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OPP Exam 1 > OPP lecture 3 and 1 > Flashcards

OPP lecture 3 and 1 Flashcards

1
Q

What did Fred Mitchell, DO first describe?

A

Muscle energy: A system of diagnosis and treatment in which the patient voluntariy moves the body as specifically directed by the physician; this directed patient action is from a precisely controlled position, against a defined resistance by the physician.

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2
Q

What kind of technique is muscle energy?

A

Active/Direct

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3
Q

What are some indications for muscle energy?

A

1) mobilize joints in which movement is restricted
2) Stretch tight muscles and fascia
- lengthen muscle fibers and decrease hypertonicity
- reduce the restraint of movement
3) Improve local circulation
4) Alter related respiratory and circulatory function
5) Balance neuromuscular relationships to alter muscle tone
- strengthen the weaker side of an asymmetry

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4
Q

What is oculocervical (oculogyric) reflex?

A

Patient makes eye movements, certain cervical and muscles reflexively contract and antagonist muscles relax.

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5
Q

What is respiratory assistance?

A

Physician directs the forces of respiration while simultaneously uses a fulcrum (hand) to direct the somatic dysfunction through the barrier.

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6
Q

How did Mitchell DO describe postisometric relaxation?

A

“immediately following (an isometric) contraction, the neuromuscular apparatus is in a refractory state during which passive stretching may be performed without encountering strong myotatic reflex opposition. All the operator needs to do is resist the contraction and then take up the slack in the fascias during the relaxed refractory period.”

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7
Q

Postisometric relaxation

A

Following increased tension on the Golgi tendon receptors (contraction), there is a refractory period in which there is a muscle relaxation (lengthening)

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8
Q

joint mobilization using muscle force?

A

Similar to HVLA but the patient actively contracts the muscles to cause movement
Use patient positioning and muscle contractions to restore motion

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9
Q

reciprocal inhibition

A

Contract an agonist to relax the antagonistic muscles. ex. biceps/triceps

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10
Q

What is an absolute contraindication to muscle energy?

A
  • Fracture, dislocation or severe joint instability at treatment site
  • uncooperative patient
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11
Q

What is a relative contraindication to muscle energy?

A
  • Moderate to severe muscle strains
  • Advanced osteoporosis
  • Severe illness (ex. post surgical patient or patient on monitor in intensive care unit who is having a myocardial infarction)
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12
Q

How do you perform muscle energy technique? What are the steps?

A
  1. Engage the barrier (single or multiple planes) - reverse the s.d. diagnosis
  2. Patient contracts into the freedom of motion with a small amount of force for 3-5 seconds against physician resistance
  3. wait 1-2 seconds (allowing tissues to relax)
  4. Physician re-engages the barrier (take up the slack)
  5. Repeat 3-5 times
    6 Recheck
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13
Q

lumbar vertebral body. Go!

A

Large size - designed to support postural weight
Wedge shaped - higher in front, maintains lordosis
L4 is at the level of the iliac crest

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14
Q

describe the lumbar process

A

spinous process - same level as vertebral body
transverse process - long and thin
-easy to palpate distally

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15
Q

describe lumbar vertebra motion during flexion/extension

A

facets align backward and medial

-couples with ventral-dorsal translatory slide

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16
Q

describe lumbar vertebra motion during sidebending

A

couples with contralateral lateral translatory slide

-SR - translates left

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17
Q

describe lumbar vertebra motion during rotation

A

couples with disk compression

18
Q

Describe the origin, insertion, action, and innervation of the latissimus dorsi

A

origin: T7-12
-iliac crest
-thoracolumbar fascia
Insertion: humerus
Action: adducts, extends, internally rotates arm
-extension and sidebending of lumbar spine
Innervation: thoracodorsal nerve (C6-C8)

19
Q

Hypertonicity of the latissimus dorsi. Pain where?

A

Pain in the shoulder

20
Q

Gluteus maximus. origin, insertion, action, and innervation

A

origin:
thoracolumbar fascia, dorsal sacrum, sacrotuberous ligament, and ilium
Insertion:
iliotibial band and greater tuberosity of femur
Action:
Extends hip and stabilizes torso
Innervation: inferior gluteal nerve (L5, S1-S2)

21
Q

erector spinae: origin and insertion and action. What muscles?

A

origin and insertion: sacrum to cervical
Inclludes: lumbar region (lateral to medial)
-Iliocostalis
-Longissimus
-Spinalis
Remember I Lover Spaghetti?!
Action:
-bilateral contraction = extension
-unilateral contraction = extension + ipsilateral sidebending
antagonists - abdominals

22
Q

quadratus lumborum

origin, insertion, and action

A

origin: 12th rib and lumbar transverse processes
Insertion: iliolumbar ligament and iliac crest
action: bilateral contraction creates extension
unilateral contraction causes extension with ipsilateral sidebending
Innervation: T12 and L1-4 ventral rami

