OOP midterm Flashcards
homeostasis
Tendency of the body to seek and
maintain a condition of balance or
equilibrium within its internal
environment, even when faced with
external changes
Allostasis
body’s attempt to compensate for a stressful
situation in a protective manner
When threatened, the neuroendocrine-immune network-
capable of altering normal homeostatic rhythms
– As threat diminishes, feedback control systems should suppress
levels of allostatic compounds, returning body to normal function
– Disease processes will activate allostatic response
- Frequent activation of stress response
damages body chronically through activation
of the hypothalamic-pituitary adrenal (HPA) axis
– Effects add up progressively (cumulative)
Allostatic load: price paid for chronic exposure
to stress-mediated neuroendocrine adaptations
– Long-term exposure to allostatic chemical
environment (catecholamines, cortisol, cytokines)
* Long-term activation of allostatic mechanism—
gradual destruction of organ systems
– Gradual loss of effectiveness of feedback pathways to
reestablish normal homeostasis
Allostatic load:
Allostatic load: price paid for chronic exposure
to stress-mediated neuroendocrine adaptations
– Long-term exposure to allostatic chemical
environment (catecholamines, cortisol, cytokines)
* Long-term activation of allostatic mechanism—
gradual destruction of organ systems
– Gradual loss of effectiveness of feedback pathways to
reestablish normal homeostasis
Biomechanical Model
patient has T4/T3 restriction, so they would have trouble walking
Uses structural/mechanical perspective to assess patient
* Structural impediment caused by a dysfunction of muscles, joints,
&/connective tissue
Can lead to disturbances in various body functions
- Assess patient for a structural impediment (somatic dysfunction)
– By using OMT to correct somatic dysfunction, patient regains associated structural,
vascular, neurologic, metabolic, & behavioral functions - Objective: Optimize patient’s adaptive potential through restoring
structural integrity & function
Respiratory-Circulatory Model
Evaluation & treatment:
– Maximize capacity & efficiency of respiratory-circulatory functions
maintenance of extra- & intra-cellular environments
– Delivery of oxygen & nutrients
– Removal of cellular waste products
OMT addresses dysfunction in:
– Respiratory mechanics
– Circulation
– Flow of body fluids
restoring fluid circulation
ex: compressed nerved—-> light headed
neurological model
- Sensory & protective
- Focuses on impairments of neural function caused by or cause pathophysiologic responses in
the other 4 domains
relationship between somatic and autonomic NS
- Considers influence on neuroendocrine immune network by:
– Spinal facilitation
– Proprioceptive function
– Autonomic nervous system
– Activity of nociceptors (pain fibers)
compression of vangus nerve, anxiety
IMPAIRMENT OF A NEURAL FUNCTION
neurological model
OMT focus and goal of treatment
- OMT focus
– Reduction of mechanical stresses
– Balance of neural inputs
– Elimination of nociceptive drive - Goal of treatment:
– Re-establish normal/optimal neural function
– Attain autonomic balance and flexibility
– Address neural reflex activity
– Remove facilitated segments
– Decrease afferent nerve signals
– Achieve pain relief
compression of vangus nerve —> anxiety
Metabolic-Energy (Nutritional) Model
Recognizes that the body seeks to maintain a balance between
– Energy production, Distribution, Expenditure
* The body’s ability to restore & maintain health requires energy-efficient response to
infectious agents & repair of injuries
* Proper nutrition enables normal biochemical processes, cellular functions, &
neuromusculoskeletal activity
injury to MSK burdens the energy
diabetic—> weight gain —-> strain on body
Behavioral (Biopsychosocial) Model
- Recognizes that patient’s health includes:
– Mental, emotional, & spiritual state of being
– Personal lifestyle choices - Health is often affected by:
– Environmental, socioeconomic, cultural, & hereditary factors
– Various emotional reactions & psychological stresses - Environmental toxicities, inactivity, lack of exercise, use of addictive substances, poor
dietary choices can diminish a patient’s adaptive capacity, make him/her vulnerable to
infections and/or organ/system failure - Provide patient EDUCATION on:
– Health
– Disease & lifestyle choices
– Mental outlook
– Preventative care
diabetic—> weight gain—>strain on body
Somatic Dysfunction:
“Impaired or altered function of related components of the
somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and
related vascular, lymphatic, and neural elements.”
