Midterm Flashcards
1
Q
Explain the changes seen in the bones of adolescents
A
- epiphyseal plates closing/closed
- innominate fuse by age 20
- sacrum fuses in late adolescence
**Adolescent athletes are particularly susceptible to SD -> watch for hyper mobility
2
Q
Explain FPR for post rib SD
A
- seated with spine neutralized, add compression, flex pt toward and add rotation and SB towards
3
Q
Explain FPR for INH/EXH rib SD
A
- seated w/spine neutralized; grip rib post have pt lean into you and turn head away and hold their breath in direction of ease, add activating force in direction of ease
4
Q
What OMT findings can you expect to find in a pregnant woman in the 2nd trimester?
A
- pelvis rotating ant about a R or L axis (forward torsion)
- increased pelvic tilt
- increase in lumbar lordosis
- compensatory inc of thoracic kyphosis -> may produce cervical strain
5
Q
The following sx are indicative of what spastic muscle: pain referral to groin and hip, exhalation 12th rib SD, diaphragm restriction?
A
quadratus lumborum
6
Q
13yo male presents for yearly physical. PMH sig for some wheezing triggered by cold weather. He takes an albuterol inhaler prn. His last usage was 2wks ago, after outdoor recess at school. Lungs: mild b/l wheezing at end of exhalation. Which of the following viscerosomatic reflex levels best corresponds to parasympathetic driven dysfunction in this pt? A. C0-C2 B. C3-5 C. T1-6 D. T5-9 E. S2-3
A
A. C0-2 -> parasympathetics to the lungs is from the vagus nerve which is influenced by OA, AA & C2
7
Q
What effect does inc progesterone during pregnancy have on fluid retention?
A
causes congestion -> dec O2 and metabolism at cellular level; inc metabolic waste products in soft tissues and GI tract
8
Q
In what plane do rotational changes occur?
A
Horizontal plane
9
Q
How is a dx of rupture of the pubic symphysis during labor made?
A
- separation grater than 1cm
- audible crack
- acute pain radiating to back and/or thighs
- palpable gap with local tissue edema
- waddling gait -> increases pain on gait or bending
10
Q
What happens to systemic vascular resistance and BP in pregnancy?
A
They both decrease
11
Q
What is the exercise rx for stretching?
A
- perform exercises 2-3 on each side 2-3x/day
- stretch each side for 12sec or 3 deep breaths unless otherwise prescribed
- once the feeling of stretch is no longer appreciated you can cut down on frequency -> must re-assess every week
**Recommend performing their stretches before and after exercising in addition to 1-2x/day if possible
12
Q
The junction of the temporal, occipital and parietal is known as: A. Asterion B. Bregma C. Pterion D. Nasion E. Opisthion
A
A. Asterion
13
Q
Explain FPR for sacral SD
A
- prone w/pillow under abd, flex leg off table, slight AB, IR/ER and add cephalic motion
14
Q
What muscles have pseudo paresis if the most relief is seen when adding compression to the iliac crests?
A
multifidus
latissimus dorsi
levator scapula
lumbar vertebrae and structures above
15
Q
Explain ME for backward sacral torsion
A
- pt at edge of table in lateral recumbent w/axis side down, flex hip and knee of bottom leg and extend top leg off table, push down on top leg w/pt pushing up against you
16
Q
List the common diagnoses related to lower crossed syndrome
A
- chronic LBP
- sacroiliac pain
- osteoarthritis L-spine -> DDD, spinal stenosis, facet pain
- spondylolisthesis (grade 1 & 2)
- osteoarthritis hips and knees
17
Q
Why can’t pregnant women lay supine in the third trimester?
A
increased uterus size causes edema which may cause hypotension when supine -> diaphragm works harder due to volume and pressure changes
18
Q
Where is AC-1 counterstain pint?
A
post aspect of ascending rams of mandible at level of earlobe
19
Q
The following sx are indicative of what inhibited muscle: restlessness, pain sitting or walking uphill, antalgic gait
A
Gluteus maximus
20
Q
27yo female presents to her OB for her 36wk appt. She complains of LBP present for several mo and has become progressively worse. The pain is generally localized to her lower back but at times radiates down the back of her thighs to just above her knees b/l. Her sleep has progressively deteriorated due to pain becoming worse at night, esp with turning. Which of the following is the most likely etiology of the pts pain?
A. Mechanical postural stress
B. Herniated L4 lumbar disc
C. Vascular compromise due to compression
D. Osteoarthritis of lumbar spine
E. Sacroiliitis
A
A. Mechanical postural stress
21
Q
What cardiovascular changes are seen during the first trimester of pregnancy?
A
- maternal systemic vasodilation ~5wks
- SVR progressively decreases
- CO progressively increases
22
Q
11yo female presents for yearly physical. Father notes she seems less active than normal. She admits feeling more SOB this winter. FH of older brother using inhaler prior to exercise. She’s taken a few puffs of his inhaler recently which helped. Upon OSE of the ribs, which of the following dysfunctions would you most expect to find?
