Physiology And Somatic Dysfunction

Question 1

What are the general goals of OMT

Answer 1

1) improve oxygenation and nutrient flow to tissues
2) reduce congestive edema and secondary effects
3) reduce intramuscular pressure and fascial tension to improve muscle balance
4) reduce increased sensitivity of all tissues
5) improve joint surface apposition to normalize neural communication to myofascial structures
6) reduce adaptive responses that result with increased energy demand
7) improve overall health and recovery of the patient

Question 2

What is the difference between the 2 primary types of nociceptors

Answer 2

1) A(delta)
- respond to mechanical injury and accompanied by tissue damage
- cutaneous receptive field is large and little, scattered throughout the skin
- thinly myelinated fibers

2) C-polymodal nociceptors
- respond to mechanical, thermal and chemical stimuli
- cutaneous receptive field is small and many with 1 or 2 sensitive spots in small patches of skin- unmyleinated fibers
- also interact with chemonociceptors

Question 3

What tissues do not contain nociceptive innervation?

Answer 3

Articular cartilage

Hyaline cartilages

Nucleus pulposus

CNS parenchyma tissue

Question 4

What are the three substances that elicit tissue pain -> nerve pain

Answer 4

Histamine

Bradykinin

Prostaglandins

nociceptors release substance P (neuropeptide) which increases the amount of histamine, bradykinin and prostaglandins

Question 5

Primary hyperalgesia

Answer 5

Primary nociceptors become more sensitive to lower threshold of energy when stimulated repetitively

Question 6

Secondary hyperalgesia

Answer 6

Pain develops outside the area of stimulation

only occurs in the presence of chronic primary hyperalgesia

Question 7

Allodynia

Answer 7

Tissues become so sensitive to pain stimulation that even non-noxious stimuli can elicit the sensation of pain

is central sensitization via the dorsal horn

Question 8

Hypesthesia

Answer 8

Diminished sensitivity to stimulation of pain

Question 9

Paresthesia

Answer 9

A spontaneously abnormal usually non-painful sensations

Caused by lesions of both the central and/or peripheral nervous system

Question 10

Anesthesia

Answer 10

Loss of sensation resulting from pharmacologic depression of nerve function or from neurogenic dysfunction

Question 11

What is spinal facilitation

Answer 11

The maintenance of a pool of neurons that remain in a state of partial excitation, requiring less afferent stimulation to trigger discharge of pain-impulses (efferent effects)
- releases substance P easier

Is only done in the presence of chronic tissue inflammation

• does not require nociceptors information to maintain facilitation (means that a dorsal root or transverse lesion can still show facilitation, as long as it was initialed before the lesion was present)

Question 12

Nociceptive with the somatic nervous system

Answer 12

Input and output is received via the cranial and spinal nerves

Initate impulses from muscle spindles

Transmitted to dorsal horn -> synapses with interneurons and stimulates efferents

Question 13

Nociceptive and the visceral (autonomic) nervous system

Answer 13

Initate impulses via cranial/spinal/splanchnic nerves

Transmitted to dorsal horn -> synapse with interneurons -> stimulates sympathetic efferents

Question 14

Viscerosomatic reflex

Answer 14

Involuntary responses that produces a reflex response via visceral sensory stimuli

• activates sympathetic outflow and motor neurons in the segmentally related somatic structures (organs, muscles, skin)
• this is known as a sympathicotonia

Question 15

When should nociceptors NOT be activated

Answer 15

Weak local applied pressures

Normal physiologic contractions

Normal joint ranges of motion

Question 16

Ischemia mechanical deformation

Answer 16

Ischemia

• local anemia and hypoxia initiates nociceptors due to decrease blood flow and increased acidic hydrogen ions from hypoxia
• also eliminates muscle spindle activity

Question 17

What is the beginning limit of pressure on nerves that can initiate an ischemic even?

Answer 17

30 mmHg

Question 18

Compression blocks what types of axonal transport?

Answer 18

Anterograde and retrograde

Question 19

When are joint capsule mechanoreceptors more sensitive?

Answer 19

Extremes of joint angle movement

Joint inflammation

Increased fluid pressure within joints

Question 20

What does increased articular mechanoreceptor stimulation cause?

Answer 20

Reflex inhibition and increased mechanoreceptor stimulation
- inhibits reflexes and slow twitch muscle fibers

this develops muscle imbalance overtime and body movements

Question 21

What muscle is inhibited in sacroiliac joint restriction

Answer 21

Ipsilateral gluteus Maximus

Question 22

What muscle is inhibited by an acetabular restriction

Answer 22

Ipsilateral Gluteus medius muscle

Question 23

What muscle is inhibited in zygapophysial restriction?

Answer 23

Multifidus muscles

Question 24

What muscle is inhibited by a knee joint restriction?

Answer 24

Ipsilateral Rectus femoris

Question 25

Golgi tendon organs

Answer 25

Is a part of a proprioceptive system

Responds to force of active contraction of the muscle and only slightly with a stretch of the applied muscle

Uses 1b interneurons to receive convergent polysynaptic input

Stimulation causes:

• inhibition of motor firing to the muscle
• stimulates firing to the antagonist muscle group
• is a protective measure

Question 26

What do 1A annulospiral endings react to?

Answer 26

Stretch and speed fo the stretch

Question 27

What is the term arousal mean?

Answer 27

A state of being awake and reactive to stimuli

Uses the neural, cardiovascular, endocrine and immune system to function

Reacts to somatic and visceral stress as well

Question 28

Nociceptors and the arousal system

Answer 28

Stimulation causes:

• brainstem responses
• general adaptation
• alters endocrine and immune functions

Question 29

What is the affect of cytokines on hypothalamic- pituitary axis?

Answer 29

Increases:

• sensory afferent activation
• lower or increase pain thresholds
• functions of the neuroendocrine immune network
• arousal system vigilance