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OS Exam I > Muscle Energy And Articulatory Principles > Flashcards

Muscle Energy And Articulatory Principles Flashcards

1
Q

Muscle energy is:

A ________ contraction of patient muscle

In a precisely controlled _______

Varying levels of ________

Against a distinctly executed ____________

A

Voluntary

Direction

Intensity

Counterforce

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2
Q

Is muscle energy an active or passive technique?

A

Active - patient contributes the corrective force

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3
Q

What is the direct technique for muscle energy?

A

Muscle energy positioned to the restrictive barrier

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4
Q

What is the patient’s direction of motion in muscle energy?

A

Away from the barrier

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5
Q

What are the 4 types of muscular contraction?

A

Isometric
Concentric isotonic
Eccentric isotonic
Isolytic

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6
Q

Which of the following refers to contraction of a muscle with no change in distance between the origin and insertion?

A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction

A

A. Isometric contraction

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7
Q

Which of the following refers to contraction of a muscle with separation of origin and insertion?

A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction

A

C. Eccentric isotonic contraction

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8
Q

Which of the following refers to contraction of a muscle with approximation of origin and insertion?

A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction

A

B. Concentric isotonic contraction

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9
Q

Which of the following refers to attempted concentric contraction, with an external force causing separation of origin and insertion?

A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction

A

D. Isolytic contraction

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10
Q

Which of the following refers to non-physiologic muscular contraction?

A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction

A

D. Isolytic contraction

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11
Q

Which of the following refers to the type of muscular contraction utilized in muscle energy techniques?

A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction

A

A. Isometric contraction

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12
Q

Which of the following refers to the “curl” part of the biceps curl?

A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction

A

B. Concentric isotonic contraction

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13
Q

Which of the following refers to the relaxation phase of the bicep curl?

A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction

A

C. Eccentric isotonic contraction

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14
Q

What physiologic principle refers to the most common form of MET?

A

Post-isometric relaxation

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15
Q

What physiologic principle of MET refers to muscle contraction –> increased tension in golgi tendon organ –> inhibition of muscle contraction

A

Post-isometric relaxation

[provides feedback inhibition on alpha motor neuron]

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16
Q

What physiologic principle of MET refers to:

Hypertonicity of musculature across a joint causing distortion of articular relationships and motion loss, increase in tone tends to compress joint surfaces, thinning the joint surfaces

Restoration of motion to the articulation results in gapping or reseating of distorted joint with reflex relaxation of the previously hypertonic musculature

A

Joint mobilization using muscle force

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17
Q

What is the force of contraction when performing MET via joint mobilization using muscle force?

A

Maximal muscle contraction that can be comfortably resisted by the physician (up to 30-50 lbs of pressure depending on the joint treated)

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18
Q

What is the physiologic basis for respiratory assistance?

A

The muscular forces involved in these techniques are generated by breathing

May involve direct use of respiratory muscles themselves, or motion transmitted to the spine, pelvis, and extremities in response to ventilation motions

Physician usually applies fulcrum against which respiratory forces can work

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19
Q

What provides the force of contraction with respiratory assistance techniques

A

Exaggerated respiratory motion

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20
Q

The physiologic basis for this technique is that eye movements reflexively affect the cervical and truncal musculature as the body attempts to follow the lead provided by eye motion

A

Oculocephalogyric reflex

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21
Q

How strong is the force of contraction used with oculocephalogyric reflex?

A

Exceptionally gentle

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22
Q

The physiologic basis to this technique is that when a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of that muscle’s antagonistic group

A

Reciprocal inhibition

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23
Q

How strong is the force of contraction used with reciprocal inhibition?

A

Think ounces, not pounds of pressure

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24
Q

What MET technique is used in the extremities where the muscle that requires treatment is in an area so severely injured (e.g., fractures or burns) that it is directly unmanipulable or inaccessible?

A

Crossed extensor reflex

25
Q

What is the physiologic basis for the crossed extensor reflex?

A

Form of MET using learned cross pattern locomotion reflexes engrammed into the CNS

When the flexor muscle in one extremity is contracted voluntarily, the flexor muscle in the contralateral extremity relaxes and the extensor contracts

26
Q

What is the strength of the force of contraction used in the crossed extensor reflex MET?

