
- -Medial
102
Local vs. Global muscles
Local: small muscles
--individual segments
Global: move whole body
103
Rule of 3's of Spinous Processes
T1-3
--same level as body
T4-T6
--1/2 way down
T7-T9
--one segment below
T10-T12
- -regresses
- -T10: like T7
- -T11: like T4
- -T12: like T1
104
Neutral
normal condition
- weight is on body of vertebrae
- facets are NOT engaged
- facets are NOT controlling segmental motion
105
What happens to vertebral facets when they are in Non-neutral position
(flexion or extension)?
Facets become engaged
- engaged facets act as pivot for motion at that segment
- couples sidebending and rotation
106
Fryette's Law I (neutral mechanics) describes when the lumbar or thoracic spine is in neutral (no flexion or extension).
What does this law state?
- sidebending and roatation will occur in OPPOSITE directions
- GROUP of vertebrae (curve)
- Rotate into convexity of curve
EX: sidebend right; rotate left
107
Which muscles are involved in Fryette's first law (neutral position)?
Global muscles -- long muscles
-pile of blocks (weight on vertebral bodies)
108
Fryette's Law Type II mechanics
-When facets are engaged in flexion or extension, sidebending and rotation occur in ________ direction.
The SAME direction
-involves single function spinal unit
109
Fryette's Law III
Introducing motion to a vertebral join in one plane automatically ____ its mobility in the other two planes
Reduces
110
A treatment in which the patient is moved into a position which directly engages the restrictive barrier and is then asked to gently move against a resistance provided by the physician (isometric contraction)
Muscle Energy
111
Rule of 3's
T1-3 same level as body/t.p.
T4-6 half way down
T7-9 one segment below
T10-12 regresses
T10 = T7-9 one below
T11 = T4-6 half below
T12 = T1-3 same level
112
Normal motion of individual vertebra follow Fryette’s _______ principle of spinal motion
2nd principle
113
Somatic dysfunction creates a mechanical problem with motion restriction. It involves motion loss within the normal range of motion.
How is it tested?
motion testing (flexion/extension/sidebending/rotation)
114
Type _______ dysfunction involves restriction of more than one vertebrae (group curve). The restriction occurs in neutral, meaning rotaion and sidebening is in the OPPOSITe direction.
Type I dysfunction
--weight bearing mass is on the BODY of the vertebrae
--long muscles involved
115
Type _________ dysfunction involves restriction of one vertebrae on another. Restriction occurs in flexion or extension, meaning that rotation and sidebending is in the same direction (in combination).
Type II dysfunction
- same direction
- in combination
* weight bearing: facets
* involves short muscles
116
_______ usually results in
asymmetric positioning of a vertebra during motion
demands.
Motion restriction
117
We name the dysfunction by the position in which they are _____
held/live
118
Understand motion with regard to restricted positions "ed" endings.
1. Flexed
2. Extended
3. Rotated right
4. Sidebent right
exed (won’t extend)
Extended (won’t flex)
Rotated right (won’t rotate left)
Sidebent right (won’t sidebend left)
119
Vertebral motion, involving two segments, is named for the _______ segment moving on the _______ segment, i.e., T2 rotates right on T3
Superior segment moves on the inferior segment
120
True/False:
The direction of mation of a single vertebra is determined by the direction of movement of the anterior surface of the body of that vertebrae
True
121
In _______ dysfunction:
1. both facets close
2. one side stays closed with flexion
3. Sidebending occurs towards the closed side
4. Rotation is in the same direction of sidebending
Extended dysfunction
*palpate the facets to reveal direction of rotation
NOTE: extension is symmetrical; flexion is asymmetrical
122
ESRL
- palpate facets
- patient extends: both facets close
patient flexes: left facet more posterior
NOTE: ESRR = right more posterior
123
In _________ dysfunction:
1, both facets open with flexion
2. one side stays open with extension
3. sidebending occurs away from the open facet
4. Rotation is in the same direction
Flexed dysfunctions
* Flexion is symmetrical
* Extension is asymmetrical
124
True/False: Muscle energy employs both direct technique (move restricted segment directly into barrier) and Isometric Contraction (active effort by patient)
True
125
The following are goals of what technique?
- mobilize joints
- stretch tight muscles
- improve circulation
- balance neuromuscular relationships
Muscle Energy
126
Which of the following best describes the golgi tendon organ?
