Opp Ii - Course Review The Basics

Front 1

What is the definition of Osteopathic Medicine

Back 1

Complete system of medical care with a philosophy that combines the needs of the patient with the current practice of:
medicine
surgery
obestrics
that emphasizes the interrelationships between structure and that has an appreciation of the body's ability to heal itself

Front 2

What are the 4 principles of Osteopathic Philosophy?

Back 2

1. The BODY IS A UNIT: person is a unit of body, mind, spirit.

2. The body is capable of SELF REGULATION, SELF HEALING, AND HEALTH MAINTENANCE

3. Structure and function are reciprocally INTERDEPENDENT

4. Rational treatment is based upon an understanding of the basic principles of body unity, self regulation, and the interrelationships of structure and function.

Front 3

What is this definition?

The impaired or altered function of related components of the somatic (body framework) system.

Back 3

Definition of somatic dysfunciton

Front 4

What is this definition?

- The maintenance of a pool of neurons in a state of partial or sub threshold excitation
- In this state less afferent stimulation is required to trigger the discharge of impulses

Back 4

Spinal Facilitation

Front 5

What are the different areas of spinal facilitation?

Back 5

1. could be premotor neurons, motor neurons, or preganglionic sympathetic neurons in one or more segments in the spinal cord

2. Once est facilitation can be sustained by nl CNS activity

3. This theory helps explain the neurophsiological mechanisms underlying the neuronal activity associated with somatic dysfunction

Front 6

What is Osteopathic Manipulative Treatment?

Back 6

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

Front 7

What is the Criteria for diagnosing somatic dynsfunction?

Back 7

TART

T - Tissue texture abnl
A - Asymmetry
R - Restriction
T - Tenderness

Front 8

What Motion barrier is this?

The limit of Motion imposed by ANATOMIC STRUCTURE.....the limit of PASSIVE MOTION

Back 8

Anatomic Motion Barrier

Front 9

What Motion barrier is this?

The limit of ACTIVE MOTION

Back 9

Physiologic Motion Barrier

Front 10

What motion barrier is this?

Also called the restrictive barrier
A functional limit that abnl diminishes the nl physiologic range

Back 10

Direct motion barrier

Use Techniques: ME, HVLA, Direct Myofacial Release

Front 11

What barrier is from the ANATOMIC TO ANATOMIC barrier?

Back 11

Passive Motion Barrier

Front 12

Label this picture for Barriers

Back 12

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

Physiologic : the limit of active motion

Direct: may also see it called the restrictive barrier; a functional limit that abnormally diminishes the normal physiologic range

Front 13

Is this Direct or Indirect OMT?

- ______ techniques are ones in which the restricted tissue is initially taken in the direction of the restriction to motion

Back 13

Direct OMT

Front 14

Is this Direct or Indirect OMT?

- ______ techniques are those that initially position the tissue away from a barrier toward relative ease or freedom of motion

Back 14

Indirect OMT

Techniques are located between neutral and new neutral barriers

Front 15

What Freyette's Law is this?

When the spine is in neutral, sidebending and rotation are in OPPOSITE DIRECTIONS

Back 15

Freyette's Law 1
Law I = when the spine is in neutral (easy normal), sidebending and rotation are in opposite directions. (Type I Mechanics)

- Occurs in neutral - (facets not engaged)
- Found in thoracic and lumbar spines
- Forms long curves, multiple segments
- Compensatory

Front 16

What is Freyette's type 2?

Back 16

Law II = when the spine is flexed or extended (non-neutral), sidebending and rotation are in the same directions. (Type II Mechanics)

- Occurs in flexion or extension- Facets engaged
- Found in thoracic and lumbar spines - Type II-like motion in cervical spine
- Usually single segments
- Found at apices and crossovers and/or sites of viscerosomatic reflexes
- Primary somatic dysfunction - Due to strain or viscerosomatic reflex

Front 17

Back 17

Front 18

What is Fryette's Law Type III?

Back 18

Law III - when motion introduced in one plane it modifies (reduces) motion in other two planes

When a segment is brought up to a restrictive motion barrier it will move in the position of greatest ease in the other two planes.

Front 19

What are the symptoms of Type 1 SD?

Back 19

- Posterior transverse process and paravertebral fullness visible when spine is in neutral.

- Asymmetry not significantly altered by flexion/extension.

- Sidebending and rotation opposite directions

Front 20

What Cervical Spinal has Type 1 mechanics?

Back 20

OA

Front 21

What Fryettes is associated with:
short leg
rotational pelvis
type II SD

Back 21

Fryette's Law Type 1

Front 22

What Cervical spine is associated with Type II Mechanics?

Back 22

Typical Cervical Spine C2-C7
&
A.A

Front 23

What cervical spine has ONLY PURE ROTATION?

Back 23

Type II

Front 24

What Fryette's is associated with viscerosomatic reflexes?

Back 24

Fryette's Type II

Front 25

If the right facet was locked closed.
What findings would you find?

Back 25

Type II mechanics - Extension SD

- In extension - NO ASYMMETRY
- Both facets can close easily in ext
- No apparent rotation or sidebending asymmetry ext
- most comfortable for the patient in ext

Front 26

In a Type II extension SD if the right facet was locked closed what will your findings be?

