Mechanisms of Activating Forces Flashcards
somatic dysfunction
impaired or altered functions of related components of somatic system
what indicates somatic dysfunction?
TART changes
not all TART changes are equal
what predisposes someone to somatic dysfunction?
posture** gravity anatomical anomalies transitional areas** - change in vertebrate muscle hyperirritability physiologic locking of joint adaptation to stressors trauma compensation for other structural deficit
viscerosomatic SD
rubbery tissue texture change
arthrodial SD
bony end feel at restrictive barrier
joint SD**
muscular SD
tight, tense end feel
strain/counterstrain SD?
tender points have more tenderness
arthrodial SD details?
not out of place (subluxed) but won’t complete full ROM
- say it is restricted
- tightening of fascia, myofascia, capsular components
two main theories of SD?
proprioceptive - proprioception
nociceptive - painful stimulus
**not sure, maybe a combination of the two
proprioceptive theory
muscles cause SD
alteration in intrinsic and extrinsic reflexes
inappropriate gamma activity creates imbalanced joint bc of inappropriate muscle length and tone
3 types of neural feedback providing proprioception?
1 - primary annulospiral
2 - secondary flower spray ending
3 - golgi tendon organs
primary annulospiral endings
transmit info on length/stretch/velocity of muscles
secondary flower spray endings
transmit info on length/stretch
**not velocity
golgi tendon organs
transmit info on muscle tension
- contraction induces firing of golgi tendon organs
- connected in series with extrafusal fibers
muscle spindle?
intrafusal fibers in a spindle attached to extrafusal fibers
intrinsic reflex system?
involves the muscle spindles
gamma motor neurons
intrafusal fibers
alpha motor neurons
extrafusal fibers
extrinsic reflex system
anterior horn cells of alpha and gamma efferents to muscle receive synaptic impulses from sensory nerves originating in other muscles or organs
important in antagonist/agonist muscle pairs
gamma gain?
one of determinants of physiologic motion barrier and barrier of SD
resetting gamma gain my occur via pre or post synaptic inhibition
spinal facilitation
asymptomatic areas have increased muscle activity as well as pain and tenderness
a facilitated segment bc it is hyperirritable and hyper responsive
-muscles in this region = hypertonic
somatosomatic reflex
defensive reflex
-step on nail, withdraw foot
viscerovisceral reflex
signal from organ that goes to another organ
-distension of gut causing increased contraction of gut muscle
somatovisceral reflex
stimulation of abdominal skin inhibits activity
viscerosomatic reflex
sense from organ affects muscles
ex/ upper back pain with an MI
nociceptive theory
noxious stimulus stimulates nociceptor
can either:
-activate sympathetic nerves
-activate skeletal muscle
what can happened with constant contraction of skeletal muscle?
lay down fibrous and scar tissue
-bc it is easier for body to maintain shortened muscle by increased connective tissue than simply contracting all the time
OMT techniques do what?
actively stretch connective tissue in joint capsules, tendons, muscles, and ligaments in segments of restricted motion
**stretching would typically increased proprioceptive and nociceptive drives
therefore, OMT must first decrease or override these drives prior to stretching the tissues
each technique does this differently
HVLA
high velocity low amplitude
aka thrust technique
a direct technique
HVLA best for what?
hard bony end feel
- can feel where lock up joint
- only forcing a short distance
how does HVLA work?
abnormal muscle activity maintains joint restriction
treat joint, because it will reflexively reset muscles surrounding it
sudden stretch or change in position of joint alters the afferent output of mechanoreceptors in joint capsule, resulting in release of hypertonicity
what is the HVLA pop?
release of gas in synovial fluid
snap/release of ligament
bone pulled out and snapped into neutral position
don’t need snap, crackle, pop for treatment**
indications for HVLA?
firm bony end feel barrier
great for short time
sicker the patient, less the dose
treating same segment with HVLA more than once a week is discouraged (bc of joint hypermobility)
absolute contraindications of HVLA?
down syndrome rheumatoid arthritis dwarfism chiari malformation fracture/dislocation/spinal or joint instability ankylosis/spondylosis surgical fusion klippel-feil syndrome vertebrobasilar insufficiency inflammatory joint disease joint infection bony malignancy patient refusal
muscle energy technique?