A. Ribs 2-6 pump handle exhalation dysfunction
B. Ribs 2-6 bucket handle exhalation dysfunction
C. Ribs 2-6 pump handle inhalation dysfunction
D. Ribs 2-6 bucket handle inhalation dysfunction
A
C. Ribs 2-6 pump handle inhalation dysfunction
**inhalation SD so you would treat rib 6 first
23
Q
List the hypotonic muscles of lower crossed syndrome
A
Gluteals (maximus, medius, minimus) abdominals vastus medialis ant tibialis peroneals
24
Q
Define tensegrity
A
the property of skeleton structures that employ continuous tension members and discontinuous compression members in such a way that each member operates with max efficiency and economy
25
What hormones promote fluid retention (tissue edema) during pregnancy?
increase in estrogen, progesterone, and adrenal hormones
26
14mo male brought to ER w/excessive crying and subjective fever. On PE, his right TM is significantly inflamed and erythematous and he has a temp of 100.3. What tx modalities could you use?
- cranial
- lymphatics -> gal breath, mandibular walking, ear pull
- articulatory
- stills
- FPR
27
List the hypertonic muscles of lower crossed syndrome
```
Iliopsoas
Quadratus lumborum
TFL
Hamstrings
Rectus femoris
Piriformis
Adductors
Gastroc
Soleus
```
28
Where is the anterior chapman's point for the nasal sinuses?
- inferomedial clavicle
- lateral to SC junction (nasal sinuses)
- sup second rib at MCL (all sinuses)
29
Lower crossed syndromes involves the _____, _____, and _______
hip, pelvis and low back
30
Name the 4 posterior pelvic muscles and the SD's they are assoc with
- quadratus lumborum = superior innominate shear
- erector spina = sacral SD
- piriformis = sacral SD
- hamstrings = posterior innominate rotation
31
What muscles have pseudo paresis if the most relief is seen when adding compression mid-way between iliac crest and greater trochanter?
gluteals
SI joints
sacrum
innominate
32
What effect does increased progesterone during pregnancy have on the mechanical configuration of the thoracic cage?
- circumference increases
- subcostal angle widens
- diaphragm pushed superiorly
- increased tidal volume 30-40%
33
What is the exercise rx for retraining?
- after stretching you need to perform retraining exercises 2-3 times per day
**Goal is to transition the pt into a general fitness program; shouldn't strength train until pain free stretching is achieved
34
What is the tx position for AC-1 counterstain?
RA
35
```
6wk old boy who never stops crying, started 1mo ago and seems to be getting worse. Infant cries uncontrollably for hrs. Mom has tried baths, car rides, stroller rides, etch and nothing works. Infant has met all developmental milestones including already showing some head control during tummy time. Mom reports he's eating well and stools 2-3x/day with yellow, seedy consistency. She denies ever seeing any blood in stool however does note the infant seems bloated and gassy during crying episodes. Which of the following is most likely the etiology?
A. post cervical hypertonicity
B. compression of occipital condyles
C. Incomplete lactose absorption
D. Inc stress during gestation
E. All of the above
```
E. All of the above
36
What are the absolute contraindications to aerobic exercise in pregnancy?
- persistent 2nd or 3rd trimester bleeding
- placenta previa >28wks
- premature labor during current pregnancy
- ruptured membranes
- preeclampsia/pregnancy-induced HTN
- incompetent cervix
- multiple gestation at risk for premature labor (triplets or more)
- intrauterine growth restriction
- restrictive lung disease
37
What is the positioning for elevator scapula counterstain
- pt prone, extend ipsilateral arm and place traction or compression, hold for 90 secs then return to neutral and reassess
38
What is the tx position for AC-8 counterstain?
F Sa Ra
39
explain FPR for hamstring SD
- prone w/pillow under abd, extend leg up w/knee bent and resting on docs knee, IR/Er to fine tune
40
Where is the chapman's point assoc with the rectum?
Near inner thigh
41
List the anterior postural muscles
abdominal obliques
linea alba
transverse abdominals
**Therapeutic exercise and OMT for the core lumbar and pelvic musculature helps pts with LBP and SI syndrome to be significant
42
In what plane do scoliotic changes occur?
coronal plane
43
Why does carpal tunnel syndrome seem to occur in the second trimester of pregnancy and what can be done to help it?
- due to edematous state
| - palliative treatment -> stretches and night-time splinting
44
Explain stills for inhalation/post TP rib
- supine, grasp ipsilateral forearm and flex pts arm, induce traction and ask pt to inhale, ask pt to exhale and at the same time extend arm while maintaining traction
45
T/F: Diaphragmatic excursion of the diaphragm is not impaired during pregnancy
True
46
How long throughout pregnancy can you treat the woman in a supine position?
