OMM technique review (DSA July 26) - from lab manual chapter 5

Question 1

Articulatory Technique

Answer 1

often referred to as low-velocity, high amplitude. Activating force is a gentle repetitive movement through the restricted barrier, and long-lever vectors are commonly used to more efficiently achieve an increase in motion. -> high amplitude (increased range of motion induced), and mvmt is done more slowly.

Never exceed the anatomic barrier.

1. Engage the restrictive barrier directly
2. Bring the body part through its restrictive barrier for 1-2 seconds with a gentle but firm force
3. allow the area to release for 1-2 seconds while the body part returns to a point just short of the restrictive barrier
4. the restrictive barrier will shift as the treatment progresses adn motion is restored.
5. Re-engage the new restrictive barrier and repeat motion through it. Each cycle should increase motion until no futher progress is made.

Absolute contraindications: lack of consent, absence of dysfunction, fracture/ dislocation/ joint instability, acute inflammation, neurologic entrapment syndromes, serious vascular compromise, local malignancy or metastasis, bleeding disorders

Question 2

Balanced Ligamentous Tension

Answer 2

the ligaments of a joint can be viewed as a complicated set of levers, pulley, and straps that maintain constant tension. Functional: distributed, balanced tension.

Physician: establish a fulcrum while an activataing force is introduced by either physician or physiologic forces generated by the body. Both dired and indirect used, often simultaneously.

Establish balanced tension (methods: exaggeration of dysfunction, direct action, decompression, molding - a fluid technique), and more)

Somatic dysfunction is placed in a position of balance relative to the surrounding tissue so that the body is allowed to return it to its inherent reciprocal tension and full range of mosion. Subtle, gentle, well tolerated.

Absolute contraindications: Lack of patient consent, absence of somatic dysfunction

Question 3

Strain/ Counterstrain

Answer 3

considers dysfunction to be a continuing, inappropriate strain reflex, inhibited by applying mild strain in opposite direction
Specific areas of tense, tender tissue: tender points

Found in myofascial tissue such as muscle bellies, tendons, and ligaments

Body’s inherent proprioceptive reflex associated with gamma efferent system –> resets myofascial tesnion so that strained tissue is more contracted and antagonis mucle’s “normal” is more stretched –> restricted motion. (= gamma gain, an inappropriate proprioceptie reflex)

90 seconds resets gamma gain

1. Locate tender point
2. Quantify
3. Monitor and assess tissue texture change during treatment
4. Move pt to position of relaxation- fold and hold. Bring origin and insertion twoard each other. Pt is passive
5. 90 seconds
6. Slowly return pt to normal
7. Re-evaluate tender point

well tolerated, helpful in delicate patients, acute pain, hypertonicity and irritation

Question 4

Differences between tender points, chapman’s points, and trigger points

Answer 4

Tender Point: in tendinous attachments, belly of muscle, ligaments.

• discrete, small, tense, edematous. Size of a fingertip
• Very tender, localized, without radiation
• assocated with somatic dysfunction
• treated with CS

Chapman’s Point
- in subcutaneous tissue, fascia, muscle, ligament, perichondral/ periosteal tissue
- Ganglioform, granular, contracted, edematous, ropy, fibrospongy. Size varies fromt eh size of a pinhead to an almond. Often described as the size of a pea.
- ay or may not be tender. Well-localized, without radiation.
- Associated with viscerosomatic reflex
Treatment: Rotatory stimulation for 20-60 seconds

Trigger Point
- in fibers in mid-portion of muscle, myotendinous junction
- distinct nodules in the muscle or rope-like “taut band” at the tendon.
Size similar to chapman’s point
-Tender, localized, radiates distinct and reproducible pain based on myofascial anatomy
- Associated with Local pathophysiology within the muscle
Treatment: injection, dry needling, ischemic compression, post-isometric relaxation MET, spray and stretch, CS

Question 5

HVLA

Answer 5

direct thrust technique within anatomic range of motion of joint.
Somatic dysfunction –> restrictive barrier and force vector directed through it.
Precise, localized.

For firm, distinctive, bony end feel (mechanical-type dysfunction)
boggy rubbery feel- not so responsive to HVLA

quick treatment, quick relief of symptoms, satisfying. Rest, ice, NSAIDs for soreness.

1. Position to restrictive barrir by stacking the motions of the joint.
2. Pt. relax
3. Short, rapid thrust in direcction of dysfunction (not winding up)
4. Reassess.

