OS Flashcards
Chapman’s point represents
The somatic manifestion of a visceral dysfxn
Appendix C.P.
Anterior- at the top of the R 12th rib
Posterior- at the TP of T11
Adrenal C.P.
A- 2” sup and 1” lateral to umbilicus
P- bt the SP and TP of T11 and T12
Kidney C.P.
A- 1” lat and 1” sup to umbilicus
P- Bt SP and TP of T12 and L1
Bladder C.P.
Periumbilical region
Colon C.P.
On the lateral thigh within the IT band from the greater trochanter to just above the knee
Cecum C.P.
A- at the R prox femur
Prox transverse colon at the hepatic flexure CP
Located at the R distal femur
Sigmoid colon CP
Located at the left prox femur
Distal transverse colon at the splenic flexure CP
Located at the left distal femur
Trigger point
Hypersensitive focus, usually within a taut band of sk m or in a muscle fascia. Painful on compression and can give rise to a characteristic referred pain, tenderness, and autonomic phenomena
Trigger point located in the R pectoralis m bt the 5th and 6th ribs intercostal space near the sterum
assoc SVTs
Trigger point represents the somatic manifestation of a viscero-somatic, somato-visceral or somato-somatic reflex
.
Txment for trigger points
Spray and stretch using vapocoolant spray
Injection with local anesthetics or dry needling
ME techniques
MFR
U/S, reciprocal inhib, or ischemic compression
Tenderpoint
Small, hypersensitive point in the myofasical tissue, treatment monitor for counterstrain. Taut myofascials bands that are painful on compression.
Tenderpoints DO NOT refer pain beyond the location compression
Trigger points may refer may when pressed
Tenderpoints do not refer pain when pressed
Goal of MFR
Improve lymphatic flow and restore functional balance
4 diaphragms all play a role in lymphatic return
Tentorium cerebelli
Thoracic inlet
Abdominal diaphragm - most important
Pelvic diaphragm
4 compensatory curves throughout the spine and their common compensatory pattern rotation (80% of healthy people)
- OA jxn -L
- Cervicothoracic jxn - R
- Thoracolumbar jxn -L
- Lumbosacral jxn -R
What empties into the R minor lymphatic duct?
R upper extremity, right hemicranium (head and face), heart and lobes of the lung (expect the L upper lobe)
What empties into the L main lymphatic duct?
The rest of the body
The thoracic duct traverses Sibson’s fascia of the thoracic inlet up to the level of C7 before turning and emptying into the left (major) duct
The R (minor) duct only traverses the thoracic inlet once
Structures the bypass lymphoid tissue and drain directly into the thoracic duct
Thyroid, esophagus and the coronary and triangular ligaments of the liver
Lymphatic system is primarily controlled by
Sympathetic system. Innervated by the intercostal nerves.
What level is the cisterna chyli? (Sympathetic control of lymph?)
T11
Factors the increase interstitial pressure above 0 mmHg that cause lymphatic ECF to enter lymphatic capillaries
Systemic HTN
Cirrhosis (decr plasma protein synthesis)
Hypoalbuminemia assoc with starvation
Toxins such as rattlesnake poisoning
CI’s to lymphatic txment
Osseous fractures, bacterial infxs with a temp > 102, absecess or localized infx, certain stages of carcinoma
Counterstrain
Passive indir technique in which the tissue being treated is postitioned at a point of balance, or ease, away from the restrictive barrier
Tenderpoint
Small tense edematous areas of tenderness about the size of a fingertip. Typically located near bony attachments of tendons, ligaments or in the belly of some muscles. DO NOT radiate pain
Maverick point
5% of tenderpoints will not improve with the expected txment wih careful fine tuning.
