Lecture 01 Somatic Dysfunction/Barriers

Question 1

4 osteopathic tenets

Answer 1

1. Body is unit
2. Body self regulating and self protecting
3. Structure and function are interrelated
4. Rational treatment based on the 3 principals

Question 2

What is somatic dysfunction?

Answer 2

• impaired or altered function of related components of the somatic system (skeletal, arthrodial, myofascial, vascular, lymphatic, neural)
• treatable using OMT

Question 3

What is OMT?

Answer 3

-therapeutic application of manual forces used to improve physiologic function and support homeostasis

Question 4

What does TART stand for?

Answer 4

Tissue texture change
Asymmetry
Restriction of motion
Tenderness

Question 5

Tissue Texture Change

Answer 5

1. Skin= warm/moist/red (acute) or cool/pale with trophic changes-dry/scaly/hairless/shiny/folliculitis (chronic)
2. Tissue= boggy/edema/fluid (acute) or doughy/stringy/fibrotic/ropy/thickened/contractures (chronic)
3. Vascular= inflammation (acute), sympathetic tone/vascular constriction (chronic)
4. Sympathetics= local vasoconstriction overpowered by chemical release (acute) or vasoconstriction (chronic)
5. Musculature= increase muscle tone/contraction/spasm (acute) or decrease tone/flaccid/mushy/contracture (chronic)

Question 6

Restriction of Motion: mobility

Answer 6

• acute= range of motion sluggish and guarded to prevent pain
• chronic= limited ROM but motion itself normal

Question 7

AROM (active) vs PROM (passive)

Answer 7

• patient demonstrates activity= active

- Patrice is not active, examiner takes relaxed limb through its complete range= passive

Question 8

Which allows the greater ROM active or passive?

Answer 8

• PROM is greater ROM because no muscles in use only ligaments to stop motion
• AROM patient uses their own muscles and agonist and antagonist are both in use so there is less ROM

Question 9

What is the “end feel”

Answer 9

• palpatory experience or perceived quality of motion when a joint is moved to its limit (barrier is approached)
• normal end feel examples= bone to bone (elbow extension), soft tissue (knee flexion), tissue stretch (ankle dorsiflexion, finger extension)

Question 10

What are abnormal end feel?

Answer 10

• early (protection post injury) and late (chronic) muscle spasm
• hard capsular (frozen shoulder)
• soft capsular (synovitis)

Question 11

What are the 5 osteopathic barrier concepts?

Answer 11

1. Anatomic
2. Physiologic
3. Restrictive
4. Elastic
5. Pathologic

Question 12

Anatomic barrier

Answer 12

• limit of motion imposed by anatomic structure

- just beyond limit of PROM

Question 13

Physiologic barrier

Answer 13

-limit of AROM
(Can increase ROM by warm ups/stretching)
-as far as you can go by yourself

Question 14

Restrictive barrier

Answer 14

• functional limit within anatomic ROM which abnormally diminishes the normal ROM so cannot achieve full range (lost ROM)
• unable to reach full motion with appropriate effort

Question 15

Elastic barrier

Answer 15

• range between physiologic and anatomic barrier or motion in which passive ligamentous stretching occurs before tissue disruption
• stretch between AROM and PROM

Question 16

Tenderness

Answer 16

• discomfort or pain elicited by physcian X through palpate on
• unusual sensitivity to touch or pressure
• acute= sharp/severe/cutting
• chronic= dull/ache/paresthesias(tingle/burn/itch)

Question 17

What is acute TART?

Answer 17

• tissue texture= red/boggy/swollen/increased tone
• asymmetry= present
• restriction= present/painful with motion
• tenderness= sharp pain

Question 18

What is chronic TART?

Answer 18

• tissue texture= dry/cool/ropy/pale/decreased tone
• asymmetry= present (compensation occurs)
• restriction= present maybe not guarded
• tenderness= dull, achy pain

Question 19

How are somatic dysfunctions named?

Answer 19

• position of ease? Where they live

- if a body segment freely rotates to the left but restricted to the right the dysfunction is named: Rotated Left