OPP Exam 1 Flashcards
Definition of Osteopathic Medicine
A comprehensive system of healthcare based upon holisitic evaluation and treatment of patients to the obtain the best possible outcome in medical care
Art of Osteopathic Medicine
“Use of sensitive palpatory diagnostic skills and osteopathic manipulative treatment to assist in facillitating the patient’s own healing abilities”
Major difference between allopathic and osteopathic medicine
200 hours of neuromusculoskeletal medicine, OMT, and osteopathic philosophy and art
What best defines osteopathic medicine?
“Utilizing our palpatory skills and OMT to facilitate the patient’s own healing ability”
In which way does osteopathic medicine differ from allopathic medicine?
Osteopathic training includes 200 hours of neuromusculoskeletal training
What is the year osteopathic medicine started?
”"”He flung the banner of osteopathy into the breeze in 1874”” -> 1874”
What year did the first osteopathic medical school open?
1892
Why did AT Still develop osteopathic medicine?
He lost his first wife, 3 of his children, and his father.
Osteopathic principles
- Human being is a unit<br></br>2. Structure equals function<br></br>3. Body is capable of self-regulation, self-healing, and health maintenance - homeostasis<br></br>4. Rational treatment is based upon an understanding of the first 3 principles
Osteopathic models
- Biomechanical -> structural<br></br>2. Respiratory -> circulatory<br></br>3. Metabolic -> nutritional<br></br>4. Neurological<br></br>5. Behavioral - biopsyschosocial
OMT/OMM definition
Therapeutic use of the hands to restore normal structure (anatomy) and function (physiology)
SOAP note
S - subjective<br></br>O - objective<br></br>A - assessment<br></br>P - plan
T.A.R.T. Changes
T - Tissue texture abnormalities (tension)<br></br>A - Asymmetry of tissue/joint motion<br></br>R - Restricted ROM of tissue/joint<br></br>T - Tenderness
Somatic Dysfunction
Impaired or altered function of related components of the somatic (body framework) system: includes skeletal, anthrodial, and myofasical structures, and related vascular, lymphatic and neural elements
Biomechanical model
Anatomy of muscles, spine, extremities; posture, motion, tensegrity<br></br>OMT -> normalizing mechanical somatic dysfunction, structural integrity, physiological function, homeostasis
Respiratory - circulatory model
Emphasizes pulmonary, circulatory, and fluid (lymphatics, CSF) systems<br></br>Goal -> normalize blood and lymphatic flow, diaphragm function, tissue oxygenation
Metabolic model
Emphasizes homeostatic adaptive mechanisms through +/- feedback loops to regulate energy exchange and conservation through metabolic processes<br></br>Lifestyle changes, nutritional counselling<br></br>OMT -> lymphatic pump, visceral techniques
Neurologic model
Emphasizes CNS, PNS, and ANS that control, coordinate and integrate body functions<br></br>OMT -> normalizing neurological functioning, balancing the autonomic nervous system (ANS), proprioception, homeostasis
Behavioral model
Mental, emotional, social and spirtual dimensions related to health and disease<br></br>Depression, anxiety, stress, habits, addictions, and other mind-body interactions<br></br>OMT -> gentle, guided imagery, hypnosis, gentle breathing exercises
Bioenergetic model
Study of how endogenous and exogenous energy sources/forms influence and control living systems and their environment<br></br>Bioenergy - energy produced endogenously by living systems
Biophysics
“an interdisciplinary science using methods of, and theories from, physics to study biological systems. Spans all scales of biological organization, from the molecular to whole organisms to ecosystems. Biophysical research overlaps with biochemistry, nanotechnology, bioengineering, computational biology and complex systems theory. Bridge between biology and physics”
Palpation
“<span>The application of variable manual pressures to</span><span>the surface of the body for the purpose of </span><span>determining the </span><span>shape, size, consistency, </span><span>position, inherent motility</span><span> and </span><span>health</span><span> of tissues </span><span>beneath</span>”
What information do you get from palpation?
Tissues, motions, rhythms
Functions of skin
Major organ of the body<br></br>Functions: protective covering, temperature regulation, sense of touch, excretory organ, absorbing organ, biochemical function
Mechanoreceptors
Touch and proprioceptive
Thermoreceptors
Cooling and heat
Nociceptors
Pain, itch, tickle, and tingling to stabbing
What can you feel from palpation?