Back 26

Remember the left facet can move
SB and Rot to the right

Front 27

In an EXTENSION SD what will your findings be in flexsion?

If the right facet was locked closed?

Back 27

Remember SD is the position of ease so it gets better in extension and worse in flexsion!

In flexsion the left facet opens freely and can pivot around the right facet
- This leads to SB right and exaggeration of asymmetry

Front 28

What will the restriction be if the SD is Extension Rot R, SB R?

Again SD is position of ease
Position of laxity

Back 28

Restriction:
Flexsion, Rot L, SB L

Front 29

Flexsion SD Type II mechanics
If the right facet is Locked OPEN
What will your findings be in flexsion?

Back 29

In flexsion.....NO ASYMMETRY***
Both facets can open easily
No apparent rotation or sidebending asymmetry
Most comfortable position for the patient

Front 30

Flesion SD Type II
right facet is opened

Back 30

Front 31

In a Flexsion SD with the right facet open how will this present?

Back 31

In Extension find asymmetry
Left facet closes nl
The right facet is Locked Open
SB and Rot to the left
Motion restriction = Res ESR right
SD = FRS left

Front 32

If you find the person in:
Restriction ERS right

What is the SD?

Back 32

FRS left

Front 33

Memory Aid for Flexsion and Extension SD:

Back 33

Front 34

Chart to remember Type 1 and Type 2 SD

Back 34

Front 35

Type 1 mechanics
are facets engaged?

Back 35

No

Front 36

Type 1 mechanics
What type of segments are seen?

Back 36

multiple segments
long curves

Front 37

Type 1 mechanics
etiology?

Back 37

compensatory
adaptive

Front 38

Type 1 mechanics
In what direction is rotation in relation to convexity?

Back 38

Rotation toward convexity
Out from under the load

Front 39

Type 1 mechanics
What is seen?

Back 39

Smooth curves

Front 40

Should you treat Type 1 or 2 SD first?

Back 40

Treat Type II (2) first

Front 41

With a Type II SD know these things:

Back 41

Type II

Facets are engaged
Single segments are affected
Causes: Traumatic / primary / viscerosomatic
Rotation toward the concavity into the load****
Treat these first

Front 42

Where would you expect to find a Type II SD?

Back 42

In apices and crossovers in curves

in relation to viscerosomatic reflexes**

Front 43

When doing a posterior static postural exam what should the vertical line normally pass through?

Back 43

The vertical line should normally pass:1. halfway between the knees
2. along the gluteal fold;
3. through all spinous processes
4. along the midline of the head;

Front 44

When observing the posterior static exam what should you look for horizontal levelness?

Back 44

poplitleal creases
greater trochanters
iliac crests
inferior angles of the scapula
tops of shoulders
mastoid processes

Front 45

What are some common anomalies found on posterior static postural exam?

Back 45

foot external rotation
ped planus (fallen foot arch)
iliac crest asymmetry
pelvic side shift
thoracolumbar scoliosis
shoulder height asymmetry
head tilt

Front 46

ON EXAM***
Lateral Static Postural Exam
What should the weight bearing line nl pass through?
hint (6 pts)

Back 46

1. just anterior to lateral malleolus
2. middle of tibial plateau
3. great trichanter
4. body of L3 (center of body mass)
5. middle of humeral head
6. external auditory meatus

Front 47

What are some common abnl seen on lateral static postural exam?

Back 47

Anterior head carriage,
shoulders anterior or posterior,
thoracic hyperkyphosis,
lumbar hyperlordosis,
anterior pelvic weight bearing.

Front 48

EXAM***
What does the Hip Drop Test screen for?

Back 48

lumbar sidebending screening***
observe lumbar sidebending and amount of hip drop

Front 49

How is the hip drop test performed?

Back 49

Ask the standing patient to shift weight onto one leg, allowing the other knee to bend which induces lumbar sidebending toward the weight bearing leg;

Observe lumbar sidebending and amount of hip drop which is normally ≥ 25°;

Hip drop < 25° (positive test) indicates restricted lumbar sidebending toward the side of the weight bearing leg.****

Test is named for the bent leg side (+ right hip drop test indicates restricted left lumbar side bending)

Front 50

What side is the hip drop test named for?

Back 50

For the bent leg side

Ex. A (+) right hip drop test indicates restricted left lumbar bending

Front 51

A women presents with restiction sidebending to the left. What leg is bent?

What side would he hip drop test be positive?

Back 51

Right leg is bent

Positive right hip drop test

Front 52

Hip Drop Tests - lumbar sidebending screening

Back 52

Front 53

What is defined as:
An abnormal lateral curvature of the spine in the coronal plane.

Back 53

Scoliosis

Front 54

What is main cause of scoliosis?

Back 54

The most common cause for scoliosis is idiopathic, accounting for 70-90% of all scoliosis cases

Front 55

How do we dx idiopathic scoliosis?

Back 55

Idiopathic scoliosis is a diagnosis of exclusion, and a neural etiology of spinal deformity must be ruled out in every case

Front 56

What is the Adam's test and what does it look for?

Back 56

Scoliosis is characterized by both lateral curvature & vertebral rotation, giving it a characteristic “Rib Hump”.