– Impaired joint mechanics
– Altered mechanics of the associated soft connective tissue (e.g., abnormal
resting length of muscle, alteration of the tension of ligament, aberrant tension
across fascia, strain in the dura, and congestion in the extracellular matrix)
– Dysfunctions of arterial supply, venous and lymphatic drainage, and nerve
conduction
– Changes in the tissues resulting from the foregoing to include tissue texture
change (ropiness,
SAM’S RV LANE
Skeletal,
Arthrodial
Myofascial Structures
Related Vascular
Lymphatic and Neural Elements
Primary Somatic Dysfunction
– The somatic dysfunction that maintains a total pattern of dysfunction including
other secondary (“key lesion”)
– Initial or first somatic dysfunction to appear temporally
– Sudden trauma (usually an external force)
– Postural imbalances, micro trauma and repetitive trauma
Secondary Somatic Dysfunction
– Compensation for a primary problem
– Compensation for musculoskeletal defects
– Reflex response to visceral disease
– Reflex response to emotional stress
– Compensation for a hereditary imbalance
what are the 4 tenets of osteopathic medicine
structure and function relationship example
1892
1874
1918
R.K. Smith, M.D., D.O. presented information collected by the AOA at the Annual
Convention of the American Association of Clinical Research in New York City on
October 18, 1919:
* 2,445 DOs reported on their patients
– Influenza
* 110,120 cases treated
* Only 257 deaths (approximately 0.25% mortality rate)
* Reported MD patient mortality rate was 5%
– Influenza-associated Pneumonia
* 6,258 cases treated
* Only 635 deaths (approximately 10% mortality rate)
* Reported MD patient mortality rate was >30% (3x higher than DO rate)
DO had less death rates overall!!!
INC patient volume for DOs
1961
- 1961 - California Osteopathic Association merged with California Medical Association
- 1961 - The College of Osteopathic Physicians and Surgeons in Los Angeles changed
to an allopathic institution, becoming the California College of Medicine (now the
University of California Irvine School of Medicine) - 1962 - Qualified and consenting D.O.s were conferred M.D. degrees
– About 2,000 D.O.s converted their degree to M.D.
– No additional training/education was required, only an administrative fee of $65
– New degrees only recognized within California & specialists unable to practice as such
– D.O.s would no longer be licensed in the state
HOMEOSTASIS VS ALLOSTASIS
Homeostasis- process how body keeps itself in threshold where body can survive
Allostasis—how the body adapts to stressors ….. When the body is under a lot of stress, the baseline will shift. “body’s attempt to compensate for a stressful situation in a protective manner”
The big goal of Osteopathy is to restore homeostasis
palpation
Application of variable manual pressure upon the surface of the body for the
purpose of determine the shape, size, consistency, position, inherent motility and
health of the tissues beneath.
Observation of Static Landmark
Observation of Static Landmark- in the Mid-Gravity
Line/Plumb Line
- Mid-heel point
- Pubic symphysis
- Umbilicus
- Xiphoid process
- Mid-sternum
- Episternal notch
- Symphysis menti
- Glabella
Anterior Static Landmarks in the Mid-Gravity
Line/Plumb Line
describe the 5 models
Somatic Dysfunction:
Somatic Dysfunction: “Impaired or altered function of related components of the
somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and
related vascular, lymphatic and neural elements.
SAM’S RV LANE”
- Somatic dysfunction is a functional disorder
- If pure somatic dysfunction is diagnosed and removed, normal function is restored
Acute Somatic Dysfunction
Chronic Somatic Dysfunction
Acute vs. Chronic Tissue Texture Changes
Acute
Moist
Boggy
Edema
Red
opposite to amber is chronic
TART
__________barrier
* The limit of motion imposed by anatomic structure; the limit of passive range of motion
* The point past which tissue disruption occurs (sprain/strain) and disruption of the joint will occur
Anatomic Barrier
__________ Barrier
* The limit of active motion
* As far as the patient can go without assistance
Physiologic Barrier
________ Barrier
* Somewhere between the physiologic and anatomic, barrier of motion
elastic barrier “feathers edge”
_________Barrier
* A functional limit [within the active range of motion] that abnormally diminishes the normal
physiologic range
* Cannot achieve full range of motion.
