MECHANISM OF ACTION Flashcards
MET
Muscle Energy Technique (MET) utilises a patient’s active muscle contraction against a controlled resistance applied by the practitioner.
1. Post-Isometric Relaxation (PIR)
* After an isometric contraction, there is a brief period of decreased muscle tone and increased stretch tolerance due to reduced activity in alpha motor neurons.
* This allows for muscle lengthening and reduced hypertonicity.
2. Reciprocal Inhibition (RI)
* Contracting the antagonist muscle inhibits the activity of the agonist (tight) muscle via spinal reflex pathways.
* This helps in releasing muscle tightness and restoring joint motion.
3. Golgi Tendon Organ (GTO) Activation
* Sustained contraction stimulates the GTO, which inhibits excessive muscle tension and promotes relaxation through reflexive inhibition.
4. Proprioceptive Neuromuscular Facilitation (PNF)
* Enhances neuromuscular control by improving communication between muscles and the nervous system.
* Improves coordination and motor control.
5. Improved Joint Mobilization and Alignment
* By engaging the muscles around a restricted joint, MET helps reposition the joint and improve its range of motion.
6. Autonomic Nervous System Modulation
* Reduces excessive sympathetic tone, promoting relaxation, pain relief, and improved circulation.
These mechanisms help restore normal muscle function, enhance flexibility, and improve joint mobility in osteopathic practice.
NMT
Neuromuscular techniques (NMT) in osteopathy focus on assessing and treating muscular dysfunction, pain, and imbalances by influencing the nervous system and soft tissues.
1. Modulation of Neuromuscular Reflexes
* NMT affects muscle spindle activity and Golgi tendon organs, helping reset abnormal muscle tone.
* It can inhibit hypertonic muscles and stimulate weak or inhibited muscles, restoring balance.
2. Pain Gate Theory (Melzack & Wall, 1965)
* By applying pressure and movement, NMT stimulates large-diameter afferent nerve fibers (A-beta), which inhibit pain transmission via the dorsal horn of the spinal cord.
3. Myofascial Release and Fluid Dynamics
* Helps break down adhesions and improve circulation of blood and lymph, reducing metabolic waste accumulation and improving tissue health.
4. Improved Proprioception and Motor Control
* Stimulation of mechanoreceptors enhances proprioceptive feedback, improving muscle coordination and reducing the risk of re-injury.
5. Autonomic Nervous System Regulation
* By reducing excessive sympathetic activity, NMT promotes parasympathetic dominance, leading to relaxation, improved tissue perfusion, and pain relief.
6. Trigger Point Deactivation
* Neuromuscular techniques target myofascial trigger points, reducing local and referred pain by altering abnormal neuromuscular firing patterns.
These mechanisms work together to restore neuromuscular balance, reduce pain, and improve functional movement patterns in osteopathic practice.
STT
Soft tissue techniques (STT) in osteopathy involve manual manipulation of muscles, fascia, and connective tissues to improve mobility, reduce pain, and restore function.
1. Mechanical Effects
* Tissue Lengthening and Relaxation: Stretching and pressure applied to muscles and fascia reduce stiffness and improve tissue extensibility.
* Breaking Down Adhesions: Helps separate muscle fibers and fascial layers, reducing restrictions that impair movement.
* Improved Tissue Glide: Enhances the ability of muscles and connective tissues to move freely, reducing mechanical resistance.
2. Neuromuscular Effects
* Reflex Muscle Inhibition: Stimulating mechanoreceptors (Golgi tendon organs, muscle spindles) reduces excessive muscle tone and prevents muscle guarding.
* Proprioceptive Enhancement: Increases awareness of muscle and joint positioning, improving coordination and movement control.
3. Pain Modulation
* Gate Control Theory: Stimulating large sensory fibers (A-beta) inhibits pain transmission from smaller nociceptive fibers (A-delta, C fibers) at the spinal cord level.
* Descending Pain Inhibition: Soft tissue work can activate central pain-modulating pathways, reducing pain perception through the release of endorphins.
4. Circulatory and Lymphatic Effects
* Increased Blood Flow: Enhances tissue perfusion, delivering oxygen and nutrients while promoting metabolic waste removal.
* Lymphatic Drainage: Encourages the movement of interstitial fluid, reducing swelling and inflammation.
5. Autonomic Nervous System Modulation
* Reduction of Sympathetic Overactivity: Soft tissue techniques can promote parasympathetic activation, reducing stress-related tension and improving relaxation.
By addressing muscular, fascial, and neurological dysfunctions, soft tissue techniques in osteopathy help restore normal movement, relieve pain, and enhance overall musculoskeletal function.
HVT
High-Velocity Thrust (HVT), also known as High-Velocity Low-Amplitude (HVLA) manipulation, is a direct osteopathic technique used to restore joint mobility and reduce musculoskeletal dysfunction.