MET
using muscles to correct SD
direct technique
direct technique
towards barrier
indirect technique
away from barrier
good for treating edema/congestion?
MET
because muscle contraction for lymphatic and venous circulation
steps in MET?
find restriction, take to barrier patient applies counterforce have patient relax wait a couple seconds (2-3 seconds) -post-relaxation phase*** move to new barrier repeat until no changes occur
reassess
isometric
no length change in muscle
isotonic
length chain and tone of muscles
concentric
muscle shortening (patient wins)
eccentric
lengthening of muscle (doc wins)
isolytic eccentric
quick movement
for fibrotic or chronically shortened myofascial tisues
isokinetic
length change at constant velocity
post-isometric relaxation
after patient contracts
-neuromuscular apparatus in refractory state during which passive stretching may be performed without encountering strong myotatic reflex opposition
takes 2-3 seconds for this to occur, so WAIT
joint mobilization using muscle force
muscular forces
we don’t really do that at RVU
respiratory assistance
use patient breathing to assist
oculocephalogyric reflex
using the eye muscles that affect cervical and truncal muscles
reciprocal inhibition
gentle contraction is initiated in agonist, there is reflex relaxation of that muscles antagonistic group
crossed extensor reflex
uses cross pattern locomotion in CNS
-left bicep dysfunction, treat right bicep
when flexor muscle contracted, flexor muscle contralaterally relaxes
absolute contraindications for absolute?
absence of SD
lack of consent
oculocephalogyric reflex - patient had recent surgery or trauma to eye
direct MFR
restrictive barrier engaged and tissue loaded until relaxes
indirect MFR
dysfunctional tissue guided along path of least resistance
MFR absolute contraindications?
absence of SD
lack of consent
OCF
osteopathy in cranial field
system of diagnosis and treatment by DO using primary respiratory mechanism and balanced membranous tension
can be direct or indirect
absolute contraindications for OCF?
increased intracranial pressures
acute intracranial bleeding
skull fracture
acute CVA
strain/counterstrain technique?
take muscle and find tender point then take muscle to the shortened relaxed phase
super shorten muscle - so that the nervous system releases the stimulation allowing it to relax
indirect technique**
steps for S/CS
10 on pain scale
super shorten muscle to level of 3
maintain for 90 seconds
passively return to original position** important
recheck
what forms a tenderpoint?
inappropriate proprioceptive reflex caused by gamma system
rapid lengthening of myofascial tissue
- body tries to prevent damage by rapidly contracting
- causes antagonist muscle to rapidly lengthen and produces inappropriate reflex and tenderpoint
- nociceptive feedback from antagonist muscle interpreted as muscle strain
- hypertonic myofascial tissue and restricted motion (SD)
**guarding reflex by patient may also produce reflex
tenderpoints in fascial or ligaments?
trauma causes damage to myofascial tissues
nociceptors alert CNS
muscle fatigue due to decreased cellular metabolism
tenderpoint formation
absolute contraindications for S/CS
absence of SD
lack of consent
lymphatic technique
designed to remove impediment to lymphatic circulation and promote flow of lymph
a direct technique
lymphatic technique mechanisms
any treatment reducing fascial restriction can improve lymph flow
steps in lymphatic technique
start centrally and move peripherally
absolute contraindications for lymphatic technique
aneuresis if not on dialysis
necrotizing fasciitis (in area involved)
lack of consent
soft tissue technique
direct technique
stretching, pressure, traction, separation of muscle while monitoring changes by palpation
stretching
traction
forces along longitudinal axis
kneading
forces along perpendicular axis (bowstring)
inhibition
forces superficial to deep over specific area of tension (tender point)
effleurage
lymphatic treatment superficially
distal > proximal
peripheral > central
petrissage and skin rolling
deep kneading and skin rolling
-breaks adhesive bands from skin to deeper tissue
tapotement
repetitively striking muscle belly with hypothenar edge of hand (karate chop!)
absolute contraindications for soft tissue technique?
absence of SD
lack of consent
