Midterm Material Flashcards
1961 event where DOs traded degree for MD degree
California incident; prohibited DO licenses
1996-2000 surgeon general of army
Lieutenant General Ronald R.Blank, DO
1st minority AOA president
Marcelino Oliva
1st Tenet of Osteopathic Medicine
The mind, body & spirit are a unit
2nd Tenet of Osteopathic Medicine
The body is capable of self-regulation, self-healing, and health maintenance
3rd Tenet of Osteopathic Medicine
Structure and function are reciprocally interrelated
4th Tenet of Osteopathic Medicine
Rational treatment is based upon understanding and implementing the other 3 tenets
Active ROM
Pt motivated and pt must give maximum effort
Acute Somatic Dysfunction
Immediate or short-term impairment or altered function
Characterized by: vasodilation, edema, tenderness, pain, and tissue contraction
Anatomical Barrier (AB)
limit of motion imposed by anatomical structure; limit of passive motion
Anterior Landmarks
acromion, clavicle, rib cage, umiblicus, crest of ilium, greater trochanter, patellar alignment
Articulatory Technique (ART)
- “sprining” techniques; gentle and reptetitive motions through restrictive barrier
- low velocity/high amplitude
- direct
Articulatory Technique Contraindications
- fracture/dislcoation
- neurologic entrapment syndrome
- serious vascular compromise
- local malignancy
- local infection
- bleeding disorders
Articulatory Technique Indications
well tolerated by:
- arthritic pts
- elderly or frail
- critically ill or post operative
- infants or very young patients
- patients unable to cooperate with instructions
Asymmetry
Absence of symmetry of position or motion
Asymmetry of muscles treatment goals
return symmetry and normalize tone
AT Still flung banner of osteopathy to the breeze on…
June 22, 1874 at 10am
Axial and Appendicular Fascia (investing layer)
internal to pannicular layer; fused to panniculus and surrounds all muscles and periosteum of bone and peritendons of tendons
Barrier “end feel” characteristics
Bone to bone (elbow extension)
Soft tissue approximation (knee flexion)
Tissue stretch (finger extension)
Bind
palpable restriction of connective tissue mobility
Bogginess (tissue texture change)
tissue texture abnormality characterized by sense of sponginess in tissue (resulting from congestion due to increased fluid)
Chronic Somatic Dysfunction
Impairment or altered function of related components of the somatic system
Characterized by: tenderness, itching, fibrosis, paresthesias, tissue contraction
Concentric isotonic muscle contraction
contraction of a muscle with shortening of muscle length
Contraction
Normal tone of muscle when it shortens
Contracture
Abnormal shortening of muscle due to fibrosis; result of chronic condition; muscle unable to reach normal length
Coupled motion
consistent association of motion about one axis with another motion about a second axis; principle motion cannot be produced without both
Creep
connective tissue under sustained, constant load will elongate (deform) in response to load
Crossed extensor reflex (MET)
used when muscle needing treatment is severely injured (burns or fractures); when flexor of one extremity is contracted volunarily, flexor muscle in contralateral extremity relaxes and extensor contracts
Describe Fascia
connective tissue layers composed of collagen fibers in an amorphous matrix of hydrated proteoglycans (PGs) which links collagen fiber networks together
Direct Techniques
go towards & eventually through the restrictive barrier
Ease
the direction in which connective tissue may be moved most easily during deformational stretching; palpated as a sense of tissue “looseness”
Eccentric isotonic muscle contraction
contraction of a muscle with increase in length of muscle
Ectomorph vs Endomorph vs Mesomorph
Ectomorph = associated w/ ectoderm (tall and lean) Endomorph = associated w/ endoderm (thick and heavy); also pyknic Mesomorph = associated w/ mesoderm (average person)
Ehlers-Danlos Syndrome Dx
Beighton score + Brighton criteria
Elastic barrier
range between physiologic and anatomic barrier or motion in which stretching occurs before tissue disruption; area that “warms up” with stretching
End Feel of ROM Meanings: abrupt, crisp, hard, elastic, empty
Abrupt - OA or hinge joint
Crisp - involuntary muscle guarding (pinched nerve)
Hard - somatic dysfunction
Elastic - like a rubber band
Empty - stops due to guarding (pt doesn’t allow motion due to pain)
Factors Influencing Successful Muscle Energy - by Operator
- not controlling joint position in relation to barrier movement
- not providing counterforce in correct direction
- not giving accurate instruction
