Mechanisms of Activating forces

Question 1

what is somatic dysfunction?

Answer 1

Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic and neural elements.

Question 2

what type of texture does a viscerosomatic SD typically have?

Answer 2

rubbery

Question 3

what is tissue texture of arthrodial SD?

Answer 3

bony end feel at the restrictive barrier

Question 4

what is the feel of Muscular SD

Answer 4

tense end feel
ropey
tight

Question 5

what does SD associated wtih strain/counterstrain have?

Answer 5

tender points have more tenderness

Question 6

what are factors that predispose people to SD?

Answer 6

posture

gravity

anatomical anomalies

transitional areas

muscle hyperirritability (emotional stress, infection)

trauma

compensation for other structural deficits (short leg, muscle imbalance)

Question 7

what do DO’s call arthrodial somatic dysfunction?

Answer 7

won’t complete full motion

NOT “subluxed” “out of place” “out of joint”

Question 8

2 main theories of why we have SD?

Answer 8

Proprioceptive
Nociceptive

usually combo of the two

Question 9

what did Korr have to say about proprioceptive theory

Answer 9

“A muscle, by changes in the degree of activation and deactivation of its contractile mechanisms, becomes the major and highly variable impediment to mobility of the lesioned joint.”

alteration in both intrinsic and extrinsic reflexes

Question 10

what is gamma gain

Answer 10

inappropriate activity which creates inappropriate muscle length and tone
resulting in a functionally imbalanced joint

can be helped with OMT

it is one of the determinants of the physiological motion barrier and the motion barrier of SD

Question 11

what are the three types of neural feedback that provide proprioceptive input to the spinal cord about muscle length and tension in the musculoskeletal system?

Answer 11

Primary annulosprial endings of afferent fibers (muscle spindle)

secondary flower spray endings (muscle spindle)

golgi tendon organs

Question 12

what do primary annulospiral endings transmit ?

Answer 12

info on the length and rate of change in length of muscles

Question 13

what is the muscle spindle?

Answer 13

connective tissue sheath that encloses intrafusal muscle fibers with each end of the spindle attached to extrafusal muscle fibers

innervated by a single group Ia afferent fiber and a single group II afferent fiber

DOES NOT transmit info about absolute length of the muscle, just the length of the spindle relative to the length of the muscle

connected in PARALLEL

intrinsic (in the muscle itself)

Question 14

what do secondary flower spray endings transmit info about?

Answer 14

relative muscle length

Question 15

what are golgi tendon organs

Answer 15

specialized stretch receptors located in tendons that transmit info on muscle tension

connected in series with extrafusal fibers

contraction induces firing of the golgi tendon organs and this sends info into the spinal cord

Question 16

what is the extrinsic reflex system?

Answer 16

anterior horn cells of the alpha and gamma efferents to the muscle receive synaptic impulses from sensory nerves originating in other muscles or organs

Question 17

what supervises both intrinsic and extrinsic reflex systems?

Answer 17

suprasegmental reflex systems = cerebral cortex

this system is probably what is responsible for us not getting more SD than we have as well as activities of daily living

in SD the muscles and reflex activity have isolated themselves from the suprasegmental control.

example?
reciprocal inhibition of antagonist muscles (biceps/triceps)

Question 18

what is spinal facilitation

Answer 18

areas of the spinal cord will stay hyperexcitable and hyperirritable playing a role in SD

muscles in this area of hypertonic

these areas sometimes have increased muscle activity as well as pain and tenderness when palpated

Question 19

somatosomatic reflexes

Answer 19

defensive reflex

info coming through soma and causes reflex and get response back through motor neurons to other area of body (example→ defensive reflex such as stepping on a nail) (effecting body part and going back out and affecting another body part)

Question 20

viscerovisceral reflexes

Answer 20

organ to another organ

digestion→ when we eat, distention of the gut causes increased contraction of the gut muscle

Question 21

somatovisceral reflexes

Answer 21

info in from soma and affects visceral organ

irritate abdominal skin it slows down digestion→ in rats

Question 22

viscerosomatic reflexes

Answer 22

problem in the viscera, input that goes from that organ into the spinal cord and causes reflex muscular activity of the paraspinal levels at that level of the spinal cord

example upper back pain with an MI (will probably feel tight muscles, ropey)

Question 23

nociceptive theory

Answer 23

noxious stimulus comes in and stimulates the nociceptor

the nociceptor can then stimulate sypathetic activation, which leads to visceral effects or immune effects

the nociceptor can also stimulate spinal cord nocifensive reflexes –> leading to shortened skeletal muscle –> maintained shortened muscle–> connective tissue reorganization in shortened form (scar tissue)

Question 24

why is pain generated by parts of the body that are adapting and not by parts that have impaired function?

Answer 24

Nociceptors are more likely to be stimulated by joint movements especially abnormal movements from adaptation or hypermobility, than by joint restriction.

Question 25

how does OMT work?

