final Flashcards
what is the major technique taught in OS med schools before 1970
HVLA
if there is clinical suspicion of ___ compromise then HVLA should not be used
vertebral A.
refers to the placatory sense of how smoothly a joint can be moved through its ROM
quality of barrier mechanics
quality of motion of a joint when it is brought passively to its final barrier of motion
End Feel
Rubbery end feel
reflex somatic dysfunction
firm and distinct end feel indiciates
typically mechanical type joint (arthroidal) dysfunction
end feel is a function of
focal tissue turgor and tethering of attached muscles and fascia
HVLA is particularly effective when there is a
distinctive barrier with a firm end feel
neuro phys of SD
local segmental irritation –> focal edema and swelling–> tightening of myofascial and capsular components of the joint –> reflex hypertonicity of muscles crossing joint –> TART changes–> SD
neuro phys of HVLA
thrust through the RB–>restoration of motion at articulation–> restoration of normal proprioception input–> reflex relaxation of muscles–> improve TART findings
As OS doctors we do NOT adjust or put back into place, our goal with OMT is
to restore motion loss and restore neutral point back to normal
HVLA forces for engaging and stacking barriers of the spine with be localized at _____ between the 2 vertebra
facet joints
how to engage barriers in HVLA stacking of the spine
- forces applied from top down through the superior vertebra (“through the dysfunction”)
- forces are applied from bottom up through the inferior vertebra (“to the dysfunction”)
- other vertebra of the unit are used as an opposing counterforce
- HVLA is utilized by stacking RBs in all 3 planes of motion
for appendicular restriction: typically restricted in _____ and ___ motion. HVLA stacking, typically focuses on the _____ restriction
one major and an associated minor motion
- HVLA focuses on minor joint motion restriction
ex: posterior tibiofemoral glide SD
____must be maintained once all RBs are stacked and cannot be lost before the thrust
engaging forces
if lost reassessment and restack
the 4 general rules for HVLA dosage
- the sicker the pt the less the dose
- older pts response more slowly
- most cases discourage thrusting the same segment more than once a week
- if the same SD reoccurs , evaluate and address for underlying inciting factors
3 benefits of HVLA
- well tolerated and time efficient
- modality of choice for SDs with distinct firm barrier mechanics
- pt typically experiences immediate relief, decreased pain, and increased ROM
the 2+ indications of HVLA
- articular (joint) SD (joint fixation)
- joint motion restriction (such as facet locking) with a firm articular barrier
- other uses: disrupt connective tissue adhesions, tx chronic SD resistant to other tx types, modify reflexes, maintenance tx in irreversible situations, hypomobile joints, restore boney alignment, meniscoid entrapment, pain modulation, CNS reprogramming, displaced disc fragment, reflex relaxation of affected muscles
___ and ____ are essential for uncovering possible diseases or conditions which would contraindicate HVLA tx
thorough history and physical examination
avoid ___ and ___ in cervical HVLA to avoid injury
hyperextension and excessive rotation
t/f
hyper mobility of joints can be exacerbated by HVLA
true
excessive force can damage tissue
absolute contraindications of HVLA
- rheumatoid arthritis (RA) in spine
- down syndrome (both 1 and 2 have alar ligament instability in cervical region of C1-C2)
- severe osteoporosis or osseous or ligamentous disruption
- local metasteses or bone malignancy
- osteomyelitis is area of tx
- joint replacement in area of tx
- vertebrobasilar insufficiency
- severe herniated disc with radiculopathy
- fracture, dislocation or spinal or joint instability
- ankylosis/ spondylosis or surgical fusion
- Klippel-Feil syndrome
- inflammatory joint dz
- pt refusal
upper cervical HVLA absolute contraindications
- RA in spine
- down syndrome
- achondroplastic dwarfism
- chiari malformation
relative HVLA contraindications
- acute herniated disc
- acute radiculopathy
- acute whiplash, strain, spasm, sprain
- mild osteopenia/osteoporsis
- spondylolisthesis
- metabolic bone disease
- hypermobility syndrome or hypermobile states
- pt apprehension
- mild to moderate strain or sprain in tx area
- RA disease other than in spine
what year did AOA form the AT Still Research institute with $16,000
1909
first 1/3 of Research was encouraged at the COMS to be
- neural and physiologic aspects of SD
- effects of OMT on symptpms and immune fxn
- results formed the basis of the lines of study later in the profession
the _____ showed growth in the professional research field with Denslow and Korr work started on ______
1940s
facilitated segment
t/f
DO research missed out on the early expansion of the NIH formation with money to fund projects
true
where is the ORC (osteopathic research center)
Texas School
- wad the first research institute for osteopathic profession
- AT still Uni Research institute formed after the ORC
who is Louisa Burns
DO
50 years devoted to OS research, pioneer
was director of the AT Still RI 1917-1935
paid as AOA researcher until 1950
-experimentally induced spinal fixations in animals and then noted the effects of the lesions on the brain heart GI lungs and kidneys (S-V reflexes)
-V-S reflexes
who is wilbur Cole
DO
studied with Louisa Burns 1948-50
reproduced her experiments and data
internal validation
who is J.S. Denslow
DO
- did research on documenting quantifying muscle and muscle reflex with autonomic change in areas of SD
- studied “osteopathic lesions”
- “reflex activity in the spinal extensors” used EMG and palpation correlation
- standard terminology proponent
- facilitation of the spinal cord with Korr
who is I.M. Korr
PhD “second great philosopher of OM”
- did research on documenting changes in galvanic skin resistance (measure of intensity of our emotional state or arousal) as a result of disturbances in autonomic function in areas of palpatory findings of SD
- axoplasmic flow and the trophic function of nerves
- facilitation of spinal cord with denslow
- sympatheticotonia
- took Stills autonomic functioned added physiologic function to it
who is william L. Johnston
DO, FAAO
- reliability studies
- validity studies
- VS reflexes
What is significant about the LA county OS hospital unit 2 of 1932
unit 1 was MD
unit 2 was DO
-saw every 10th pt but DOs say total of 1/7 of total patients and many transferred over.