- moving to new joint position too soon after pt stops contracting
First and lasts states to legally licence DO’s
Vermont and Mississippi
First Female Dean of Medical College
Barbara Ross-Lee
first woman to receive DO degree
Jeanette Bolles
Functional unit of spinal cord
two vertebrae, their associated disc, neurovascular and other soft tissues
Hooke’s Law
Strain (deformation) placed on elastic body is proportion to stress (force) placed on it
Hypertonia
state of abnormally high muscle tension; spastic
Hypotonia
state of low muscle tone; reduced muscle strength
Hysteresis
Difference between loading and unloading characteristics represents energy lost in connective tissue; energy lost is hysteresis
Stretching connective tissues into its plastic deformational range will bring about lengthening of tissue
Indications of MFR
- somatic dysfunction
- when HVLA or Muscle Energy is contraindicated (consider indirect MFR)
- when counterstrain may be difficult due to pt’s inability to relax
Indirect Techniques
Go away from restrictive barrier
INR (Integrated Neuromusculoskeletal Release)
Uses REM’s to speed the treatment of process during MFR
Isokinectic stregthening (MET)
when muscle is chronically tight, antagonist muscle is chronically loose (leads to weakness of muscles - asymmetry)
- sustained gentle pressure (10-20lbs); allows motion but slowly and controlled
Isolytic lengthening (MET)
used to lenghten muscle shorted by contracture or fibrosis (stroke/cerebral palsy)
patient contracts and and physician pulls against the contraction; can be painful technique (uses maximal force)
Isolytic muscle contraction
non-physiologic; attempted concentric contraction with an external force causing muscle lengthening
Isometric Muscle contraction
contraction of a muscle with no change in distance between origin and insertion (no length change)
Isometric vs Isotonic Procedures
Isometric - light to moderate contraction and unyeilding counterforce
Isotonic - hard to maximal contraction and counterforce permits controlled motion
joint mobilization methods
direct, indirect, combined, physiological, exaggeration
Joint Mobilization using Muscle Force (MET)
Hypertonicity of musculature across a joint causes distortion of joint; restoration of motion to the joint results in gapping or reseating of joint relations; uses maximal muscle contraction (usually 30-50 lbs)
Linkage
relationship of joint mechanism with surrounding structures; linking structures give you greater ROM
Ex. shoulder/spine
Meningeal Fascia
surrounds the nervous system; includes the dura mater
MET vs ART
MET: direct, pt muscle contraction 3-5 seconds 3-5 times, active (requires pt cooperation)
ART: direct, repetitive physician directed motions, passive (pt relaxed)
MFR Endpoint
when a 3D release is often palpated: warmth, softening, and increase compliance/ROM
- continue til forces no longer produce change
Models of Osteopathic Treatment
Psychosocial Respiratory-circulation Bioenergy Biomechanical Neurological
Most common compensatory pattern
L/R/L/R
tentorium cerebelli/thoracic inlet/thoracolumbar diaphragm/pelvic diaphragm
Muscle Energy Contrainidcations
- local fracture/dislocation
- moderate to severe segmental instability of cervical spine
- neurologica symptoms or signs on rotation of neck
- low vitality
- unable/unwilling to follow commands
- situation that could be worsened by muscle energy (post surgical, post MI, recent eye surgery)
Newton’s Third Law
when 2 bodies interact, force exerted by one is equal in magnitude and opposite in diretion as forces exerted by other
Oculocephalogyric Reflex (MET)
eye movements reflexively affect cervical and truncal musculature as body attempts to follow lead provided by eye motion (exceptionally gentle)
Pannicular Fascia Layer (panniculus)
outermost layer derived from somatic mesenchyme and surrounds entire body except orfices; outer layer is adipose and inner layer is membranous and adherent
Passive ROM
Pt must relax fully and you must “block the linkage” of associated structures
Physiologic Barrier (PB)
limit of active motion
Flexion/Extension Plane
Sagittal
Abduction/Adduction Plane
Frontal/Coronal
Horizontal Abduction/Adduction Plane
Transverse/Horizontal
Plumb Line
Lateral View Landmarks: external auditory canal, acromion process, greater trochanter, anterior lateral malleolus
Post-isometric relaxation (MET)
muscle->golgi tendon organ (GTO)->tendon
muscle contraction->increases tension in GTO->inhibition of muscle contraction and muscle releases further
Posterior Landmarks
scapular spine, scapular angle, arm carriage, spinous process alignment, iliac crests, PSIS, gluteal line, popliteal space, achilles tendon