Temperature, mositure/dryness, depth/thickness (tissue layers), textures (smooth, rough, hair), tissue tension, tenderness/irritability, swelling, elasticity, turgor (hydration), motions, barriers/ease
Phases of Basic Palpation
“<span>1.</span><span> </span><span>Detection (“feeling”)<br></br></span><span>Through the development of psychomotor skills</span><br></br><span>2.</span><span></span><span>Internal amplification (“seeing”)<br></br></span><span>“</span><span>See” the structures that you are palpating by having a thorough </span><span>knowledge of the anatomy </span><br></br><span>Create a visual mind-image</span><br></br><span>3.</span><span></span><span>Analysis and interpretation (“thinking and </span><span>knowing”)<br></br></span><span>Must be correlated with a knowledge of gross and functional anatomy, </span><span>physiology, and pathophysiology.</span>”
Acute tissue changes
Temp -> increase<br></br>Texture -> boggy, rough<br></br>Moisture -> increased<br></br>Tension -> increased, rigid, board-like<br></br>Tenderness -> greatest<br></br>Edema -> yes<br></br>Erythema test -> redness lasts
Chronic tissue changes
“<span>TEMP</span><span> – decrease</span><br></br><span>TEXTURE</span><span> – thin, smooth</span><br></br><span>MOISTURE</span><span> – decreased</span><br></br><span>TENSION</span><span> – slight increased, </span><span>ropy, stringy</span><br></br><span>TENDERNESS</span><span> – present - </span><span>less</span><br></br><span>EDEMA</span><span> - no</span><br></br><span>ERYTHEMA TEST </span><span>– fades </span><span>quickly or blanches</span>”
Active ROM
movement produced voluntarily by the patient
Passive ROM
motion induced by the osteopathic physcian while the patient remains passive or relaxed
Physiologic barrier
-> limited by muscle length and angles<br></br>-> limit of ACTIVE motion
Anatomic barrier
-> limited by joint architecture<br></br>-> limit of PASSIVE range of motion
Tissue disruption
Moving beyond the anatomic barrier
Restrictive barrier
-> A limit in the NORMAL physiologic range of motion<br></br>-> Limit due to muscle/tendon/ligament tightness
Pathologic barrier
-> result of disease or trauma<br></br>-> lies within the physiologic range of motion<br></br>-> prevents symmetrical movement of joint within physiologic range of motion
Direct manipulation
“<span>Restricted joint or </span><span>tissue is taken in the </span><span>direction of the </span><span>restriction (barrier)</span><br></br><span>Physician’s force </span><span>allows the joint or </span><span>tissue to move </span><span>beyond the restrictive </span><span>barrier in motion</span>”
Indirect manipulation
“<span>Joint positioned away </span><span>from the barrier </span><span>toward the ease</span><br></br><span>Allows neural </span><span>mechanisms or </span><span>fascial tensions to be </span><span>altered to permit </span><span>improved motion</span>”
Counterstain
“<span>An osteopathic method of diagnosis and </span><span>indirect</span><span> treatment in which the patient’s </span><span>somatic dysfunction, diagnosed by an </span><span>associated myofascial </span><span>tender point</span><span>, is </span><span>treated by using a </span><span>position</span><span> </span><span>of</span><span> </span><span>spontaneous tissue </span><span>release</span><span> while </span><span>simultaneously monitoring the tender </span><span>point.</span>”
Myofascial release technique
“<span>An osteopathic method of treatment which </span><span>utilizes continual palpatory feedback to alleviate </span><span>restriction of the somatic dysfunction and its </span><span>related fascia and musculature</span>”
Facilitated positional release
“<span>A treatment method in which a dysfunctional </span><span>body region is addressed with a combination </span><span>of neutral positioning, application of an </span><span>activating force (compression, torsion, or </span><span>distraction), and placement into position of </span><br></br><span>ease</span>”
Balanced ligamentous tension
“<span>An osteopathic treatment that involves the </span><span>minimization of periarticular tissue load and </span><span>the placement of the affected ligaments in a </span><span>position of equal tension in all appropriate </span><span>planes so that the body’s inherent forces can </span><span>resolve the somatic dysfunction</span>”
Soft tissue technique
“<span>A group of direct techniques that usually </span><span>involve lateral stretching , linear stretching, </span><span>deep pressure, traction and/or separation of </span><span>muscle origin, and insertion while monitoring </span><span>tissue response and motion changes by </span><span>palpation.</span>”
Inhibitory technique
“<span>A treatment method in which steady </span><span>pressure is applied to soft tissues to reduce </span><span>reflex activity and promote tissue relaxation</span>”
Muscle energy
“<span>A form of osteopathic manipulative diagnosis and </span><span>treatment in which the patient’s muscles are </span><span>actively used on request, from a precisely </span><span>controlled position, in a specific direction, and </span><span>against a distinctly executed physician </span><br></br><span>counterforce</span>”
High velocity low amplitude
“<span>An osteopathic method in which the </span><span>restrictive barrier is engaged in one or more </span><span>planes of motion and then a rapid, </span><span>therapeutic force of brief duration traveling a </span><span>short distance is applied within the anatomic </span><span>range of motion</span>”
Still technique
“<span>System of OMT developed by A.T. Still to </span><span>treat specific tissues which exhibit </span><br></br><span>segmentally defined somatic dysfunction</span>”
Planes of motion
Transverse/horizontal plane -> vertical axis<br></br>Coronal plane -> anterior/posterior AP axis<br></br>Sagittal plane -> horizontal axis
Ipsilateral
same side
Contralateral
opposite side
Concave
surface curves inward like the inner side of a circle
Convex
surface curves outward like the outer side of a circle
Superior
situated higher up - can be both anterior or cephalad
Inferior
situated lower down - can be both posterior and caudad
Landmarks for thoracic spine
Mastoids<br></br>Shoulder<br></br>Inferior angle scapula<br></br>Iliac crest<br></br>PSIS<br></br>Greater trochanter
Scoliosis
Named according to the convexity<br></br>Left -> levoscoliosis<br></br>Right -> dextroscoliosis
Key thing about scoliosis convexity
NAME IT IN THE DIRECTION IT CURVES (NOT ANATOMICAL POSITION ALOKI)
Functional scoliosis
-> muscle hypertonicity<br></br>-> short leg syndrome<br></br>-> compensation<br></br>-> weak musculature
Structural scoliosis
-> idiopathic<br></br>-> genetic?<br></br>-> diagnosed in preteen or early teen years
Review dermatomes
Okay
What structures impact range of motion?
