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136 Cards in this Set
- Front
- Back
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A. T. Still
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fxnal restrictions = source of visceral dysfxn & disease
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Louisa Burns
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correlated CT changes with somatic dysfxn - 1900s
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Irvin "Kim" Korr & J. Stedman Denslow
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scientific evidence for OMM
1940s-60s |
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what are the 3 models of somatic dysfxn initiation
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1. circulation / fluid distribution
2. CT 3. neural / autonomic |
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**who is the founder of circulatory model of somatic dysfxn?
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Gordon Zink
failure of **lymphatic & **blood circulation toxins not removed from tissue localized edema & inflam. --> mechanical restriction fluids spread dysfxn distally |
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what is wrong with the circulatory model?
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-doesn't account for autonomic arousal
-doesn't account for segmental specificity -would create irreversible texture changes **it is a component of somatic dysfxn, but not THE cause |
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who coined CT model?
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Louisa Burns
SD is accompanied by microscopic **extravasation of blood, edems, & inflam in CT of affected joints & mms |
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what is the process of CT model?
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extravasation --> thickened CT --> restriction of mobility & pain
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discribe CT changes
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-normal elastin / collagen fibers = parallel to force
-abnormal tissue fibers = random pattern -resistant to stretch -weaker along original axis -it takes about 3 DAYS to begin this process |
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**CT model - consequences of immobilization and chronic m. stretch??
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immobilization =
-decrease fiber diameter -increase m. mass chronic muscle stretch = -MUSCLE "CREEP" -laxity at "neutral" |
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CT model SD?
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SD=
-tissue displaced FROM normal neutral -restricted motion TOWARD neutral -increased range of motion AWAY from neutral both injured muscle & ITS ANTAGONIST undergo CT changes - maintains abnormal ROM |
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**
passive ROM? active ROM? motion loss? |
passive = elastic barrier to restrictive barrier
active = physiolocgic barrier to restrictive barrier motion loss = what motion the restictive barrier is keeping you from achieving |
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what are the shortcommings of CT model?
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-doesn't acount for:
-segment specificity -acute somatic dysfxn -autonomic arousal associated w SD **useful in development of secondary SD or postural adjustments to SD **CT model = pictures of scoliosis and also lady aging and becoming more bent over |
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who termsd neural / autonomic mechanims?
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Korr & Denslow
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N/A accounts for?
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-operates quickly, quick onset of SD and releif w manipulation
-autonomic arousal - autonomic & motor neruons share interneurons -hyperexcitability in motorneurons |
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tissues without nociceptors?
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-brain parenchyma
-hyaline cartilage |
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where do nociceptrs synapse?
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rexed's lamina I or II, or with dendrites of interneurons from lamina V
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what segment has the most input from the heart from nociceptor input?
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T2 (some T1, T3, T4 & T5)
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nociceptors NTs
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peptide (substance p, etc.)
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**how does referred pain work?
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bc nocioceptors diverge as they leave the SC, a pain perceived in one location may in fact by due to noxious stimulation from another area
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**T /F: referred pain is based on a spinal reflex
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FAIL.
nope, it sure isn't |
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why is it?
visceral pain = diffuse, poorly-localized somatic pain = sharp, well-localized |
bc there are FAR FEWER afferent fibers from viscera than from the soma
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T/F:
there is no evidence for any ascending pathway that transmits ONLY VISCERAL signals from the SC to the brain |
true!
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T/F:
reflexes are monosynaptic |
false
they can be mono or polysynaptic |
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what reflex is regulated by the golgi tendon apparatus?
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myotatic reflex = tonic contraction of the mm. in response to stretching force, due to stimulation of m proprioceptors
this is the simplest of reflexes |
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what are the 4 types of reflexes?
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somato-somatic
viscero-visceral somato-visceral viscero-somatic |
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what reflex?
intestinal distention --> increase contraction of intestinal m? |
viscero-visceral reflex:
visceral afferent nociceptor --> SC interneurons --> efferent to SANS or PANS motoneurons |
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what reflex?
injury to m --> increased HR |
somato-visceral reflex
peripheral afferent nociceptor --> SC IN --> efferent to SANS or PANS |
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what reflex?
withdrawal from noxious stimuli? |
somatosomatic reflex
peripheral afferent nociceptor --> INs (central gray matter) --> ventral horn motoneurons --> somatic m. contraction at least one IN may affect distant sites |
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**TQ**
what reflex? chronic asthma produces tissue texture changes in upper thoracic region? |
viscero-somatic reflex
visceral afferent nociceptor --> SC INs --> ventral horn motonerutons --> somatic m contraction usuallly affect small rotators (rotatores) |
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what type of SD does viscerosomatic reflexes exhibit
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non-neutral (TYPE II) SD
increased moisture (skin drag) increased temperature poorly defined end point = rubbery |
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what are the 3 types of reflex modifiers?