Restrictive
_____ barrier
a restriction of joint motion associated with pathologic change of tissues (example: osteophytes)
Pathologic barrier
* a restriction of joint motion associated with pathologic change of tissues (example: osteophytes)
Erythema Friction Rub
landmarks to find spinal process
NAME the Planes and Axes of Motion
Superior Facet Orientation
rules of 3
Fryettes principles
Type I vs Type II Somatic Dysfunctions
categories of somatic dysfunction
fascial and ligamentous restrictions
articular restriction
muscular restriction
edematous
FAME
direct vs indirect treatments
What is the classification of OMT that applies a vector of force in towards the restrictive barrier
Direct technique
Name 3 direct MT and 3 Indirect OMT
Direct
Soft tissue
Myofascial release
MUSCLE ENERGY TECHNIQUE
INDIRECT
myofascial release
ACTIVE vs PASSIVE
Active- patient does something
MET
Passive- patient does not do anything
Soft tissue
MFR
What is the absolute contraindication for all OMT
Lack of pt consent
Lack of somatic dysfunction
What tissues form layer and sheets that envelops and separate tissues..
FASCIA
7 stages of Spencer technique (Week 5) and what does it treat ?
EFC CAARD
treats shoulder
How do you perform direct myofascial release
“Direct MFR:The dysfunctional myofascial tissues are loaded and restrictive barrier is engaged with a constant force.”
- Paplate soft tissue.
2.Find area of restriction in all three planes ( up/down, left/right, and clockwise/counterclockwise)
- Stack all three planes and move in the direction of restriction
Hold and wait for it to soften ]. Follow the creep if the tissue softens and allows you to travel further into the restriction area.
BRING FASCIA TO DIRECT BARRER AND HOLD FOR 60 SECONDS
what are the 4 different type of MET?
What is an absolute contraindications for muscle energy besides lack of consent or somatic dysfunction
Fracture in area
Patient cannot follow directions– CANT DO ON PERSON IN COMA.
- How many seconds does a patient contract for during a cycle of muscle energy?
3 to 5 seconds
- How much force is typical applied by the patent vehicle contracting
3 to 5 oz
- How many times repeat muscle energy
3 to 5 times
- How long is the post-isometric relaxation?
1 to 2 seconds
Isometric vs isotonic(concentric, eccentric) vs isolytic
Isometric– contract, muscle length stays same
Isotonic- tone in muscle stays same, muscle shorten; mostly concentric
-Concentric- While a contracting muscle, under a constant load, experiences a decrease in the distance between that muscle’s origin & insertion points (approximation)
-Eccentric- muscle lengthens
Isolytic - muscle lengthening while it is being contracted, A form of eccentric contraction designed to break adhesions using an operator-induced force to lengthen the muscle and in which, the counterforce is greater than the patient force.
things to keep in mind during soft tissue
Unilateral Thoracic and Lumbar Prone Pressure-soft tissue
suboccipital release
barriers
extrinsic vs intrinsic force vs inherent forces
inherent ROM? spontaneous motion of every cell, organ system, and their component units within the body.
direct vs indirect technique and what forces do they use
techniques that we have learned so far use active, passive, direct or indirect approach
soft tissue technique
muscle energy technique (MET)
________________
* A group of direct techniques that usually involve
lateral stretching, linear stretching, deep pressure,
traction &/or separation of muscle origin
and insertion while monitoring tissue response
and motion changes by palpation.
* Historically considered a form of myofascial
treatment.
soft tissue technique
________________
A direct treatment method which the patient’s muscles
are employed upon request, from a precisely
controlled position, in a specific direction, and against a
distinctly executed physician counterforce.
* Contraction of an antagonistic muscle would help relax
the agonistic muscle.
muscle energy technique
- An osteopathic method in which the restrictive
barrier is engaged in one or more planes
of motion and then a rapid, therapeutic force of
brief duration traveling a short distance is applied
within the anatomic range of motion of a joint. - Aka: Thrust treatment method
RAPID SHORT
________
A direct treatment method employing a low velocity/moderate to high amplitude force applied
to a dysfunctional joint through either:
– A repetitive springing motion
or
– A single movement of the joint through the
restrictive barrier.