Through the second trimester
47
Where is the anterior chapmans point for the middle ear?
superior clavicle ~2-3cm lateral to the SC junction
48
Explain the parasympathetics of the GI system
- Vagus nerve (OA, AA) = upper GI, SI and ascending and transverse colon
- pelvic splanchnic (S2-4) = descending colon, sigmoid, rectum; inc tone -> inc peristalsis
49
Explain FPR for piriformis SD
- prone w/pillow under abd, flex leg off table, adduct hip, add axial compression to knee
50
```
81yo female is hospitalized with community acquired pneumonia, fatigue and SOB and lower R rib cage pain. OMT findings: T7-9 FRrSr; R ribs 7-9 prefer exhalation. Which of the following describes best hand placement and starting position for FPR tx after initial neutralization of the spine?
A. Palpate rib 7, accentuate exhalation
B. Palpate rib 7, accentuate inhalation
C. Palpate rib 9, accentuate exhalation
D. Palpate rib 9, accentuate inhalation
```
A. Palpate rib 7, accentuate exhalation
51
The following sx are indicative of what inhibited muscle: inc lordosis, constipation
rectus abdominis
52
How can an operative vaginal delivery affect cranial nerves and what are the presenting sx?
- CN VI -> lateral rectus palsy
| - CN VII -> facial palsy
53
Explain still's for post rib SD
- seated, adduct ipsilateral arm, compress elbow and adduct arm across chest
54
```
18yo male presents with HA, nasal congestion and a sore throat for the past 3 days. HA is mainly in his forehead, eyes and maxillary area. PE: cobblestoning of post oropharynx, tonsils 1/4 w/out exudate, C2 doesnt translate from left to right, which improves with extension. Which of the following is the setup position for the pts head and neck to employ a side bending emphasis HVLA tx?
A. Rotated left, SB L
B. Rl, SB R
C. Rr, SB R
D. Rr, SB L
E. F, Rl
```
D. Rr, SB L -> rotation in motion preference and side bending towards restrictive barrier
55
What sacral SD is encouraged during labor from infant positioning and the lithotomy position?
anterior sacral base -> cranial extension
**Assoc with sx of fatigue, depression and low energy
56
Explain FPR for gluteus maximus SD
- prone w/pillow under abd, flex leg off table, knee flexed to 90 on docs knee, extend hip, add torsion force w/ER
57
Where is the anterior chapman's point for the larynx?
superior second rib just medial to sinuses CR
58
List the posterior postural muscles
latissimus dorsi
thoracolumbar fascia
gluteus maximus
ITB
59
```
29yo prima gravid female presents to OB for 37wk appt. Pt complains of back pain that has been present for several months but is becoming unbearable. The pain worsens w/activity and is alleviated by rest. The pain is generally localized to her low back, but at times radiates down the back of her thighs. Her sleep is progressively deteriorated during the pregnancy, but the pt reports worse back pain at night, esp w/turning. Which of the following will most likely be found on PE?
A. +1/4 achilles reflex b/l
B. Dec ROM of lumbar spine
C. 3/5 muscle strength of hip flexor b/l
D. Inc pain on pelvic compression
E. Leg length discrepancy
```
B. Dec ROM of lumbar spine
60
The following sx are indicative of what inhibited muscle: pain with walking, pain referred to post iliac crests and SI joints, positive trendelenberg
gluteus medius
61
When should you evaluate CV and/or respiratory sx when prescribing a general fitness program?
- extreme fatigue during or after exercise
- pain above waist
- inability to maintain conversation due to SOB
- strong CV disease FH or risk factors
62
What are the absolute contraindications of OMT in pregnancy?
- undiagnosed vaginal bleeding
- prolapsed umbilical cord -> umbilical cord descending into birth canal before the baby during labor
- placental abruption
- ectopic pregnancy
- placenta previa
- threatened or incomplete abortion
- severe pre-eclampsia/eclampsia
63
19yo prima gravid female at 37wks presents with complaints of back pain that awakens her at night. Her pregnancy has been unremarkable up to this point other than mild nausea during 1st trimester, LBP that previously was relieved by heat and acetaminophen, and vulvar varicosities identified 3wks ago. She reports show bought a device to minimize the varicosities, wears compression socks most days and makes an effort to sleep on her left side but typically wakes up on her back. The pt wants to know why her back hurts more at night, even though she is more active during the day. The pt most likely has LBP due to which of the following?
A. inc pressure on left ILA leading to a R/L sacral torsion
B. dec RR at night leading to congestion at pelvic diaphragm
C. Stagnant hypoxia of neural and vertebral tissues at night
D. Undiagnosed rheumatoid arthritis aggravated by stagnant position
E. Increased pressure on nerve root when supine due to bulging disc
C. Stagnant hypoxia of neural and vertebral tissues at night
64
List FPR absolute contraindications
- unstable fracture affected by tx position
- neuro sx brought on by tx position
- exacerbation of potentially life-threatening symptomatology by tx position (drop in O2 sat or EKG changes, etc)
65
Differentiate between kneading and inhibition sub occipital release methods
- kneading: pressure may be slowly and rhythmically applied until tissue texture changes occur or for 2 mins
- apply a constant pressure for 30sec to 1 min
66
Where should you expect SD's during labor?