1. Cavitation and Joint Gapping
* HVT creates a rapid but controlled separation of joint surfaces, leading to the formation of gas bubbles (cavitation) within the synovial fluid.
* This reduces intra-articular pressure and increases joint mobility.
2. Reflex Neuromuscular Inhibition
* The sudden stretch stimulates mechanoreceptors (e.g., Golgi tendon organs and muscle spindles), leading to a reflex relaxation of hypertonic muscles surrounding the joint.
* This decreases muscle guarding and improves range of motion.
3. Pain Modulation (Gate Control Theory & Descending Inhibition)
* The rapid stimulation of proprioceptors and mechanoreceptors inhibits nociceptive (pain) signals at the spinal cord level.
* Activation of descending inhibitory pathways from the brainstem further reduces pain perception.
4. Restoration of Joint Arthrokinematics
* HVT improves joint congruency and restores normal accessory movements (gliding, rolling, and spinning), reducing mechanical dysfunction.
5. Improved Blood Flow and Lymphatic Drainage
* The release of fascial and muscular tension enhances local circulation, promoting tissue healing and reducing inflammation.
6. Autonomic Nervous System Modulation
* HVT may influence the sympathetic nervous system, shifting towards parasympathetic dominance, which promotes relaxation and systemic balance.
These mechanisms collectively help alleviate pain, restore mobility, and optimize musculoskeletal function in osteopathic practice.
JOINT MOBILISATIONS
Joint mobilization is a manual therapy technique used in osteopathy to improve joint function, reduce pain, and restore mobility. It involves rhythmic, low-velocity movements applied to a joint within its physiological range of motion. The mechanism of action involves several physiological and neurological effects:
1. Mechanical Effects
* Restoration of Joint Arthrokinematics: Mobilization improves accessory joint movements (gliding, rolling, and spinning), enhancing overall joint function.
* Reduction of Joint Stiffness: By stretching the joint capsule and surrounding connective tissues, mobilization increases joint compliance and flexibility.
* Synovial Fluid Movement: Enhances lubrication and nutrient exchange within the joint, improving cartilage health and reducing friction.
2. Neuromuscular Effects
* Reflexive Muscle Relaxation: Stimulates mechanoreceptors (e.g., muscle spindles, Golgi tendon organs), reducing muscle tone and guarding around the joint.
* Proprioceptive Enhancement: Improves the body’s awareness of joint positioning and movement, aiding in better coordination and motor control.
3. Pain Modulation
* Gate Control Theory: Mobilization stimulates large-diameter afferent fibers (A-beta), which inhibit pain transmission from smaller nociceptive fibers (A-delta, C fibers) at the spinal cord level.
* Descending Pain Inhibition: Activates central pain-modulating pathways from the brainstem, leading to decreased pain perception.
4. Circulatory and Lymphatic Effects
* Improved Blood Flow: Mobilization enhances circulation in surrounding tissues, promoting oxygenation and nutrient delivery.
* Lymphatic Drainage: Helps remove metabolic waste and inflammatory byproducts, reducing swelling and stiffness.
5. Autonomic Nervous System Modulation
* Reduction of Sympathetic Overactivity: Mobilization can decrease excessive sympathetic tone, promoting relaxation and systemic balance.
By incorporating these mechanisms, joint mobilizations in osteopathy help restore joint function, alleviate pain, and improve overall movement quality.
FORAMINAL GAPPING
Foraminal gapping is an osteopathic technique aimed at increasing the space within the intervertebral foramen, where spinal nerves exit. This technique helps alleviate nerve compression, improve mobility, and reduce pain.
1. Mechanical Decompression of Neural Structures
* Foraminal gapping increases the space between vertebrae, reducing mechanical compression on spinal nerves and nerve roots.
* This relieves irritation caused by conditions such as herniated discs, osteophytes, or inflammation.
2. Reduction of Intervertebral Disc Pressure
* By creating space between vertebrae, foraminal gapping decreases disc bulging and allows for better hydration and nutrient exchange in the disc.
* This may reduce nerve impingement caused by disc herniation or degeneration.
3. Reflex Neuromuscular Inhibition
* The technique stimulates mechanoreceptors (e.g., Golgi tendon organs, muscle spindles) in muscles surrounding the spine, leading to reflex relaxation of hypertonic muscles.
* This reduces muscle guarding and allows for improved joint mobility.
4. Pain Modulation (Gate Control Theory & Descending Inhibition)
* Increased movement and joint gapping stimulate large-diameter afferent fibers (A-beta), which inhibit pain signals transmitted by smaller nociceptive fibers (A-delta, C fibers).
* This leads to decreased pain perception through spinal cord-level inhibition.
5. Improved Circulation and Lymphatic Drainage
* Reduced mechanical compression allows for better blood flow to neural and surrounding soft tissues.
* Enhanced lymphatic drainage helps clear inflammatory mediators and metabolic waste, reducing local swelling and irritation.