Structural: does not reduce with side bending toward the rib hump

Functional: reduces with side bending toward the rib hump

This an application of Type 1 mechanics

Front 57

What is the Key Difference between Functional and Structural SD?

Back 57

Structural: DOES NOT reduce with side bending toward the rib hump

Functional: reduces with side bending toward the rib hump
Pt sidebendins into rib hump
Functional curve rib hump diminishes

Front 58

What is the Epidemiology of Scoliosis?

Back 58

10% of children have some spinal asymmetry
0.2% of children need treatment

Front 59

Do women or men have scoliosis more commonly?

Back 59

Female: Male ratio varies with the severity of the scoliosis
As the Cobb Angle INCREASES so does the female to male ratio

Meaning women have more scoliosis with more severe cobb angles

Front 60

At what age is most scoliosis Dx?

Back 60

Preteen to teen yrs

Front 61

What are the presenting symptoms of scoliosis?

Back 61

Children and adolescents present with back pain more often than adults, regardless of the severity.

Front 62

What is the MOST COMMON CAUSE of Functional Scoliosis?

Back 62

SHORT LEG SYNDROME***

Front 63

What direction will the sacrum and pelvis tilt toward with short leg syndrome?

Back 63

Sacrum and Pelvis tilt TOWARD the shorter leg****

SPINE CURVES BACK IN ATTEMPT TO KEEP THE EYES LEVEL

Front 64

What are 2 other known causes to cause FUNCTIONAL SCOLIOSIS?

Back 64

1. Muscle strain
- Tight muscle on one side of spine causes “bowstring effect” - Psoas syndrome
- Relaxing & stretching the muscle allows spine to straighten.

2. Weak musculature
- A weak muscle on one side of spine allows opposing muscles to cause “bowstring effect.”
- Strengthening the weak muscle allows spine to straighten.

Front 65

How do we Name a Curve in Scoliosis?

Back 65

Front 66

What are the 4 patterns of Scoliosis?

Back 66

You Side bend away from the short leg.
Short Leg and Convexity are on the SAME SIDE --> Scoliosis is name for the side of the side leg***

Double major - short leg is on the left

Front 67

What is the most common type of scoliosis?

Back 67

DOUBLE MAJOR***

Front 68

Go through the 4 different studies to rule out scoliosis:

1. Static postural exam
2. Adam's test
3. Neurological exam
4. Radiographs

Back 68

Static postural exam
Rule out short leg

Adam’s Test
Determines side & flexibility

Neurological Exam
Rule out underlying neurologic cause

Radiographs, if indicated
- Scoliosis
- Risser (ossification of iliac crest identified w/ x-ray) - Lower value = skeletal immaturity = curve more likely to progress.
- Brain MRI

Front 69

What radiographic sign can tell you if the scoliotic curve might progress?

Back 69

Risser***

This is ossification of iliac crest identified with X-ray

A lower value = skeletal immaturity = curve more likley to progress***

Front 70

What are the 3 tests we have for determination of short leg?

Back 70

1. posterior standing postural exam
2. iliac crest height
3. medial malleoli levelness

Front 71

What are the 2 types of X-rays we order to see if scoliosis is present?

Back 71

1. Scoliotic X-ray :
- erect AP from occiput to sacral base
- Measurement of Cobb angle

2. Postural radiographs:
- Anterior-posterior (AP) - Erect
- Lateral - Erect
- Obliques, when suspect spondylolisthesis (scottie dog deformity)

Front 72

How do we measure the COBB ANGLE?

Back 72

Draw lines from the top of the superior vertebra & the bottom of the inferior vertebra into the concavity of the curve.

Drop intersecting lines perpendicular to these lines & measure the acute angle.

Front 73

What is the Ferguson's Angle?

Back 73

Lateral View Standing***

Lumbosacral angle (Ferguson’s angle)
Normal = 40° + 2°****

Weight bearing line
Bisect L3, drop a vertical line. It should fall on anterior 1/3 of sacral base

Front 74

Treatment of Scoliosis is based on the Cobb Angle***

What is Mild, Moderate, and Severe Tx for scoliosis?

Back 74

Mild 5-15°
Conservative, including OMT, exercises & treatment of short leg

Moderate 20-45°
Above plus
Bracing (80% will not progress with bracing)
Electrical stimulation

Severe >50°
Surgical stabilization

Front 75

What is pathology can present with Functional Impairment of thoracic curves?

Back 75

Possible respiratory impairment >50 °

Possible cardiac impairment >75 °

Front 76

Will the curve get worse over time?
What are prognostic factors?

Back 76

Future growth potential:

1. Age at diagnosis:
- Risser sign (ossification of iliac crest identified w/ x-ray)
- Lower value = skeletal immaturity = curve more likely to progress.

2. Menarche in females:
- Growth spurt (critical time for curve increase) occurs 12-18 months prior to menarche.

3. Curve severity at diagnosis

4. Curve patterns:
- Thoracic curves have a higher risk for progression than lumbar

5. Gender:
Females are more likley to have curve progression

Front 77

What are the principles of Indirect techniques?

Back 77

(move into position of laxity)
Counterstrain
Indirect myofascial release
Indirect cranial

Front 78

What are the principles of Direct OMT techniques?