A

Think ounces, not pounds of pressure

27
Q

What is the difference between reciprocal inhibition and the crossed extensor reflex?

A

Reciprocal inhibition is done on the ipsilateral side, while the crossed extensor reflex is meant to affect the contralateral side

28
Q

What MET is used to reestablish normal tone and strength in a muscle weakened by reflex hypertonicity of the opposing muscle group?

A

Isokinetic strengthening

29
Q

What is the physiologic basis for isokinetic strengthening?

A

Where asymmetry for ROM exists, there is also potential for asymmetry in muscle strength. If there is shortening of an antagonist muscle, attend to that first and feel the agonists spontaneously increase their strength if the shortened or hypertonic fibers are lengthened first

Once this is accomplished, further restoration of strength can be accomplished through the use of an isokinetic conraction.

In isokinetic contractions, the length change occurs at a constant velocity.

30
Q

What type of muscle contractions are used with isokinetic strengthening MET?

A

Concentric contractions, where muscle is permitted to shorten, but at a controlled rate

31
Q

What is the force of contraction used in isokinetic strengthening?

A

Sustained gentle pressure (10-20 lbs of pressure)

32
Q

What MET is used to lengthen a muscle shortened by contracture and fibrosis?

A

Isolytic lengthening

33
Q

What is the physiologic basis for isolytic lengthening?

A

It is postulated that the vibration used here has some effect on the myotactic units in addition to mechanical and circulatory effects

34
Q

What is the force of contraction used in isolytic lengthening?

A

Maximal contraction that can be comfortably resisted by the physician (30-50 lbs of pressure)

35
Q

What is the physiologic basis for the MET using muscle force to move one region of the body to achieve movement of another bone or region?

A

For some dysfunctions, it is often more effective to move one body structure by moving another body structure adjacent to it.

Muscular force is used to move the first structure and that body part’s response to the muscle force is transmitted to yet another part of the body

36
Q

What is the force of contraction used when using muscle force to move one region of the body to achieve movement of another bone or region?

A

Sustained gentle pressure (10-20 lb of pressure)

37
Q

What 3 things do isometric and isotonic procedures have in common?

A

Careful positioning
Relaxation after contraction
Repositioning

38
Q

Isometric and isotonic METs both utilize careful positioning, relaxation after contraction, and repositioning. They are also different in several ways.

Which procedure (isometric or isotonic) utilizes hard to maximal contraction, and counterforce permits controlled motion?

A

Isotonic

39
Q

Isometric and isotonic METs both utilize careful positioning, relaxation after contraction, and repositioning. They are also different in several ways.

Which procedure (isometric or isotonic) utilizes light to moderate contraction and an unyielding counterforce?

A

Isometric

40
Q

T/F: METs are versatile to use in combination with other osteopathic manipulative techniques

A

T

41
Q

What are some indications to using muscle energy techniques?

A

Balance muscle tone

Strengthen reflexively weakened musculature

Improve symmetry of articular motion

Enhance circulation of body fluids

Lengthen a shortened, contractured, or spastic muscle group

42
Q

What are the first 3 steps in the sequence of a muscle energy technique?

A
  1. Physician positions body part to be treated and position of initial resistance
  2. Patient is instructed on intensity, duration, and direction of contraction
  3. Physician directs patient to contract appropriate muscle/group
43
Q

MET - Sequence of technique:

  1. Physician positions body part to be treated and position of initial resistance
  2. Patient is instructed on intensity, duration, and direction of contraction
  3. Physician directs patient to contract appropriate muscle/group

What are the next 3 steps?

A
  1. Physician uses counterforce in opposition to and equal to the patient contraction
  2. Physician maintains forces until an appropriate patient contraction is perceived at critical area (takes 3-5 seconds)
  3. Patient is directed to relax while physician simultaneously matches the decrese in patient force
44
Q

MET - Sequence of technique:

  1. Physician positions body part to be treated and position of initial resistance
  2. Patient is instructed on intensity, duration, and direction of contraction
  3. Physician directs patient to contract appropriate muscle/group
  4. Physician uses counterforce in opposition to and equal to the patient contraction
  5. Physician maintains forces until an appropriate patient contraction is perceived at critical area (takes 3-5 seconds)
  6. Patient is directed to relax while physician simultaneously matches the decrese in patient force

What are the next 4 steps?

