Lectures 7, 8, & 9 Flashcards
The student will be able to define an Osteopathic Structural Examination. The student will be able to define static analysis and motion testing. The student will be able to define the different types of motion. The student will be able to define the different types of motion barriers.
Osteopathic Manual (Manipulative) Medicine
Application of Osteopathic philosophy, structural diagnosis, and the use of OMT in the diagnosis and management of the patient.
CRITERIA FOR DIAGNOSING A SOMATIC DYSFUNCTION
(S; Sensitivity) T:Tenderness Abnormal sensitivity of the tissue. Pain is what the patient complains about (subjective); tenderness is what you find when you palpate their tissues (objective). A: Asymmetry R: Restricted range of motion T:Tissue texture changes Ropy, boggy, pliable, compressible, rough, edematous \_\_\_\_\_\_\_\_\_\_ -Need at least 2 to have SD -If one is tenderness then need 3. -compare L and R sides for diferences
Most important 2 criteria for diagnosis SD?
restricted ROM and tissue texture changes
forces used in OMM
flexion (sagittal-AP), extension (sagittal-AP), side bending (frontal-coronal), rotation (transverse-horiz)
anatomic barrier
PHYS MOVES absolute limit of passive motion - its the final barrier limited by bone, muscle, ligament
-if you pass this limit = injury
physiologic barrier
PT MOVES -limit of active motion - what individuals can do themselves
restrictive barrier
- a limit that abnormally dimishes normal physiologic ROM
- caused by somatic dysfunctions, surgery muscle tightness, chronic dieases, swelling, scar tissue….
- IF NOT THE SAME ON BOTH SIDES THEN CLEARLY SOME SD
elastic barreir
- not a true barrier
- range between the physiologic and anatomic barriers
extrinsic force (OMT)
- (OUT OF)
- Treatment forces which are not supplied by the patient.
- Operator effort; thrusting, springing, traction, etc.
- Gravity.
- The use of a mechanical table (one that moves the patient).
intrinsic force (OMT)
- (IN)
- Voluntary or involuntary forces from within the patient that assist in manipulation.
- Respiration.
- Muscle contractions.
- Involuntary motions of the cranium and visceral organs.
active force (OMT)
Patient voluntarily performs a physician directed action.
Passive force (OMT)
Patient refrains from voluntary muscle contractions.
Osteopathic Manual (Manipulative) Treatment
Therapeutic application of manually guided forces by an Osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by a somatic dysfunction.
Direct movement
Engagement of the restrictive barrier carrying the dysfunctional component (somatic dysfunction = SD) TOWARD OR THROUGH THE BARRIER.
indirect movmenet
- The motion barrier is disengaged.
- The dysfunctional body part (SD) is moved AWAY FROM THE RESTRICTIVE BARRIER and towards a point of balanced or decreased tissue tension in all planes or directions.
purpose of both indirect and direct movments?
to increase ROM
transitional areas are areas where
- Areas in the body where most dysfunctions can be found.
- Those areas that have the most mobility or are transition points within the: musculoskeletal system. Head/neck. Neck/thorax. Thorax/lumbar. Lumbar/sacral.
- Most SD’s will develop here because of the increased motion within these areas.–>Most people can adapt to these…it is when they don’t that they seek your help.
HVLA
- An articulatory manipulative procedure whereby the barrier or end-point of joint motion is engaged directly, carrying the dysfunctional component through the barrier in order to bring about an increase in freedom and range of motion.
- A quick motion over a short distance that may often produce an auditory noise (pop).
- Direct technique.
- Passive.-pt cant be doing anything
- Extrinsic.
- use is determined by pts condition
- Pt feels instant relief
- may overstretch ligaments if done too freqeuntly
- perform once or twice a week
HVLA treats…
BONY not MUSCULAR SD.
highest injury potential treatment
HVLA
over stretched ligaments can… (due to HVLA)
weakened ligaments = instability of the joint
HVLA mech of action:
gamma and alpha motor neuron inhibition due to stretch of spindle and Golgi apparatus mechanisms
After HVLA immediate change in muscle tone is due to
mimediate change in neural activity
How does HVLA trust change the neural activity
A sudden stretch or change in position of the joint alters the afferent output of the mechanoreceptors (of joint capsule), resulting in release of the muscle hypertonicity.
benefits and precautions of HVLA
- Very efficient use of physician’s time.
