OPP lecture 3 and 1 Flashcards
What did Fred Mitchell, DO first describe?
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.
What kind of technique is muscle energy?
Active/Direct
What are some indications for muscle energy?
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
What is oculocervical (oculogyric) reflex?
Patient makes eye movements, certain cervical and muscles reflexively contract and antagonist muscles relax.
What is respiratory assistance?
Physician directs the forces of respiration while simultaneously uses a fulcrum (hand) to direct the somatic dysfunction through the barrier.
How did Mitchell DO describe postisometric relaxation?
“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.”
Postisometric relaxation
Following increased tension on the Golgi tendon receptors (contraction), there is a refractory period in which there is a muscle relaxation (lengthening)
joint mobilization using muscle force?
Similar to HVLA but the patient actively contracts the muscles to cause movement
Use patient positioning and muscle contractions to restore motion
reciprocal inhibition
Contract an agonist to relax the antagonistic muscles. ex. biceps/triceps
What is an absolute contraindication to muscle energy?
- Fracture, dislocation or severe joint instability at treatment site
- uncooperative patient
What is a relative contraindication to muscle energy?
- 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)
How do you perform muscle energy technique? What are the steps?
- Engage the barrier (single or multiple planes) - reverse the s.d. diagnosis
- Patient contracts into the freedom of motion with a small amount of force for 3-5 seconds against physician resistance
- wait 1-2 seconds (allowing tissues to relax)
- Physician re-engages the barrier (take up the slack)
- Repeat 3-5 times
6 Recheck
lumbar vertebral body. Go!
Large size - designed to support postural weight
Wedge shaped - higher in front, maintains lordosis
L4 is at the level of the iliac crest
describe the lumbar process
spinous process - same level as vertebral body
transverse process - long and thin
-easy to palpate distally
describe lumbar vertebra motion during flexion/extension
facets align backward and medial
-couples with ventral-dorsal translatory slide
describe lumbar vertebra motion during sidebending
couples with contralateral lateral translatory slide
-SR - translates left
describe lumbar vertebra motion during rotation
couples with disk compression
Describe the origin, insertion, action, and innervation of the latissimus dorsi
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)
Hypertonicity of the latissimus dorsi. Pain where?
Pain in the shoulder
Gluteus maximus. origin, insertion, action, and innervation
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)
erector spinae: origin and insertion and action. What muscles?
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
quadratus lumborum
origin, insertion, and action
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
multifidus and rotatores
postural muscles
Controls and stabilizes individual vertebral motions
Iliopsoas
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