Innominates
sacrum
pubic symphysis
67
In what plane do kyphotic and/or lordotic changes occur?
sagittal plane
68
A SD of the occiput can compress various cranial nerves, what nerves are compressed if the presenting sx is poor suck?
CN XII, IX
69
Where is the anterior chapmans point for the tonsils?
lateral manubrium
70
Where is the chapman's point assoc with the colon?
along the IT band
71
What counterstain point is on the post-sup surface of the clavicle at the clavicular attachment of the SCM?
AC 7
72
List the risk factors for lower back pain during pregnancy
- previous hx of low back pain -> preexisting or LBP in previous pregnancy
- multiparty
- higher BMI
- smoking
- age
strenuous work
- pain during menstruation
**LBP resolves in 80-95% of cases postpartum
73
Where does segmental facilitation occur due to chronic postural strain?
- cross-over sites
- apices of curves
**Determines systemic sx
74
What is the uncommon compensatory pattern seen in 20% of healthy people?
R/L/R/L
75
A SD of the occiput can compress various cranial nerves, what nerves are compressed if the presenting sx is reflux, vomiting, colic
CN X
76
11yo female w/hx of asthma presents w/SOB. She's been using her daily inhaler only sporadically, but has had to use her rescue inhaler daily, often 2-3 times per day. What dysfunction would you presume to find in this pt?
A. Inhalation dysfunctions of ribs 2-10
B. Exhalation dysfunctions of ribs 2-10
C. Chapman's point at the lateral proximal humerus
D. Chapmans point at the tip of the 12th rib
A. inhalation dysfunction of ribs 2-10
77
Explain how relaxin levels change throughout pregnancy
- relaxin is elevated during the first trimester and declines early in 2nd trimester
- remains stable throughout pregnancy
- widening and mobility of SI joints and pubic symphysis starts at 10-12wks
- women incapacitated by LBP have higher levels of relaxin!
78
What are the signs of an upper crossed syndrome?
- forward head posture
- inc lordosis in upper and mid cervical spine
- inc kyphosis at cervicothoracic junction
- protraction of shoulders
- IR of humerus
- tends to stress C4-C5, cervicocranial and cervicothoracic junctions
79
How does the eustachian tube angle change with age?
it increases -> the younger the age = decreased eustachian tube angle
80
What GI sx can condylar decompression of the cranium of infants cause?
poor suckle/feeding
81
What is the tx for rupture of the pubic symphysis during labor?
- conservative: bed rest (lateral recumbent), pelvic binder (reduces separation), OMM (spine & pelvis PRN)
- may cause pain in subsequent pregnancies
82
What are the relative contraindications to aerobic exercise in pregnancy?
- unevaluated maternal cardiac arrhythmia**
- intrauterine growth restriction in current pregnancy**
- poorly controlled HTN, hyperthyroid, seizure disorder, T1DM
- severe anemia
- extreme morbid obesity or underweight
- chronic bronchitis
- hx of extremely sedentary lifestyle
83
What is the common compensatory pattern seen in 80% of healthy people?
L/R/L/R
84
A SD of the occiput can compress various cranial nerves, what nerves are compressed if the presenting sx is colic and muscular dysfunction?
CN XI
85
Differentiate between a positive vs negative cervical flexion text
- positive = immediate recruitment of SCM and scalene w/absence of chin nod
- negative = longue colli activation causes chin nod w/SCM and scalènes firing late
86
The following sx are indicative of what spastic muscle: pain sitting or walking, pain disturbs sleep, pain referral to post thighs, limited straight leg raising
hamstrings
87
Where is the posterior chapmans point for the middle ear?
Base of the occiput at the OA joint
88
Explain Still's for post innominate rotation
- Flex hip and knee and add adduction, compress through knee, maintain compression while abducting and extending knee then traction
89
What are the causes of radicular back pain?
- most commonly caused by a bulging disc, sometimes by a herniated disc
- likely due to mechanical pressure of ligamentous structures of the spine on the nerve root
- present as paresthesias in ilioinguinal and genitofemoral nerve distribution -> "lightening pains"
90
Where are the ant and post chapmans points for the appendix?
- anterior: tip of 12th rib
| - posterior: TP of T11
91
Explain how pregnancy affects ankylosing spondylitis
- aggravated by pregnancy due to inc stress on SI joints
92
What is the firing pattern for LE extension?