- May be longer lasting.
- Immediate relief for the patient.
HNP (herniated nucleus pulposis = herniated disc), acute whiplash, post-surgical, vertebral artery ischemia, anticoagulation therapy, hemophilia.
HVLA is what kind of treatment?
passive extrinsic
what is the prolem with HVLA? How to avoid?
when the pt doesnt RELAX. Not passive. Muscle spasms?
need to make sre that the pt is comfortable with the treatment. Also can use other soft tissue techniques to loose up and relax pt/tissues
golgi tendons measure
measuretension
muscle spindles
measure how fast something is moving
very sensitive to changes in length – involved with the facilitated segment (or SD)
bringing restriction back to its physiological
stretch/mvoement of HVLA thrust–> changes afferent output of mechanoreceptors –> changes muscles hypertonicity—> allows joint to go back to normal
muscle energy
- A form of manipulation in which the patient uses their muscles, on request, from a precisely controlled position, and in a specific direction, against a physician’s counterforce.
- The physician takes the body region into its barrier and the patient pushes back against them.
- Direct technique.
- Patient is active.
- Must be able to follow directions to assist in treatment.
- Extrinsic and intrinsic.
isometric muscel energy
- change in the tension of a muscle without approximation of its origin or insertion
- muscle is same lenght throughout
- correct a SD
isotonic ME
- Approximation of the muscle origin and insertion without change in its tension.
- The patient pushes with greater force than the physician.
- The patient wins.
- Used to tone muscle or will strengthen a physiologic weak muscle.
isolytic ME
- Contraction of a muscle against resistance -while forcing the muscle to lengthen.
- The physician overcomes the patient.
- The physician wins.
- Used to break up scar tissue, adhesions, or fibrous tissue
ME mechanism of action
This mechanism sets the baseline level of activity in Alpha-motor neurons and helps to regulate muscle length and tone.
ME physiologic principle of isometric technique
Isometric technique resets the intrafusal and extrafusal muscle fiber lengths during the post-contraction relaxation phase;
true treatment phase of ME
when youre taking up the slack during the refractory period … NOT when the patient is pushing against you
when is ME most effective?
Most effective when a specific joint or muscle is involved and when patient cooperation and operator forces can be well controlled.
when to NOT use ME
- Not to be performed on patients with low vitality who could be further compromised by adding active muscular exertion.
- Fractures.
- Severe neuromuscular injuries involving potential treatment sites.
- Patient cannot follow directions.
- Proper patient positioning cannot be achieved.
soft tissue
- A procedure directed toward tissues other than the skeleton while monitoring response and motion changes using diagnostic palpation.
- AKA- MYOFASCIAL TREATMENT
- Direct technique.
- Patient is passive.
- Extrinsic and intrinsic (monitoring what Pt is doing )
- –> NOT WORKING ON BONE SPECIFICALLY
applications of soft tissue
- Relax tight muscles.
- Stretch passive fascial structures.
- Enhance circulation to local myofascial structures.
- Improve local tissue nutrition, oxygenation, and removal of metabolic wastes.
- Improve abnormal somato-somatic and somato-visceral reflex activity.
- Identify areas of somatic dysfunction.
- Observe tissue response to manipulation.
- Improve local and systemic immune responsiveness.
- Provide a general state of relaxation.
- Prepare the tissues for further treatment.
mechanisms of soft tissue techniques
1) Tractional technique (stretching). -Origin and insertion of the myofascial structures being treated are longitudinally separated.(Cervical stretching).
2) Kneading. -Rhythmic, lateral stretching of the myofascial structure in which the origin and insertion are held stationary and the central portion of the structure is stretched (like a bowstring (Thoracolumbar soft tissue prone).
3) Inhibition. -Sustained deep pressure over a hypertonic (tight) myofascial structure. (Suboccipital tension release, trapezius pinch).