6. Restoration of Joint Arthrokinematics
* By improving intervertebral motion, foraminal gapping restores normal joint function and reduces restrictions that may contribute to pain and stiffness.
7. Autonomic Nervous System Regulation
* Reducing nerve root irritation can balance sympathetic nervous system activity, leading to improved autonomic regulation and reduced pain-related stress responses.
By incorporating these mechanisms, foraminal gapping in osteopathy can effectively reduce nerve compression symptoms, alleviate pain, and improve spinal function.
MYOFASCIAL RELEASE
Myofascial release (MFR) is a manual therapy technique in osteopathy that focuses on reducing fascial restrictions, improving tissue mobility, and alleviating pain.
1. Mechanical Effects
* Fascial Elongation and Viscoelastic Changes: Sustained pressure and stretching modify the viscoelastic properties of fascia, reducing stiffness and restoring normal tissue extensibility.
* Breaking of Adhesions: Helps release fibrotic adhesions between fascial layers, allowing for improved movement between muscles and connective tissues.
* Improved Tissue Glide: Enhances the sliding ability of fascial layers, reducing friction and movement restrictions.
2. Neurological Effects
* Stimulation of Mechanoreceptors: Activates Ruffini endings and Golgi tendon organs, which reduce fascial tension and inhibit muscle hypertonicity.
* Reflexive Muscle Relaxation: Modulates muscle spindle activity, decreasing unnecessary muscle contraction and improving muscle function.
3. Pain Modulation
* Gate Control Theory: Stimulating mechanoreceptors inhibits nociceptive input from pain fibers (A-delta and C fibers) at the spinal cord level, reducing pain perception.
* Descending Pain Inhibition: Myofascial release can activate central inhibitory pathways, decreasing pain sensitivity via endogenous opioid release.
4. Fluid Dynamics and Circulatory Effects
* Enhanced Blood Flow: Releases vascular restrictions, improving circulation and oxygenation of tissues.
* Lymphatic Drainage: Reduces congestion and promotes the removal of metabolic waste, decreasing inflammation and swelling.
5. Autonomic Nervous System Modulation
* Reduction of Sympathetic Overactivity: Helps shift the nervous system toward parasympathetic dominance, promoting relaxation and systemic balance.
By addressing fascial restrictions and promoting neuromuscular and circulatory balance, myofascial release enhances mobility, reduces pain, and optimizes musculoskeletal function in osteopathy.
LYMPHATICS
Lymphatic techniques in osteopathy aim to enhance the movement of lymphatic fluid, improve immune function, and reduce tissue congestion.
1. Mechanical Pumping and Fluid Mobilization
* Techniques such as thoracic pump, pedal pump, and lymphatic drainage massage create rhythmic pressure changes that enhance lymphatic circulation.
* This reduces edema, promotes venous return, and improves tissue oxygenation.
2. Fascial Release and Tissue Compliance
* Lymphatic techniques release fascial restrictions around lymphatic vessels, improving their ability to transport fluid.
* This decreases interstitial fluid buildup and enhances drainage.
3. Autonomic Nervous System Modulation
* Stimulating the lymphatic system can decrease sympathetic overactivity, promoting parasympathetic dominance.
* This reduces stress-related inflammation and improves immune function.
4. Increased Immune Function
* Enhanced lymphatic flow increases the circulation of immune cells (e.g., lymphocytes) and helps in detoxification.
* This supports the body’s ability to fight infections and clear metabolic waste.
5. Respiratory-Circulatory Model Influence
* Techniques that enhance diaphragmatic motion and rib cage mobility (e.g., thoracic pump) improve pressure gradients that drive lymphatic flow.
* This optimizes systemic fluid dynamics and enhances the overall efficiency of the circulatory system.
By addressing lymphatic stagnation, these techniques help reduce swelling, enhance immune response, and promote overall physiological balance in osteopathic practice.
GATE CONTROL THEORY
(Melzack & Wall, 1965)
The Gate Control Theory explains how pain signals are regulated in the spinal cord before reaching the brain. It proposes that a “gate” mechanism in the dorsal horn of the spinal cord controls the transmission of pain signals to the brain.
How It Works:
* Large, fast-conducting nerve fibers (A-beta fibers) carry touch, pressure, and vibration sensations.
* Small, slow-conducting nerve fibers (A-delta and C fibers) carry pain signals.
* When A-beta fibers are stimulated (e.g., through rubbing, massage, or joint mobilization), they inhibit pain signalsfrom A-delta and C fibers by “closing the gate” in the spinal cord.
* If A-delta and C fibers dominate, the “gate” remains open, and pain signals reach the brain.
Clinical Application in Osteopathy:
* Techniques such as joint mobilization, soft tissue work, and myofascial release stimulate A-beta fibers, reducing pain perception.
* This helps modulate pain naturally without relying solely on medication.
Essentially, stimulation of non-painful sensory input can block or reduce the perception of pain, explaining why rubbing an injured area often provides relief.
