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OS II > Introduction to Muscle Energy and HVLA Lecture (Test 1) > Flashcards

Introduction to Muscle Energy and HVLA Lecture (Test 1) Flashcards

1
Q

Aspects of the Restrictive Barrier

A

1) Quantity
2) Quality
3) End Feel

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2
Q

Quantity of Motion

A
  • Anatomic Barrier End Point of Passive Motion
  • Normal Active Range of Motion occurs between the Physiologic Barriers
  • The RESTRICTIVE BARRIER is the Limit of Permitted Motion in Somatic Dysfunction
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3
Q

Quantity of Motion Cont

A

BE CAREFUL with Certain Terminology

1) “OUT of PLACE”
- Leads to Misunderstanding of the nature of Motion Loss, IMPLIES TISSUE DISRUPTION

2) “Adjustment” or “Putting it Back”
- OMT goal is RESTORE Motion loss and Shift the Neutral Point back to Normal

  • Treatment involves the Dynamics of Motion, not simply STATIC Positional Change
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4
Q

Quality of Motion

A

CHARACTERISTICS of the MOTION
1) END FEEL
( Placatory Experience as Barrier Engaged)

2) Motion INTO the Restrictive Barrier: BIND
3) Motion INTO the Freedom of Motion: EASE

As the Joint is moved into he Restrictive Barrier the Tension gets Tighter
- Agonist/ Antagonist Muscles and Fascia Responsible

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5
Q

Restrictive Barrier

A
  • Loss of Motion!!!!
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6
Q

Quality of Motion Cont

A

DESCRIBE Motion Quality by asking 3 Questions:
1/2) Where is it/ What Will it do?
(Position of Ease/ Freedom)

3) What won’t it do?
( Restriction)

EXAMPLE AA ROTATED RIGHT:

  • Rotated Right
  • Freedom of Rotation to the RIGHT
  • Restriction of Rotation to the LEFT
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7
Q

Boundaries of Motion

A

Barrier is 3 DIMENSIONAL

  • Sagittal Plane
  • Transverse Plane
  • Coronal Place
  • Translatory Motions
    a) Forward and Back
    b) Right and Left
    c) Compression and Distraction
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8
Q

Boundaries of Motion Cont

A
  • Each of the Planes of Motion can be Evaluated Individually
  • The Restrictive Barrier can be “Stacked” by Engaging SB, Rotation, and F/E and Accumulating Forces
    (Makes the END FEEL Very SLID)
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9
Q

Muscle Energy Defined

A
  • A Form of OMT where Patients Muscles are Actively used on Request, from a Precisely Controlled Position, in a Specific Direction, and Against a DISTINCTLY Executed Counterforce
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10
Q

Origin of Muscle Energy

A

1) A.T. Still D.O:
- Understand the Anatomy and Osteopathic Philosophy., and you will now what to do

  • “The attempt to restore Joint Integrity before soothingly restoring Muscle and Ligamentous Normality was pitting the Cart before the Horse”

2) FRED MITCHELL Sr. D.O.
- Described MUSCLE ENERGY in 1958 (Yearbook of the AAO)

  • He held a 5 day Tutorial in 1970, and after his death, his sons and others published his Material
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11
Q

Muscle Energy

A
  • DIRECT Technique

- ACTIVE Technique

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12
Q

Basics of Muscle Energy

A
  • Using Patient’s “Muscle Energy” as Activating Force
  • Dr. COUNTERACTS Patient’s Force
  • ISOMETRIC = NO MOVEMENT in ACTIVE PHASE
    a) Muscles Remain the SAME LENGTH

b) Achieve RELAXATIOn after CONTRACTION of Muscle

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13
Q

Muscle Energy Key Highlights

A
  • Mobilize Restricted Joints and Tissues
  • Stretch Tight Muscles and Fascia
  • Decrease Hypertonicity
  • Lengthen Fibers
  • Improve Local Circulation
  • Balance Neuromuscular Relationships
  • Strengthen weaker side of Asymmetry
  • Make Patient Feel Better
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14
Q