Back 78

(move into restriction)
Soft tissue
Direct myofascial release
Direct cranial
Muscle energy
HVLA

Front 79

What are 2 examples of combined indirect and direct techniques?

Back 79

Combined Techniques:
1. Articulatory
2. Visceral

Front 80

What are the only 2 absolute contraindications to OMT?

EXAM***

Back 80

1. The absence of somatic dysfunction.

2. The patient refuses to have OMT performed - to do so would be considered battery.

Front 81

Please detail the system of Counterstrain:

Back 81

1. Find and label tender point 10/10
2. Position to relieve tenderness (2/10 or less)
3. Fine-tune to 0/10 if possible
4. Hold position for 90 seconds (some schools teach 120 seconds for the ribs)
5. Slow passive return to neutral
6. Retest tender point

Front 82

What is the lowest pt you need to get to for counterstrain?

Back 82

2/10

Front 83

What are some counterstrain principles you need to be aware of?

just read

Back 83

1. Patient must be able to relax for the treatment to work
2. Treat the worse tender point first
3. The monitoring finger is only monitoring
So don’t be pushing with it during the treatment
4. Don’t move your monitoring finger until the treatment is finished
5. Some points may be “mavericks”
6. Positioned completely opposite of what you would expect based on the anatomy
7. Limit treatment to 5-6 tender point per visit

Front 84

What is the MAX # of Tx for counterstrain you should try in 1 visit?

Back 84

5-6 tender points

Front 85

What is a maverick point?

Back 85

“Maverick” which is used most commonly to describe a treatment position that is opposite of the common expected treatment position

Front 86

If a person presents with say 5 tenderpoints which should you treat first?

Back 86

Treat the WORST tender point first

Front 87

Do you Tx babies with counterstrain?

Back 87

NO!

Front 88

What is the difference between the piriformis and Lower L5 pole counterstrain tenderpoints?

Back 88

Piriformis

- Origin – anterior surface of S2-4 segments.
- Insertion – superior and posterior aspect of greater trochanter.
- Action – external rotation and abduction of hip.

Front 89

Lower Pole L5 is located at the inferior surface of the PSIS

Back 89

Notice the Tx for Piriformis and LPL5 are very different

Piriformis is external rotation and extension

LPL5 is more Flexsion and hip adduction

Front 90

Just in case they ask you about the Lumbar tenderpoints for the Anterior and Posterior TPs. Let's review them

Back 90

Woo extra slide

Front 91

Now begin.....

What is the POSTERIOR T10-L5

Back 91

spinious process or 1/2-1'' lateral

Front 92

What is the POSTERIOR L3?

Back 92

gluteal muscle half way between posterior L4 and L5

Front 93

What is Posterior L4

Back 93

iliac crest in posterior axillary line

Front 94

What is Posterior L5
aka Upper Pole L5

Back 94

aka Upper Pole L5
superior surface of PSIS at insertion of iliolumbar ligament

Front 95

What is Lower pole L5?

Back 95

Inferior surface of the PSIS

Front 96

Image of the Posterior Lumbar Counterstarin Tenderpoints

book pg 114

Back 96

• T10-L5: spinous processes or 0.5-1” lateral
• L3: gluteal musculature halfway between posterior L4 and L5 (refer to as lateral L3)
• L4: iliac crest in posterior axillary line (refer to as lateral L4)
• L5 (upper pole): superior surface of PSIS at insertion of iliolumbar ligament
• L5 (lower pole): inferior surface of PSIS

Front 97

Now describe the anterior Lumbar counterstrain tenderpoints

Back 97

• T9: 0.5-1” superior to umbilicus
• T10: 1” below umbilicus
• T11: 2” below umbilicus
• T12: inner aspect of iliac crest in mid-axillary line
• L1: 0.5” medial to ASIS
• L2: medial surface of AIIS (push tender point laterally)
• L3: lateral surface of AIIS (push tender point medially)
• L4: inferior surface of AIIS (push tender point caudally)
• L5: pubic ramus 0.5” lateral to pubic symphysis

Front 98

What is the Tx position for the T10-L5 Posterior counterstrain tenderpoints?

Back 98

• T10-L5 Posterior Counterstrain (Figure 1)
o Patient is on prone
o Lift thigh on the side of tender point to extend the hip
o Fine tune with slightly more hip extension, abduction or adduction

Front 99

What is the position for posterior Lower Pole L5 counterstrain TP?

Back 99

• Lower Pole L5 Counterstrain (Figure 2)
o Patient is on prone
o Flex hip and knee 90°
o Fine tune with slight hip adduction

Front 100

What is the position for T9-L5 Anterior counterstrain TP?

Back 100

• T9-L5 Anterior Counterstrain (Figure 3)
o Patient is supine
o Passive flex both knees and hips 90°
o Fine tune with increased hip flexion and slight rotation and sidebending of knees

Front 101

The location of counterstrain tender points can be suggested by the clinical history and presenting complaints......

Back 101

More on Counterstrain:

- Patient tends to bend around tender points – If the patient presents forward bent, tender points tend to be anterior
- The location can also be suggested by the position the patient was in when the original injury occurred

Front 102

If a pt presents bent forward....would his tenderpt be anterior or posterior?

