Intro to direct techniques Flashcards
4 osteopathic principles
1: Body is a unit
2: Body is capable of self regulation and healing
3: Structure and function are interrelated
4: Rational treatment is based on above principles
What barriers are reached in normal active and passive motion?
Active: physiologic barrier
Passive: anatomical barrier
Difference between direct and indirect techniques
Difference is in relation to the restrictive barrier
Direct engages the barrier and can go beyond, where it doesn’t want to go
Indirect moves away from the barrier, where it wants to go
Explain rule for choosing direct vs indirect methods of treatment
Direct: chronic conditions that may require longer duration of treatment, it is more aggressive
Indirect: acute conditions that may require multiple treatments, for patients with other contraindications for direct techniques
Pros and cons of direct techniques
Engagement of barrier can be painful
Faster results, but shorter lasting benefits
Greater chance of injury/flare
More physically demanding
Conceptually easy to understand
Requires more dexterity but less palpatory skill
Describe articulatory techniques
Direct technique
Passive, smooth, rhythmic motion to engage the barrier repeatedly
Designed to stretch muscles, ligaments, capsules
Decreases tissue tension
Enhances lymphatic flow and circulation
Few contraindications
Describe soft tissue techniques
Used to lengthen, stretch, and relax muscles, fascia, and connective tissue
Forces must be applied slowly, held long enough, and release slowly
Examples are traction, bowstringing, inhibition
Explain Myofascial release
Load and hold
Takes fascia where it doesn’t want to go and holds until release
Lowers inappropriate afferent input in increased tissue sensitization
After trauma, fascia can be damaged and have strains/patterns/distortions that may not be reversible
Explain Muscle Energy technique
1: Make specific diagnosis
2: Engage barrier in all planes
3: Patient dow isometric contraction away from the barrier, or with the muscle that is trying to be stretched for 3-5 seconds
4: Relax for 2 seconds
5: Engage new barrier and repeat
6: If no progress in ROM, do not continue
How are extrafusal muscle fibers innervated?
Alpha motor neurons from anterior roots of spinal cord
These cause the muscle to contract
Explain Golgi Tendon
Prevents excessive muscle tension by monitoring muscle force and rate of change of force
In muscle tendons
Responds to changes in force and not length
Inhibits alpha motor neurons
Describe intrafusal muscle fibers (muscle spindles)
Protects muscle from tearing by monitoring length, rate of change in length, and tone
Innervated by gamma motor neuron
Length of the intrafusal muscle fiber is independently reported to CNS to help body judge position of muscle and rate of position change
How does an indirect technique relax the muscle fibers?
Indirect techniques such as counterstrain would relax the intrafusal muscle fibers, resetting the gamma gain to a new, lower level
How do direct techniques relax muscle fibers?
Direct techniques stretch the extrafusal fibers which pull on the Golgi tendon receptors which cause the alpha motor neurons to relax and decrease the muscle tension
Isometric vs isotonic muscle contraction
Isometric is constant length
Isotonic is constant force, but change in length
(concentric is shortening of the muscle, eccentric is lengthening of the muscle)