Advantages of Muscle Energy

A

“SAFER” than HVLA
- Gently Technique

  • Geriatric Patient
  • Osteoporosis or Risks
  • Other Conditions which may not allow the use of Thrust Techniques
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15
Q

Contraindications of Muscle Energy

A
  • Open Wounds
  • Broken Bones
  • Uncooperative Patients
  • Unresponsive Patients
  • Severe pain in MUSCLE GROUP UTILIZED
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16
Q

Indications of Muscle Energy

A

1) SOMATIC DYSFUNCTION

2) Used ALONE or to Prepare Patient for HVLA or other Modality:
- After ME, may find HVLA not Needed

  • Segmental or Regional Somatic Dys
  • Useful in TORTICOLLIS
  • Also good for Chronic Pain Conditions, Tight Hamstrings, Tension HA
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17
Q

Technique Specifics of Muscle Energys

A
  • Make Diagnosis
  • Positon body part at position of Initial Resistance = RESTRICTIVE BARRIER
  • As Patient provides LIGHT to moderate Force Away from Restrictive/ Barrier
  • Dr. provides Equal COUNTERFORCE to Achieve ISOMETRIC CONTRACTION while monitoring Patient
  • Hold 3 to 5 Seconds!!!!!!!
  • Then Patient and Dr. Relax Simultaneously
  • After POST ISOMETRIC RELAXATION: Dr. “takes up Slack” and repositions Body part further towards Restriction/ Barrier = ENGAGE NEW BARRIER
  • Repeat: Continue until no further Restrictions/ New Barriers noted, or full Range of Motion is Obtained (Approx 3 to 5 times)
  • REASSESS
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18
Q

Physiology- Golgi Tendon Reflex

A

GOLGI TENDON ORGANS (Tendon Spindles)
- Encapsulated Sensory Mechanoreceptors

  • In Tendons between Muscle and Tendon Insertion
  • Detect Organ per 3-25 Muscle Fibers
  • Detect Degree of Skeletal Muscle Tension and send this info to CNS
  • THEY ARE STRETCHED WHENEVER MUSCLES CONTRACT
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19
Q

Golgi Tendon Reflex Cont 1

A
  • AFFERENT Neurons form the Golgi Tendon Body are 1b Group
  • Upon Entering Gray Matter of Spinal Cord, Synapse with INHIBITORY INTERNEURONS
    ( As well s other Interneurons)
  • That ascend to HIGHER CNS Levels
20
Q

Golgi Tendon Reflex Cont 2

A
  • INHIBITORY INTERNEURON Synapses with LARGE ALPHA MOTOR Neurons in ANTERIOR GRAY HORN of Spinal Cord
  • Send an INHIBITORY Message to the Same Muscle from where the 1b AFFERENT Originated
  • Causing a REFLEX Relaxation of the Muscle
21
Q

Golgi Tendon Reflex Cont 3

A
  • Purpose is to prevent Tissue Disruption (Responds to Rapid Change in Length/ Tension)
  • When it is Abnormally Set/activated, it can create or Maintain Abnormal Muscle Function
22
Q

Physiology of Muscle Energy

A

1) POST- ISOMETRIC RELXATION
- Neuromuscular Bundle is in a Refractory State Immediately after contraction, allowing passive Stretching to occur without Reflex Opposition

  • Also, Muscle Contraction stretches GOLGI Tendon Organ ultimately causing REFLEX RELAXATION

2) RECIPROCAL INHIBITION- To Lengthen Shortened Muscle
- Gentle Contraction in AGONIST Muscle and REFLEX Relaxation of Antagonist

23
Q

Variables

A

1) Accurate Diagnosis
- Need to be sure you are Directing Forces at the CORRECT Level and Direction

2) Amount of Force
- Varies by Individual
- And by Body part be treated

24
Q

Variables Cont

A

1) INSTRUCT PATIENT TO JUST APPLY A LITTLE FORCE
- Only enough to Obtain Isometric Contraction

2) May need to USE YOUR BODY WEIGHT or Brace Yourself with the Table

3) LOCALIZATION
- Need to Isolate and Monitor the Segment you are Treating

  • Chance of SUCCESSFUL Treatment Greatly Decreased if you are DIRECTING Forces ABOVE or BELOW Dysfunction
25
Q

