Introduction to Somatic Dysfunction Flashcards
4 Osteopathic Tenets
- The body is a unit (mind, body, spirit)
- The body possesses self-regulatory mechanisms
- Structure and function are reciprocally interrelated
- Rational therapy is based on principles 1-3
Somatic dysfunction
impaired or altered function of the components of the somatic system –> skeletal, arthrodial, and myofascial (SAM) –> and related vascular, lymphatic, and neural (VLAN)
-usually treatable with OMT
arthrodial
joints
Consequences of somatic dysfunction
EX) interaction between vertebrae and the nerves they protect may cause change in visceral function or vice versa
How to diagnose somatic dysfunction
TART Tissue texture abnormalities Asymmetry (static or active) Restriction of motion (passive or active) Tenderness
How to name somatic dysfunction
Conditions named based on what the part CAN DO (likely that is where the dysfunction actually is, but it shows up on the other side)
EX) if elbow can extend but not flex - would be elbow extension dysfunction
terms related to acute somatic dysfunction
pain, erythema, relative warmth, increased moisture/bogginess (swollen), vasodilation, edema, tenderness, tissue contraction
Terms related to chronic somatic dysfunction
itching, paresthesia, palpable sense tissue dryness, coolness, tissue contracture, fibrosis tenderness, pallor
Contraction
process of which a muscle becomes or is made shorter and tighter
Contracture
abnormal, sometimes permanent, contraction of a muscle (chronic vs acute)
Osteopathic Manipulative Treatmetn (OMT)
manually guided force by an osteopathic physician to improve function and/or support homeostasis that has been altered by somatic dysfunction
Active vs Passive ROM
Active - patient does the moving
Passive - doctor does the moving
Passive ROM > Active ROM
Physiologic barrier
limit of active motion
Anatomic barrier
Limit imposed by anatomic structure
- past this barrier is where injuries happen - barrier is to prevent injuries
Elastic range
range between the physiologic and anatomic barriers
Restrictive barrier
functional limit that abnormally diminishes the normal physiologic range
Levels of evidence for OMT
A. Randomized clinical trials, systematic reviews or meta-analyses of RCTs
B. case-control or cohort studies, retrospective studies, certain controlled studies
C. (none of these are on chart) consensus statements, expert guidelines, usual practice, and opinion
OMT Contraindications
- If there is NO somatic dysfunction
- patient does not consent (some exceptions, pt intubated - physician can consent on their behalf)
- inappropriate clinical situation (pt unstable)
- anatomic physiologic concerns (ex. broken arm)
Post OMT symptoms
some patients report aggravations post-OMT, such as worsening symptoms, behavioral issues, headache, dizziness, flu-like symptoms, etc. These are short-lived and usually the patient feels better than they did after the side-effects subside
- very few people have serious or dire complications after OMT
How to avoid Post-OMT symptoms
- take a good history and physical exam (allows to ascertain avoidable risks)
- Appropriate choice of technique - understand quick versus slow (what are the symptoms associated with each)
- appropriate application of techniques
- Recommend hydration and rest
Body systems
HEENT, cardiovascular, respiratory, GI, GU, Musculoskeletal, endocrine, integumentary, nervous, immune, psychiatric
5 Osteopathic Models
- Biomechanical
- Neurologic
- Respiratory/circulatory
- Metabolic/Energetic/Immune
- Behavioral (biopsychosocial)
- Some overlap between them
used to help form a differential diagnosis and plan
Biomechanical model
-musculoskeletal system (muscles, bones, tendons, ligaments, fascia)
- integumentary
- body and its response to gravity
THREE DOMAINS
- Health - efficient and effective posture and motion throughout MSK system
- Disease - somatic dysfunction; inefficient posture; joint motion restrictions or hyper mobility; instability
- Patient care - Alleviate somatic dysfunction with osteopathic palpatory diagnosis and oMT to restore normal motion and function
Neurologic model
Nervous system
-brain
-spinal cord - (musculoskeletal, autonomic - parasympathetic [cranial nerves, sacrum S2-S4], sypathetic [T1-L2])
THREE DOMAINS
- Health - efficient and effective sensory processing, neural integration and control, autonomic balance, central and peripheral nervous functions
- Disease - Abnormal sensation, imbalance of autonomic functions (ex. IBS), central and peripheral sensitization/malfunction; pain syndromes
- Patient care - restore normal sensation, neurological processes and control; alleviate pain
Respiratory/Circulatory Model
- Cardiovascular (including lymphatic)
- respiratory
- nose, throat
- genitourinary
THREE DOMAINS - Health - efficient and effective arterial supply, venous and lymphatic drainage to and from all cells; effective respiration
- Disease - vascular compromise, edema, tissue congestion; poor gas exchange
- Patient Care - remove mechanical impediments to respiration and circulation and relieve congestion and edema by improving venous and lymphatic drainage
Metabolic/Energetic/Immune Model
- Gastrointestinal
- Lymph organs (spleen, liver, thymus, tonsils, appendix, lymph nodes)
- Enodcrine (hypothalamus-pituitary-adrenal axis)
THREE DOMAINS - Health - Efficient and effective cellular metabolic processes, energy expenditure and exchange, endocrine and immune regulation and control
- Disease - energy loss, fatigue, ineffective metabolic processes, toxic waste buildup, inflammation, infection, poor wound heating, poor nutrition, advrse reponse to medication, loss of endocrine control of vital functions
- Patient Care - Restore efficient metabolic processes and bioenergetics, alleviate inflammation, infection, restore healing and repair functions and endocrine control (abx would fit into this category because of their effects on the immune system)
Behavioral (Biopsychosocial)
psychological
- behaviors that influence health
- behaviors that influence health decisions
THREE DOMAINS
- Health- efficient and effective mental, emotional, and spiritual functions, healthy lifestyle choices and activities, good social support systems
- Disease - Ineffective function due to drug abuse, environmental chemical exposure or trauma, poor lifestyle choices (inactivity, dietary indiscretions), inability to adapt to stress or environmental challenges
- Patient Care - Assess and treat the whole person - physical, psychological, social, cultural, behavioral, and spiritual aspects, collaborative partnership, individualized patient care and self-responsibility for healthy lifestyle choices
Three domains of a Philosophy of medicine
Health, disease, patient care
- using combinations of OMM, medications, surgery, and education as appropriate