LOW velocity , Springy motion
__________
– A system of diagnosis and treatment, first described by A.T. Still
MD, DO, & his early students, which engages continual palpatory
feedback to achieve release of myofascial tissues.
MYOFASCIAL RELEASE (MFR
MYOFASCIAL RELEASE (MFR)
Indications and Physiologic Effects
Indications and Physiologic Effects
_________a generalized term for the sheets and layers of connective
tissue that envelop specific structures and segregate one structure,
organ, or area from another.
principles of myofascial release
Fascial System
what layer of facia do we work with?
functions of fascia
ppppp
myofascial release
MFR Contraindications
_______palpable resistance to motion of an articulation or tissue
______relative palpable freedom of motion of an articulation or tissue
_______the capacity of fascia and other tissue to lengthen when
subjected to a constant tension load
- Bind: palpable resistance to motion of an articulation or tissue
- Ease: relative palpable freedom of motion of an articulation or tissue
- Creep: the capacity of fascia and other tissue to lengthen when
subjected to a constant tension load - MFR allows for fascial creep which are associated with release of energy (heat,
electromagnetic, etc.
how should the pressure be in myofascial release?
MFR General Considerations/Rules? (how do you perform MFR)
steps for Prone Thoracic/Thoracolumbar Junction MFR(Direct)
steps for Thoracic Inlet/Outlet MFR
Seated, “Steering Wheel” (Direct)
do you need to diagnose the patient before doing Soft tissue?
Soft Tissue Techniques – Indications
how do we perform a soft tissue technique?
The technique tension or force applied
should match the tension in the
patient’s tissue
* Modify the force applied as the
patient’s tissue responds in real time
Unilateral Thoracic and Lumbar Prone Pressure
uses kneading
Bilateral Thoracic Prone Pressure with Counterpressure
Lumbar Prone Pressure
with Counterleverage
AGR principles
Suboccipital Release, things to note
normal end feel motions after range of motion
BAS C
Abnormal End-Feel DURING RANGE OF MOTION
MUSCLE ENERGY INDICATIONS
Post-Isometric Relaxation
Muscle Energy Technique (MET) STEPS
MET mechanism
post isometric relaxation vs reciprocal inhibition
the problematic (agonist muscle) is used as the contracting muscle during MET. The Golgi organ will send signals to the muscle to relax during the post-isometric relation and then you can take it to the next feather’s edge
RECIPROCAL INHIBITION
For example, the bicep is the problem during reciprocal inhibition, but we will use the tricep to perform a post-isometric relaxation. This will cause the bicep to relax. Patient pushes toward barrier (where it doesn’t want to go)
what muscle contraction is most commonly used during MET
Concentric Isotonic Muscle Contraction
Eccentric Isotonic Muscle Contraction
Isolytic Muscle Contraction
4 different types of MET
Post isometric relaxation
goal
method
physiology
force of contraction
reciprocal inhibition
goal
method
physiology
force of contraction
Respiratory Assistance
goal
method
physiology
force of contraction
oculocephalogyric reflex
goal
method
physiology
force of contraction
muscle energy mechanism of action
Deep Fascia of The Upper Extremity
effect of muscle energy
Evaluation for Radial Head Somatic Dysfunction
steps for MET Elbow: Posterior Radial Head Somatic Dysfunction
(Radioulnar Pronation Dysfunction)
Three common gears that get jammed in the body are:
*Joints- most common
*Muscles
*Fascia.
what happens when fascia slide past eachother?
Fascial sheets must continually slide against other sheets.
Frequently two sheets get stuck together (forming an
adhesion) and can no longer glide due to that adhesion.
These commonly form after injuries, surgeries or sustained
periods of immobility.
______ is used to define Osteopathic Manipulative Techniques
The two most common forms of muscle energy are “joint
mobilization” and “post-isometric relaxation
Post Isometric Relaxation and Joint
Mobilization I
Post Isometric Relaxation and Joint
Mobilization II
post isometric relaxation steps
understand this!!
Post Isometric Vertebral ME