Back 102

anterior

Front 103

You need to be able to differentiate between:
1. Counterstrain TP
2. Chapman's Points
3. Trigger Points

review Counterstrain TP

Back 103

Counterstrain tender point
Usually tender
may be palpable tissue texture changes
non-radiating****

Front 104

Chapman's Points are.....

Back 104

Chapman's Pts
usually tender
that present as anterior and posterior fascial tissue texture abnormalities assumed to be visceral dysfunction or pathology (Glossary of Osteopathic Terminology)
Viscerosomatic reflex
Helps to know the locations!

Front 105

Trigger points are......

Back 105

Trigger points
Usually tender
a small hypersensitive site that, when stimulated, gives rise to referred pain and/or other manifestations in a consistent reference zone

Front 106

Where might the Trapezius have trigger points?

Back 106

Retro-orbital pain
Pain behind the ear

Front 107

Where might the Sternocleidomastoid have trigger points?

Back 107

 ipsilateral hearing loss (clavicular branch)
 tongue pain (sternal branch)
 visual disturbances
 chronic cough
 TMJ pain (sternal)

Front 108

Where would Supraspinatus Trigger Point be found?

Back 108

Front 109

Where are trigger points for Iliopsoas?

Back 109

Front 110

Please review Myofacial release treatment

Back 110

1. Diagnose restricted motion
2. Slowly move into position of laxity and follow release until completed (indirect)
3. Slowly move into restriction and stretch until tissue give completed (direct)
4. Retest motion

Front 111

When referring to barriers which comes first the physiological or anatomical?

Back 111

Physiological barrier is before the anatomical

Front 112

When performing Myofacial release where should you position a person?

Back 112

At the Point of balanced tension

Front 113

What Law is:

When a muscle receives an nerve impulse to contract, its antagonists receive, simultaneously, an impulse to relax.

Back 113

Sherrington's Law

Front 114

What law is:

Fascia will deform as a result of the lines of force to which it has been subjected

Back 114

Wolff's Law

Front 115

What is Tensegrity?

Back 115

Myofascial release (myofascial unwinding)
“Local” treatment produces changes in other parts of the body.
Fascia moves as a unit in a tensegrity matrix down to the cellular level.
Mechanical forces into fascia transmitted throughout the entire organism.

Front 116

What is Fascial Continuity?

Back 116

Fascial restrictions in one area will strain areas away from the restriction causing abnormal movement patterns.

Front 117

Fascial continuity and tensegrity come into play during ______?

Back 117

myofascial release (MFR) treatments***

- Injury to fascia at one location is carried through the whole fascial tissue.
- OMT to fascia at one level is carried through the whole of fascial tissue.
- MFR engages tensegrity structure of the body.

Front 118

Review Cranial manipulation:
Frontal and parietal lifts
SBS compression-decompression
Temporal decompression
Compression of the 4th ventricle
Balanced membranous tension (Ligamentous articular strain)
Sutural disengagement
TMJ compression/decompression
Occipital decompression

Back 118

Oh Boy here we go

Front 119

Frontal and parietal lifts

Back 119

1. Frontal Lift:
gently contact frontal bone posterior to orbital ridge on both sides.
Gently lift the frontal bone until slight give is equal on both side
Used for: restricted frontal mobility, headaches, depression, sinus congestion, etc

2. Parietal lift
located superior to the squamous sutures. Gently press medially into the parietal bones until give is equal on both sides.
Used for: Headaches, resp congestion, other problems

Front 120

SBS compression - decompression

Back 120

Used for: diminished CRI amplitude, mood disorders, cranial nerve entrapment, upper resp infec,

Using the temp or frontoccipital hold gently compress SBS then decompress

Front 121

What Techniques are used for:
Falx Cerebri membranous strain?

Back 121

Falx cerebri - treat with frontal/parietal lift, SBS compression/decompression, or balanced membranous tension

Front 122

What techniques are used for:
Tentorium Cerebelli strain?

Back 122

Tentorium cerebelli - treat with temporal decompression or balanced membranous tension

Front 123

What is the purpose of CV4 technique?

compression of 4th ventricle

Back 123

Compression of the 4th ventricle (CV4) is used to normalize CSF fluctuation (one of the most comprehensive and effective procedures in the whole cranial concept)
• Treats low amplitude
• In this treatment you encourage cranial extension and resist cranial flexion until still point is achieved. Once achieved, compression is then gently and slowly released **remember to keep off the occiptomastoid suture**

Front 124

Describe Balanced membranous tension

Back 124

o Balanced Membranous Tension:
 Find neutral point of strain pattern by Exaggeration of the Abnormal Motion
 Position toward ease of motion
 Hold until a “still point” is reached
 Inherent Motion returns --> recheck for symmetry/amplitude/rate

Front 125

TMJ compression / decompression

Back 125

Temporomandibular Joint dysfunction can be detected if there is jaw pain with eating (can also cause facial pain or headache)  jaw deviates to the side of TMJ restriction
 Progresses to more restricted mobility, cartilage degeneration, and/or subluxation
• Treat with anti-inflammatory medications, orthodontic evaluation, OMT for cervical and cranial somatic dysfunction
• Suboccipital inhibition, C1 treatment (anterior counterstrain), temporal balancing, and TMJ compression-decompression