-DOs delivered 1/3 of the OB patients
-DO hospital had only 5.53% mortality, 9.7 day average LOS, and 14% coroners cases
significant results of standard care of subacute LBP between MD and DO
outcomes for patients were no different, except the OS group required less medication (NSAIDs and muscle relaxants) and less PT time
results of pancreatitis study
OMT group decreased LOS, meds, and increased pt satisfaction
results of ankle sprain study
OMT group decreased edema, pain, and increased ROM
dog lab with lymphatic pump tx have shown
- increased flow of lymph in the thoracic duct
- increase circulating WBCs (memory cells already exposed to AG, neutrophils, and monocytes)
- abdominal pump showed greater increase than thoracic pump
takes ___ to get max release (of cells, cytokines, and proteins) from the nodes during the lymphatic pump tx. what are the influences of NO and inflammation?
2 minutes
-NO influences contraction of lymph vessels and is stimulated by inflammation
t/f
clinical evidence that LPT helps clear infection in the lungs bc increased lymph flow should decrease the number of bacteria in the lungs
true
all studies showed no serum changes between groups for CBC markers, ALL changes discussed occurred in the lymph system
layers of the the spinal cord gray matter and what they respond too: 3,4 ? 1, 5? and 2?
3,4- mechanoreceptors
1, 5 - Alpha-delta fast pain fibers
2 - small C fibers of slow pain
1-6 are upper layers
7-10 are lower layers of interneurons and motornueron cell bodies
t/f
70-80% of interneurons recieve afferent input from both visceral and somatic afferents which overlap and can explain the localized pain pattern of somatic afferents and the diffuse and poorly localized pain pattern seen with visceral afferents
true
overlap is the basis for the activation of somatic muscle activity seen with visceral disturbances which is a reflex that can produce dysfunction of facilitated segment
the visceral afferents activate ____ and _____ to increase tone and somatic inputs alter ___and ___
- sympathetic outflow and somatic muscle motor neurons
2. sympathetic and parasympathetic outflow and visceral function
what is the somatic component of disease mean in viscerosomatic reflexes
- the MSK palpatory findings (somatic findings) associated with visceral disturbances
- normalizing the MSK components may allow normalization of the autonomic outflow resulting in restoring homeostasis
interneurons can act as an ____ or ___ to sending afferent fibers to the motoneurons of the autonomic and MSK system
amplifier or inhibitor
short term vs long term vs fixation vs permanent excitability relating to sensitization of neurons
- short term- 1-2 seconds of afferent input = 90-120 seconds of excitability
- long term- minutes of afferent in put = hours of excitability
- fixation - 15-40 minutes of input = days/ weeks of excitability
- death of inhibitory neuron last forever
denslow was the first to show reflex changes with EMG and found ____________
long lasting, low threshold areas to afferent input
i.e. reflexes can be induced and maintained by a long lasting, low threshold point being stimulated by pain causing a contraction (TART findings) and consequently a SD
kore suggested that the ______ represented pathways in a _____ by continuous bombardment of input which is the basis of “facilitated segment”
low threshold spinal reflexes hyperexcited state ( as by inflammation )
-skeletal muscles also respond to low threshold areas of the Spinal cord
define habituation
process of decreasing response of a neural pathway with continous stimulation
*opposite of sensitization
what is the nociception theory
habituation and sensitization exist together to help maintain homeostasis b/t over reaction and under reaction to a stimulus
- nocicpetive input that meets threshold elicits a inflammatory cascade release of PGs and bradykinin which causes a lowering of the threshold and increases input into the cord
- inflammation disrupts the balance and results in larger than normal motor outputs to the autonomics and somatic systems
- this sets up the low-threshold spinal reflexes as talked about in the facilitated segment
define allostasis
- process by which the body responds to stressors to regain hemostasis; control of protective mechanisms
- effects multiple body systems affecting homeostasis (cardiovascular, neuro, immune)
-long term neural effect by long term facilitation causes loss of allostasis and results in hyperalgesia (abnormally heightened sensitivity to pain) from an exaggerated response to noxious stimuli
ventral horns vs dorsal horns function in allostasis
dorsal - maintain facilitation
-CA channels, phosphoryaltion, lose inhibitory neuron fxn
ventral -elicits outflows to autonomics to affect visceral function and to the body to cause muscle spasm (asymmetry and altered ROM)
allostasis and the brainstem: facilitation ____ endogenous descending pathways
decreases
long term facilitation damages what system
arousal system with catecholamines and glucocorticoids
-which leads to loss of control of protective mechanisms (loss of allostasis)
withdrawal response and mytotatic reflex are types of ___ reflex. distention and contraction of gut muscle is an example of _____ reflex.
somatosomatic reflex
viscerovisceral reflex
how are Chapman reflexes manifested
gangliform contractions which are believed to be congestions within fascia due to lymph stasis secondary to visceral dysfunction
-these contractions (caused by viscerosomatic reflex) block lymph drainage and causes neurolymphatic dysfunction (SNS dysfxn)
-small smooth firm nodules about 2-3mm wide (dense but not hard) located deep tp skin in the sub q areolar tissue on deep fascia or periosteum
contraindications of chapman reflexes
- pt refusal
- emergent care
- relative: fracture, cancer, pt instability