23
Q

multifidus and rotatores

A

postural muscles

Controls and stabilizes individual vertebral motions

24
Q

Iliopsoas

A 
Psoas major
origin:  transverse process of T12-L5
insertion:  lesser trochanter of femur
action:  flexes and internally rotates hip
innervation:  L1-3(2-4) ventral rami
Iliacus
origin:  superior 2/3 of iliac fossa, inner lip of iliac crest, ventral sacroiliac, iliolumbar ligaments, and upper lateral sacrum
insertion:  lateral tendon of psoas
ACTIONS:
Hip flexion
Lumbar sidebending (unilateral contraction)
Constant activity in erect posture
Important in function and stability
25
Q

lumbar ligaments

A

Anterior longitudinal ligament
-from the base of the occiput to the anterior sacrum (anterior vertebrae)
Posterior longitudinal ligament
-from posterior body of the axis to the sacrum - narrows in the lumbar region, decreases support, and increases risk of disc herniation

26
Q

iliolumbar ligament

A
  • Attaches - transverse process of L4 and L5 and iliac crest
  • Increases stability at the lumbosacral junction - commonly strained in traumatic injuries
  • first ligament to becom tender with lumbar postural changes (tender area 1 inch superior and lateral to the PSIS on the iliac crest)
27
Q

what’s one of the two most common complaints?

A

back pain. huge differential diagnosis.

28
Q

clinical approach to diagnosing back pain?

A

-low back pain is a symptom of many things
-pain from renal carcinoma is not very different than pain from a lumbar sprain
Also TAKE A GOOD HISTORY!

29
Q

What are some worrisome low back pain symptoms?

A

Sudden low back pain of sudden onset and without history of trauma (ex dissecting aortic aneurysm)
Pain that wakes the patient from sleep (malignancy until proven otherwise)
Rapidly progressing neurological deficits (epidurlal abscess/infection)
claudication symptoms (low blood flow during exercise causes pain) with back pain - could be spinal stenosis

30
Q

lumbar muscle energy? account for what 3 planes?

A

Account for all 3 planes of motion:
coronal (sidebending)
horizontal (rotation)
sagittal (FB or BB)

31
Q

describe lumbar somatic dysfunction.

subjective, objective, and treatment

A 
subjective 
-low back pain
-increased muscle tension and aching pain
objective (follows Fryette)
Type I SD
-neutral
-sidebend and rotate in opposite directions
-group
Type II SD
-flexed or extended
-sidebend and rotate in same direction
-single
Treatment
-lumbar region
-other regions which may affect lumbar (body is a unit) - sacrum, innominates, psoas, lower extremity etc
32
Q

FDR

A

flexion dysfunction
down (rostation side of SD down)
Recumbent (lateral recumbent)
Steps:
-Patient is lateral recumbent: extends the lumbar spine (erector spinae and QL are bilaterally engaged)
-rotate into the barrier (some multifides and rotatores)
-when the leg is lifted (sidebends the spine into the barrier, erector spinae and QL are unilaterally engaged)

33
Q

SUE

A

Sims (lateral sims)
UP (SD side up)
Extension dysfunction

Patient in the sims flexes

  • psoas and abdominal muscles
  • rotates the lumbar spine into the barrier
    - some multifides and rotatores
  • dropping the legs off the table
    - sidebends into the barier by unilaterally engaging erector spinae
34
Q

type 1 sd

A

pt conVEX up, lateral recumbent (ex N RrSl)

  • doc faces patient and monitors apex
  • flex knees and hip until motion felt (psoas and abdominal muscles)
  • doc lifts both ankles toward the ceiling until motion at apex (sidebending component)
  • pt pushes legs toward floor against doc’s isometric resistance
35
Q

what is the classic somatic dysfunction of lumbar spine?

A

low back/buttock pain
aching
increased pain with activity/prolonged
Treatment OMT: muscle energy or other

36
Q

What is a superior shear?

A

ASIS - superior

PSIS - superior

37
Q

What is an anterior innominate rotation?

A

ASIS - more inferior
PSIS - more superior
Ipsilateral hamstring tightness/spasm and sciatica are common complaints.
Tissue changes at ILA of sacrum same side as well as iliolumbar ligament tenderness. Freedom of motion anteriorly.

38
Q

what are 5 anterior ilium rotators?

A
  1. tensor fascia latae
  2. quadratus lumborum
  3. iliocostal
  4. internal abdominal oblique
  5. latissimus dorsi
39
Q

what is the function of the tensor fasica latae

A

Origin: anterior lateral iliac crest
Insertion: anterolateral tibia below the plateau
Normal function is to pull inominate into anterior rotation.

40
Q

what is the function of the quadriceps?

A

Origin: (rectus femoris muscle ) ASIS
Insertion: tibial tuberosity via patellar ligament
Function: extends leg at knee, rectus femoris crosses so hip flexor also

41
Q

Posterior innominate rotation

A

ASIS - superior
PSIS - inferior
Inguinal groin pain, medial knee pain, inguinal tenderness, tissue changes at the sacral sulcus. Etiology - tight hamstrings

42
Q

Name 6 posterior rotators

A 
gluteus maximus
semitendinosis
semimembranosus
piriformis muscle (weak)
External abdominal oblique muscle

OPP Exam 1 (6 decks)

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