Osteopathic Skills 2 Flashcards
Anterior displacement of the vertebrae is know as?
spondylolisthesis
Spondylosis involves the separation of the?
pars interarticularis
Posterior displacement of the vertebrae is known as?
retrolisthesis
Inflammation and fusion of the vertebral bodies is known as?
Ankylosing spondylitis
osteoarthritis is associated with the formation of bone spurs called?
Osteophytes
Before you lengthen a muscle you always?
Strengthen
What does the acronym S.T.A.R.T stand for?
S.ymptom Reproduction/Sensitivity T.enderness A.sympetry R.estriction of ROM T.issue Texture
What factors impact tissue health?
Sleep!
Perception of Pain
Sleep deprivation can change the circuitry in the brain in ways that amplify pain, a new study from the University of California has found. For instance, people who develop chronic pain often lose the ability to sleep well, and quickly point to a bad back, sciatica or arthritis as the reason
Directly effects growth and stress hormones, cardio vascular health and arterial supply.
Hormone
Prolactin is released as we sleep by the pituitary gland
Prolactin helps to regulate inflammation
*The rule of the artery rains supreme *
Growth Hormone is produced by the pituitary gland
GH stimulates whole-body protein accretion with protein synthesis occurring in muscular
Arterial
Sleep influences cardiovascular health by regulating hypocretin production in the brain.
(profusion of blood to the tissue, carrying oxygenated blood and fresh nutrients to aim in recovery/maintenance and growth) ------------------------------------------------------------------------------ Congenital factors (Scoliosis) idiopathic/functional
Dietary (intolerance/deficiencies)
Overuse, misuse and abuse (and disuse) factors
(Hypertrophy/Atrophy)
Postural stresses (work/sport/lifestyle related) (Ergonomics/Postural adaptations/Imbalances/antalgic)
Psychological factors
(Anxiety and depression)
Neurological deficit (Superior Gluteal Nerve L4,5,S1)
Trigger points, OSD
Pathology to the hip may cause the muscles which enclose and surround the joint to guard causing imbalances
Describe the techniques used to administer NMT
Longitudinal: Direct pressure along the line of axis of stress/muscle fibres (consider fascial planes of tension)
Cross-fibre Direct pressure against the line of axis of stress/muscle fibres
Traction on fascial tissue
Inhibition: Maintained superficial and deep pressure sustained and firm stretch produces inhibition of muscle response
What are the Neurological effects of NMT?
Decrease neuromuscular excitability Decrease pain (through modulation / non-noxious stimulous) Decrease muscle tension/spasm by influencing muscle spindles/golgi tendons
What are the Psychological effects of NMT?
Increased relaxation
Reduced anxiety
What are the Physiological effects of NMT?
Mechanism: Changes in tissue or organ
Increase parasympathetic activity
Increase tissue/organ arterial supply, venous drainage, lymphatic drainage
Increase tissue permeability
Increase relaxation hormones (Seratonin/Oxytocin)
Decrease stress hormones (cortisol)
What are the Biomechanical effects of NMT?
Mechanism: mechanical pressure on tissues
Decrease tissue adhesion Increase muscle compliance Increase ROM Decrease passive resistance Decrease active stiffness Increase proprioception/muscle control Increase micro-circulation by dilating blood vessels through stretch
What is a neuromuscular lesion?
- Congestion of the local connective tissues
- Disturbance of the acid-base balance of the connective tissues
- Fibrous infiltration (adhesions)
- Chronic muscular contractions, or hypertonic or hypotonic changes.
What are Muscle spindles? How do they work?
Muscle spindles are stretch receptors within the body of a muscle that primarily detect changes in the length of the muscle.
They convey length information to the central nervous system via afferent nerve fibers. This information can be processed by the brain as proprioception.
What are Golgi tendon bodies?
Stretch receptors called Golgi tendon organs are found within the collagen fibers of tendons and within joint capsules.
It responds to increased muscle tension or contraction as exerted on the tendon, by inhibiting further muscle contraction.
Which NMT technique influances Golgi tendons?
(particularly in the case of longitudinal stroke towards the muscle belly – i.e. away from the insertion)
Explain how NMT works? Compression Golgi tendon bodies Muscle spindles Pain Modulation
Compression
General compression reduces the sensitivity of the γ -efferent control of muscle spindles, leading to a decreased tendency to muscle shortening
Direct pressure or longitudinal stretch of Golgi Tendon Bodies leads to muscle relaxation(particularly in the case of longitudinal stroke towards the muscle belly – i.e. away from the insertion)
Muscle spindles are stretch receptors within the body of a muscle that primarily detect changes in the length of the muscle.
They convey length information to the central nervous system via afferent nerve fibers. This information can be processed by the brain as proprioception.
Pain modulation
Possible modulation of pain at the spinal cord level (pain gate theory)
How can you optimism application of the technique?
Maintain your ATTENTION, CONCENTRATION, AWARENESS of the tissue condition and response (and the patient)
Vary the contact accordingly: thumb, fingers, pisiform, thenar eminence, knuckles, forearm, elbow
Use passive limb movement to improve the technique if possible (e.g. rotatingthe hip to produce hamstring cross fibre strokes, or abducting the arm to open the intercostals space)
Your body position and posture is key – you must adjust the bench as necessary.
