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108 Cards in this Set
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- 3rd side (hint)
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contraindications for cranial manipulation
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pt has or might have an intracranial bleed, a CNS infection or malignancy, or a craniofacial fracture
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cranial manipulation (CR)
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treats cranial venous sinuses - improves blood flow to alleviate cranial pressure
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cranial rhythmic impulse
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cyclic fluctuations you can palpate. Caused by pressure changes. Peak pressure --> cranial flexion
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cranial somatic dysfunction
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to diagnose check rate (should be 10-14 cycles/min), amplitude (graded 0-5, 4-5 is nl, 0 indicates cranial base compression), symmetry
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entrainment model
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CRI may be the palpable summation of multiple intrinsic oscillations into a frequency selective entrainment mediated by ANS. [fluctuation of various fluid changes in body synchronized by the ANS balance. Result of pressure changes (synchronize the rhythm)]
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extension (cranial)
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cranium becomes long, more ovoid
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flexion (cranial)
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cranum becomes shorter, rounder. Peak pulse pressure --> flexion
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indications for Cranial maniupulation
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SD associated with headache, neck pain(occiput), upper resp. congestion, cranial nerve dysfunction, TMJ dysfunction, otitis media, torticollis
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inherent motion
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motility - how much tissues move around
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mobility
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passive secondary motion - associated with tissue pressure
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motility
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inherent motion
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osteopathy in the cranial field is indicated for
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cranial SD associated with headache, neck pain, Upper Resp. congestion, cranial nerve dysfunction, torticollis, mood disorders, plagiocephaly, infant feeding disorders
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primary respiratory mechanism model
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sutherland's theory that cranial mobility is due to: 1. motility of brain and spinal cord (not proven - may or may not play a role). 2. fluctuation of CSF - surges= periodic and correspond to BP. 3. mobility of intracranial and intraspinal membranes. proven - attachments of dura mater. 4. mobility of cranial bones. 5. involuntary mobility of sacrum between the ileum (sacrum moves with head somewhat)
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pulse pressure
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the difference between systolic and diastolic pressure. Drives cranial mobility. Varies cyclically, driven by sympathetic tone. Pathological changes narrow pulse pressure --> e.g. 120/90
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tissue pressure model
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CRI corresponds to tissue pressure - cyclic volume variations in both BP and Cranial rhythmic impulse
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traub-herring-mayer oscillation
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Rhythmical variations in blood pressure, usually extending over several respiratory cycles, with a frequency varying from 6 to 10 cycles a minute, related to variations in vasomotor tone.
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venous sinus drainage
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pressure treatment at sutures improves venous drainage of cranial sinuses. Increases sinus drainage from head--> improving headache, circ.
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william garner sutherland
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D.O that rediscovered that the skull has mobility transmitted outwards from internal pressure via the sutures. Can treat skull at sutures by affecting attached membranes
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asymmetry in cranial rhythms is due to
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cranial base strains, membrane strains, bone restrictions
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flexibility of sutures
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provides brain with some protection
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sacral motion corresponds to
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cranial motion due to attachments of dura mater
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barrier
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important in diagnosis. Must be engaged (ME is a direct technique). Muscle contraction is away from the barrier (advance the barrier by having the pt flex away from it)
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conditioning
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less tissue resistance with repeated stretch. Condition/train muscle to relax
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contraindications to muscle energy
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rel: fractures, sprains, cancer or infection, DVT. Treat c caution: osteoporosis (m. evulsion can occur), osteoarthritis, undiagnosed neuropathy, joint inflammation, pt. guarding
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creep
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"tissue creep" - constant load causes tissue to give - loosen
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direct method
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engages a barrier. Muscle energy is a direct technique.
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fryette'
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proper fryette's diagnosis can allow spine to be treated with muscle energy
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indirect method
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MFR, for example. Moves away from tissue restriction
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isometric contraction
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contraction where length of muscle does not change (muscle does not shorten)
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golgi tendon reflex
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GTO - responds to tension in muscles. Strong pull triggers muscle relaxation (give) to prevent tearing. Yoga uses this
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ligamentous laxity
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hypermobility --> leads to joint instability
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localization
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isolating/engaging the correct muscle/body part at the barriers in all planes.
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muscle energy
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patient voluntarily moves the body as directed by a doctor. Directed patient action = controlled position against a defined resistance.
