Mechanisms of Activating Forces 9/10 Flashcards
Not all TART changes are equal…..
- Viscerosomatic SD typically has a rubbery tissue texture change (will be treated and will come right back again, beause dealing with organs tissues)
- Arthrodial SD usually a bony end feel at the restrictive barrier (Joint somatic disfunctions)
- Muscular SD has a tight, tense end feel (tight muscles, ropy feel)
- SD associated with strain/counterstrain tender points have more tenderness
Arthrodial somatic dysfunction
- An external or internal force or factor has caused local segmental irritation sufficient to create focal edema and swelling in a small discrete area.
- This causes a tightening of the fascial structures, myofascial component, and capsular components of a specific joint.
- The articular distortion creates reflex hypertonicity of the muscles crossing that joint, resulting in decreased range of motion.
- Motion restoration of the joint results in restoration of normal proprioceptive input from the joint and reflex relaxation of muscles surrounding the joint.
- probably caused by proprioceptive and/or nociceptive triggers
Proprioceptive theory
- The alpha motor neuron activity has been abnormally reset to a higher gain, keeping the muscle’s resting length abnormally short (secondary to decreased tension on the nuclear chain fibers of the spindle.)
Alteration in both the intrinsic and extrinsic reflexes
Inappropriate gamma activity (“gamma gain”) creates inappropriate muscle length and tone, resulting in a functionally imbalanced joint
–> see slides on reflexes
How is gamma gain altered?
- The gamma gain is one of the determinants of the physiologic motion barrier and the motion barrier of the SD
- Resetting the gamma gain may occur via pre- and post-synaptic inhibition at the cord level
- This resetting can be affected by cognition. Ex: muscular movement events aren’t as anticipated
HVLA
- “An osteopathic technique employing a rapid, therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint, and that engages the restrictive barrier in one or more planes of motion to elicit release of restriction. Also known as thrust technique.”
- Direct technique
- HVLA best suited to SD with restricted motion with a hard end feel
- The physician precisely positions the patient’s restricted joint to the restrictive barriers of the somatic dysfunction 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.
HVLA indications and dosage
- SD with distinct, firm barrier mechanics*
- Useful when not much time is available
- The sicker the patient, the less the dose
- Generally, treating the same segment with HVLA more than once a week is discouraged due to the possibility of causing joint hypermobility
- If the same SD keeps recurring, investigate!
Absolute contraindications of HVLA
- 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
Relative Contraindications of HVLA
- Acute herniated nucleus pulposus
- Acute radiculopathy
- Acute whiplash / severe muscle spasm / strain/sprain
- Osteopenia / Osteoporosis
- Spondylolisthesis
- Metabolic bone disease
- Hypermobility syndromes
Muscle Energy Technique
- A form of osteopathic manipulative diagnosis and treatment in which the patient’s muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed physician counterforce.
- Direct technique
- Muscle contraction is a principle mechanism for promoting lymphatic and venous circulation, thereby making muscle energy technique important in the treatment of edema/congestion.
- 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. All the physician needs to do is resist the contraction, and then take up the soft tissue slack during the refractory period.
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
Similar to HVLA: distortion of articular relationships and motion loss results in a reflex hypertonicity of the musculature crossing the dysfunctional joint. This increase in muscle tone tends to compress the joint surfaces and results in thinning of the intervening layer of synovial fluid and adherence of joint surfaces. Restoration of motion to the articulation results in a gapping, or reseating of the distorted joint with reflex relaxation of the previously hypertonic musculature.
Respiratory Assistance
Goal: To produce improved body physiology using the patient’s voluntary respiratory
motion.
Force of Contraction: Exaggerated respiratory motion
The muscular forces involved in these techniques are generated by the simple act of breathing. This may involve the direct use of the respiratory muscles themselves, or motion transmitted to the spine, pelvis, and extremities in response to ventilation motions. The physician usually applies a fulcrum against which the respiratory forces can work.
Oculocephalogyric Reflex
Goal: To effect reflex muscle contractions using eye motion.
Force of Contraction: Exceptionally gentle
Functional muscle groups are contracted in response to voluntary eye motion on the part of the patient. These eye movements reflexively affect the cervical and truncal musculature as the body attempts to follow the lead provided by eye motion. It can be used to produce very gentle post-isometric relaxation or reciprocal inhibition.