These Maverick points are treated by positioning the pt in a position opposite of what would be used typically
Anterior cervical tenderpoints
- usually slightly anterior to or on the most lateral aspect of the lateral masses
- tx: SB and R away from side of TP
Anterior cerical Maverick Points- Anterior 7th cervical
- about 2-3 cm lateral to the medial end of the clavicle at the lateral attachment of the SCM
- txment: flex, SB toward & R away from side of TP
Posterior cervical tenderpoints
- tip on the SP or on the lateral side of the SP
- txment: extend, SB, rotate away
Posterior cervical Maverick points- Inion (Posterior 1st cervical)
- at the inion (posterior occipital protuberance) or just below
- tx: marked flexion
Anterior thoracic tenderpoints
- T1-T6: midline of the sternum at the attachment of the corresponding rib
- T7-T12: located i nthe rectus abdominus m about 1” lateral to the midline on the R or L
- tx: flex thorax and add small amount of SB and R away
Posterior thoracic tenderpoints
- on either side of the SP or on the TP
- txment: Extend, R away and SB slightly away
Anterior Ribs tenderpoints
Anterior ribs assoc with depressed ribs (exhalation ribs, an exhalation dysfxn/inhalation restriction)
-hold 120 seconds
Rib 1: TP just below medial end of clavicle
Rib 2: TP is 6-8 cm lateral to sternum on rib 2
Txment Rib 1-2: Flex head, SB and R towards
Rib 3-6: TP along mid-axillary line on the corresponding rib
txment Ribs 3-6: SB and R the thorax toward, slight flexion
Posterior rib tenderpoints
- assoc with elevated ribs (inhalation ribs, inhalation dysfxn/exhalation restriction)
- hold for 120 seconds
- TP at the angle of the corresponding rib
- txment: most txed with minimal flexion, SB away and R away
Anterior lumbar tenderpoints
L1: Medial to ASIS
L2-L4: On the AIIS
L5: 1 cm lateral to the pubic symphysis on the superior ramus
Txment: pt supine, knees and hips flexed and markedly rotated away
Posterior lumbar tenderpoints
On either side of the SP or on the TP. L3 and L4 may be found on the iliac crest. L5 may be found on the PSIS
Txment: pt prone, extended and SB away (R may be towards or away)
Posterior Lumbar Maverick Point- Lower Pole 5th Lumbar
- Caudad to PSIS as much as 1 cm
- txment: pt prone, hip and knee flexed, leg IR and adducted
Pelvis Tenderpoints - iliacus
Approx 7 cm medial to ASIS
Tx: pt supine w/ the hip flexed and ER
Pelvis Maverick point - Piriformis
Usually in the piriformis m 7 cm medial to and slightly cephalad to the greater trochanter
Txment: pt prone, hip and knee flexed, thich abducted and ER
Facilitated Positional Release (FPR)
The component region of the body is placed into a neutral position, diminishing tissue and joint tension in all planes and an activating force (compression or torsion) is applied. Easily applied, non-traumatic, takes 3-4 secs to induce release
Used to tx: superficial mm, deep intervertebral muscles to influence vertebral motion
Muscle energy
Can be performed as an active direct or active indirect technique. Most txments are direct
ME: postisometric relaxation - direct technique
Physician takes pt into restrictive barrier. Pt provides activating force to ease of motion
- isometric contraction - where the distance bt the origin and the insertion of the muscle remains the same as the muscle conttacts will stretch the internal connective tissues
- golgi tendon organs senses this change in tension in the muscle tendons and causes a reflex relaxation of the agonist muscle fibers -> physician can then engage new restrictive barrier
ME: Reciprocal inhibition - direct or indirect
By contracting the antagonist muscle, signals are transmitted to the spinal ord and through the reciprocal inhib reflex arc, the agonist muscle is then forced to relax
Rib muscles
1: Anterior and middle scalenes
2: Posterior Scalene
3-5: Pectoralis Minor
6-9: Serratus Anterior
10-11: Latissimus dorsi
12: Quadratus lumborum
Pt postion for Forward Sacral torsion
Forward sacral torsion, pt lies Face down (axis side down)
-ex: L on L -> L lateral Sims position (lying on L side with face down)
Pt position for Backward sacral torsion
Backward sacral torsion = patient lies on their Back
Ex: R on L -> Left lateral recumbant with face up (axis side down)
Articulatory techniques ( springing techniques or low velocity/moderate amplitude)
Direct techniques that incr range of motion in a restricted joint
- physican engages the restrictive barrier and uses gentle repetitive forces to increase ROM within that joint
- respiratory cooperation and/or muscle energy activation can be added for my stretch of tight myofascial structures that may limit articular motion
- post-op and elderly pts find articulatory techniques more acceptable
Indications for articulatory technique
- limited or lose articular motion
- need to incr freq or amplitude of motion of a body region
- need to normalize sympathetic activity (rib raising technique)
Rib raising purpose - articulatory technique
Increase chest wall motion, normalize sympathetic tone, improve lymphatic return
-useful for pts who have a resistant or noncompliant chest wall, such as viral pneumo pt (pneumo= assoc with hypersympathetic activity)
Spencer’s techniques (7 stages) - used as articulatory technique
Useful in pt who have developed fibrosis and restriction during a period of inactivity (adhesive capsulitis) following an injury
-Ex: healed rotator cuff tear, immobilization of the shoulder girdle after a humerus fracture
Purpose of spencers technique
Improve motion in the glenohumeral joint. It is important that the physician limit motion at the scapula by placing his hand at the top of the pt’s shoulder
Stages of Spencer’s technique
1: stretching tissues and pumping fluids - arm extended
2: GH ex/flex with elbow flexed
3: GH flex/ex with elbow extended
4: a- circumduction with slight compression with elbow flex/ext
4: b- circumduction and traction with elbow extended
5: adduction and ER with elbow flexed
6: Abduction with IR with arm behind the back
7: stretching tissues and pumping fluids with arm extended