Front 126

Occipital Decompression

Back 126

Used for restricted occipital mobility ass with infant feeding disorders, congenital muscular toricollis

gently contact the cranial base with index fingers on mastoid processes
middle finger on occipital condyles
ring fingers on supraocciput

Front 127

Discuss Lymphatic and facial techniques
Venous sinus drainage
Facial effleurage
Trigeminal stimulation
Sphenopalatine ganglion stimulation
Mandibular drainage

Back 127

wooo weeee

Front 128

Facial effleurage

Back 128

Facial effleurage: start at the neck (one side at a time) then depending on where the congestion is either work on the frontal portion, maxillary portion, and/or mandibular portion

Front 129

Trigeminal Stimulation

Back 129

Trigeminal stimulation: pressure on trigeminal nerve foramina stimulates vasoconstriction of mucous membranes to help open sinus orifices

Front 130

Sphenopalatine ganglion stimulation

Back 130

Sphenopalatine ganglion stimulation: pressure on pterygopalatine ganglion stimulates watery mucous that more easily drains from sinuses

Front 131

How is Muscle energy Performed?

Back 131

1. Diagnose restriction
2. Move into restrictive barrier
3. Isometric contraction away from the restrictive barrier 3-5 seconds
4. Stretch until give stops
5. Repeat 3-5 times
6. Retest motion

Front 132

How does muscle energy work?
(hint 4 reasons)

Back 132

1. Tissue creep - constant load causes tissue give
2. Conditioning - less tissue resistance with repeated stretch
3. Post-isometric relaxation*****
4. Reciprocal inhibition - reflex relaxation of antagonist

Front 133

What is the most unique aspect about muscle energy that does NOT occur with any other treatment?

Back 133

Post-Isometric Relaxation*** --> needs an activating force

Front 134

What is:

Isometric contraction?

Back 134

muscle contraction that results in increased tension without approximating the 2 ends of the muscle
i.e. stays the same length
ex. press palm to palm with hands

Front 135

What is:

Isotonic contraction?

Back 135

muscle contraction that results in NO increased tension;
but! does result in the 2 ends of a muscle approximating
i.e have increased tone
ex: lifting a dumbell

Front 136

What is Isolytic contraction?

Back 136

forcing a muscle to lengthen during contraction***
It is neither isometric or isotonic
i.e. outside force breaks contraction
Ex: loser in an arm wrestling match

Front 137

Describe Articulatory technique

Back 137

1. Diagnose restricted joint motion
2. Slow movement of joint to its position of laxity for all planes
3. Slow movement of joint into its restriction for all planes
4. 3-5 repetitions as one smooth movement
5. Retest motion

Front 138

Describe HVLA technique

Back 138

1. Diagnose restriction
2. Move into restrictive barrier for all planes
3. Short quick movement through barrier
4. Retest motion

Front 139

Describe Soft Tissue Technique:

1. Traction
2. Kneading
3. Inhibition
4. Effleurage
5. Petrissage

Back 139

1. Traction – longitudinal muscle stretch

2. Kneading – lateral muscle pressure

3. Inhibition – sustained muscle pressure

4. Effleurage – stroking pressure to move fluid

5. Pétrissage – squeezing pressure to move fluid

Front 140

For an ACUTE SEVERE problem describe the following:

Method
Dose
Frequency
Duration

Back 140

Method - Indirect Techniques

Dose - Fewer regions lower dose

Frequency - 1-2 treatments per week

Duration - 2-4 treatments

Front 141

For an CHRONIC problem describe the following:

Method
Dose
Frequency
Duration

Back 141

Method - Any technique including direct

Dose - More regions, higher dose

Frequency - Every 2-6 weeks

Duration - As long as helpful

Front 142

Who invented the common compensatory pattern?

What does is look at?

What is the treatment approach?

Back 142

- Developed by J. Gordon Zink, D.O.
- Utilizes the respiratory-circulatory model.
- Identifies four patterns of body structure:
1. Ideal
2. Common compensatory
3. Uncommon compensatory
4. Uncompensated
- Treatment approach: Emphasis on crossover points of spinal curves.
- Transverse fascial diaphragms

Front 143

Give me the locations of the common compensatory pattern TRANSVERSE FACIAL DIAPHRAGMS

Back 143

1. Pelvic diaphragm (L5-S1)
2. Thoracic diaphragm (T12-L1)
3. Thoracic inlet (T1, 1st rib)
4. Suboccipital region (OA, AA)

Front 144

What are the 3 different Common Compensatory Patterns?

Back 144

2 Main types:
1. Compensated
A) Common
B) Uncommon

2. Uncompensated

Think** Always start on the Right foot (for pelvic) and then alternate for the common compensatory

Front 145

What is the Main difference with the compensated and uncompensated patterns?

Back 145

Compensated: alternates diaphragms directions

Uncompensated: has 2 diaphragms in the same direction

Front 146

What is the order of treatment for the common compensatory patterns?

Back 146

1. Treat uncompensated findings first.
Treat the worst first.

2. Treat the compensatory findings with goal of approaching ideal structure.

Front 147

How the Lymph drained from the left and right sides of the body?