1. ipsilateral hamstring
2. ipsilateral gluteus maximus
3. contralateral erector spinae
4. ipsilateral erector spinae
93
Explain supine HVLA (OB roll) for the sacrum
- pt supine with hands behind head w/doc on side opp of SD, sidebend trunk into barrier, caudal hand blocks linkage at ASIS on side of SD, doc then rotates trunk into barrier and rotational thrust is applied
94
```
9yo male w/intermittent abd pain, complains of diffuse abd pain and is occasionally nauseated. He has 2-3 bowel movements/wk and they are very hard and painful to pass. He denies vomiting, diarrhea, hematochezia, and melon, but his mom notes dec appetite. His last BM was 4 days ago. Where would you expect to find viscerosomatic tissue texture changes in this pt?
A. C2-5
B. T1-4
C. T10-L2
D. L3-L5
```
C. T10-L2 -> colon
95
Explain stills for EXH/Anterior TP rib
- supine, grasp ipsilateral forearm, induce traction by pulling arm inferiorly and ask pt to exhale, ask them to inhale and at that time flex pt's arm while maintaining traction
96
The following sx are indicative of what spastic muscle: nocturnal leg cramps, pain referral to upper calf, instep and heel
Gastroc-soleus complex
97
What are the relative contraindications for OMT in pregnancy?
- premature rupture of membranes before onset of labor
| - premature labor -> regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks
98
24yo, 7mo pregnant female presents with leg swelling and LBP. Severity is 3/10 at worst and averages 1/10. Significant TART in lumbar spine, esp on Right near thoracolumbar junction. Which of the following findings could be addressed as part of tx targeting Zink's compensatory patterns?
A. L2 ERrSr
B. L4 ERrSr
C. T4 FRlSl
D. C4 FRlSl
E. Pea-sized tender nodule in 1st ICS near sternum
A. L2 ERrSr
99
What 3 SD's can postural muscles vs movement/dynamic muscles have?
- postural: facilitation, hypertonicity, shortened
| - movement/dynamic: inhibition, hypotonic, weakness (pseudoparesis)
100
According to the neurologic model, how do you diagnose postural decompensation?
balance and strength testing
101
What muscles have pseudo paresis if the most relief is seen when adding compression through the greater trochanter?
pelvic diaphragm
hamstrings
STL
structures below pelvic diaphragm
102
What does a positive scapular stabilization test indicate?
- excessive winging of the medial border of the scapula
| - weakness of the lower trapezius, serrates ant and rhomboids
103
26yo male presents w/complaints of LBP after a triathlon. PE reveals left hip flexors w/ 4/5 strength. All other neuropathy findings are negative. Which of the following diagnostic findings confirms pseudoparesis common to a lower crossed syndrome?
A. left paracentral disc herniation at L3
B. left torsion on a left oblique axis
C. L3-5 neutral RlSr
D. Left hypertonic rectus femoris
E. Left hypotonic quadratus lumborum
D. Left hypertonic rectus femoris
104
The following sx are indicative of what inhibited muscle: buckling knee, weakness going upstairs, thigh and knee pain, chondromalacia, patellae
vastus medialis
105
```
17yo male distance runner complains of knee pain, particularly after running and foot pain that's worse when he gets up in the morning. On PE, he has a positive over's test and is acutely tender upon palpation of his anterior calcaneus. With what would you diagnose him?
A. Plantar fasciitis
B. IT band restriction
C. Probable stress fracture
D. Both A and B
E. Both A and C
F. Both B and C
```
D. Both A and B
106
2mo old female has left head rotation and doesnt seem to follow stimuli past midline in rotation of her head. Inspection of cranium shows her left occipital region is absent of hair and flattened. What is this baby most likely to benefit from?
Passive SCM stretch exercises -> teach to parents
107
Where is the chapman's point assoc with the intestines?
just below the ASIS
108
What counterstain point is on the medial head of the clavicle at the sternal attachment of the SCM?
AC 8
109
What are the signs and sx of lower crossed syndrome?
- inc sacral flexion between ilia
- inc lumbar lordosis -> inc loading of facet joints
- inc flexion of hip & knees -> altered loading characteristics
- hypermobility in sagittal and coronal planes in the L4-5, L5-S1 levels
- sitting up from supine and forward bending are dysfunctional
110
What is the firing pattern for LE abduction?
1. ipsilateral gluteus maximus
2. ipsilateral TFL
3. ipsilateral QL
4. ipsilateral erector spinae
111
What is the tx position for AC-2-6 counterstain?
F Sa Ra
112
What cardiovascular changes are seen during the second trimester of pregnancy?
- SVR progressively drops 35-40% until mid-second trimester
| - CO continues to increase
113
What is the tx position for AC-7 counterstain?