Answer 25

omt tends to actively stretch the CT tissues in joint capsules, tendons, muscles and ligements in restricted motion BUT stretching would make SD worse b/c it increases the proprioceptive and nociceptive drives SOOOOO OMT must FIRST DECREASE OR OVERRIDE THESE DRIVES prior to stretching the tissue

Question 26

HVLA

Answer 26

employs a rapid, therapeutic force of brief duration elicits release of restriction best suited to SD with restricted motion with a hard boney end feel useful when not much time is available discouraged to treat the same segment more than once a week due to the possibility of causing joint hypermobility

Question 27

what is end feel

Answer 27

quality of motion at is final barrier what the barrier feels like!

Question 28

how does HVLA work. what are the steps?

Answer 28

doc places pt's restricted joint to the restrictive barriers of the SD by stacking in each plane of the SD a short (low amplitude) quick (high velocity) force is applied to the joint to move it through the restrictive barrier (NO BACKING OFF OR WINDING UP) the joint resets itself and appropriate physiological motion is restored

Question 29

HVLA mechanisms (direct technique)

Answer 29

abnormal muscle activity maintains joint restriction when treating joint, there is an immediate change in the muscles and the quality and quantity of motion, which suggests an immediate change in neural activity sudden stretch or change of position (as with HVLA) alters the AFFERENT OUTPUT of the mechanoreceptors in the joint capsule reflexively switches off muscles that are tight in that area (release of hypertonicity)

Question 30

do you need the snap, crackle or pop for successful treatment?

Answer 30

no

Question 31

HVLA contraindications

Answer 31

``` 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 ```

Question 32

what is MET (direct technique)

Answer 32

using patient's muscles on request, from controlled position, in a specific direction, against a distinctly executed physician counterforce important in the treatment of edema and congestion

Question 33

what are the steps of MET

Answer 33

find restricted joint take joint to restricted barrier (take joint where it doesn't want to go) have the patient apply counterforce to EASE for 5 seconds pause for 2-3 seconds for neuromuscular adaptation resposition to the new restrictive barrier repeat until no further change is obtained REASSESS (this is isometric, muscle stays the same length)

Question 34

what are the MET types of therapeutic muscle contractions?

Answer 34

Isometric - no length change (most common) Isotonic - length change (good for hypotonic), reflexively inhibited muscles - concentric - eccentric - isolytic eccentric - isokinetic

Question 35

concentric ?

Answer 35

shortening | "the patient wins"

Question 36

eccentric?

Answer 36

lengthening "the doc wins"

Question 37

isolytic eccentric

Answer 37

quick movement | used to treat fibrotic or chronically shortened myofascial tissues

Question 38

isokinetic

Answer 38

concentric or eccentric | where the length change occurs at a constant velocity/pace

Question 39

Post-isometric relaxation

Answer 39

the pause during MET this is immediately after an isometric contraction, the neuromuscular apparatus is in a refractory state during which passive stretching may be performed without encountering strong myotatic reflex opposition (the nervous system isn't guarding) this is where the treatment is taking place and not in the contraction itself

Question 40

MET mechanisms by type of activating force

Answer 40

``` post-isometric relaxation joint mobilization using muscle force respiratory assistance oculocephalogyric relfex reciprocal inhibition crossed extensor reflex ```

Question 41

joint mobilization using muscle force

Answer 41

using alot of force to do the MET contraction releases joint surfaces

Question 42

respiratory assistance

Answer 42

using their breathing to provide activating force of treatment

Question 43

oculocephalogyric reflex

Answer 43

using the eye muscles and their is a reflex that goes to upper neck muscles GOAL= to effect reflex muscle contractions using eye motion exceptionally gentle force of contraction

Question 44

reciprocal inhibition

Answer 44

when a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of that muscle's antagonistic group GOAL--> to lengthen a muscle shortened by a cramp or acute spasm very gentle force of contraction good for acutely injured or painful muscles

Question 45

crossed extensor reflex

Answer 45

When the flexor muscle in one extremity is contracted voluntarily, the flexor muscle in the contralateral extremity relaxes and the extensor contracts. ``` 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. ``` very gentle force of contraction

Question 46

Absolute contraindications for MET

Answer 46

Absence of somatic dysfunction Lack of patient consent and/or cooperation Oculocephalogyric reflex technique in someone with recent eye surgery or trauma

Question 47

what are the absolute contraindications for MFR?

Answer 47

absence of somatic dysfunction lack of patient consent and or cooperation

Question 48

what are the contraindications for doing OCF

Answer 48

increased intracranial pressure acute intracranial bleeding skull fracture scute cerebrovascular accident

Question 49

what is strain /countersrain technique?

Answer 49

it is an indirect technique SD diagnosed by myofascial tender point, is treated by using a position of spontaneous tissue release while simultaneously monitoring the tender point

Question 50

steps of Strain/Counterstrain

Answer 50

Palpate for areas of increased sensitivity (tenderpoints) Establish a pain scale (“this is a 10”) Place the patient passively in a position that will eliminate this tenderness (pain scale 3 or less) Maintain this position for 90 seconds while continuously monitoring the point (light touch) (let up on the pressure so you may palpate the pulsation) Passively return the patient’s body to its original position Recheck the tenderpoint

Question 51

how is a tender point formed?