HVLA Defined

A
  • “An Osteopathic Technique employing 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”
  • Also known as THRUST TECHNIQUE
26
Q

HVLA

A

1) THRUST
- Mobilization with Impulse

2) HVLA
- High-Acceleration, Low-Distance (HALD)

27
Q

Introduction to HVLA

A
  • DIRECT TECHNIQUE
  • PASSIVE TECHNIQUE
  • Moving the Joint in the Direction of the Restrictive Barrier
  • Applying a Precise THRUST
  • Immediate RESTORATION in Range of Motion
  • Consider Relaxing Surrounding Soft Tissues First
28
Q

Historical Perspective

A
  • Major Modality taught in COM’s
  • Other Modalities added to Curriculum of Many School in 1970’s
  • A.T> Still M.D./ D.O. : Some references in his writings indicate he may have used it some
    (“Lightning Bone Setter”)
29
Q

Historical Perspective Cont

A
  • THRUST Techniques fairly easy to Conceptualize
    (Describe Restriction that setup for treatment by engaging that RESTRICTION)
  • MYOFASCIAL and INDIRECT Techniques require the Doctor to respond more to TACTILE and PROPRIOCEPTIVE INPUT
30
Q

Indications of HVLA

A

PRIMARY = Somatic Dysfunction

  • Must Understand Somatic Dysfunction and Barrier Concepts
  • SECONDARY BENEFITS: Restoration of Motion, Removal of Restrictions
    a) Improve Motion and Biomechanics Function

b) Pain Reduction
c) Decrease Inappropriate Somato-Visceral Reflexes

31
Q

Accumulation of Force at Restriction

A
  • Spinal Somatic Dysfunction Involves: VERTEBRAL SEGMENT

Vertebra above and Below and the DISCE between the Two

32
Q

Accumulation of Force at Restriction Cont 1

A

ENGAGE THE BARRIER:
- Forces are Applied from the TOP DOWN through the SUPERIOR VERTEBRA

  • Forces are applied from the BOTTOM UP through the INFERIOR VERTEBRA
33
Q

Accumulation of Force at Restriction Cont 2

A

Localization is at the FACETS between the 2 VERTEBRA
- One Force is applied to ONE Vertebra

  • The other has an Opposing COUNTERFORCE to resist the INERTIA of the Body Mass
  • The DISH RAG Effect
34
Q

Thrust Force

A
  • The Thrust is applied after the Setup is locked against the Restrictive Barrier

a) If the Localization is not Accurately Against the Restrictive Barrier the THRUST FORCE will Dissipate through other parts of the Body
* *** INCREASED Risk of IATROGENIC Side Effects

  • Short, QUICK THRUST
    (NOT TOO FORCEFUL)
35
Q

Thrust Force Cont 1

A
  • Do not BACK OFF the barrier Just Before the Thrust
  • Do not carry the Thrust over a GREAT DISTANCE
  • Do not be over TENTATIVE and Apply a LOW-VELOCITY FORCE
    (THURST, don’t push, THROUGH THE BARRIER)
36
Q

Thrust Force Cont 2

A
  • There are times that on Setup you will get a Click or Motion and the Dysfunction is RESOLVED
    a) Attests to Proper Engagement of the Restrictive Barrier
  • Some patients require you to “TEASE” a Joint Carefully and Slowly apply the Forces
    a) You modify the Forces to MEET the NEEDS
37
Q

Thrust Force Cont 3

A
  • The more relaxed the patient the MORE SUCCESSFUL the MODALITY
  • Pain on Engagement of the Barrier WILL cause Involuntary Spasm
  • Watch for NONVERBAL CLUES
  • Thrust at end of EXHALATION
  • Try to Divert the PATIENT’S Attention
38
Q

Thrust Force Cont 4

A
  • The patient can Sense Confidence and Skilled Hands (Therefore PRACTICE)
  • A Click or Pop can be heard with Thrust