Joints, muscles, tendon, ligaments, medical conditions, biotensegrity
Tensegrity
An architectural system in which structures stabilize themselves by balancing counteracting forces of compression and tension
Fascia components
Cells, ECM
Myofascia
Muscle + fascia
Fascia major function
Helps regulate cell function (mechanotransduction)
Layers of fascia
-> pannicular (superficial)<br></br>-> investing (deep)<br></br>-> visceral<br></br>-> meningeal
Myofascial diagnosis major awareness
REQUIRES KNOWLEDGE OF ANATOMY
Absolute contraindications
Absence of somatic dysfunction, poor patient cooperation
Relative contraindications
“<span>Open wounds, burns, abscesses, </span><span>soft tissue infections, recent post-</span><span>operative sites, aortic aneurysm, </span><span>cancer</span>”
Direct action
gentle forces toward the restrictive barrier
Indirect action
gentle forces are applied with the hand away from the restrictive barrier
Unwinding
“<span>G</span><span>entle forces are applied </span><span>indirectly</span><span> in successive directions in a dynamic </span><br></br><span>manner. The tissue “unwinds” until the tissue </span><span>reaches a state of balance</span>”
Model definition
“<span>a set of ideas </span><span>and numbers that describe </span><span>the past, present, or future </span><br></br><span>state of something (such as </span><span>an economy or a business)</span>”
Adaptability
ability to respond to stresses to meet needs of the system
Plasticity
ability to be formed, molded
Elasticity
recoverability after stretching
Viscosity
rate of deformation under load and capability to yield under stress (TART)
Colloid
a non-precipitating suspension
Mechanotransduction
“<span>Mechanical force acting </span><span>on a cell membrane</span><br></br><span>•</span><span> </span><span>Opening of </span><span>mechanosensitive pores</span><br></br><span>•</span><span> </span><span>Distortion of </span><span>mechanosensitive </span><span>proteins</span><br></br><span>•</span><span> </span><span>Signal transduction into </span><span>the cell and nucleus</span><br></br><span>•</span><span> </span><span>Generation of a cellular </span><span>response</span>”
Piezoelectric phenomena
Mechanical stress is transformed into electrical potentials and electrical potentials are transformed into mechanical motion<br></br>Examples: quartz crystal, collagen, bone
“Wolff’s Law”
<div>Mechanical stress results in bone remodeling (piezoelectric)</div>
Structure affects function
Biofield
“complex, extremely weak <span>EMF </span>of the organism hypothesized to involve electromagnetic bioinformation for regulating homeodynamics”
Bioelectromagnetics
study of the interaction between electromagnetic fields and biological living systems
Biofield therapy
any therapeutic modality that interacts and changes the biofield and its manifestations
FPR
“<span>system of OMT that is </span><span>utilized to normalize </span><span>hypertonic voluntary muscles</span>”
Who developed FPR
Stanley Schiowitz, DO in 1990
FPR Contraindications
“<span>1. Moderate to severe joint instability</span><br></br><span>2.</span><span> </span><span>Herniated disc where the positioning could exacerbate </span><span>the condition</span><br></br><span>3.</span><span> </span><span>Moderate to severe intervertebral foraminal stenosis, </span><span>especially in the presence of radicular symptoms at the </span><span>level to be treated if the positioning could cause </span><span>exacerbation of the symptoms by further narrowing the </span><span>foramen</span><br></br><span>4.</span><span> </span><span>Severe sprains and strains where the positioning may </span><span>exacerbate the injury</span><br></br><span>5.</span><span> </span><span>Certain congenital anomalies or conditions in which the </span><span>position needed to treat the dysfunction is not possible </span><span>(e.g., ankylosis)</span><br></br><span>6.</span><span> </span><span>Vertebrobasilar insufficiency</span><br></br><span>7.</span><span> </span><span>No somatic dysfunction</span>”
FPR Principles
Neutral, compress, ease
Scoliosis degrees of severity
Normal -> no curve<br></br>Mild -> 5-15 degrees<br></br>Moderate -> 20-45 degrees<br></br>Severe -> anything greater than 50 degrees<br></br>> 50 compromises respiratory function<br></br>> 90 compromises cardiovascular function