Trapezius 0rigin Inerstion Action Nerve innervation Level Arterial
Origin Superior nuchal line external occipital protuberance spinous processes of vertebrae C7-T12, Nuchal ligament
Insertion posterior border of the lateral one-third of the clavicle
Acromion process
spine of scapula
Artery
superficial branch of transverse cervical artery or superficial cervical artery
Nerve
Accessory nerve (motor)
cervical spinal nerves C3 and C4 (motor and sensation)
Actions
Rotation, retraction, elevation, and depression of scapula
Levator Scapulae 0rigin Inerstion Action Nerve innervation Level Arterial
Origin
Posterior tubercles of transverse processes of C1 - C4 vertebrae
Insertion
Superior part of medial border of scapula
Artery
dorsal scapular artery
Nerve
Dorsal scapular nerve (C5)
cervical nerve (C3, C4)
Actions
Elevates scapula and tilts its glenoid cavity inferiorly by downwardly rotating the scapula
Latissumus Dorsi 0rigin Inerstion Action Nerve innervation Level Arterial
Origin Spinous processes of vertebrae T7-L5 Thoracolumbar fascia iliac crest inferior 3 or 4 ribs inferior angle of scapula
Insertion
Floor of intertubercular groove of the humerus
Artery Thoracodorsal branch of the subscapular artery
Nerve Thoracodorsal nerve (C6, C7, C8)
Actions
Adducts, extends and internally rotates the arm when the insertion is moved towards the origin.
When observing the muscle action of the origin towards the insertion, the lats are a very powerful rotator of the trunk.
Rhomboids 0rigin Inerstion Action Nerve innervation Level Arterial
Origin
Nuchal ligaments
Spinous processes of the C7 to T5 vertebrae
Insertion
Medial border of the scapula
Artery dorsal scapular artery
Nerve dorsal scapular nerve
Actions
Pulls scapulae medially, rotates scapulae, Holds scapluae into thorax wall
Teres Major 0rigin Inerstion Action Nerve innervation Level Arterial
Origin
Posterior aspect of the inferior angle of the scapula
Insertion
Medial lip of the intertubercular sulcus of the humerus
Artery
Subscapular and circumflex scapular arteries
Nerve
Lower subscapular nerve (segmental levels C5 and C6)
Actions adduct the humerus, Internal rotation (medial rotation) of the humerus, extend the humerus from flexed position, Depress shoulder
Teres minor 0rigin Inerstion Action Nerve innervation Level Arterial
Origin
lateral border of the scapula
Insertion
inferior facet of greater tubercle of the humerus
Artery
posterior circumflex humeral artery and the circumflex scapular artery
Nerve axillary nerve (C5-C6)
Actions laterally rotates the arm, stabilizes humerus
Infraspinatus 0rigin Inerstion Action Nerve innervation Level Arterial
Origin infraspinous fossa of the scapula
Insertion middle facet of greater tubercle of the humerus
Artery suprascapular and circumflex scapular arteries
Nerve suprascapular nerve
Actions External rotation of arm and stabilization of glenohumeral joint
Supaspinatus 0rigin Inerstion Action Nerve innervation Level Arterial
Origin supraspinous fossa of scapula
Insertion superior facet of greater tubercle of humerus
Artery suprascapular artery
Nerve suprascapular nerve
Actions abduction of arm and stabilizes humerus see part on controversy of action.
subscapularis 0rigin Inerstion Action Nerve innervation Level Arterial
Origin Subscapular fossa
Insertion Lesser tubercle of humerus
Artery subscapular artery
Nerve Upper subscapular nerve, lower subscapular nerve (C5, C6)
Actions Internally rotates and adducts humerus; stabilizes shoulder
Deltoid 0rigin Inerstion Action Nerve innervation Level Arterial
Origin the anterior border and upper surface of the lateral third of the clavicle, acromion, spine of the scapula
Insertion deltoid tuberosity of humerus
Artery thoracoacromial artery, anterior and posterior humeral circumflex artery
Nerve Axillary nerve
Actions shoulder abducti
Pectoralis Major 0rigin Inerstion Action Nerve innervation Level Arterial
Origin
Clavicular head: anterior surface of the medial half of the clavicle.
Sternocostal head: anterior surface of the sternum, the superior six costal cartilages, and the aponeurosis of the external oblique muscle
Insertion Lateral lip of the bicipital groove of the humerus
(anteromedial proximal humerus)
Artery pectoral branch of the thoracoacromial trunk
Nerve lateral pectoral nerve and medial pectoral nerve
Clavicular head: C5 and C6
Sternocostal head: C7, C8 and T1
Actions Clavicular head: flexes the humerus Sternocostal head: horizontal and vertical adduction, extension, and internal rotation of the humerus
Depression and abduction of the scapula.[1]
Pectoralis Minor 0rigin Inerstion Action Nerve innervation Level Arterial
Origin Third to fifth ribs, near the costochondral junction
Insertion Medial border and superior surface of the coracoid process of the scapula
Artery Pectoral branch of the thoracoacromial trunk
Nerve Medial pectoral nerve (C8)
Actions
Stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall, raises ribs in inspiration
serratus anterior 0rigin Inerstion Action Nerve innervation Level Arterial
Origin
fleshy slips from the outer surface of upper 8 or 9 ribs
Insertion
costal aspect of medial margin of the scapula
Artery
lateral thoracic artery, superior thoracic artery (upper part), thoracodorsal artery (lower part)
Nerve
Long thoracic nerve
(from roots of brachial plexus C5, 6, 7)
Actions
Protracts and stabilizes scapula, assists in upward rotation.