Reciprocal Inhibition
Goal: To lengthen a muscle shortened by cramp or acute spasm.
Force of Contraction: Very gentle
When a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of that muscle’s antagonistic group.
Crossed Extensor Reflex
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
This form of muscle energy technique uses the learned cross pattern locomotion reflexes engrammed into the central nervous system. When the flexor muscle in one extremity is contracted voluntarily, the flexor muscle in the contralateral extremity relaxes and the extensor contracts.
MET contraindications
Absolute:
- Absence of somatic dysfunction
- Lack of patient consent and/or cooperation
- Oculocephalogyric reflex technique in someone with recent eye surgery or trauma
Relative:
- Infection, hematoma, or tear in involved muscle
- Fracture or dislocation of involved joint
- Rheumatologic conditions causing instability of the cervical spine
- Undiagnosed joint swelling of involved joint
- Positioning that compromises vasculature
- Patient with low vitality who could be further compromised (acute post myocardial infarction for example)
Myofascial Release Technique (MFR)
- A system of diagnosis and treatment, first described by Andrew Taylor Still and his early students, which engages continual palpatory feedback to achieve release of myofascial tissues.
- Direct MFR
- a myofascial tissue restrictive barrier is engaged for the myofascial tissues and the tissue is loaded with a constant force until tissue release occurs.
- Indirect MFR
- the dysfunctional tissues are guided along the path of least resistance until free movement is achieved.
- MFR provides peripheral neuroreflexive alterations in muscle tone and neural facilitation, in part, by its influence on mechanoreceptors.
- The application of MFR allows for connective tissue plastic changes (creep) which are associated with release of energy. This may include heat, electromagnetic, and piezoelectric changes.
- External forces applied to fascia facilitate restoration of normal structure and function.
- Tensegrity principles coupled with fascial bioelectric (piezoelectric) properties influence the anatomical and physiological responses of tissues to applied manipulative forces.
- Slow stretching of connective tissues allows them to elongate and creep, absorbing the forces involved and preventing reactivation of the proprioceptors as well as preventing distribution of these forces to the nociceptor endings.
Contraindications of MFR
Absolute*
- Absence of somatic dysfunction
- Lack of patient consent and/or cooperation
Relative
- Fractures
- open wounds,
- acute thermal injury
- soft tissue or bony infections
- deep venous thrombosis (threat of embolism)
- disseminated or focal neoplasm
- recent post-operative states over the site of proposed treatment (wound dehiscence)
- aortic aneurysm
Strain/Counterstrain Technique
- An osteopathic system of diagnosis and indirect treatment in which the patient’s somatic dysfunction, diagnosed by an associated myofascial tender point, is treated by using a position of spontaneous tissue release while simultaneously monitoring the tender point.
- Indirect technique
- 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)
- 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
- 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.
S/CS mechanisms
- 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
S/CS indications
- Acute or chronic somatic dysfunctions
- Somatic dysfunctions with a neural component like a hypershortened muscle
- As primary treatment or in conjunction with other approaches
- Somatic dysfunctions in any area of the body
S/CS contraindicaions
Absolute*
Absence of somatic dysfunction
Lack of patient consent and/or cooperation.
Relative
Patient who cannot voluntarily relax
Severely ill patient
Vertebral artery disease
Severe osteoporosis
Lymphatic Technique Mechanisms
- Lymphatic flow depends on several factors including diaphragmatic motion, gravitational forces, muscle contraction, and visceral motion.
- Any treatment that reduces fascial restrictions can theoretically improve lymphatic flow by optimizing the capacity of intrinsic lymphatic pumps.
- Lymphatic treatments enhance lymphatic return by increasing the gradient for lymph and assisting the return of lymph from the lung, abdomen, and other tissues
Lymphatic technique steps
Remove impediments to lymphatic flow starting centrally and moving peripherally
- Evaluate diaphragms/fascia including thoracic inlet
- Palpate tissues to evaluate presence of congestion/excess fluid
Utilize an extrinsic pumping motion that mobilizes lymphatic fluid through:
- external pressure
- changes in pressure gradients
- oscillatory movements
Indications:
- Edema, tissue congestion, or lymphatic stasis
- Infection
- Inflammation