Back 147

Right - area drained by the right lymph duct
Right Lymph Duct: drains right upper body, crosses thoracic inlet once, drains into jugulosubclavian junction

Left - area drained by the thoracic duct:
Drains Left upper and ALL LOWER body
Crosses thoracic inlet twice
Drains into subclavian and left brachiocephalic vein junction

Front 148

What are the Intrinsic Lymphatic Pumps?

Back 148

Lymphagions***
Vessels contracted 6-8 times per minute
Affected by autonomics*

Front 149

What are the Extrensic Lymphatic Pumps?

Back 149

-Diaphragms
-Respiration
-Peristalsis
-Arteries adjacent to lymphatics
-Body movement
Vigorous exercise increases flow 15-20x
-External compression
Bandages, water emersion, manual therapies - including OMT

Front 150

What is the Osteopathic Goal for the Lymphatic System?

Back 150

-Approach tailored to patient needs
-Remove restrictions (proximal to distal)
Treat transverse fascial diaphragms
Treat fascial restrictions
Normalize autonomic activity
Rib raising
Suboccipital Inhibition
Sacral rocking

Front 151

What are some pressure techniques to promote and adjust flow?

Back 151

- Pressure techniques
Compression stockings
Pétrissage (kneading/squeezing)
Effleurage (Stroking)
Soft tissue
Abdominal lifts

Front 152

What are some pump techniques to promote lymphatic flow?

Back 152

- Pump techniques (distal to proximal)
Pectoral traction
Thoracic pump
Abdominal pump
Pedal pump
Liver/Spleen pump

Front 153

EXAM
What are Viscerosomatic Reflexes for Acute findings?

1. Temperature
2. Tissue Texture
3. Red Reflex

Back 153

1. Temperature - hot

2. Tissue Texture - Moist, full, edema, tension

3. Red Reflex - increased or prolonged redness

Front 154

EXAM
What are Viscerosomatic Reflexes for Chronic findings?

1. Temperature
2. Tissue Texture
3. Red Reflex

Back 154

1. Temperature - Cool

2. Tissue Texture - thickness, dryness, ropiness, pimples

3. Red Reflex - prolonged blanching

Front 155

The moment you have been dreading.....

Back 155

Autonomic Innervation SNS reflex levels****

Front 156

Head and Neck
SNS
PNS

Back 156

SNS - T1-4
PNS - Vagus

Front 157

Cardiovascular
SNS
PNS

Back 157

SNS - T-5
PNS - Vagus

Front 158

Resp
SNS
PNS

Back 158

SNS -T2-7
PNS - Vagus

Front 159

Stomach, Liver, Gallbladder
SNS
PNS

Back 159

SNS - 5-9
PNS - Vagus

Front 160

Small Intestine
SNS
PNS

Back 160

SNS 9-11
PNS vagus

Front 161

Ovary, Testicle
SNS
PNS

Back 161

SNS 9-10
PNS S2-4

Front 162

Kidney, ureter, bladder
SNS
PNS

Back 162

SNS 10-11
PNS S2-4

Front 163

Large Intestine
SNS
PNS

Back 163

SNS T8-L2
PNS Vagus, S2-4

Front 164

Uterus
SNS
PNS

Back 164

SNS 10-11
PNS S2-4

Front 165

Prostate
SNS
PNS

Back 165

SNS L1-2
PNS S2-4

Front 166

Have this memorized!!!

******************EXAM******************

Back 166

Front 167

Pancrease
SNS
PNS

Back 167

SNS T5-11
PNS Vagus

Front 168

Arm
SNS
PNS

Back 168

SNS T2-7
PNS - NONE

Front 169

Leg
SNS
PNS

Back 169

SNS T10-L2
PNS - NONE

Front 170

What are some Treatment of sympathetic component of thoracic visceral disease?

Back 170

Rib Raising:

- Sympathetic chain ganglia just anterior to rib heads
- Constant or repetitive lift of rib angles stimulates chain ganglia

Front 171

Treatment of sympathetic component of bowel dysfunction with _______?

Back 171

abdominal plexus inhibition

-Push posteriorly into celiac, superior mesenteric, or inferior mesenteric ganglion
- Hold until tissue release, about 10-20 seconds
- Ganglion inhibition is contraindicated in patients with peritonitis, bowel obstruction

Front 172

Treatment of parasympathetic component of visceral disease?
(hint 2 of them)

Back 172

1. Upper cervical soft tissue (suboccipital inhibition)
2. Sacral rocking

Front 173

How do you treat Chapman Points?

