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172 Cards in this Set

  • Front
  • Back
Muscle used for Muscle Energy: 1st Rib exhalation dysfunction
Anterior and middle scalenes
Muscle used for Muscle Energy: 2nd Rib
Posterior Scalene
Muscle used for Muscle Energy: Ribs 3-5
Pectoralis Minor
Muscle used for Muscle Energy: Ribs 6-8 (9)
Serratus anterior
Muscle used for Muscle Energy: Ribs 9-11
Latissimus Dorsi
Muscle used for Muscle Energy: Rib 12
Quadratus Lumborum
what lymphatic ducts drain the lungs?
Right lymphatic duct (The same as the heart)
What are the autonomic levels for the lungs?
Sympathetics- T1-T6; Parasympathetics- CN X, OA, C1, C2
Effect of parasympathetic stimulation on the lungs
contracts bronchiolar smooth muscle, decreases goblet cells, thins mucus secretions/ broncoconstriction vasodilation
Sympathetic Levels Lungs?
T1-T6
Sympathetic Levels Trachea & Bronchi?
T1-T6
Sympathetic Levels Visceral Pleura?
T1-T6
Sympathetic Levels Parietal Pleura?
T1-T11
Sympathetic effects on lungs
relaxation of bronchiolar smooth muscle, increases goblet cells, thickens mucus secretions
When treating a patient with bronchospasm (asthma) which side of the autonomic system should be treated first? Why?"
"Treat the parasympathetic side of the autonomic system first to decrease any neurally mediated bronchoconstriction. If the sympathetic side of the system is treated first, the patient may go into acute refractory bronchspasm
Stretch receptors transmit signals via the___. When the lungs are inflated, how does this affect respiration?
"Vagus Nerve: when the lungs are inflated this signal turns off respiration
T/F: The vagus reflex is sensitive to stretch caused by air or fluid - causing cessation or slowing of the respiratory signal.
True: it does not differentiate.
The ___ reflex mechanism cannot distinguish between air sacs filled with air and those filled with fluid
"Hering-Breuer Reflex"
What baroreceptor is sensitive to oxygen?
Carotid Body - sends its signals to the respiratory center (medulla)
With lung tissue congestion, the respiratory center receives information from the vagus nerve: what happens next?
This limits the excursion of the diaphragm
Diaphragm's greatest excursion is in what position?
The supine position
Thoracic Diaphragm motion increases the volume of the thorax in __ planes of motion.
3 Planes of Motion
what are Tender Points, Anterior vs Posterior?
Small tense edematous areas of tenderness *2-3mm* diameter which do not radiate pain. Anterior Tender Points: Diagnostic Purposes; Posterior Tender Points: Are treated with *counterstrain* techniques
Chapman points at the 2nd intercostal space suggest problems with?
2nd intercostal space= Thyroid, Myocardium, Esophagus, Bronchus
What are Chapman Reflex Points?
Small nodules of tissue texture change that are *2-3 mm* in diameter, that are thought to be reflections of visceral dysfunction (visceral-somatic reflex). Treated by rubbing in a firm rotating motion for 10-30 seconds
The "Asthma Reflex"
T2 left
Anterior bronchial Chapman's reflex
Intercostal space between the 2nd and 3rd ribs close to the sternum
Posterior bronchial Chapman's reflex
Midway between the spinous process and the tips of the transverse processes at T2
Anterior upper lung Chapman's reflex
Intercostal space between the 3rd and 4th ribs close to the sternum
Posterio upper lung Chapman's reflex
Midway between the spinous processes and the tips of the transverse processes of T3 and T4
Anterior lower lung Chapman's reflex
Intercostal space between the 4th and 5th ribs close to the sternum
Posterior lower lung Chapman's reflex
Midway between the spinous processes and the tips of the transverse processes of T4 and T5
Which way do the vertebrae rotate in a visceral dysfunction
Vertebrae rotate towards visceral dysfunction
sympathetic innervation of the heart has its origins ___
cord segments T 1-6
The parasympathetic innervation of the heart has its origins from ___
Vagus Nerve
When the Ventricles are involved in production of pain, it tends to refer to
C8 to T3 dermatomes
When the Atria are responsible for the pain, it tends to occur where?
lower in the chest wall in the T4 to T6 dermatomes
Where are the posterior Chapman reflex points?
Midway between the spinous process and the tips of the transverse processes in the space between the transverse processes of T2 & T3 bilaterally
Where are the anterior Chapman Myocardial Reflexes?
2nd intercostal space at the Sternal Border
Where are the posterior Chapman Myocardial Reflexes?
The space between the transverse processes of T2 and T3 midway between the spinous process and the tip of the transverse process
Where are the anterior Chapman Adrenal Reflexes?