F St Ra
114
Explain FPR for quads SD
- supine w/pillow under head, rest leg on docs leg, push patella cephalad, add IR/ER and Ab/Ad, add axial traction or contraction
115
What muscle is being tested with the bilateral shoulder flexion test?
latissimus dorsi
- test can be negative, unilateral positive, or bilateral positive
116
What OMT can be done for a pregnant woman in the first trimester with hyperemesis gravidarum?
treat areas C2 and T5-9
117
Name the 3 anterior pelvic muscles and the SD's they are assoc with
- rectus abdominis = pubic SD
- quads = anterior innominate rotation
- adductors = pubic SD
118
Differentiate between form vs force closure
- form closure = specific properties of articular surfaces of SI joint; requires proper size, shape and attitude of articulating surfaces -> how the joint fits together
- force closure = compression produced by body weight, muscle action and ligament force -> due to gravity and loading forces
119
What are the sx of CNS congestion?
HA
Nausea
Light-headedness
**During pregnancy, more blood (fluid) gets to the tissues than can be returned/removed by the venous and lymphatic systems
120
58yo male presents with complaints of LBP that started this past weekend. He reports he was playing basketball but cant recall a specific injury. PE: significant TART in lumbar spine, esp on R at lumbosacral junction; hypertonicity of R quadratus lumborum; positive R standing flexion test; ASIS, PSIS, medial malleolus all superior on the R. Which of the following is the final step in a still's technique for this pt?
A. HVLA R lef inferior tug
B. Low velocity, medium amplitude R lef inferior tug
C. IR of R hip
D. ER of R hip
E. Knee flexion
F. Knee extension
B. Low velocity, medium amplitude R lef inferior tug -> this is considered mild traction
121
What percentage of pregnant women report lower back pain?
60%
122
What viscerosomatics can be addressed during the third trimester of pregnancy?
- upper GI -> T5-9
| - Adrenal and ovaries -> T10-L2
123
What are the 3 activating forces (REM's) that can be used for lower crossed syndromes?
- inhalation/exhalation
- leg extension/flexion
- arm abduction/adduction
124
How do infants ribs differ from adults and older children?
They are more lateral and not as rounded
125
Explain FPR for costochondral SD
- seated w/spine neutralized, monitor joint, add compression through shoulders, rotate pt towards until motion is felt
126
```
11yo female presents for yearly physical. Father notes she seems less active than normal. She admits feeling more SOB this winter. FH of older brother using inhaler prior to exercise. She's taken a few puffs of his inhaler recently which helped. Which of the following viscerosomatic levels is most expected to have TART changes indicative of sympathetic drive dysfunction?
A. OA-AA
B. T2-6
C. T5-9
D. T10-L2
E. L3-5
```
B. T2-6
127
Explain Still's for superior innominate shear
- ER and abduct, compress through foot, maintain compression and IR then traction
128
What is the exercise prescription for a general fitness program?
- for some pts, walking 3-5mins/day will be a good starting goal
- each week they can add 3-5 mins more as tolerated until exercising 30-50 mins/day
- 50mins/day 5 days/week is optimum
129
What cardiovascular changes are seen during the third trimester of pregnancy?
- CO peaks early 3rd trimester
- HR peaks (~16bpm more than non-pregnant)
- supine position: dec CO and SV, inc HR**
- BP returns to pre-pregnancy levels
130
When do most sx of lymphatic congestion occur in pregnancy and what are they?
- 3rd trimester
| - hemorrhoids, vulvar and LE varicosities due to sluggish venous return
131
The following sx are indicative of what spastic muscle: pain referred to inguinal ligament, inner thigh and medial knee
Adductors
132
What are the 3 causes of decreased lymphatic flow in pregnancy?
- fascial torsions
- organ hypertrophy
- diaphragm restriction
**All of these -> less effective pressure gradient
133
What are the contraindications for still's technique?
not advised across recent wounds or fractures less than 6 weeks old
134
What are the common complaints of the 3rd trimester of pregnancy?
- loss of balance
- back pain
- gait changes
- constipation
- GERD
**mechanical and structural changes are maximal now; increase in interstitial fluids
135
Explain ME for forward sacral torsion
- pt in modified sims w/axis side down, hips and knees flexed, push both down to the ground and have pt push up against you
136
During the predatory stage of pregnancy (last 4 weeks) it is important to evaluate the pelvic diameters to anticipate delivery problems. How do you evaluate the mid-pelvis
structures between the inlet and outlet
137
What are the viscerosomatics assoc with GERD?
- parasympathetics = OA, AA
| - sympathetics = T5-T9
138
The following sx are indicative of what inhibited muscle: pain when arising from chair, pain referral to buttock, lateral and/or post thigh, pseudo sciatica, antalgic gait, positive trendelenberg sign
gluteus minimus
139
Explain ME for Iliopsoas
- pt supine, doc on side being treated, pts leg extended off table, block linkage at ASIS and extend leg further while pt pushes up toward ceiling
140
What are the risk factors for muscle imbalance and/or postural decompensation?
- gravitational strain
- congenital (pelvic tilt, short leg syndrome, scoliosis)
- altered proprioceptive input (trauma, sedentary lifestyle, poor exercise technique, muscle weakness)
- stress (emotional and physical)
- hormonal imbalances/changes
- nutritional deficiencies
- aging - metabolic changes
141
What milestones are reached in school-age children?
