Osteopathic Treatment Techniques Flashcards
Define direct and indirect techniques (provide examples).
Direct - directly engages the restrictive barrier (e.g. MET and MFR)
Indirect - joint/tissue position is away from the restricted barrier or tissue bind (e.g. counterstrain)
What are the 7 principles of MET application to the spine and small articular muscles?
1 - accurate localisation of forces (to “first barrier”) in all planes of restricted motion
2 - light patient contraction (3-7 seconds) away from barrier
3 - controlled, unyielding counterforce
4 - patient relaxation
5 - careful engagement of new barrier (“take up the slack”)
6 - 3 – 5 repetitions
7 - Retest
How is MFR performed?
Muscle is simultaneously stretched whilst longitudinal soft tissue technique is applied for 60-90 sec. or until TTC.
What are 6 steps to follow when performing counterstrain technique?
1 - find tender point
2 - establish baseline tenderness (if this is 100%)
3 - reduce tenderness by placing patient in position of max comfort (<30%)
4 - hold position for 60-90 sec. or until TTC
5 - slowly return patient to neutral
6 - retest tender point (ask patient if it has improved)
How does MET differ when applied to articular/smaller rather than larger muscles?
- more precise localisation of forces in all areas of restricted motion
- more gentle isometric contraction
- take up slack, don’t stretch
List key articulation techniques to be performed at the hip joint. Demonstrate how these are performed.
Supine:
- Flexion
- Internal rotation (hip at 90)
- External rotation (hip at 90)
- Abduction
- Adduction
- Traction (short and long lever)
- Circumduction
Prone:
- Extension
Variations:
- Side-lying: flexion, extension, int. and ext. rotation, abduction
- Prone: int. and ext. rotation
- Supine: extension
List common areas of the hip subject to soft tissue techniques.
Inhibition: hamstrings, quads, glute med, glute max, psoas, TFL, piriformis
Longitudinal or cross-fibre: hamstrings, quads, glute max
Stretching is a soft tissue technique. Demonstrate how to stretch the hamstrings, glute med and min, rec fem (prone) and piriformis.
Demonstrate how the iliopsoas, rec fem, adductors and TFL can all be stretched using the Thomas/FABER test position.
For how long should a stretch technique be held for?
Stretching should be held for (ideally) 30 sec.
What is the most commonly used soft tissue technique in osteopathic practice? How long is this technique applied for?
Cross-fibre kneading.
60-90 sec. or until TTC.
Longitudinal soft tissue technique is best applied to..?
Long muscles/contracted bands or fibres/myofascial trigger points.
What are 5 possible physiological mechanisms for therapeutic effect of MET?
1 - Stretched myofascial tissues (stretches connective tissues & contractile fibres)
2 - Inhibition of pain (stimulates mechanoreceptors & descending inhibition of pain)
3 - Fluid drainage (contraction/ relaxation strongly influences venous & lymph drainage)
4 - Improvement of proprioception and motor control
5 - Reflex muscle relaxation via GTO or muscle spindle (commonly proposed but little evidence to support)
Demonstrate how MET is performed at the hip joint for the following actions:
Flexion (supine, sidelying) Extension (prone, sidelying) Internal rotation (supine, sidelying, prone) External rotation (supine, sidelying, prone) Abduction (supine, sidelying) Adduction (supine)
Remember how MET is applied to the joint:
Take the joint to the restrictive barrier as you would a normal articulation techniques
Get the patient to do the opposite movement lightly against your unyielding resistance for 3-7 seconds
Repeat 3-5 times and retest
E.g. if you take the hip into flexion, get the patient push against you into extension
Demonstrate how MET is performed at the hip for the following muscles:
Psoas (supine, sidelying) Rectus femoris (supine, sidelying, prone) Hamstrings (supine, sidelying, prone) Adductors (supine) Gluteus maximus (sidelying, prone) Gluteus medius (sidelying)
Remember how MET is applied to muscles:
Stretch the muscle to the restrictive barrier as you would a normal stretch
Get the patient to the concentrically contract the muscle lightly against your unyielding resistance for 3-7 seconds
Repeat 3-5 times and retest
What are the principles of MET application to lengthen myofascial tissues?
Stretch the involved muscle
- Light force - muscle painful
- Moderate force - muscle mildly painful or not painful
Isometric contraction against your controlled, unyielding resistance for 5-7 seconds
- Light contraction - muscle painful or active MTrPs
- Moderate contraction - pain-free, fibrotic muscles
Muscle relaxation with the stretch maintained
- A deep inhalation or exhalation may assist relaxation
- Duration of stretch? Up to 30 seconds - chronically shortened muscle
- A few seconds - tender and irritable muscles
Re-engage barrier
Repetition
- 2-4 times or until change
Re-examine
Explain the biopsychosocial approach.
Osteopaths should approach health in a way that combines biological (physical health, genetics, drugs, etc.), social (peers, family circumstances/relationships) and psychological (coping and social skills, family relationships, self-esteem, mental health) aspects.