Lateral Aspect of rectus abdominus at the level of the inferior margin of the costal margin
Where are the posterior Chapman Adrenal Reflexes?
Intertransverse spaces on both sides of T11 and T12 midway between the spinous processes and transverse processes
Severe Scoliosis with thoracic curve greater than ____ seriously compromises cardiac function
60-75 degrees
Severe Kyphosis measuring greater than __ degrees compromises cardiac function
60 degrees
Patients with flattening of the thoracic kyphosis or with postural crossovers in the upper thoracics, tend to develop _____ when subjected to other stressors
tachyarrhythmias
anterior triggerpoint which serves an initiating or perpetuation role in tachyarrhythmias
5th intercostal space located in the right pectoralis major muscle
Abnormal gait patterns may increase cardiac work by up to ___%
300%
sympathetic Innervation of the heart emanates from
cord segments T1-T6
Right sided sympathetic fibers to the hart innervate ___
right heart and sinoatrial (SA) node.
Hypersympathecotonia in right sided nerve fibers to the heart predisposes to
supraventricular tachyarrhythmias
autonomic innervation to the Left side of the heart innervates ___
left heart and atrioventricular (AV) node
Hypersympathecotonia in LEFT heart sympathetic fibers predisposes to
ectopic foci and ventricular fibrillation
Increase in sympathetic tone in blood vessels produces
generally vasoconstriction
Vasculature of the arms receives its sympathetic supply from
T2 to T8 levels
Vasculature of the legs receives its sympathetic supply from
T11 to L2 levels
The Vagus nerves have fibers which join and course to them from
C-1 & C-2 nerve roots
Observation of patients has demonstrated that correction of high cervical somatic dysfunction resulted in ____ vagal tone
transient increase in vagal tone followed by a reduction in vagal effect
Right Vagus innervates what part of the heart?
Sino Atrial Node
Hyperactivity of the right vagus predisposes
sinus bradyarrythmias
Left Vagus innervates the ___
Atrio Ventricular Node
Hyperactivity of left vagus predisposes
AV Blocks
Deep pressure over the ______ suture on the skull will reflexly slow the heart
occipitomastoid suture
Heart lymphatics drain predominantly to the
right lymphatic duct
Lymphatic drainage from the heart and lungs is carried back to the heart primarily by the
right lymphatic duct
Head and neck Lymph drains to
right lymphatic trunk via Right Jugular Trunk
Heart, Lungs, Liver Lymph drain to
right lymphatic duct via Right Bronchomediastinal Trunk
Right arm lymph drains to
right lymphatic trunk via Right Subclavian Trunk
Pleural causes of chest pain
effusion, consolidation, bronchospasm, pulmonary embolism, pulmonary hypertension, pneumothorax, hemothorax, atelectasis, asthma, copd, pneumonia
Musculoskeletal disorders of chest pain
strain, sprain, contusion, fracture, costochondritis, fibrositis, myositis, thoracic outlet syndrome, diaphragmatic dysfunction, ankylosing spondylitis, disc disease
Cardiac causes of chest pain
coronary ischemia, myocardial infarction, arrhythmias
Infections that cause chest pain
viral, bacterial, parasitical, fungal, mediastinitis, pleurisy, interstitial pneumonitis, bronchitis, tracheitis
In CHF, lymphatic flow through the thoracic duct increases ___ times the resting level
3-40 times
In Acute MI autonomic Techniques are directed at dysfunctions located
OA, C1, C2, T1 to T4 and R1 to R4
in Acute MI paraspinal soft tissue techniques may be performed from
T1 to L2 to generally diminish sympathetic tone and decrease peripheral vascular resistance
Cranial Acute MI autonomics treatment is ___
Treat dysfunction of the skull base and occipitomastoid suture, if present
Acute MI tx of Lymphatics: apply indirect techniques to the_____; Apply _____ to assist inhalation and promote lymphatic flow; Redome diaphragm using_____ technique
Lymphatics: Apply indirect techniques to the thoracic inlet; Apply pectoral traction to assist inhalation and promote lymphatic flow; Redome diaphragm using indirect AP diaphragm technique
Autonomics treatment for hypertension is directed to
entire sympathetic bed (T1 to L2) to generally decrease peripheral vascular resistance. Study of 100 hypertensive patients: Drop of 33 mm Hg systolic, Drop of 9 mm Hg diastolic P
What are the chapman points for hypertension?
"Treat Posterior Adrenal Points (Intertransverse spaces of T11 and T12 midway between the spinous processes and transverse processes):Drop of 15 mm Hg Systolic, Drop of 8 mm Hg Diastolic,
CHF tx of Lymphatics: Treat any restriction at the ____, Treat dysfunctions of the ___, _____, and rib cage, _____ the diaphragm, Apply thoracic, abdominal and pedal lymphatic pumps if their heart can handle it (NOT ACUTELY)
Treat any restriction at the thoracic inlet
Treat dysfunctions of the thoracic spine, L1 to L3, and rib cage
Redome the diaphragm
Apply thoracic, abdominal and pedal lymphatic pumps (NOT ACUTELY)
Where are the heart anterior Chapman reflex points?
