Somatic Dysfunction And Barriers Lecture Flashcards
What are the 4 tenants of Osteopathic Medicine?
- Mind, body, and spirit are a unit
- Body is capable of self-regulation, self-healing, and health maintenance
- Structure and functions reciprocally interrelated
- Rational treatment is based upon understanding and implementing the other 3 tenets
What is the definition of somatic dysfunction?
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.
What is the definition of Osteopathic Manipulative Treatment (OMT)?
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
What is acute somatic dysfunction?
Immediate or short-term impairment or altered function of related components of the somatic system, characterized by: vasodilation, edema, tenderness, pain, or tissue contraction
What is chronic somatic dysfunction?
Impairment or altered function of related components of the somatic system, characterized by: tenderness, itching, fibrosis, paresthesias, and/or tissue contraction
What is the diagnostic criteria for somatic dysfunction?
TART exam
What does TART stand for?
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
What is tissue texture abnormality and what are different types?
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
What is tone, hypertonicity, and hypotonicity?
Tone: Normal feel of muscle in the relaxed state
Hypertonicity: At the extreme = spastic paralysis
Hypotonicity: Flaccid paralysis with no tone at all
What is contraction vs contracture?
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
What is spasm?
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
What does ropiness tend to indicate?
Typically indicates a chronic condition
What is an acute vs chronic vascular tissue texture change?
Acute: Inflamed vessel wall injury, endogenous peptide released
Chronic: Sympathetic tone increases vascular constriction
What is acute vs chronic sympathetic tissue texture change?
Acute: Local vasoconstriction overpowered by local chemical release, net effect is vasodilation
Chronic: Vasoconstriction, hypersympathetic tone, may be regional
What is acute vs chronic musculature tissue texture change?
Acute: Local increase in tone, muscle contraction, spasm - mediated by increase spindle activity
Chronic: decreased muscle tone, flaccid, mushy, limited ROM due to contracture
What is an Anatomic barrier? How about Physiologic Barrier?
Anatomic: limit of motion imposed by Anatomic structure; the limit of passive motion
Physiologic: the limit of active motion
What is the elastic barrier?
The range between the physiologic and Anatomic barrier of motion in which passive stretching occurs before tissue disruption
What is the restrictive barrier?
A functional limit that abnormally diminishes the normal physiologic range
What is AROM and PROM?
AROM - patient initiated ROM, examiner visually observes
PROM - examiner initiated ROM with passive patient
PROM > AROM because pt’s muscles are relaxed
What is “blocking the linkage”?
Stabilization of associated and adjacent structures to focus movement to only the joints being assessed
What is Barrier “end-feel” and what are some characteristics/examples?
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]
What are differences between acute and chronic pain?
Acute: sharp, severe, cutting
Chronic: dull, ache, paresthesias
What are the differences between acute vs chronic visceral functions?
Acute: minimal somatovisceral effects
Chronic: Somatovisceral effects are common
What are the differences between acute vs chronic visceral dysfunction?
Acute: May or may not be present; if trauma is severe, it is often present
Chronic: often involved in somatic dysfunction
What are the differences noted in the TART exam between acute and chronic somatic dysfunction?
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
What is the difference between a tender point and a trigger point?
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
What are somatic dysfunctions named for?
Where the position of ease is (aka where it LIKES to go)
What are some indications and adverse reactions of OMT?
Indications: somatic dysfunction and/or visceral dysfunction
Adverse reactions: soreness similar to workout or massage soreness
What are some precautions, recommendations, and contraindications for OMT?
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)
What do direct techniques vs indirect techniques do?
Direct: method of action engage the restrictive barrier directly
Indirect: method of action involve positioning away from the restrictive barrier
What is the role of OMT in the 5 Models (Biomechanical, neurological, respiratory/circulatory, metabolic, and behavioral)?
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