- cranium fully ossified
- epiphyseal plates still open -> rapid growth of long bones, may develop a leg length discrepancy, short leg syndrome, functional scoliosis
142
What are the parasympathetics assoc with respiratory complaints?
- nose: facial nerve (CNVII)
| - OA and AA - vagus nerve
143
What are the ACOG recommendations for exercise during pregnancy?
30 mins or more, moderate exercise, most/all days of the week
144
What can be done to alleviate second trimester constipation in pregnant women?
- pelvic diaphragm release
- stool softeners
- laxatives
**These are all part of the metabolic-energetic-immue model
145
Where is the anterior chapmans point for the pharynx?
inferior first rib at sternocostal junction
146
What happens to plasma volume and hematocrit in pregnancy?
Plasma volume increases and hematocrit decreases
147
Explain a pelvic diaphragm release
- pt lateral recumbent (OB pt) w/tx side up or can do prone; place fingers medial to ischial tuberosity, have pt inhale and exhale, on exhalation push cephalad, resist on inhalation
148
What MSK changes occur during pregnancy?
- ligamentous laxity
- exaggerated lordosis of lower back
- forward flexion of neck
- downward movement of shoulders
- weakness and separation of abdominal muscles
- joint laxity of ant and post longitudinal ligaments
- widening and inc mobility of SI joint and pubic symphysis
- ant tilt of pelvis
- compression of structures due to fluid retention
149
Explain the location and tx of the round ligament counterstain
- near iliacus tender point, doc on ipsilateral side
- flex hips and knees
- cross contralateral ankle over top and spread knees into ER, hold 90 sec and return to neutral and reassess
150
What are the 3 factors that influence SD in pregnant pts?
- change in maternal structure & biomechanics
- body fluid circulation
- hormonal changes
151
Explain how pregnancy effects scoliosis
- curvatures don't increase
- may develop more pain
- possible inc risk of premature birth
152
What is the USPSTF vs american academy of pediatrics recommendation regarding scoliosis screening?
USPSTF Recommend against screening asymptomatic children/adolescents for scoliosis but AAP doesnt support any recommendation against scoliosis screening
153
During the predatory stage of pregnancy (last 4 weeks) it is important to evaluate the pelvic diameters to anticipate delivery problems. How do you evaluate the pelvic inlet?
iliopectineal line/pube to sacrum
154
What are the indications for OMT in pregnancy?
- SD
- scoliosis or structural condition assoc with pregnancy
- edema, congestion, or other pregnancy assoc condition amenable to OMT
155
What 3 OMT techniques can you do for asthma?
- rib raising
- MFR
- assess for and treat any inhalation or exhalation SD's
**Treat pneumonia the same wa
156
The following sx are indicative of what spastic muscle: pain down post thigh, may entrap sciatic nerve, perpetuated by SI dysfunction, assoc with pelvic floor dysfunction, dyspareunia, prostadynia
piriformis
157
What is sherrington's law?
when a muscle receives a nerve impulse to contract, its antagonists, receive stimulataneously an impulse to relax
158
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If passive evaluation of an infant's head shows limited side bending when bringing the R ear to the Right shoulder, this most likely indicates spasms of the left SCM. Upon evaluation of the CRI, which is the most likely cranial strain pattern?
A. left lateral
B. right side bending rotation
C. left sidebendiing rotation
D. Right lateral
```
D. Right lateral
**Want to encourage tummy time to strengthen neck muscles
159
What happens to CO and blood volume in pregnancy?
They both increase
160
What are alarm findings in regards to back pain that would grant referral for further evaluation?
- severe pain that interferes with function, particularly non-positional persistent pain at night
- inc pain w/cough, sneezing, valsalva
- neuro deficits by hx (bladder, bowel incontinence, paresis) or on exam (weakness, sensory deficits, abnormal reflexes
161
Where is the posterior chapman's point for the nasal sinuses?
mastoid process
162
What does a positive cervical flexion test indicate?
- facilitated SCM and scalenes
- inhibition of deep neck flexors (longs colli)
- subsitiution by the SCM and scalene muscles
163
Why is there an increase in interstitial fluids during pregnancy?
Increased demand to pelvic organs for metabolic needs of the fetus
164
Explain ME for posterior rotation of innominate
- pt supine w/doc on side being treated, pt leg extended off table while doc blocks linkage at contralateral ASIS, pt pushes leg toward ceiling while doc resists then doc takes further into barrier during isometric relaxation
165
How can a temporal bone SD in an infant increase the chance of getting otitis media?
Internal rotation
166
What is the positioning for counterstain of the scalene?
F St Rt
167
What counterstain point is on the anterolateral aspect of the corresponding ant vertebrae?
AC 2-6
168
What is the tx position for pectorals counterstain?
adduct arm across midline
169
What is the common cause of cranial dysfunctions in infants and what cranial bone is most susceptible to dysfunction?
