Session #4: Overview of osteopathic techniques Flashcards
goals of osteopathic manipulation
- relief of pain or reduction of other symptoms
- improve function
- increased movement
- improve blood supply and nutrition to affected areas
- ensure return flow of fluids
- normal nerve transmission
- decreased patient stress
goal setting in osteopathic manipulation
Goals are made on an individual basis for the patient
Need to have realistic expectations. Longer illness means longer recovery time usually. Reevaluated during each visit.
what are the difference classes of osteopathic manipulation techniques?
direct, indirect and both
passive and active
direct techniques
take the restricted joint or tissue into the barrier, sometimes gradually and sometimes quickly
indirect techniques
the restricted joint or tissue is moved away from the restriction and into the relative ease or freedom at beginning of treatment
allows neural mechanisms or fascial tensions to change to permit better movement
direct and indirect technique
the tissues or joints are placed into their barrier or freedom, then moved into the opposite position
active vs passive techniques
active means the patient is required to participate under the direction of the doctor (eg contract or deep breathing)
passive means the doctor does all the work
extensibility of soft tissue
when you place connective tissue under prolonged mild tension, it will show plastic elongation
muscle spindle reflex
if the intrafusal fibers (sensory fibers) are stretched rapidly, they cause a reflex contraction of the extrafusal fibers (muscle fibers)
golgi tendon organ reflex
when tension on a muscle’s tendon becomes extreme, the reflex inhibitory effect from the golgi tendon organ may cause sudden relaxation of the entire muscle
reciprocal inhibition
when a stretch reflex excites one muscle, it simultaneously inhibits the antagonist muscle (e.g. hamstrings and quadriceps during running)
crossed extensor reflex
when one muscle contracts voluntarily, the reflex will simultaneously relax the same muscle on the contralateral side and excite the contralateral antagonist muscle (e.g. stepping on nail, opposite hip will be extended)
concentric contraction
approximation (bringing into proximity) of the muscle attachments causes contraction of a muscle
eccentric contraction
muscle becomes lengthened during contraction due to an external force
isometric contraction
change in the tension of a muscle without the approximation of the muscle origin and insertion, e.g. arm wrestling
isotonic contraction
concentric contraction where muscle shortens steadily with varying rate, e.g. curling weights
isokinetic contraction
concentric contraction where the muscle shortens under constant load at constant rate
isolytic contraction
form of eccentric contraction where muscles forced to lengthen as they contract; to try to lengthen the muscle
isokinetic resistance
a force is applied to a contracting muscle but the applied force is less than the contracting muscle’s force; muscle contracts with isokinetic contraction
used to activate reciprocal inhibition and crossed extensor reflex
isometric resistance
a force is applied to the contracting muscle, and the force is equal to the contracting muscle’s force, so muscle contracts with isometric contraction
used to activate golgi tendon reflex
soft tissue passive direct techniques
working to extend the connective tissue, with a longitudinal or perpendicular stretch
e.g. massage
active direct vs indirect soft tissue techniques (resistance used and reflexes triggered)
active direct soft tissue techniques use isometric resistance to trigger the golgi tendon reflex to relax the muscle
active indirect soft tissue techniques use isokinetic resistance to cause reciprocal inhibition or crossed extensor reflex
what class of technique is the muscle energy technique, which physiological principle does it target?
active direct technique
triggers golgi tendon organ reflex
how to do muscle energy technique
- guide patient’s dysfunction into their barriers of motion (e.g. if something is extended, bring it to barrier of flexion)
- patient tries to move one freedom against an isometric resistance for 3-5 sec
- relax
- re-engage with barrier
- repeat
what is the counterstrain technique used for
when one muscle becomes strained from trauma, resistance, or gravity, its antagonist hypershortens. Shortened muscle gets stretched, it contracts by reflex and this overlap leads to reflex tender points.
Counterstain treats the tender points
what kind of technique is the counterstain?
passive indirect technique
how do you do the counterstain technique?
- patient placed in position of ease with respect to their tender point
- position held for 90 seconds (“fold and hold”)
- slowly return patient to neutral position, don’t want to reexcite muscle spindles
what kind of technique is the facilitated position release? What is it used for
passive indirect technique
wants to relax the muscle by decreasing the load on the muscle, to stop excitatory discharges from muscle
facilitated positional release technique
- guide affected region into neutral position
- add compression or traction to facilitate force to the point you’re testing
- area is placed into its freedoms (the movement that it does more easily) while the force is applied, held for 3-5 seconds
what kind of technique is the high velocity, low amplitude (HVLA) thrust technique? what is it used for?
passive direct
want to move a joint through its restrictive barrier, by applying a thrust to it
how do you do the high velocity, low amplitude thrust technique?
- prepare joint with soft tissue or indirect treatment
- place joint into its barrier to motion, and lock out other joint movements
- specific, controlled, rapid, low amplitude (little force) thrust applied through the barrier
what kind of technique is inhibition? what is it used for?
passive
diminution or elimination of over-reactive muscle
how do you do the inhibition technique?
apply a steady mild-moderate pressure to region of hypertonic muscle
** testable techniques from reading: progressive inhibition of neuromusculoskeletal structures, myofascial release, ligamentous articular strain, balanced ligamentous tension, still technique, functional technique, articulatory technique, lymphatic technique
?
indication
something that suggests the advisability for prescribing a treatment
contraindication, absolute vs. relative
something that suggests the inadvisability for prescribing a treatment (absolute means no exception, relative means circumstance based)
some indications for performing an osteopathic technique
somatic dysfunction, identified by TART
hypertonic muscles
excessive tension in fascial structures
findings related to somato-somato or viscero-somatic reflexes
one absolute contraindication to all techniques
lack of patient/caretaker consent or cooperation
some relative contraindications to OMT
- infection, hematoma, or muscle tear
- fracture/dislocation
- instability of cervical spine
- undiagnosed joint swelling
- positioning the compromises vasculature
- unresponsive patient
- absence of somatic dysfunction
