Mechanisms of activating forces Flashcards
Describe the various factors that predispose someone to a somatic dysfunction.
1) **Posture: habitual, occupational, sport
2) Transitional areas (OA, thoracic inlet, TL juctions, LS junction)
3) Emotional stress
4) not stretching after exercise
Intrinsic reflex system
Muscle spindle that is located w/in the muscle belly
Provide proprioceptive input
transmit info about the length of spindle fibers relative to the length of muscle (**relative length)
–> measure stretch
Proprioceptive theory
alteration in both intrinsic and extrinsic reflexes
The alpha motor neuron activity has been abnormally reset to a higher gamma gain, keeping the muscle’s resting length abnormally short
GTO
in the tendon, in series with the muscle
tells CNS about relative length CHANGES
to avoid tearing
Extrinsic Reflex system
everything spinal cord and in the cerebral cortex. Brain is keeping track of what is going on, sends coordinated signals to the SC which transmits signals to coordinate muscle activities.
Problems arise when brain has not prepped the body for an unexpected movement –> muscle tears
Ex: reciprocal inhibition of agonist/antagonist muscle pairs and visero-somatic muscle guarding
gamma gain
determinant of physiological/SD barrier of the SD
reset when muscle movements establish a positive feedback loop which increases gamma gain–>hypertonicity
Somatosomatic reflex
e.g. defensive
info from body–>reflex via motor neuron in another body bart (think stepping on a nail)
Viscerovisceral reflex
distension of gut causing contraction of the gut muscle
organs–>SC–> output to same or other organs
think food enters gut and stimulates contraction to move bolus
Somatovisceral
stimulation of abdominal skin inhibits gut activity
Viserosomatic
problem in viscera can cause SD in paraspinals
Not usually resolved after initial tx
How does OMT work
override overactive protective mechanisms in a shortened muscle, then actively stretch CT
HVLA
Very quick, over short distance that engages the restrictive barrier to release this barrier
Best suited to an SD with restricted motion with a hard/distinctive/firm/bony end feel
(Arthordial SD)
Sudden stretch or change of position of the joint alters the afferent output of the mechanoreceptors in the joint capsule, resulting in release of muscle hypertonicity
the sicker the patient, the lower the dose
HVLA contraindications
Rheumatoid arthritis Down syndrome Achondroplastic dwarfism Chiari malformation Fracture / dislocation / spinal or joint instability Ankylosis / Spondylosis with fusion Surgical fusion Klippel-Feil syndrome Vertebrobasilar insufficiency Inflammatory joint disease Joint infection Bony malignancy Patient refusal
MET Contraindications
Absence of somatic dysfunction
Lack of patient consent and/or cooperation
Oculocephalogyric reflex technique in someone with recent eye surgery or trauma
MFR Contraindications
absence of SD
lack of pt consent or cooperation
OFC contraindication
Increased intracranial pressure
Acute intracranial bleeding
Skull fracture
Acute cerebrovascular accident
S/CS contraindications
absence of Sd
lack of pt consent/cooperation
Lymphatic technique contraindications
aneuresis if not on dialysis
necrotizing fascitis of area involved
lack of pt consent or cooperation
MET
patient’s muscles are actively used on request against a physicians counterforce in order to correct the dysfunction of the joint
can be used at any joint that is crossed by skeletal muscle
** important of edema or congestion
**direct technique
take joint where it does not want to go
Isometric MET contractions
no length change, most common
Isotonic
Tone is constant, but length change, the counterforce moves
good for hypotonic reflexively inhibited muscles
Concentric
shortening, the patient wins
eccentric
lengthening, the doc win s
isolytic eccentric
quick movement, used to treat fibrotic myofascial tissues
isokinetic
concentric or eccentric where the length change occurs at constant velocity
Post isometric relaxation
delay after the pt is pushing against you when you can push the muscle past the original barrier without the CNS restricting motion with guarding
**critical to wait 2-3 seconds
Goal: To accomplish muscle relaxation –> increased ROM
Force of Contraction: Sustained gentle pressure
Joint mobilization using muscle force
Goal: To accomplish restoration of joint motion in an articular dysfunction
Force of Contraction: Maximal muscle contraction that can be comfortably resisted by
the physician
thought to push out fluid etc
Respiratory assistance
breathing to provide active force
good for ribs etc
Goal: To produce improved body physiology using the patient’s voluntary respiratory
motion.
Force of Contraction: Exaggerated respiratory motion
Oculocephalogyric reflex
uses eye muscles that reflexes back to neck muscles
Goal: To effect reflex muscle contractions using eye motion.
Force of Contraction: Exceptionally gentle
Reciprocal inhibition
using contraction of agonist to relax the antagonist
Goal: To lengthen a muscle shortened by cramp or acute spasm.
Force of Contraction: Very gentle
cross extensor reflexes
agonist on one side to relax on the other side
Goal: Used in the extremities where the muscle that requires treatment is in an area so
severely injured (e.g., fractures or burns) such that manual contact with the affected limb is inadvisable.
Force of Contraction: Very gentle
Steps to S/CS
1) Palpate for areas of increased sensitivity (tenderpoints)
2) Establish a pain scale (“this is a 10”)
3) Place the patient passively in a position that will eliminate this tenderness (pain scale 3 or less)
—> motion depends on the area involved
4) Maintain this position for 90 seconds while continuously monitoring the point (light touch)
5) Passively return the patient’s body to its original position
Recheck the tenderpoint
formation of a tenderpoint
**Development of an inappropriate proprioceptive reflex caused by the gamma system
caused by rapid lengthening of the antagonist muscle in response to abnormal lengthening of myofascial tissue
nociceptive feedback from the antagonist
upregulated gamma gain due to rapid myofascial length change that causes an inappropriate reflex on the agonist muscle that when stimulate sends nociceptive signals to the brain which are interpreted as stretch, when there is none.
lymphatic techniques
remove impediments to lymphatic circulation and promote and augment flow of lymph
if pt has edema, infection, or cold to improve the immune response
ST contraindications
absence of SD
lack of pt consent and/or cooperation