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1. sensitization
2. habituation 3. facilitation |
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**what modifier protects against repeat injuries by maintenance of a pool of neurons in a state of partial or subthrshold excitation?
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facilitation
ex: the music in a scary movie |
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what modifier?
progressive amplification of a response follows repeated administration of stimulus |
sensitization
if the stimulus is terminated, neurons return to baseline ex: rub your arm for aprolonged period |
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what modifier allows us to "tune out" that which isn't important through a decrease in response to stimulus after repeated exposure to the stimulus over time?
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habituation
if the stimulus is terminated, neurons return to baseline |
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what is axonal transport?
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non-impulse (AP) inegration btw viscera, soma, & nerve cell bodies
- anterograde - retrograde |
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T/F:
nerve growth factor = family of chemicals which use action potential & Ca++ dependent release of NT to maintain health of nerves & end organ tissues maintain |
false
NGF use AXONAL TRANSPROT to maintain health |
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what are the rates for axonal transport?
slow med fast very fast |
slow = 0.52 mm/day
med = 25 mm/day fast = up to 400 mm/day very fast = up to 2000 mm/day |
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there are 12 steps to SD...
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1. nociceptors are stimulated
2. nociceptor activation send impulses to ather axon branches of the same nociceptor & into SC 3. impulses in axon branches cause release of peptide NTs - vasodilation, extravasation of fluid, attraction of immune cells = all LOWER the threshold for nociception 4. impulses entering the SC stimulate spinal neurons -CSN = pain appreciation -spinal intermediolatersal system - preganglionic autonomic neurons -spinal motoneurons - nocifensive reflexes 5. pain may be poorly localized (if perceived at all) 6. most nocioautonomic reflexes involve the sympathetic nervous system -local immune respnse is increased, but other immune responses are suppressed 7. single or multiple segmental responses attempt to min the noxious input from the affected nociceptors -m shortends, overlying muscle contract the guard 8. axonal reflex & sympathetic vasodilation engorge the affected mms -direct, mechanical restiction -seratonin, histamin, bradykinin, PCl 9. any attempt to stretch tissue to "normal" will cause nociceptor firing -m creep! 10. continued contraction of affected mm = cause fatigue & further nociceptor firing 11. if abnormal position is held long enough (hrs to days) CT (fibrocytes) reorganize into non-parallel fashion -m creep & chronic stress 12. SD becomes chronic -continuous autonomic activation -visceral dysfxn & immune deficits |
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**T/F:
referred pain is a reflex |
NO!!!
of course it isn't! |
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T/F:
SD alters the 4 reflexes & reflex modifiers |
true
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what neuron can eventually be degraded from chronic somatic dysfxn?
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inhibitor neurons (permanent loss)
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T/F:
if nociceptors are damaged by chronic firing, A-beta fibers (light touch, vibration) can be recruited to take their place |
true
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what is the famous quote regarding SD from Fred Mitchell??
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"implicit in the term "SD" is the notion that manipulation is APPROPRIATE, EFFECTIVE, and SUFFICIENT tx for it"
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tissue manipulation stimulates release of?
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NO
-free radical properties -immune, vascular, and neural signaling molecule -antibacterial & antiviral -stimulates release of endocannabinoids |
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what does ME do?
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isometric contraction of antagonist m.
= resets Golgi = voluntary activation of motor neurons black spinal nociceptive pathways |
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what does CS do?
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shortens already shorteded area = COMPLETELY deactivates nociceptor activity
= improbes local circulation = release from chronic sympathetic activity |
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what does myofascial release do?
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initial shortening followed by gradual lengthening of tissue
= ****benefits of CS + stretching of ME!!! |
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what does HVLA do?
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restricted tissue carried to its abnormal limit
=small additional stretch (swift reorganization of CT) = low amplitude decrease likelihood of recurrence = ENDOGENOUS MORPHINE is released after high-impact motion |
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what are chapman's reflexes? what kind of reflex are they???