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muscle spindle
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responds to change in length of muscle and the velocity of the change. If too quick - will initiate a stretch reflex --> cause muscle to contract to counteract the stretch. Why you must advance slowly
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muscle stretch
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post-isometric facilitation
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neuromuscular apparatus is refractory temporarily removing the myotactic (stretch) reflex
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proprioceptive neuromuscular facilitation
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muscle energy treatment
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in the muscle energy technique, the muscle contraction should occur
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away from the barrier.
e.g. pt's biceps restricted - position at the barrier, have pt. contract the extensors. |
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localization of muscle energy techniques refers to
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positioning the muscle against barriers of all planes
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reciprocal inhibition
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reflex relaxation of the antagonist. (allows agonist to move)
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*in OPP ME treatment there is a small but significant
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change in active ROM
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neurologic mechanism
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reduces tension, stretches the barrier - induces relaxation response in muscle.
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ankle inversion sprain
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85% of all ankle sprains, most occur while plantar flexed. Dirupts lateral ligaments. Foot= inverted (sole pushes up medially)
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anterior drawer test
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tests ATFL. Greater than 3 mm is a positive test, indicates ATF compromise.
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ankle swing test
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tests for restriction in glide of talus. Hold feet horizontally, push posteriorly.
Positive ankle swing test: restricted posterior talus glide. SD Anterior talus, SD plantar flexed ankle |
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ant. talofibular lig.
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the only ligament preventing anterior subluxation of the talus. Is ruptured first in an inversion ankle sprain.
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cuboid
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lateral on foot. Makes up proximal transverse arch with the navicular (medial). Glides in plantar direction under weight bearing (or pes planus).
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fibular head
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proximal portion of fibula, slightly posterior to the tibia. Glides anterolaterally or posteromedially. Moves in the opposite direction of the distal fibula
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fibular/peroneal neuritis
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entrapment of the fibular nerve (L4-S2). causes dythesias of lateral leg and foot, weak ankle plantarflexion and eversion.
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fibular nerve runs behind the fibular head - consider SD posterior fib. head
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interosseous membrane testing - lower limb
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connects the tibia and fibula. Injury in inteross. Mem. Can be detected by the squeeze test.
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metatarsal
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between phalanges and the cuneiform bones and cuboid.
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myofascial restriction of forefoot
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can transmit restriciton to plantar fascia --> plantar fascitis
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navicular
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medial on foot. Makes up proximal transverse arch with cuboid.
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medial longitudinal arch
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reduced in pes planus. -- produces a valgus strain. Elevated in pes cavus --> varus strain
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pes planus
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flat feet, reduced medial long. Arch. Valgus strain on knees and ankles. Eversion of forefeet and ankle (turn in). Causes talus anterior glide, navicular and cuboid plantar glide
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plantar fascitis
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inflammation of plantar fascia. Tenderness at anteromedial calcaneus. Can result from pes planus. Result of weight-bearing of the soft tissue repetitively. (think runner!) self-resolving 6-18 months. Heel pain with first few steps in the am
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red flags - ankle injury that suggest fracture
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unable to bear weight, point tenderness over post edge of malleoli, 5th metatarsal base, navicular, proximal fibula. Do squeeze test, radiographs to check widening of the mortise joint
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squeeze test
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detects interosseous membrane, syndesmosis strain/problem. Thenar eminences placed on distal tibia and fibula. Squeeze 2 sec. Pos. sign = pain.
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syndesmosis
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connects the tibia and fibula distally. Ligamentous bone-bone
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talus
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tibia rests on talus. Ankle joint = talotibial joint. Glides anteriorly with plantar flexion (PAT), glides posteriorly with dorsiflexion (DPT)
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talotibial range of motion
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dorsiflexion (15-20) and plantar flexion (50-65)
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tarsal bones
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bones of foot (pre-metatarsal)
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tarsal tunnel syndrome
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entrapment of the tibial nerve in the tarsal tunnel (between flexor retinaculum and talus).
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ankle mortise joint
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distal tibia and fibula and the proximal talus. gliding motion.
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transverse arch
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cross-sectional arch - formed by the navicular and the cuboid at the base of the metatarsal heads
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distal fibular anterior =
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somatic disfunction plantar flexion, restriction dorsiflexion
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SD fibular head anterior -
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means distal fibula is posterior (in dorsiflexion)
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atypical vertebrae
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C1 and C2
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spurling's test
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spurling. Specific for radiculopathy but not sensitive (negative test does not rule out herniated disc). Press on head with extension and sidebending
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cervical compression test
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place hands on top of head without flexing or extending. Pos. test - arm pain, numbness, tingling. Specific but not sensitive.
