L7-8: OMM Treatment Styles I-II Flashcards
In what direction or how are SD primarily named?
- The direction in which motion is freer, position of ease
True / False. All somatic dysfunctions should be treated.
True / False. All somatic dysfunctions should be treated.
Criteria for diagnosing a SD
- Any 1 (or more) of TART qualifies for diagnosis
- Most important would be restricted ROM and tissue texture changes
True / False. Area of tenderness corresponds to location of SD.
- False, compensatory mechanisms can cause this to be located in a different region
Sidebending of vertebrae named how?
- Named for side of concavity
Rotation of vertebrae named how?
- Named by motion of a pt on anterior, superior surface of a vertebral body (NOT spinous process)
Types of barriers in joint motion
- ) Anatomic: limit of passive motion, final barrier that should not be passed, limited by bone, muscle, ligament
- ) Physiologic: limit of active motion
- ) Restrictive (in some joints): functional limit within anatomic ROM which abnormally diminishes normal physiologic ROM – caused by SDs, surgery, tightness, etc.
- ) Elastic (in some joints): not true barrier, rather space between anatomic and physiologic barrier as a result of passive ligamentous stretching
What barrier is the limit of passive motion?
- Anatomic barrier
What barrier is the final barrier that should not be passed?
- Anatomic barrier
What barrier is the limit of active motion?
- Physiologic
Define barrier
- restriction or binding point felt when a joint is put through its ROM
Extrinsic vs intrinsic forces used in OMT
- Extrinsic: treatment force provided by operator, gravity, table
- Intrinsic: voluntary or involuntary forces from within pt such as respiration, muscle contractions, involuntary motions
Active vs passive forces used in OMT
- Active: pt performs action
- Passive: physician performs action
Types of treatment modalities that increase ROM
- ) Direct: engaging restrictive barrier carrying the SD component toward or through the barrier
- ) Indirect: motion barrier is disengaged and the SD component is moved away from restrictive barrier
Which areas of the body have the most dysfunctions? Why?
- Head/neck, neck/thorax, thorax/lumbar, lumbar/sacral
- These areas have the most mobility
OMM Treatment techniques
- HVLA
- Muscle Energy
- Soft tissue
- Strain/counterstrain
- Cranial / craniosacral
- Myofascial release
- Springing (LVMA)
- Articulatory
- Functional
HVLA. Direct/indirect, passive/active, extrinsic/intrinsic?
- Direct
- Passive
- Extrinsic
Mechanism of HVLA action
- Abnormal muscle activity restricts joints
- Mechanoreceptors exist in the joint capsule, a suddent stretch/change in position of joint alters afferent output of the mechanoreceptors, resulting in release of muscle hypertonicity
Precautions and contraindications to HVLA
- Precautions: herniated disc, acute whiplash, post-surgical, vertebral artery ischemia, anticoagulation therapy, hemophilia
- Contraindications: osteoporosis, bony metastases from CA, spondylolisthesis, osteomyelitis, fractures, RA (d/t laxity of transverse ligament of atlas), Down’s syndrome (same reason as RA), vertebral artery stenosis secondary to plaques
Complications from HVLA
- overstretch ligaments leads to injury and subsequent instability of joint and hypermobility
- dislocations
- CVAs
- Muscle spasms
Muscle energy. Direct/indirect, passive/active, extrinsic/intrinsic?
- Direct
- Active
- Extrinsic and intrinsic
Types of muscle energy. Use?
- ) Isometric: change in tension of muscle without approximation of its origin or insertion (ie. muscle stays same length), pt and physician push with equal force, corrects SD
- ) Isotonic: approximation of muscle origin and insertion withtout change in its tension, pt pushes with greater force than physician, tones muscle/strengthens weak muscle
- ) Isolytic: contraction of muscle against resistance while forcing muscle to lengthen, physician overcomes pts force, used to break up scar tissue, adhesions or fibrous tissues
Mechanism of muscle energy action
- Isometric technique resets intrafusal and extrafusal muscle fiber lengths during post-contraction relaxation phase (2-3 second relaxation period)
With regards to isometric muscle energy, resetting the length of muscle fibers occurs during the contraction phase (period when pt is placing force against physician). True/False.
- False. Resetting the length takes place during the post-contraction relaxation phase (period after pt has stopping giving force against physician and physician is then taking up slack)
Contraindications to muscle energy
- Low vitality (fatigued, malaise, not feeling well), fractures, severe NM injuries, pt unable to follow directions, unable to properly position pt
Complications from muscle energy
- Temporary increase in pain
Soft tissue. Direct/indirect, passive/active, extrinsic/intrinsic
- Direct, passive, extrinsic and intrinsic
Contraindications to soft tissue technique
- Cellulitis
Strain/counterstrain. Direct/indirect, passive/active, extrinsic/intrinsic
- Indirect, passive, extrinsic and intrinsic
Strain/counterstrain works by reintroducing a new strain (which is the position of ease). True/False.
- False, reintroducing the original strain, which is the position of ease
Mechanism underlying strain/counterstrain
- Muscle spindles are very sensitive to change in length and monitor stretch and rate of change. They are involved in the SD
- When stretched, will induce reflex contraction of same muscle and inhibit antagonistic muscle
Location of tenderpoints
- Deep in muscle, tendon, ligament of fascia, NOT IN SKIN
There are single tenderpoints for a given SD. True / False
- False, may be multiple for one SD
Tenderpoints are associated with what OMM treatment technique
- Strain/counterstain
Contraindications to strain/counterstrain
- Positions that cause dizziness or radicular pain (radiating pain)
- Extreme forward bending of the thoracolumbar spine in osteoporotic pts must be avoided
Cranial treatment. Direct/indirect, passive/active, extrinsic/intrinsic
- Direct on children, indirect on adults
- Passive
- Extrinsic and intrinsic
What is the primary respiratory mechanism used in cranial/craniosacral treatment?
- Inherent motility of CNS, fluctuation of CSF, mobility of cranial bones, mobility of reciprocal tensions membrane, mobility of sacrum between ilia
Contraindications of cranial treatment
- Acute head trauma
Myofascial release technique. Direct/indirect, passive/active, extrinsic/intrinsic
- Direct or indirect
- Passive
- Extrinsic and intrinsic
Contraindications to myofascial techniques
- Flare-up of symptoms in pts with Lupus and fibromyalgia – these are relative contraindications
Exclusively direct OMM treatments
- HVLA, ME, soft tissue
Exclusively indirect OMM treatments
- Strain/counterstrain
All OMM treatments utilize intrinsic and extrinsic forces except for?
- HVLA, entirely extrinsic
