Second Year Spring Flashcards
Eustachian tube dysfunction
creates negative pressure in the middle ear
- impedes normal drainage to the nasopharynx - promotes reflex of nasopharyngeal secretions into the middle ear
Tensor veli palatini
decreased muscle tension impedes opening
-increased muscle tension impedes closing and distorts lumen impeding opening
Galbreath technique
Simple mandibular manipulation that allows the ear to drain accumulated fluid.
A pumping action
Otitis media structural targets
- posterior pharyngeal mm. (TVP and medial pterygoid)
- jugular canal contents (CN IX and XII)
- impaired motion of the petrous portion of the temporal bone (OM sutures)
- SCM hypertonicity (effects the temporal)
GERD
- High-pressure zone (HPZ) of the lower esophagus
- Transient lowering of the lower esophageal HPZ is the most commonly recognized mechanism for gastroesophageal reflux.
- Accompanied by transient increase in intra-abdominal pressure and a decrease in crural activity.
Golden House of Sympathetics
T1-4: Head and neck (not cervical)
T5-9: Upper GI
T10-T11- Room on Right- Renal, Right colon
T12-L2- Room on the Left: Pelvis, Left colon
GERD OMT tx
- Diaphragm/rib cage/crura/psoas (attachments).
- Cranial base (Vagus)
- Autonomics of the stomach
- Birth position release.
Strains brought on by pregnancy
- Lumbar and cervical lordotic curves increase
- Thoracic kyphosis increases
- Relaxin responsible for ligamentous & muscular laxity w/in lumbopelvic region
- Sciatic pain
Discuss the pelvic changes in pregnacy
- Pelvis tips anteriorly
- Excess tissue stretch on lumbar extensor mm
- Distention of pelvis increases mobility/instability in the SI joint
Discuss Sciatic pain in pregnancy
- Posterior pelvic pain
- Does not go to foot and ankle
- No motor or sensory impairment
- No reflex changes
Consequences of congestion in pregnancy
- Increased metabolic demand to uterus and placenta
2. Uterus increases in volume and affects the body’s ability to manage pressure gradients
Hormonal changes in pregnancy
Relaxin responsible for ligamentous & muscular laxity
Estrogen and adrenal hormones promote fluid retention
Changes in pregnancy 28-36 wks
Hormonal changes increase fluid in tissues
Uterus compresses IVC to impede venous and lymph drainage
LE edema, hypotension in supine position
OMT approach in pregnancy 36-delivery
Check cranial-sacral mechanism
Tx will aid in neural & hormonal function during L & D
OMT approach in pregnancy labor & delivery
Sacral pressure can be comforting
CV4 helps induce uterine contractions or uterine inertia
Omt approach in post partum pt
Usually will find anterior sacral base
Usually will find anterior sacral base
ANS of pregnant pt
Sympathetics
Uterine contraction, cervical relaxation, vasoconstriction
Parasymp
Uterine relaxation, cervical constriction, vasodilation
Anterior innominate
Pt supine
Flex leg on dysfunctional side at the hip
Sensing hand under lower SI joint
Operating hand on pts knee
Compress from knee towards SI joint
Move knee in arc to full hip flexion, flexion w/ adduction across midline, and finally into hip extension
Move knee down toward other foot
After 30 degrees of hip extension, release compression
Return leg to neutral. Retest
Posterior Innominate
Dx: Restriction focused around the upper or S1 pole of sacrum
Tx:
Pt supine
Flex dysfunctional leg at the hip to more than 90 degrees. Slightly adduct the leg
Sensing hand under upper SI joint
Operating hand on Pts knee with compression towards SI joint
Move knee in arc into full hip abduction, then begin hip extension
After 30 degrees of hip extension, release compression
Return leg to neutral. Retest.
Upslipped Innominate
Exaggerate by initially abducting the affected leg
Introduce traction from lower leg
Adduct leg across midline while maintaining force vector
Release traction, return to neutral. Retest
Downslipped Innominate
Pelvis is sidebent so iliac crest is tilted out and ischium tilted in
Tx:
Initial adduction of leg across midline
Compression from lower leg carries leg into abduction
Retest
Pubic Ramus
Pt supine
Flex hips and knees bilaterally so feet are on table close to ischial tuberosities
Knees are together and roughly vertical
Stand at foot of table with one hand on each knee
Introduce compression towards pubic ramus
Bring knees simultaneously towards their respective sides
Remove hands from knees and capture ankles
Draw patients feet towards foot of table until knees and hips are extended
Retest