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**viscerosomatic relexes = palpable as "gangiform contractions"
result of hypercongestion of local lymphatics anatomic "map" for specific points (each point relates to specific disease or condition) |
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who's chapman? how many points did he find and chart??
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Frank Chapman, DO
discovered & charted over 200 reflexes Kirksville 1897 graduate |
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who was chapman's bro-in-law who continued his work, but stressing importance of "pelvic-thyroid syndrome?"
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Dr. CHarles Owens
one of the first to describe interrelated NEURO-ENDOCRINE-IMMUNE SYSTEMS |
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T/F:
every systemic condition has anterior AND posterial reflex |
true
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**TQ** a bunch of random easy shit about "gangliform contractions" (palpable, hypercongestion, tenderness, etc) and then, again, what type of reflex is champman?
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viscerosomatic reflex
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what is the etiology of chapmans?
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organ
-irritated -diseased -stressed --> increased sympathetic tone --> myofascial nodule -boggy -ropy -shotty -thickened |
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what are the 3 components to chapman's gangliform contractions?
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1. neurologic
2. lymphatic 3. myofascial |
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what component?
localized congestion secondary to sympatheticotonia, tissue stasis & accumulation of pro-inflammatory substances, painful/tender? |
lymphatic
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what component?
lymphatic vessels innervated by sympathetic fibers, facilitation from visceral irritation leds to constriction of lymphatic vessels? |
neurologic
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what component?
palpable tissue changes, mostly intercostal & spinal area, some extremities? |
myofascial
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what are some acute palpatory characteristics of chapmans?
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acute
-tender, NON-RADIATING -pea feeling -smooth, circumscribed -firm (DENSE, not hard) -discretely palpable -moves slighly, but otherwise fixed -in deep aponeurosis or fascia |
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**how do chapman's reflexes differ from jones CS points?
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chapmans points:
-tenderness, while present, is NOT sole criteria -lymphatic congestion & myofascial tissue changes more important criteria -NOT TRIGGER POINTS |
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what are some chronic palpatory characteristics of chapmans?
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chronic/residual
-less tender -less discrete, somewhat confluent -generalized increased tension, rubbery, stringy, ropy, firm **in chronic or severe cases: coalescent mats or even "stings of pearls" may be felt, sepecially with the points on the lower extremities |
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anterior of posterior reflex?
follow intercostal sympathetic nns, reflexes are more descrets, first in tx sequence? |
anterior
located in intercostal spaces near sternum |
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a or p?
less descrete, more rubbery feel of classic viscerosomatic reflex, oftern resolve with treatment of the other side reflex |
posterior
located btw spinous process & transverse process of adjacent vertebrae **often resole with tx of anterior reflex |
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T/F:
chapman's reflexes are considered to be more Sp than Sn indicators of disease? |
false
chapman's reflexes are considered to be MORE SENSITIVE than specific indicators of disease? |
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what are wilson's rules?
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1. NEVER make dx solely on NON-tender chapman's reflex
2. NEVER ignore or trivialize a TENDER chapman's reflex |
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T/F:
presence of points in hospitalized pts with pneumoniea is a current application. points classified for "lung" relationship occurs within the first 72 hours |
true
(study described in class) |
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appendix?
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tip of 12th rib on R
T10-11 SP/TP on R |
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how do you tx chapman's reflex?