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cervical somatic dysfunction
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structural exam shows TART (tissue texture abnormality, asymmetry, restriction in motion, tenderness). Can occur in Flexion, extension, or neutral.
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cervical strain and sprain
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treatment goal: reduce edema and acute tissue reaction, restore ROM. OMT, ice, rest, NSAID, nighttime muscle relaxor, manage pain, improve pt's activities
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cervical HVLA
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HVLA - high velocity low amplitude. Thrust.
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muscle energy technique for C2-C7
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2 techniques - sidebending and rotation. Diagnosis: FRS right. SB technique: Extend, SB left, rotate R. Rot technique: Extend, rotate left, SB right.
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tension cephalgia
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headache
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typical cervical vertebrae
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C2 inferior facet through C7
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vertebral artery challenge test
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aka de Klejn's maneuver. Screen for vertebral artery insufficiency before cervical manipulation. Rotate and extend head and observe the eyes. Maintain for 20 sec on each side. Positive test: HVLA contraindicated. Nystagmus, dizziness, pallor, sweating, tinnitus (ringing in ears)
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vertebral artery dissection
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tear in the vertebral artery. Blood enters artery wall--> intramural hematoma. Can occur during thrust techniques. Rare and unpredictable
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foramen transversarium
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located in C1-C7. house the vertebral artery
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uncinate processes
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protect cervical spine- posterior on vert. project inferiorly for a "shingling" effect. Helps prevent herniation
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most common herniated disc
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C6 spinal root (C5-C6 disc)
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most cervical sidebending occurs in the
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lower cervicals
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primary motion of the occipito-atlantal joint
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flexion/extension
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primary motion of the atlantoaxial joint
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rotation (50% cervical rotation occurs here)
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cervical radiculopathy
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pain/sensation change in arms due to nerve compression in neck. Paracervical tenderness, loss of ROM esp rotation, relief with vertical traction. Do x-rays, MRI to detect herniated disc.
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radiculopathy
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nerves are affected, do not work properly - problem in nerve root. Can lead to pain in areas far from point of compression
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torticolis
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ear to neck presentation. Neck muscles lock down due to acute spasm or herniated nucleus pulposis
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dorsokyphosis
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increased kyphotic curve of thoracic vert - due to depression, adv. Age
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most sensitive indicator of neck pathlogy
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loss of rotation
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passive ROM for neck
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90 degree rotation in each direction
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if loss of neck ROM
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do an Xray - neurologic exam of upper extremities
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most commonly irritated neck muscle
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trapezius
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effect of herniated nucleus pulposis
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narrows neuroforaminal space up to 50%. Nerve root occupies 30% of this space.
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wallenberg's test
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with pt supine hold each position for 10 seconds: flexion, extension, extension and rot. Right, extension and rot. Left. Positive test: nystagmus, dizziness, visual disturbance
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atypical cervical vertebrae
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occipital-atlanto segment (c0-C1) - rotation and sidebending occur to opposite sides - R:R, S:L
atlantoaxial segment (C1-C2): entirely rotation |
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cervical counterstrain - posterior tenderpoint
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extend head, sidebend and rotate AWAY from tenderpoint
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cervical counterstrain - anterior tenderpoint
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flex head, AC2-C6 - sidebend and rotate away from tender point. AC7 sidebend toward and rotate away from tenderpoint
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risks with HVLA
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temp. increase in neck pain, muscle spasm, guarding, arthralgia. Dizziness. Risk cervical strain and sprain with Downs syndrome and Rheumatoid arthritis and hypermobility. Vertebral artery dissection
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whiplash
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most common cause of cervical strain and sprain.
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cervical sprain
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ligamentous stretch injury. Joint injury without fracture or dislocation
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cervical strain
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muscular injury. (less strict def. Includes cervical disc and facet joint ligaments.)
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What mechanisms allow ME to work?
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tissue creep, conditioning, post-isometric relaxation, activation of golgi tendon reflex, reciprocal inhibition
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reciprocal inhibition
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in a myotactic reflex, antagonist relaxes while agonist contracts
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muscle energy treatment position
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Directly into barrier (restriction). Pt contracts muscle opposite the restriction.
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the talus glides this direction in planterflexion
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anteriorly
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the distal fibula glides posteriorly in
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dorsiflexion
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When an ankle in plantar flexed, the talus is ___ and the distal fibula is ___
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talus: anterior, dist. fibula: anterior
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muscle energy treatment for SD fibular head posterior
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Practitioner:
1. pulls fibular head anteriorly. 2. dorsiflexes the foot Pt.: 3. plantar flexes the foot |
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