Birth trauma; occiput
170
28yo female presents with HA, nasal congestion and sore throat for the past week. HA is mainly in forehead, eyes and maxillary area. PE: afebrile, cobblestoning of posterior oropharynx. Which of the following findings could be addressed as part of tx targeting Zink's compensatory pattern?
A. OA F, Rl, SB R
B. C4 ERrSr
C. T4 FRlSl
D. R Rib 6 exhalation SD
E. Pea sized tender nodule in 1st ICS near sternum
A. OA FRlSr
171
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22yo, 6mo pregnant female presents w/LBP and mild constipation for 1mo. Severity is 7/10 at worst and averages 3/10. Significant TART in lumbar spine, esp on R near thoracolumbar junction; L2 TP is prominent on R and becomes more symmetric w/Extension (asymmetric w/flexion). Which of the following best describes the ending position for seated stills technique?
A. ERrSr
B. ERlSl
C. FRrSr
D. FRlSl
E. NRrSl
F. NRlSr
```
D. FRlSl
172
What happens to resting minute ventilation and respiratory rate during pregnancy and why?
- resting minute ventilation increases by ~50% mostly due to large tidal volume
- respiratory rate is nearly unchanged
- likely due to increased progesterone -> stimulates respiration and respiratory drive
173
What cranial treatment should be avoided in the third trimester of pregnancy and why?
CV4 bc it can provoke uterine contractions
174
Explain SI joint articulation with still's for an OB pt
- pt supine w/doc at side being treated, flex hip and knee, compress, ER and circumduct to straightedges leg, hip then IR and circumducted to straighten leg and this is repeated
**Used immediately postpartum
175
Where is the posterior chapmans point for the larynx, pharynx, tongue and all sinuses?
just lateral to spinous process of C2
176
Explain the physiology behind how venous stress during pregnancy can lead to LBP
dependent edema moves back into vasculature due to osmotic gradient & direct pressure on IVC by uterus -> dec flow in pelvis -> stagnant hypoxia of the neural and vertebral tissues -> delayed LBP
177
The following sx are indicative of what inhibited muscle: pain referral to great toe and anteromedial ankle, foot may drag or trip when tired
Tibialis anterior
178
What 2 OMT techniques can you do for rhino sinusitis?
- sinus milking
| - cranial lifts
179
What age range classifies a toddler and what 3 milestones are seen with this age group?
- 1-4yo
- ossification increases -> some bones become fused
- increased falls, learning to walk
- hit their head a lot
180
Explain the PROMOTE study that Dr. Hensel done for LBP in pregnancy
- 400 women in 3rd trimester assigned usual care, OMT or placebo US tx
- 7 txs over 9wks
- goal: reduce LBP, improve functioning during 3rd trimester
- significant tx effects for pain and functioning in OMT an due group
- no higher likelihood of conversion to high risk status in OMT group
181
Explain the elevator scapulae "still-ish" technique
- abduct UE to 180 regress, distraction and adduction to 90 then 0 and have pt hold back of table, flex head to opposite knee, 3 deep breaths and follow release
182
If passive evaluation of an infant's head shows limited side bending when bringing the R ear to the Right shoulder, what is most likely the cause of the infant's presentation?
Spasms of the left SCM
**Want to encourage tummy time to strengthen neck muscles
183
What does a positive testing force during FPR sacral evaluation tell you?
Diminished cephalad motion
184
What is a positive scapular stabilization test?
- scapula on weight bearing UE protrudes away from the body
185
Explain how pregnancy affects rheumatoid arthritis
- improved sx from time of conception to 6wks postpartum
186
19yo primagravid female presents to urgent care at 34wks. Her pregnancy has been unremarkable up to this point, other than mild nausea during the first trimester and LBP that is relieved by heat and acetaminophen. The pt was alarmed when her BF reported soft bumps over her vulvar region that are non-tender. The pt is confused and wants to know that her child is ok. After examining the pt, which of the following is the next best step?
A. Educate the pt that she could transmit the virus to her child during vaginal delivery but the bumps are otherwise benign
B. Benign acyclovir tx now; if lesions present during labor, C-section is indicated
C. 1g azithromycin. Recheck in 1wk for improved sx
D. Recommend pt sleep in left lateral recumbent positioning and apply pressure to the area
E. I&D of abscesses followed by topical Abx
D. Recommend pt sleep in left lateral recumbent positioning and apply pressure to the area
187
During the predatory stage of pregnancy (last 4 weeks) it is important to evaluate the pelvic diameters to anticipate delivery problems. How do you evaluate the pelvic outlet?
pubic bone, ischial tuberosities, coccyx
188
What 3 OMT techniques can you do for otitis media?
- ear pull
- gal breath
- muncie technique
189
Explain SCM counterstrain position
F St Ra
190
The following sx are indicative of what spastic muscle: inability to stand striaght, knees flexed, L1-2 SD, pain referral to back and groin, positive thomas test
iliopsoas