Close to the sternum in the second intercostal space bilaterally
What are the effects of increased sympathetic tone on the healthy heart
"In the healthy heart, increased sympathetic tone Increases the force of contraction, Shortens the time of systole, Increases ventricular output
Consequences of Increased Sympathetic Tone in cardiovascular disease?
Vasospasm; Increases morbidity following myocardial infarction, Predisposes to arrhythmias, Inhibits development of collateral circulation, Adversely affects degree of recovery post-MI
________ tone implicated in essential hypertension due to vascular changes with the kidneys"""
"""Vasomotor nerves are unopposed
Consequences of Increased Sympathetic Tone: ______ lymphatic drainage,_______ bronchodilation, _______ gastrointestinal activit, Is involved in almost all disease processes
Diminished lymphatic drainage, Increases bronchodilation, Decreases gastrointestinal activity, Is involved in almost all disease processes
What is the Oculocardiac Reflex?
Pressure on the carotid body or the globe of the eye (Oculocardiac Reflex) will also slow the heart, Slows heart by 5-13 bpm, Will not slow at all in sympathecotonic patients"
Parasympathetics cause peripheral arteriolar vasodilation in select regions (5)
Vessels of Submaxillary Gland, Vessels of Parotid Gland, Vessels in the Blush Region of the Face, Vessels in the tongue, Vessels of the penis & clitoris (erection & engorgement)
Parasympathetics:_____ heart rate and contractility, ______ bronchoconstriction, ______ gastrointestinal activity, Only rarely causes _____
Decrease heart rate and contractility, increase bronchoconstriction, Increase gastrointestinal activity, Only rarely causes vasodilation
OMM Treatment for Acute Myocardial Infarction
"Use indirect methods or soft tissue techniques for at least first 72 hours post MI, Search for right Pectoralis Major trigger point Treat if present
Sympathetics to lung
T1-6
Sympathetics to trachea, bronchi
T1-6
Sympathetics to visceral pleura
T1-6
Sympathetics to Parietal pleura
T1-11
What are the main muscles of respiration?
inhalation: external intercostals, and innerchondral part of the internal intercostals, diaphragm, (deep inhalation also includes scalene, SCM, levator costorum, serratus posterior superior); exhalation: passive recoil (quiet breathing), internal intercostals and abdominal muscles (active breathing)
what are the motor and sensory nerves to the diaphragm?
phrenic nerve (C3-5)
inhalation dysfunction key rib in group:
bottom rib… holds the rest up
exhalation dysfunction key rib in group:
top rib… holds the rest down
what are the boundaries of the superior thoracic inlet?
manubrium, proximal clavicles, first ribs, and body of T1
tx for prevention of post-op pneumonia
Pre-op: Treat C3-5; Post-op: Treat C3-5 and ribraising
The right lymphatic duct drains what?
heart, lungs, liver, head, neck, and right upper limb
MI treatment
"General: use indirect methods or soft tissue techniques for at least first 72 hours post MI. Somatic: Search for right Pectoralis Major trigger point, Treat if present
lymphatic ducts are under what nervous control?
sympathetic
An MI with involvement of the ventricles where will TART be detected?
C8-T3
An MI with involvement of the atria where will TART be detected?
T4-6
An anterior MI infartct would reffer TART where?
T2-3 Left
An inferior wall MI would reffer TART where?
T3-5 Left and C2
Hyertension is associated with TART changes where?
C6, T2, T6
General treatment for all tenderpoints
COUNTERSTRAIN: Find position of comfort (70% improvement) via sidebending, flexion, extension, rotation as directed. Maintain the position for 90 seconds. Return to neutral and reasses.
Posterior tenderpoint for C1 is found where?
inion or muscle mass lateral to nuchal line
Posterior tenderpoints for C2-7 are found where?
on the articular pillars or "located on the interspinous ligaments between the spinous processes or slightly medial or lateral to them."
