Lecture 13 The Facilitated Pathway Flashcards
The rule of the artery***
1) disease was a state in which the proper amount of blood flow through the diseased part of the body was lacking. If the blood flow was slowed (Ischemia) then there was disease and eventually death (Direct blockage
direct blockage***
The rule of the artery - direct constriction of the artery or vein delivering the blood by a bone, ligament muscle, tumor …etc
neurologic control**
1) closing of arteries, veins, or lymphatics due to the irritation of certain nerves that control them (poor sympathetic or parasympathetic innervation)
2) Nerve irritation: direct compression as nerve moves through foramen of b/w soft tissue planes = decrease in axoplasmic flow and this leads to a change in circulation and even decrease in function of end organ
Poor diaphragmatic action leads to:***
(due to somatic dysfunctions of the bony and fascial tissues) leads to improper venous and lymphatic drainage which can allow fluids to pool, lead to congestion, and in turn doesnt allow arterial blood to reach end organ. (Gordon Zink DO)
Irvin Korr PhD
proposed the major theory of the facilitated segment responsible for focused abnormal skeletal and visceral function his book
Facilitation:***
Maintenance of a pool of neurons in a state of partial or subthreshold excitation. In this state, less afferent stimulation (incoming pulse) is needed to trigger a response.
Facilitated segment:***
a vertebral segment of spinal cord level that exhibits facilitation
facilitated state may lead to:***
alterations in muscle tone, resulting in myofascial CT stiffness, contracture, pain
–> A SOMATIC DYSFUNCTION.
reflex**
involuntary action or response
nociception***
the detection and transmission of a noxious stimulus - nociception is the ability of the body to transmit the feeling of pain
pain***
unpleasant sensory AND EMOTIONAL experience associated with actual or potential tissue damage - actual pain or mentally you think something is going to hurt
Dr Korr theory on somatic dysfunctions:***
1) large portion of neurons in somatic dysfunction areas are kept near their points of depolarization, making them more sensitive to the production of an action potential.
2) action potentials sent via nerve axons to final end organ
facilitated state may lead to:***
alteration in muscle tone, resulting in myofascial CT stiffness, contracture and pain. Repeated of strong stimuli tend to elicit a decremental response in most types of nerve receptors
repeated stimulation of nociceptors (noxious sensation) leads to:***
1) repeated noxious sensation appears to lower the activation energy necessary to provoke an action potential.
2) nociceptors play an integral role in the facilitation process
Osteopathic approach to evaluation and treatment of somatic dysfunctions:***
1) Start with med diagnosis
2) Figure out which arteries feed that area and which nerves control that area and where those nerves originate from
3) Do structural exam of that relevant area -any palpatory changes?
4) Can you apply OMM to correct that area? Stimulate or inhibit with OMM.
5) Allow the body to heal on it’s own
6) Further body rest, avoiding certain activites or meds/surgery if needed.
3 steps to osteopathic approach and SD**
Step 1: Perform a history and physical exam - develop diagnosis
Step 2: Diagnose the SD after reasoning what anatomical areas are related to the disease
Step 3: Treat the SD FIRST and then remove all tissue texture changes, asymmetry, restriction of motion, and tenderness if possible.
Step 4: Area of relevance- do I need to stimulate or inhibit?
a) stimulation - with percussion or faster, deeper soft tissue techniques on the paraspinal areas already treated
b) inhibition - with soothing slow pressure that increase on the paraspinal areas already treated
90-ish percent of the time you only need to:
Balance the area in question - then you can stimulate or inhibit
treatment for constrictatory lung issues:
stimulatory
autonomic system preference:
segmental preference in regard to visceral organs
impairment or restriction along the pathway will:
develop a lower threshold for irritation and dysfunction when it or other structures are stimulated
facilitated pathways (4)
1) Viscero somatic: starts with a problem and effects the spine
2) Somato-visceral: problem in the spine that effects organ
3) Somo-somatic: area of spine will affect a joint or non-organ like the knee
4) viscero-visceral: problem in an area causes a problem in another area ex) heart issue causing nausea
viscero-somatic reflex:**
problem in an internal organ results in a reflex dysfunction of a segmentally related musculoskeletal region (Short term development)
somato-visceral reflex:*****
repeated somatic stimuli produce a reflex pattern in segmentally related visceral structures.
sensitization
chronic
take years to show symptoms
somato-somatic reflex:*****
injury to one area of the soma results in dysfunction in another area
vescero-visceral reflex:***
localized visceral stimuli will produce a reflex pattern in segmentally related visceral structures
facilitated nerves…
the nerves were ready on the verge of being stimulated for pain