A. proprioception
B. Senses increased tension and sends a signal to the spinal cord to relax (lengthen)
C. acts as a protective circuit breaker to prevent the tendon from tearing
All of the above
127
Change in the tension of a muscle without approximation of muscle origin and insertion.
Operator force = patient force
Isometric contraction
128
Shortening of muscle during contraction
Concentric contraction
129
Lengthening of muscle during contraction
Eccentric contraction
130
A form of concentric contraction in which a constant force is applied.
Operator force < patient force.
*treat Hypotonic muscles
Isotonic contraction
131
A form of eccentric contraction designed to break adhesions using an operator-induced force to lengthen the muscle.
The counterforce is > patient force.
*treat fibrotic or chronically shortened tissue.
Isolytic contraction
132
Physiologic Components of MET
1. Joint Mobilization using muscle force
2. Post-isometric relaxation (golgi tendon)
3. Reciprocal inhibition
4. Respiratory assistance
5. Oculocephalogyric reflex
6. Crossed extensor reflex
7. Isokinetic strengthening
8. Isolytic lengthening
133
Describe the steps to muscle energy treatment
**Accurate diagnosis and positioning to barier
1. Patient tries to straighten leg against Dr. resistance (isometric contraction 3-5 sec)
2. Dr. says "relax" 1-2 sec
- -maintains position
3. Dr. repositions to new restricitve barrier
4. Wash, rinse, repeat
134
________ describes when the flexor muscle of one extremity is contracted voluntarily, the flexor muscle of the opposite extremity relaxes and the extensor contracts.
Crossed extensor reflex
*can use for fracture or burns (on opposite side)
135
Essential Steps of Muscle Energy
1. Accurate and specific diagnosis
2. Accurate positioning of the patient to the point of initial resistance of the barrier (in all planes of motion)
3. Physician must establish an appropriate counterforce
4. Appropriate patient muscle effort
5. Amount of force (isometric, amount appropriate for the muscle group(s) involved)
6. Direction (against a counterforce)
7. Duration (usually 3-5 seconds)
8. Complete relaxation by the patient
9. A pause of 1-2 seconds (post-isometric relaxation phase)
10. Reposition (up to the new restrictive barrier)
11. Repeat steps 3-6 until no further change is obtained (usually 2 - 6 times)
12. Retest for appropriate changes (in tenderness, asymmetry, range of motion and tissue texture)
136
If you diagnose a patient with T5 FSRr, how would you treat them with MET?
Place patient into
T5ESRl position.
perform isometric contraction
137
If you diagnose a patient with:
Dx: Contracted hamstring, (Extended hip)
How would you treat?
Tx: Place hip into flexion until resistance. Followed with an isometric contraction.
138
“When an agonist contracts, the antagonist should relax (e.g., brachialis and biceps contract and triceps relaxes). The force of contraction in this style of technique should be very light, only slightly more than the thought to contract”
Reciprocal Inhibition
lengthens muscles shortened by cramps or spasms
139
Steps to isolating reciprocal inhibition:
1. Diagnose S.D.
2. Place segment into Barrier
3. Patient pushes INTO (isometric contraction)
1. Dx: T5 FSRr
2. Barrier: T5 ESRl
3. Initial Tx Position
T5 ESRl
4. Patient force
5. Into Barrier - ESRl
6. Physician counterforce
FSRr
140
Standard Muscle Energy
1. Diagnose S.D.
2. Place segment into Barrier
3. Patient pushes AWAY from barrier toward neutral (isometric contraction)
Dx: T5 FSRr
1. Barrier: T5 ESRl
2. Initial Tx Position
T5 ESRl
3. Patient force
4. Towards neutral - FSRr
5. Physician counterforce
ESRl
141
When would you use muscle energy?
- Lengthen a shortened, contracted muscle
- Strengthen weakened muscles
- Treat or mobilize any joint crossed by voluntary muscles
- Reduce localized edema and relieve passive congestion
142
Contraindications to muscle energy include:
```
A. Lack of patient consent
B. Infection, hematoma, tear in muscle
C. Fracture or dislocation
D. Rheumatologic Functions
E. Coma
F. Undiagnosed joint swelling
G. positioning that compromises vaculature
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A. Absolute
| B-G: Relative
143
The exaggerated A-P curve of the thoracic spine with concavity anteriorly
Kyphosis
144
The anterior convexity in the curvature of the lumbar and cervical spine
Lordosis