Answer 51

Development of an inappropriate proprioceptive reflex caused by the gamma system Rapid lengthening of myofascial tissuse --> afferent feedback indicates possible damage from a strain > the body tries to prevent damage by rapidly contracting the myofascial tissue --> this causes the antagonist muscle to rapidly lengthen and produces the inappropriate reflex and the tenderpoint Nociceptive feedback from the antagonist muscle is interpreted as a muscle strain (although one hasn’t occurred) --> hypertonic myofascial tissue and restricted motion (SD) A guarding reflex by the patient, without actual trauma, may also produce the inappropriate reflex.

Question 52

what are the S/CS mechanics?

Answer 52

The already shortened and restricted tissues are initially further shortened, removing all internal stresses and resetting gamma gain and deactivating the nociceptors Maintaining the comfortable position for 90 seconds allows local circulation to improve due to reduction of chronic sympathetic stimulation Local inflammation and edema decrease as the noxious chemicals are carried away Slowly returning to neutral will passively stretch the connective tissues

Question 53

absolute contraindications to S/CS

Answer 53

Absence of SD lack of patient consent

Question 54

Soft tissue absolute contraindications

Answer 54

absence of SD lack of patient consent

Question 55

what are lymphatic techniques and their purpose?

Answer 55

are techniques that are designed to move the lymph use them in times of the patient having infection, cold, edema, because it helps improve immune response remove any central impediments first b/c it is a very low pressure system, and then move peripherally

Question 56

lymphatic technique steps

Answer 56

remove impediments to lympathic flow starting centrally and moving peripherally utilize an extrinsic pumping motion that mobilizes lymphatic fluid through: external pressure changes in pressure gradients oscillatory movements

Question 57

lymphatic technique absolute contraindications

Answer 57

aneuresis if not on dialysis necrotizing fasciitis lack of patient consent or cooperation

Question 58

what is soft tissue technique

Answer 58

A direct technique that usually involves lateral stretching, linear stretching, deep pressure, traction and/or separation of muscle origin and insertion while monitoring tissue response and muscle changes by palpation.

Question 59

what are the types of ST manipulation styles?

Answer 59

``` stretching kneading inhibition effleruage petrissage and skin rolling tapotement (karate chop) ```

Question 60

what is the best technique for hypotonic muscles?

Answer 60

soft tissue technique because it create tonic muscle stimulating by activating the stretch reflex

Question 61

if you have a transverse process that is more posterior to the right what is its dysfunction called?

Answer 61

rotated right

Question 62

what if something prefers extension?

Answer 62

then you name it extension

Question 63

look at practice questions on fryette's powerpoint

Answer 63

do it

Question 64

what is the goal of myofascial technique?

Answer 64

normalize range of motion

Question 65

Deformation of bone and connective tissue along lines of force is an example of what?

Answer 65

Wolff's law

Question 66

pt has right hand contacting the back of his neck and brought to flexion of T6

Answer 66

so he is rotated right and side bent right b/c it is type II isolating T6 with muscle eneryg take patient into restriction, so we put him in flexion so he is named extension put up hand on the side of the posterior process

Question 67

the 1st 30 degress of shoulder abduction primarily occurs at which joint?

Answer 67

glenohumeral joint

Question 68

which muscle primarily contracts and produces the 1st 30 degrees of shoulder abduction?

Answer 68

supraspinatous

Question 69

what muscle is most likely injured in someone with noted decreased external rotation?

Answer 69

infraspinatous teres minor or posterior head of deltoid

Question 70

subscapularis action?

Answer 70

``` internal rotation (medial) ```

Question 71

where will you most likely find a counterstrain tenderpoint in an injury to the infraspinatous?

Answer 71

infraspinous fossa

Question 72

what are you thinking posteriormedial border of the scapula?

Answer 72

rhomboids

Question 73

the arterial supply to his shoulder will most likely be improved by treating dysfunction at which levels? in a man who has right shoulder pain after his dog pulled his right arm and he has restricted motion in all directions

Answer 73

T2-T6 sympathetics towards the arm

Question 74

stage 1 of spencer's technique is used to improve extension . so the patient primarily contracts which muscle

Answer 74

anterior deltoid pushing the patient into the restrictive barrier so they use their anterior deltoid to push into ease or flexion in this case

Question 75

what is an absolute contraindication for spencer's techniques?

Answer 75

LOOK UP, page 31 of lab manual one of them is septic glenohumeral joint

Question 76

if you have restricted flexion and right rotation what is the dysfunction?

Answer 76

E RSL (rotated and side bent left)

Question 77

if your L3 is extended and rotated to the right you would expect to find L3....

Answer 77

Side bent to the right this is a type II dysfunction

Question 78

a fall on an outstretched hand onto palms puts the radial head in what position?

Answer 78

posterior

Question 79

if you have right medial elbow pain and on exam you find right wrist that is adducted and an increased carrying angle, what SD is present?

Answer 79

abducted ulna

Question 80

medial glide of olecranon (elbow)

Answer 80

is abduction of the forearm wrist adduction