Session #4: Overview of osteopathic techniques

Question 1

goals of osteopathic manipulation

Answer 1

• 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

Question 2

goal setting in osteopathic manipulation

Answer 2

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.

Question 3

what are the difference classes of osteopathic manipulation techniques?

Answer 3

direct, indirect and both

passive and active

Question 4

direct techniques

Answer 4

take the restricted joint or tissue into the barrier, sometimes gradually and sometimes quickly

Question 5

indirect techniques

Answer 5

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

Question 6

direct and indirect technique

Answer 6

the tissues or joints are placed into their barrier or freedom, then moved into the opposite position

Question 7

active vs passive techniques

Answer 7

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

Question 8

extensibility of soft tissue

Answer 8

when you place connective tissue under prolonged mild tension, it will show plastic elongation

Question 9

muscle spindle reflex

Answer 9

if the intrafusal fibers (sensory fibers) are stretched rapidly, they cause a reflex contraction of the extrafusal fibers (muscle fibers)

Question 10

golgi tendon organ reflex

Answer 10

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

Question 11

reciprocal inhibition

Answer 11

when a stretch reflex excites one muscle, it simultaneously inhibits the antagonist muscle (e.g. hamstrings and quadriceps during running)

Question 12

crossed extensor reflex

Answer 12

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)

Question 13

concentric contraction

Answer 13

approximation (bringing into proximity) of the muscle attachments causes contraction of a muscle

Question 14

eccentric contraction

Answer 14

muscle becomes lengthened during contraction due to an external force

Question 15

isometric contraction

Answer 15

change in the tension of a muscle without the approximation of the muscle origin and insertion, e.g. arm wrestling

Question 16

isotonic contraction

Answer 16

concentric contraction where muscle shortens steadily with varying rate, e.g. curling weights

Question 17

isokinetic contraction

Answer 17

concentric contraction where the muscle shortens under constant load at constant rate

Question 18

isolytic contraction

Answer 18

form of eccentric contraction where muscles forced to lengthen as they contract; to try to lengthen the muscle

Question 19

isokinetic resistance

Answer 19

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

Question 20

isometric resistance

Answer 20

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

Question 21

soft tissue passive direct techniques

Answer 21

working to extend the connective tissue, with a longitudinal or perpendicular stretch
e.g. massage

Question 22

active direct vs indirect soft tissue techniques (resistance used and reflexes triggered)

Answer 22

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

Question 23

what class of technique is the muscle energy technique, which physiological principle does it target?

Answer 23

active direct technique

triggers golgi tendon organ reflex

Question 24

how to do muscle energy technique

Answer 24

1. guide patient’s dysfunction into their barriers of motion (e.g. if something is extended, bring it to barrier of flexion)
2. patient tries to move one freedom against an isometric resistance for 3-5 sec
3. relax
4. re-engage with barrier
5. repeat

Question 25

what is the counterstrain technique used for

Answer 25

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

Question 26

what kind of technique is the counterstain?

Answer 26

passive indirect technique

Question 27

how do you do the counterstain technique?

Answer 27

1. patient placed in position of ease with respect to their tender point
2. position held for 90 seconds (“fold and hold”)
3. slowly return patient to neutral position, don’t want to reexcite muscle spindles

Question 28

what kind of technique is the facilitated position release? What is it used for

Answer 28

passive indirect technique

wants to relax the muscle by decreasing the load on the muscle, to stop excitatory discharges from muscle

Question 29

facilitated positional release technique

Answer 29

1. guide affected region into neutral position
2. add compression or traction to facilitate force to the point you’re testing
3. area is placed into its freedoms (the movement that it does more easily) while the force is applied, held for 3-5 seconds

Question 30

what kind of technique is the high velocity, low amplitude (HVLA) thrust technique? what is it used for?

Answer 30

passive direct

want to move a joint through its restrictive barrier, by applying a thrust to it

Question 31

how do you do the high velocity, low amplitude thrust technique?

Answer 31

1. prepare joint with soft tissue or indirect treatment
2. place joint into its barrier to motion, and lock out other joint movements
3. specific, controlled, rapid, low amplitude (little force) thrust applied through the barrier

Question 32

what kind of technique is inhibition? what is it used for?

Answer 32

passive

diminution or elimination of over-reactive muscle

Question 33

how do you do the inhibition technique?

Answer 33

apply a steady mild-moderate pressure to region of hypertonic muscle

Question 34

** 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

Answer 34

?

Question 35

indication

Answer 35

something that suggests the advisability for prescribing a treatment

Question 36

contraindication, absolute vs. relative

Answer 36

something that suggests the inadvisability for prescribing a treatment (absolute means no exception, relative means circumstance based)

Question 37

some indications for performing an osteopathic technique

Answer 37

somatic dysfunction, identified by TART
hypertonic muscles
excessive tension in fascial structures
findings related to somato-somato or viscero-somatic reflexes

Question 38

one absolute contraindication to all techniques

Answer 38

lack of patient/caretaker consent or cooperation

Question 39

some relative contraindications to OMT

Answer 39

• infection, hematoma, or muscle tear
• fracture/dislocation
• instability of cervical spine
• undiagnosed joint swelling
• positioning the compromises vasculature
• unresponsive patient
• absence of somatic dysfunction