Reciprocal Inhibition (MET)
when a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of muscle antagonistic group; uses ounces not pounds of pressure; same side - ipsilateral
REMs
- Breath holding
- R/L cervical rotation
- Prone and supine simulated swimming and pendulum arm swing
- Isometric limb and neck movement against table or chair
- Pt evoked movement from cranial nerves (eye, tongue, jaw, oropharynx)
Respiratory Assistance (MET)
use of breathing and exaggerated respiratory motion in the muscle forces (does not use a lot of force); used in treating ribs and sacrum
Restricted motion of soft tissue Treatment Goal
set the fascia free
Restriction of Motion
resistance or impediment to movement
Restrictive barrier (RB)
a functional limit that abnormally diminishes normal physiologic range
Ropiness
Hard, firm, rope-like muscle tone; usually indicates chronic condition
SAM VLAN
Skeletal
Arthrodial
Myofascial structures and their related
Vascular
Lymphatic
and
Neural elements
Sherrington’s Law
When muscle receives a nerve impuse to contract, its antagonist receive a simultaneous impulse to relax
Soft Tissue (ST) Contraindications
- Severe Osteoporosis - prone pressure may be contraindicated but lateral recumbent techniques could be applied
- Acute Injuries - direct techniques may do additional damage and increase pain
Soft Tissue (ST) Indications
- Diagnostically to idenfity areas of restricted motion, tissue texture changes, and sensitivity
- Feedback about tissue response to OMT
- Provide general state of relaxation
- Enhance circulation to myofascial structures
Soft Tissue Absolute Contraindications
Don’t use in local region of any:
- fracture/dislcoation
- neurologic entrapment syndrome
- serious vascular compromise
- local malignancy
- local infection
- bleeding disorders
Soft Tissue Techniques
Stretch - increase distance between origin and insertion
Knead - repetitive pushing of tissue perpendicular to muscle fibers
Inhibition - push and hold perpendicular to fibers; hold until relaxation of tissue
Somatic Dysfunction
Impaired or altered function of related components of the somatic (body framework) system
Spasm
suddent involuntary muscular contraction usually accompanied by pain/restriction of normal function
Static vs Dynamic Flexibility
Static - max ROM a joint can achieve with externally applied force
Dynamic - ROM an athelete can produce and speed at which it can be produced
Stress-Strain
Stress is force that attempts to deform connective tissue structure
Strain is percentage of deformation of connective tissue
During cyclic loading of tendon, stress-strain curve shifts right
TART
Diagnostic Criteria for Somatic Dysfunction
Tissue texture abnormalities
Asymmetry of structure or motion
Restriction of motion
Tenderness
Tenderness Treatment Goals
normalize neurologic activity (pain) and improve abnormal somato-somatic and somato-visceral reflexes
Tenderpoints
small discrete hypersensitive areas within myofascial structures - results in localized pain
Timeline of AT Still life events: 1864, 1874 (2), 1885
1864 - battle of westport; 1874 - flung banner of osteopathy; 1874 - removed from methodist church; 1885 - coins term “osteopathy
Tissue Texture Abnormalities
Palpable change in tissues
Ex. bogginess, thickening, striginess, ropiness, firmness, temperature change, moisture change
Tissue Texture Abnormality Treatment Goals
- stretch and increase elasticity of shortened myofascial structures
- improve local tissue nutrition and removal of metabolic waste to normalize tissues
Trigger point
small discrete hypersensitive areas within myofascial structures - palpation causes referred pain away from site
Visceral Fascia
surrounds body cavities (pleural, pericardial, and peritoneum)
What body systems do somatic dysfunction have an affect on?
nervous + fluid dynamics + biomechanics + visceral
What did AT Still study from his father?
Medicine and ministry
What is Muscle Energy?
- voluntary contraction of patient muscle in a precisely controlled direction
- varying levels of intensity
- against a distincly executed counterforce
- active technique
- can be direct or indirect
What makes up ROM?
Direction, Range, Quality
What year did American School of Osteopathy open?
1892
When were DO’s accepted as equal to MDs in military? When were DO’s drafted as military medical officers?
1963; 1967
Which is greater? PROM or AROM
PROM because pt’s muscles are relaxed
Which part of the spine produces the greatest ROM?
Cervical Spine
Who decreased mortality rate in obstetrics by washing hands?
Ingaz Semmelweiss
Wolff’s Law
bone will develop under the sress placed upon it; extends to fascia too