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-start w anterior reflex
-light massage -small circular motion -15-20 sec (or longer) until lymphatic congestions diminishes / change in myofascial tissue -next, tx posterior reflex -recheck anterior side and retreat is still there |
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T/F:
do not use excessive pressure on points, you get results more quickly & with more lasting effect by gentle menas |
true
avoid excess pressure during txmt |
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ENT screen
middle ear sinuses tonsils larynx |
anterior- around sternum at claviacal, rib 1, rib 2 (pic)
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pulmonary screen
larynx bronchus upper lung lower lung |
anterior- 3 points on each side of sternum, btw ribs 2-3, 3-4, & 4-5
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cardio
myocardium bronchus esophagus thyroid |
anterior- 1 point on each side of sternum btw ribs 2-3
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upper GI screen
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starting under rib 5 (btw ribs 5-6) on each side and going down:
R pylorus liver gall bag & liver small intestine APPENDIX! L pylorus stomach (acidity) stomach (peristalsis) spleen |
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**TQ**
colon can be "cut" and "flipped" open onto legs |
right colon = right femur
left colon & sigmoid= left femur rectum is actually on both sides of proximal femur (see pic) |
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urinary screen
adrenal kidney urethra urinary bladder ureter |
adrenal ---- R & L around upper umbilicus
kidney ----- R & L below adrenal urethra ----- midline just about umbilicus urinary bladder ----- midline ureter ------ R & L around umbilicus lower |
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genital screen
ovary uterus broad ligament / prostate |
ovary -------- R & L on pubes
uterus ------- R & L below and lateral to ovary broad ligament / prostate ------- down lateral femor R prostate / BL = R femur L prostate / BL = L femur |
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discribe the respiratory epithelium
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pseudostratified, columnar, ciliates, goblet cells
mucociliady clearance |
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respiratory mucosa has what protective enzymes & immunoglobuline?
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lysozymes
IgA |
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mucociliary clearance
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ciliary action
movement of mucous blanket clearing debris |
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T/F:
the dependent drainage of maxillary sinus requires active mucous transport |
true
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what is the anterior sinus drainage pattern?
the posterior? |
a = osteomeatal unit under middle turb.
p = sphenoethmoid recess |
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name some things that influence ciliary activity
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-tobacco smoke & pollutanta
-antihistamines -iflammation -viscosity of mucous |
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neurogenic inflammation
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afferent nns from nose CN V
protective reflex: irritation --> sneeze release of neuropeptides --> NEUROGENIC INFLAMMATION |
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which acute phinosinusitis pathophys involves HYPOactive SNS?
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non-alergic (vasomotor)
increases nasal airway resistance |
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what is rhinitis medicamentosa?
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overuse of topical decongestants
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factors in mucociliary transport
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viscosity of mucus
primary ciliary dyskinesia (rare) drying of mucosa --antihistamines --poor hydration cigarette smoke inflammation of mucosa chronic infection & diabetes |
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what does auditory tube do?
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-connects middle to nasopharyns
-balances pressure -clears debris & secretions -protects middle ear from noxious agnets in nasopharynx |
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infant vs adult auditory tube
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infant
-courses btw temporal bone (petrous) & sphenoid -1/2 the length of adult tube -more horizontal adult -1/3 in temporal bone -2/3 in cartilage -tube narrowest at jxn -adult tube length by 7 y/0 |
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T/F:
otitis media with effusion usually resolves with antibiotic treatment & this hastens resolution |
FALSE
otitis media with effusion usually RESOLVES SPONTANEOUSLY & antibiotic treatment does not hasten resolution |
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what are some risk factors for otitis media?
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-genetic
-male -low birth weight -# of siblings -day care -not breastfed -pacifier use -smoking exposure -low socioeconomic status |
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T/F:
3 months of breastfeeding reduces OM |
TRUE!
breast is best (for ears, too) |
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what is the name of the technique designed by Dr. Galbreath to assist in opinging the auditory tube and decrease lymphatic congestion?
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Galbreath Technique:
Mandibular Drainage |
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what does sympathetic regulation do to blood flow?
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vasoconstriction & mucosal drying
inrease airway patency overdrying puts mucosa at risk |
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what areas correspond sympathetic regulation of blood flow?
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T1-T3
superior cervical ganglia C2-C3 |
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parasympathetic regulation of mucous production
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increases goblet cell secretions
neuromediators (sub P) also influence mucosal gland fxn among neuropeptides associated with PNS in nose = NO (cilia effect!) |
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what areas correspond parasympathetic regulation of mucous production
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CN VII (facial)
Pterygoid canal (sphenoid) Pterygopalatine ganglion |
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OMT for upper respiratory
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-lymphatic drainage
-autonomic NS balance |
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OMT lymph / venous drainage?
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start centrally, work peripherally
-thoracic inlet = lymph enters at jxn of subclavian & internal jugular vv. |
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what are the thoracic inlet structures?
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rib 1-2
T1-T2 SC AC (nice pic in ppt) |
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OMT cervical & face
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cervical mm.
cervical facet joints cranial base (OA decompression) effleurage over sinuses infraorbital/supraorbital pressure points mandibular drainage |
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OMT thorax
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diaphragm release
thoracic lymphatic pump |
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OMT SNS upper respiratory
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T1-T3
C2-C3 (superior cervical ganglion) |
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OMT PNS upper respiratory
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Cranium
-OA decompression -vagus, glossopharyngeal sphenopalatine ganglion |
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rib attachments?