A
  1. Physican allows pt to relax and senses tissue relaxation with proprioception
  2. Physician takes up slack permitted by procedure, allowing decreased tension in tight muscle so that it is passively lengthened
  3. Repeat steps 1-8 three to five times
  4. Reevaluate initial dysfunction
45
Q

What are some things that can go wrong due to patient error in METs?

A

Patient:

Contracts too hard

Contracts in wrong direction

Sustains the contraction for too short a time

Does not relax appropriately following contraction

46
Q

What are some things that can go wrong with MET due to operator/physician error?

A

Not controlling the joint position in relation to the barrier movement

Not providing counterforce in correct direction

Not giving accurate instructions

Moving to a new joint position too soon after patient stops contracting

47
Q

What are some contraindications to METs?

A

Local frature
Local dislocation
Moderate-to-severe segmental instability in the cervical spine
Evocation of neurologic symptoms or signs on rotation of neck
Low vitality
Unable/unwilling to follow verbal commands

48
Q

One contraindication to METs are situations that could be worsened by muscle activity, what are some examples of this?

A

Post-surgical patient - could cause internal bleeding

Immediately following myocardial infarction

Recent eye surgery - use of oculocephalogyric reflex

49
Q

Muscle energy has been shown to cause what potentially harmful conditions?

A

Tendon avulsion (with inappropriate force)

Rib fracture (in patient with osteoporosis)

Anterior chamber intraocular hemorrhage (in patient s/p cataract removal and lens implant)

50
Q

What type of osteopathic approach utilizes direct “springing” techniques that are low velocity/high amplitude, and is as old as osteopathy itself?

A

Articulatory approaches

51
Q

Articulatory approaches utilize ______ and ______ motions through restrictive barriers to restore physiologic motion

They are applicable with restrictive barriers in the joint or ________ tissues

A

Gentle; repetitive

Periarticular

52
Q

What are some indications for articulatory techniques in terms of the types of patients they are well tolerated by?

A 
Arthritic patients
Elderly or frail
Critically ill or post-op
Infants or very young patients
Patients unable to cooperate with instructions
53
Q

With ARTs, the patient should be comfortable and able to ______; at no time is the ________ barrier to joint motion exceeded

A

Relax; anatomic

54
Q

What are the first 4 steps of ART?

A
  1. Physician in position of comfort
  2. Physician moves affected joint/body part until restrictive barrier is engaged
  3. Gentle but firm force is applied carrying body part to a short distance through barrier
  4. This force applied rhythmically, typically 1-2 sec of stretch followed by a similar time frame releasing that stretch; joint is then permitted to return to point just short of restrictive barrier
55
Q

Steps of ART:

  1. Physician in position of comfort
  2. Physician moves affected joint/body part until restrictive barrier is engaged
  3. Gentle but firm force is applied carrying body part to a short distance through barrier
  4. This force applied rhythmically, typically 1-2 sec of stretch followed by a similar time frame releasing that stretch; joint is then permitted to return to point just short of restrictive barrier

What are the last 3 steps?

A
  1. As pt responds, restrictive barrier shifts position within physiologic ROM, continue to reengage RB until normal ROM is reached
  2. Applied forces may cause discomfort, but good discomfort
  3. Technique continued until RB reaches plateau, or normal ROM is reached
56
Q

What is the relative contraindication to articulatory technique?

A

Vertebral artery compromise (avoid combination of rotation and extension in cervical spine)

57
Q

What are the absolute contraindications to articulatory techniques?

A 
Local fracture or dislocation
Neurologic entrapment syndrome
Serious vascular compromise
Local malignancy
Local infection
Bleeding disorders
58
Q

What are the 2 similarities between MET and ART?

A

Both direct techniques, both have the goal of alleviating somatic dysfunction

59
Q

The 2 primary differences between MET and ART have to do with activating forces and levels of patient cooperation, what are they?

A

MET:
Activating force is patient muscle contraction, patient cooperation is required

ART:
Activating force is repetitive physician directed motions, patient cooperation requires relaxation

OS Exam I (18 decks)

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