Somatic Dysfunction And Barriers Lecture

Question 1

What are the 4 tenants of Osteopathic Medicine?

Answer 1

1. Mind, body, and spirit are a unit
2. Body is capable of self-regulation, self-healing, and health maintenance
3. Structure and functions reciprocally interrelated
4. Rational treatment is based upon understanding and implementing the other 3 tenets

Question 2

What is the definition of somatic dysfunction?

Answer 2

Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, Myofascial structures, and their related vascular, lymphatic, and neural elements.

Question 3

What is the definition of Osteopathic Manipulative Treatment (OMT)?

Answer 3

The therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction

Question 4

What is acute somatic dysfunction?

Answer 4

Immediate or short-term impairment or altered function of related components of the somatic system, characterized by: vasodilation, edema, tenderness, pain, or tissue contraction

Question 5

What is chronic somatic dysfunction?

Answer 5

Impairment or altered function of related components of the somatic system, characterized by: tenderness, itching, fibrosis, paresthesias, and/or tissue contraction

Question 6

What is the diagnostic criteria for somatic dysfunction?

Answer 6

TART exam

Question 7

What does TART stand for?

Answer 7

Tissue texture abnormalities
Asymmetry of structure or motion
Restriction of Motion
Tenderness illicited

Any one of which must be present for the diagnosis of somatic dysfunction

Question 8

What is tissue texture abnormality and what are different types?

Answer 8

A palpable change in tissues from skin to periarticular structures

Ex) bogginess (sponginess due to congestion from increased fluid content), thickening, stringiness, rosiness, firmness, temperature change, moisture change

Question 9

What is tone, hypertonicity, and hypotonicity?

Answer 9

Tone: Normal feel of muscle in the relaxed state

Hypertonicity: At the extreme = spastic paralysis

Hypotonicity: Flaccid paralysis with no tone at all

Question 10

What is contraction vs contracture?

Answer 10

Contraction: Normal tone of a muscle when it shortens or is activated against resistance

Contracture: Abnormal shortening of a muscle due to fibrosis, and often results from a chronic condition and the muscle is no longer able to reach its full normal length

Question 11

What is spasm?

Answer 11

Abnormal contraction maintained beyond physiologic need.

Most often sudden and involuntary muscular contraction that results in abnormal motion and is usually accompanied by pain and restriction of normal function

Question 12

What does ropiness tend to indicate?

Answer 12

Typically indicates a chronic condition

Question 13

What is an acute vs chronic vascular tissue texture change?

Answer 13

Acute: Inflamed vessel wall injury, endogenous peptide released

Chronic: Sympathetic tone increases vascular constriction

Question 14

What is acute vs chronic sympathetic tissue texture change?

Answer 14

Acute: Local vasoconstriction overpowered by local chemical release, net effect is vasodilation

Chronic: Vasoconstriction, hypersympathetic tone, may be regional

Question 15

What is acute vs chronic musculature tissue texture change?

Answer 15

Acute: Local increase in tone, muscle contraction, spasm - mediated by increase spindle activity

Chronic: decreased muscle tone, flaccid, mushy, limited ROM due to contracture

Question 16

What is an Anatomic barrier? How about Physiologic Barrier?

Answer 16

Anatomic: limit of motion imposed by Anatomic structure; the limit of passive motion

Physiologic: the limit of active motion

Question 17

What is the elastic barrier?

Answer 17

The range between the physiologic and Anatomic barrier of motion in which passive stretching occurs before tissue disruption

Question 18

What is the restrictive barrier?

Answer 18

A functional limit that abnormally diminishes the normal physiologic range

Question 19

What is AROM and PROM?

Answer 19

AROM - patient initiated ROM, examiner visually observes

PROM - examiner initiated ROM with passive patient

PROM > AROM because pt’s muscles are relaxed

Question 20

What is “blocking the linkage”?

Answer 20

Stabilization of associated and adjacent structures to focus movement to only the joints being assessed

Question 21

What is Barrier “end-feel” and what are some characteristics/examples?

Answer 21

The Palpation experience or perceived quality of motion when a joint is moved to its limit

Early muscle spasm [protective] and known as guarding, late muscle spasm [chronic], hard capsular [frozen shoulder], and soft capsular [synovitis-swelling of the knee after injury]

Question 22

What are differences between acute and chronic pain?

Answer 22

Acute: sharp, severe, cutting

Chronic: dull, ache, paresthesias

Question 23

What are the differences between acute vs chronic visceral functions?

Answer 23

Acute: minimal somatovisceral effects

Chronic: Somatovisceral effects are common

Question 24

What are the differences between acute vs chronic visceral dysfunction?

Answer 24

Acute: May or may not be present; if trauma is severe, it is often present

Chronic: often involved in somatic dysfunction

Question 25

What are the differences noted in the TART exam between acute and chronic somatic dysfunction?

Answer 25

Acute:
Tissue texture - red, swollen, boggy, increased tone
Asymmetry - present
Restriction - present, painful with motion
Tenderness - sharp pain

Chronic:
Tissue texture - dry, cool, ropy, pale, decreased tone
Asymmetry - present, compensation occurs
Restriction - present but maybe not. Guarded or “empty”
Tenderness - dull, achy pain

Question 26

What is the difference between a tender point and a trigger point?

Answer 26

A tender point is a small discrete hypersensitive area within Myofascial structures that result in LOCALIZED pain

A trigger point is a small discrete hypersensitive area within Myofascial structures where Palpation causes REFERRED pain away from the site

Question 27

What are somatic dysfunctions named for?

Answer 27

Where the position of ease is (aka where it LIKES to go)

Question 28

What are some indications and adverse reactions of OMT?

Answer 28

Indications: somatic dysfunction and/or visceral dysfunction

Adverse reactions: soreness similar to workout or massage soreness

Question 29

What are some precautions, recommendations, and contraindications for OMT?

Answer 29

Precautions: cancer, fraility due to severity of disease, youth, and/or elderly

Recommendations: rest (1-4 days) and hydration

Contraindications: generally cancer, Rheumatoid arthritis, fractures, or severe frailty (but otherwise different techniques have different contraindications)

Question 30

What do direct techniques vs indirect techniques do?

Answer 30

Direct: method of action engage the restrictive barrier directly

Indirect: method of action involve positioning away from the restrictive barrier

Question 31

What is the role of OMT in the 5 Models (Biomechanical, neurological, respiratory/circulatory, metabolic, and behavioral)?

Answer 31

Biomechanical: Myofascial and joint function optimization

Neurological: remove neurologic imbalances; address nociception (pain)

Respiratory/Circulatory: maximize function

Metabolic: structure and function are reciprocally related

Behavioral: more of a cause than an effect; how we spend our time affects the above 4; the exercise Rx teaches patients to treat themselves