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-2 thoracic vertebrae
-transverse process of the LOWER vertebra |
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accessory mm. of respiration:
-anterior scalene -middle scalene -posterior scalene -SCM |
scalene
-anterior = 1st rib -middle = 1st rib -posterior = 2nd rib -SCM = ...really? |
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other mm of INhalation:
-pec minor -latissimus dorsi -serratus anterior |
pec minor = corocoid process to ribs 3-5
lats = lower T's & ribs 10-12 -thoracolumbar fascia -iliac crest -intertubercular groose of humerus serratus anterior = ribs 1-8 to medial border of scapula |
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direction of internal & external intercostals??
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internal = hands in your BACK pocket
external = hands in your FRONT pocket |
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m of posterior chest wall?
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transversus thoracis
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diaphragm attachments
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diaphragm = lower 6 ribs
L1-L3 xyphoid process |
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phrenic n
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C3,4,5 keep diaphragm alive
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intercostal nn
DRG?? |
DRG = sympathetic innervation
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respiratory rate & depth are controlled in __ .
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medulla
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Parasympathetic innervation
Sympathetic innervation |
Parasympathetic innervation
-vagus -increase secretions -bronchoconstriction Sympathetic innervation -T2-T7 -bronchodilation -decreased secretions |
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T/F:
asthma rates in children under 5 have increases more than 160% from 1980-1994 |
true
100 million asthmatics by 2025 each year: 13 million school days missed 10.1 million missed work days 500,000 hospitalizations |
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what kind of lower airway obstructions take place in asthma? is it reversible?
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mucous plugging
hyperiflation usually reversible |
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OMT asthma
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somatovisceral reflexes = ex. T2FSRL
chronic viscerosomatic reflexes = group curve techniques: -HVLA -ME -Still -articulation (rib raising) |
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OMT asthma - nervous system
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-sympathetic chain ganglia
-phrenic n. -vagus **older study suggested that OA decompression may INCREASE BRONCHOSPASM and should be avoided in severe cases techniques: -soft tissue -rib raising -MF release |
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lymphatics (mucus plugging, hyperinflation) techniques
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-thoracic pump
-pedal pump -pec lift -diaphragm release |
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pneumonia most serious for?
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<2 or >65
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what fraction of pneumonia is viral?
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1/3
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pneumonia techniques?
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HVLA (outpt)
ME Still Artivulation - rib raising |
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T/F:
OMT decreases need for IV antibiotics, and LOS in hospital for pneumonia? |
true
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ant. chapman's reflexes:
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69% Sn
64% Sp 87% PV- |
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T/F:
abdominal lymphatic pump increases leukocytes 2 fold and flow through the thoracic duct 2 fold |
false
abdominal lymphatic pump increases leukocytes TWO (2) fold and flow through the thoracic duct FOUR (4) fold |
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sympathetic
**TQ** celiac ganglion?? |
celiac T5-T9
-esophagus T1-T6/8 -stomach -proximal duodenum -liver/gall -spleen -pancreas |
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sympathetic
superior mesenteric ganglia?? |
SMG = T10-T12
-distal duodenum -jejunum & ileum -ascending colon -proximal 2/3 trans colon |
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sympathetic
inferior mesenteric ganglia |
IMG = L1-L2
-splenic flexure to rectum |
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sympathetic
esophagus? |
esophagus:
cervical T2-T4 thoracic T3-T6 abd T5-T8 |
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sympathetic
liver/gall |
liver/gall = T6-T9
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sympathetic
small intestine |
SI = T9-T11
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sympathetic
colon / rectum |
colon / rectum = T10-T12
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parasympathetic
-pelvic splanchnics -vagus |
parasympathetic
-pelvic splanchnics left colon rectum -vagus = everything else from the splenic flexure down, PSs, everything else = vagus |
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parasympathetic
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cranial - sacral
tx: O/A & sacrum!! |
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**abdominal diaphragm
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LES
IVC & cisterna chyli vagus passes through |
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**TQ**
lymph pours from mesentery to join lumbar lymph & celiac vessels at ___ . |
cisterna chyli
-nestled under the diaphragm -leading to the thoracic duct |