Absolute contraindications: lack of consent, absence of dysfunction, joint instability, severe osteoporosis, local metastasis, osteoarthritic joint with ankylosis, severe pondylosis with ankylosis, severe herniated disc with radiculopathy, osteomyelitis or local infection, joint replacement, down syndrome, congenital anomalies such as chiari malformation, blocked vertebra, klippel-feil syndrome, achondroplastic dwarfism (cervical spine) osteogenesis imperfecta, etc., Vertebrobasilar insufficiency

Question 6

Facilitated Positional Release

Answer 6

indirect treatment for superficial dysfunctions (muscle spasm, articular dysfunctions)
Basic principles: bringing dysfunctional area into neutra, activating force such as compression, traction, torsion, or combo of these while area brought into the position of ease until tension is diminished.
Should induce relaxation of myofascial tissue, unloading of the joint, and increased motion. Decreases gamma gain
Benefits: treat superficial and deep musculature, time efficient
If restriction caused by degenerative changes, anatomic malformation, or ligamentous damage, not as optimal an outcome

1. Monitor area, position in neutral to release tension
2. Apply activating force until relaxation palpated
3. Bring into ease
4. 3-5 seconds
5. passively return

Question 7

GOT

Answer 7

rhythmic oscillation, fluid circles –> improve motion and function
globally treating the body by region and then more localized
integration of entire body into a harmonious, functional unit
simple and effective, applied to almost any patient

Question 8

Lymphatic technique

Answer 8

For fluid stasis and congestion
aids healing mechanism

lymphatis- thinnest-walled vessels

the thoracic duct passes through the thoracic inlet and associated Sibson fascia before entering into the subclavian vein; imporant site of treatment.
Thoracic and pelvic diaphragms also important lymphatic pumps. Order significant– open up the dams before unleashing the river.
Thoracic inleet and sibson fascia first, then thoracic diaphragm, pelvic diaphragm and other congested areas.

Principles include:

1. Remove impediments to lymphatic flow
2. Enhancing mechanisms involved in respiratory-circulatory homeostasis
3. Extrinsically augment the flow of lymph and other immune system elements (soft tissue effleurage, massage, petrissage, etc.)
4. Mobilize lymphatic fluids from local or reginal tissues that would benefit from decongestion

Especially in hospitalized, pre-op, post-op, pregnant, and immunocompromised patients.

Absolute contraindications:
- lack of consent, absence of dysfunction, necrotizing fasciitis, anuria, if patient is not on dialysis

Question 9

Muscle Energy

Answer 9

direct technique; patient is moved through restrictive barrier. Resets proprioception and balances muscle tone across joints.
-muscle spindles
- golgi tendon organs
= major proprioceptive receptors in muscle.

extrafusal fibers - bulk of muscle (contracting motor units); efferent innervation provided by alpha motorneurons.
Muscle spindles provide info about length/ rate of change via group Ia and II fibers. Maintains muscle tone.
Contraction- spindle fiber decreases in length
Gamma-motorneurons - efferent innervation to muscle spindles, regulated by the CNS.

Golgi tendon organs- in tendons and along fascial coverings- provide info about muscle tension to protect from over-contracting.
IB- increases firing when golgi tendon orgon is stretched. –> inhibition of alpha-motorneurons.

in MET:
isometric- same length
concentric isotonic- origin and insertion approximate while constant tension
eccentric isotonic- origin and insertion separate while constant tension
Isokinetic- constant velocity
isolytic- attempted conentric isotonic with external force in opposite direction

Technique principles:

1. Place patient to feather edge of restrictive barrier
2. PT: move into position of ease while resisting counterforce
3. 3-5 seconds
4. relax
5. Take up slack, reach new barrier

relax so that muscle stretching occurs during refractory period without proprioceptive response.

Absolute contraindications:

• lack of consent
• absence of dysfunction
• unable/ unwilling to follow verbal diretions
• fracture, dislocation, joint instability

Question 10

Myofascial Release

Answer 10

Fascia- connects every cell, tissue, organ. Tensegrity. Metabolically active. Piezoelectricity

distortion –> biochemical, immunologic, and electric changes.

MFR- can be direct, indirect, or combined.

fascia- framework of life

absolute contraindications: lack of consent, absence of somatic dysfunction

Question 11

Soft Tissue

Answer 11

direct technique
usually involves lateral stretching, linear stretching, deep pressure, traction/ separation of muscle origin and insertion while monitoring tissue response and motion changes by palpation.
used before other tecniques to facilitate treatment, for example. (as in, before HVLA)
Goes into the restrictive barrier

1. apply gentle force of low amplitude
2. while assessing pt response, force can be increased for maximal tissue relaxation but rate should be 1-2 seconds of stretch/ 1-2 seconds of release
3. Continue until no further change

• stay comfortable
• not pain, but good hurt is fine

Techniques:

• parallel traction
• perpendicular traction (neading)
• direct inhibitory pressure
• effleurage
• petrissage and skin rolling (deep pressure and lifting skin/ associated fascia away from deeper structures to break down adhesions)
• tapotement- rapid and repeated striking- with edge of hand, cupped hand or tips of fingers

Absolute contraindications:
- lack of consent, absence of dysfunction, fracture or dislocation, neurologic entrapment syndromes,
serioius vascular compromise local malignancy, local infection, bleeding disorder

Question 12

Still Technique

Answer 12

specific, non-repetitive articulatory method: first indirect and then direct. long levers is common.

1. Evaluate tissue –> go to posn of ease
2. Introduce force vector (compression or traction) to point that it engages the tissue
3. While maintaining force vector, move affected tissue through its restriction
4. Passively move back to neutral and reassess.

posn of ease disarms neuroreflexes, myofascial tissue is relaxed. Force vector allows re-patterning of neuro-fascial-vascular complex.

Absolute contraindications: lack of pt consent, absence of dysfunction.