Theories for Pop:
1) Sudden Distraction produce a VACUUM and the Familiar Sound = Some say release of Nitrogen Bubble, Ballooning of the Capsule, releasing Ligamentous Adhesions

2) Not related to the Success of Modality
3) May not be present with a SUCCESSFUL Application of the Modality
4) Keep the Focus on the Restoration of Motion

39
Q

Neurophysiology of HVLA

A
  • Asymmetric Tension in Tissues around a Joint (Muscle/ Myofascial Structures)
  • Asymmetrical Tissue Pressure and this Asymmetric Afferent Inputs
  • Thrusting Gaps the Joint Causing a Sudden Stretch
40
Q

Neurophysiology Cont

A
  • Sudden Stretch activates the GOLGI TENDON ORGAN
    a) STRONGLY inhibits Muscle Activity
  • Muscle Tensions are allowed to equalize Restoring Proper Functional Position and Motion
    a) Thus Normalizing IMBALANCED Afferent Input
  • Also see a Stretching of the Related Myofascial Tissues
41
Q

HVLA Precautions/ Contraindications

A

1) RISK- Benefit Ratio
- If the Risk Outweighs the benefit, the Technique is NOT INDICATED

2) NEUROLOGICAL IMPLICATIONS
- Vertebral/ Basilar Artery, Dens Fracture or Dislocation (RA or Down Syndrome), Disc Disruption

3) Joints can be Sprained
- Excess Forces can Damage Tissue
- Consider Hypermobile Joints

42
Q

Precautions and Contraindications Cont

A

1) Osseous or Ligamentous Damage

2) Pathologic Fractures
a) Ostoepororsis
b) Metastatic Disease
c) Arthritis Spurs

3) Psychological Contractindications
a) Patient Apprehension: Make sure patient Understand what to EXPECT

b) Patient DOES NOT Want HVLA

43
Q

Guidlines for Safety

A
  • Be aware of Possible Complications
  • Make an ACCURATE DIAGNOSIS
  • Listen with your Hands and Fingers (If it doesn’t feel right back off and re-evaluate)
  • If Barrier DOES NOT Feel right, DONT Thrust
  • Emphasize specificity with Engagement of Barrier
44
Q

Guidelines of Safety Cont

A
  • Ask Permission to treat
  • If response to Treatment does not meet Expectations, re-evaluate
  • SOMATIC DYSFUNCTION is the INDICATION NOT PAIN
  • Be aware that Somatic Dysfunction can co-exist with Other Conditions
45
Q

HVLA

A

1) Position Paper on OMT of the Cervical Spine- Adopted by AOA House of Delegates (2005)
- Speaks on Overwhelming Safety of Cervical Manipulation

2) JAOA Article fo Dr. Vick
- Evaluated reported Injuries form Manipulation
- Risk 1 in a Million for Injury
- Included many types of Practitioners

3) Apply the Principles
- Accurately Diagnose
- Engage the Barrier
- Apply the Thrust
- Re-Evaluate

4) Article by S. Haldeman, MD, PhD, FRCP
- Unpredictability of Cerebral Vascular Ischemia Associated with Cervical Spine Manipulation Therapy, Spine 2002
a) CVS after Cervical Manipulation is Unpredictable by Physical Examination and should be “Considered an Inherent, Idiosyncratic, and rare Complication of this Treatment approach”

b) Most Vertebral artery dissections don’t occur with Manipulation, but with Backing out of Driveways, Painting a Ceiling, Playing Tennis, Sneezing, or Engaging in Yoga Classes

46
Q

HVLA Safety

A
  • HVLA is a Safe and Effective Modality
    a) Not withstanding the Risk

b) You can Minimize that risk by being accurate in Assessment and Application of Technique

  • Practice, Practice, Practice
    a) This will give you a better feel for the Barrier and the Amount of Thrust required to Restore Motion

b) Can provide Immediate Relief and Increased Motion

47
Q

HVLA Summary

A
  • Diagnosis
  • Localize Segment
  • Position to Restrictive Barrier
  • Release-Enhancing Maneuver (Patient Breathing)
  • Mobilizing Force- THRUST
  • REASSESS (T.A.R.T)

OS II (8 decks)

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