Lecture 13 The Facilitated Pathway

Question 1

The rule of the artery***

Answer 1

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

Question 2

direct blockage***

Answer 2

The rule of the artery - direct constriction of the artery or vein delivering the blood by a bone, ligament muscle, tumor …etc

Question 3

neurologic control**

Answer 3

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

Question 4

Poor diaphragmatic action leads to:***

Answer 4

(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)

Question 5

Irvin Korr PhD

Answer 5

proposed the major theory of the facilitated segment responsible for focused abnormal skeletal and visceral function his book

Question 6

Facilitation:***

Answer 6

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.

Question 7

Facilitated segment:***

Answer 7

a vertebral segment of spinal cord level that exhibits facilitation

Question 8

facilitated state may lead to:***

Answer 8

alterations in muscle tone, resulting in myofascial CT stiffness, contracture, pain
–> A SOMATIC DYSFUNCTION.

Question 9

reflex**

Answer 9

involuntary action or response

Question 10

nociception***

Answer 10

the detection and transmission of a noxious stimulus - nociception is the ability of the body to transmit the feeling of pain

Question 11

pain***

Answer 11

unpleasant sensory AND EMOTIONAL experience associated with actual or potential tissue damage - actual pain or mentally you think something is going to hurt

Question 12

Dr Korr theory on somatic dysfunctions:***

Answer 12

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

Question 13

facilitated state may lead to:***

Answer 13

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

Question 14

repeated stimulation of nociceptors (noxious sensation) leads to:***

Answer 14

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

Question 15

Osteopathic approach to evaluation and treatment of somatic dysfunctions:***

Answer 15

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.

Question 16

3 steps to osteopathic approach and SD**

Answer 16

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

Question 17

90-ish percent of the time you only need to:

Answer 17

Balance the area in question - then you can stimulate or inhibit

Question 18

treatment for constrictatory lung issues:

Answer 18

stimulatory

Question 19

autonomic system preference:

Answer 19

segmental preference in regard to visceral organs

Question 20

impairment or restriction along the pathway will:

Answer 20

develop a lower threshold for irritation and dysfunction when it or other structures are stimulated

Question 21

facilitated pathways (4)

Answer 21

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

Question 22

viscero-somatic reflex:**

Answer 22

problem in an internal organ results in a reflex dysfunction of a segmentally related musculoskeletal region (Short term development)

Question 23

somato-visceral reflex:*****

Answer 23

repeated somatic stimuli produce a reflex pattern in segmentally related visceral structures.
sensitization
chronic
take years to show symptoms

Question 24

somato-somatic reflex:*****

Answer 24

injury to one area of the soma results in dysfunction in another area

Question 25

vescero-visceral reflex:***

Answer 25

localized visceral stimuli will produce a reflex pattern in segmentally related visceral structures

Question 26

facilitated nerves…

Answer 26

the nerves were ready on the verge of being stimulated for pain