Treatment for posterior cervical tenderpoints
C1 (inion) flex, C1-7 (articular pillars) Extend and SARA, EXCEPT C3= Flex and STRAw
Location of ant. C1 tenderpoint
posterior edge of the ascending mandible
Location of ant. C2-C3 tenderpoint
on or deep to the SCM (or anterolateral tip of the articular pillars of the cervical vertebrae)
Location of ant. C4-C6 tenderpoints
anterior to the SCM (or anterolateral tip of the articular pillars of the cervical vertebrae)
Location of ant. C7 tenderpoint
lateral attachment of SCM to clavicle
Location of ant. C8 tenderpoint
medial tip of the clavicle
Treatment for anterior cervical tenderpoints
C1 rotate away, C2-C8 Flex and SARA, EXCEPT C7= Flex ans STRAw
Location of the Ant. Tenderpoint 1
mindline at episternal notch
Location of AT2
Midline, junction of manubrium and sternum (angle of Louis)
Location of AT3-5
Midline at level of corresponding rib;
Location of AT 6
"Midline xiphoid–sternal junction
Location of AT 7
Midline on the xiphoid or inferolateral to tip of xiphoid;
Location of AT 8
3 cm below xiphoid at level of T12, midline or lateral
Location of AT 9
1–2 cm above umbilicus at level of L2, midline or 2–3 cm lateral
Location of AT 10
1–2 cm below umbilicus at level of L4, midline or 2–3 cm lateral
Location of AT 11
5–6 cm below umbilicus below level of iliac crests at superior L5 level, midline or 2–3 cm lateral
Location of AT 12
Superior, inner surface of liac crest at mid-axillary line
Treatment for AT 1-6
Flexion to dysfunctional level
Treatment for AT 7-9
F STRAw
Treatment for AT 10-12
Hip flexion 90–135 degrees, slight side bending, rotation toward (type I) or side bending toward, rotation away (type II)= F STRT or F STRAw
describe the Still technique
take it the way it likes to go, add compression, maintain compression while reversing all components
Sympathetic innervation to the head and neck
T1-4
Sympathetic innervation to the heart
T1-6
Sympathetic innervation to the respiratory system
T1-6/T2-7
sympathetic innervation to the esophagus
T2-8
sympathetic innervation to upper GI (stomach, liver, gallbladder, pancreas, doudenum)
T5-9 (greater splanchnic n./ celiac ganglion)
sympathetic innervation to middle GI (pancreas, doudenum, jejunum, illium, ascending colon, proximal 2/3 of transverse colon)
T10-11 (lesser splanchnic n./ supperior mesenteric ganglion)
sympathetic innervation to lower GI
T12-L2 (least splanchnic n./ inferior msenteric ganglion)
sympathetic innervation to appendix
T12
sympathetic innervation to kidneys
T10-11 (lesser splanchnic n./ supperior mesenteric ganglion)
sympathetic innervation to the adrenal medulla
T10
sympathetic innervation to upper ureters
T10-11 (lesser splanchnic n./ supperior mesenteric ganglion)
sympathetic innervation to lower ureters
T12-L1 (least splanchnic n./ inferior msenteric ganglion)
sympathetic innervation to bladder
T11-L2
sympathetic innervation to gonads
T10-L2
sympathetic innervation to uterus and cervix
T10-L2
sympathetic innervation to erectile tissue of the penis/clitorus
T11-L2
sympathetic inervation to prostate
T12-L2
sympathetic innervation to arms
T2-8
sympathetic innervation to legs
T11-L2
parasympathetic innervation to lower ureter and bladder
pelvic splanchnic S2-4
parasympathetic innervation to uterus, prostate, genitalia
pelvic splanchnic S2-4
parasympathetic innervation to kidney and upper ureter
vagus (CN 10)
parasympathetic innervation to gonads
vagus (CN 10)
parasympathetic innervation to ascending and transverse colon
vagus (CN 10)
parasympathetic innervation to decending colon and rectum
pelvic splanchnic S2-4
anterior chapman's points for adrenal glands
1 inch lateral and 2inches superior to the umbilicus ipsilaterally (lateral aspect of the rectus abdominus at the level of the inferior costal margin
anterior chapman's points for the kidneys
1inch lateral and 1inch superior to the umbilicus ipsilaterally
ant. Bladder chapman's points
umbilical area
posterior chapamn's points for the small intestine
B/L (R>L) T8-T10
ant. And posterior chapaman's points for the appendix
ant: tip of the 12rib; post: T12 right
post. Chapman's points for cecum and ascending colon
T12-L1 right
post. Chapman's points for decending colon
L2-3 left
anterior chapman's points for the pancreas
leteral to the costal cartilage 7th intercostal space on the right
posterior chapman's points for the pancreas
bwtween transverse processes of T7-8 right
"upper GI reflex"
C2 left, T3 right, T5 left, T7 right
posterior chapmans reflex for esophagus
T3 right
post. Chapmans reflex for stomach
T5-8 left
post. Chapman's reflex for doudenum
T7-8 right
ant. Chapman's point for the urethra
myofacial tisues along the superior margin othe the pubic ramus about 2inches lateral to the pubic symphysis
ant. Chapman's point for the prostate
myofacial tissues along the posterior margin of the illiotibial band
ant. Chapman's point for the colon
iliotibial band (flipped)