Back 173

-Treat posterior points
-Anterior points may also be treated but often to sensitive and uncomfortable for patient

-Light rotatory massage with your fingertip
-Treat about 10-30 seconds
-Treat 2 or 3 times each day for best results

Front 174

Ok Now the chapman's pts lol

Back 174

i just wanta go to sleep ugggggggg

ONLY HAVE TO KNOW THE ANTERIOR PTS.......IM NOT GOING TO WRITE ANTERIOR FOR EACH ONE SO JUST KNOW THEY ARE ANTERIOR****

Front 175

Chapman's
Middle ear

Back 175

Superior to medial clavicles

Front 176

Chapman's
Sinuses

Back 176

Inferior to medial clavicles

Front 177

Chapman's
Pharynx

Back 177

Inferior to sternoclavicular joints

Front 178

Chapman's
tonsils

Back 178

medial 1st intercostal spaces

Front 179

Chapman's
tongue

Back 179

medial 2nd ribs

Front 180

Chapman's
esophagus, thyroid, and heart

Back 180

medial 2nd intercostal

Front 181

Chapman's
Upper Lung and Arm

Back 181

Medial 3rd intercostal

Front 182

Chapman's
Lower Lung

Back 182

Medial 4th intercostal space

Front 183

Chapman's
Liver

Back 183

Right medial 5th and 6th intercostal spaces

Front 184

Chapman's
stomach acidity

Back 184

Left medial 5th intercostal space

Front 185

Chapman's
Gall Bladder

Back 185

Right medial 6th intercostal space

Front 186

Chapman's
Pancrease

Back 186

Right medial 7th intercostal space

Front 187

Chapman's spleen

Back 187

left 7th intercostal space

Front 188

Chapman's small intestine

Back 188

medial 8th-10th intercostal space

Front 189

Chapman's pyloris

Back 189

midline body of sternum

Front 190

Chapman's adrenals

Back 190

1'' lateral and 2'' superior to umbilicus

Front 191

Chapman's kidneys

Back 191

1'' lateral and 1'' superior to umbilicus

Front 192

Chapman's
bladder

Back 192

periumbilicus

Front 193

Chapman's
Intestine / Peristalsis

Back 193

1-2'' inferior and lateral to ASIS

Front 194

Chapman's
Appendix

Back 194

tip of rib 12

Front 195

Chapman's Ovaries

Back 195

Pubic Tubercles

Front 196

Chapman's Urethra

Back 196

Pubic Tubercles

Front 197

Chapman's Uterus

Back 197

Inferior pubic rami

Front 198

Chapman's rectum

Back 198

lesser trochanters

Front 199

Chapman's Colon

Back 199

Anterior iliotibial bands

Front 200

Chapman's
Prostate, Broad Ligament

Back 200

Lateral iliotibial bands

Front 201

Champan's reflexes why is the colon upside down?
What is the right and left colon found?

Back 201

Look at it as if it were laid out in front of you

Right Iliotibial Band:
1. iliocecal area
2. ascending colon
3. hepatic flexure
4. right 2/5th of transverse colon

left iliotibial bands
1. sigmoid area
2. descending colon
3. splenic flexure
4. left 3/5th of transverse colon

Front 202

The ankle has both an upper and lower joint that act together as a functional unit

1. What is the upper joint?
2. What is the Lower joint?

Back 202

1. Upper joint is tibiotalar (talocrural)
2. Lower joint is the subtalar (talocalcaneal)

-The upper joint involves the talus moving in the ankle mortise
-The major motions of the of the tibiotalar joint is described as dorsiflexion and plantar flexion

Front 203

EXAM****

How does the Ankle (talotibial) Mechanics move with:

1. Plantar flexsion
2. Dorsiflexsion

Back 203

1. Talus glides anteriorly with plantar flexion

2. Talus glides posteriorly with dorsiflexion

Front 204

What does the ankle swing test, test for?

Back 204

Tests for talus anterior glide somatic dysfunction:***

-Hold feet horizontally and push them posteriorly.
-Tests ankle dorsiflexion and posterior talus glide
-Positive swing test= restricted posterior talus glide= anterior talus = plantar flexed ankle = restricted ankle dorsiflexion*****

Front 205

Review the major ankle counterstrain points for location and treatment position
-Extension ankle
-Lateral ankle
-Medial ankle

Back 205

Extension: Tenderpoint in gastronemius muscle assocaited with ankle pain, leg pain, foot pain, gait abnl
TP is proximal gastronemicus nead its medial or lateral origin

Lateral Ankle: Pt lying on side of problem, hold distal tibia and TP
TP - Anterior and Inferior to the lateral malleolus. Hold the calcaneous and evert foot for tx

Medial Ankle: Pt lays on Opposite pf problem, TP is inferior to the medial malleolus. Invert the foot and retest.

Front 206

What 3 things can be associated with anterior and posterior innominate rotations?

Back 206

1. ipsilateral tight hamstrings
2. tight iliolumbar ligament
3. piriformis syndrome ass with sciatica pain

Front 207

tricky***

What are the findings for pubic compression?

Back 207

tender pubic symphysis

Pubic Tubercles are symmetrical***

Front 208

With Cranial Flexsion which way does the sacrum move?

Back 208

sacral base moves posterior
aka
sacral base extends
counternuates

Front 209

With Cranial Extension how does the sacrum move?

Back 209

sacral base flexes
moves anterior
nutates

Front 210

time to review the anterior and posterior THORACIC counterstrain tenderpoints.....

Back 210

Remember that the anterior thoracic tender points are midline only from T1-4

Front 211

Posterior thoracic tender points

1. Posterior T1-9
2. Posterior T10-12

Back 211

1. Posterior T1-9
- spinious process or 1/2'' lateral

2. Posterior T10-12

Front 212

Anterior thoracic tender points

T1
T2
T3-4
T5
T6
T7
T8

Back 212

T1 - sternal notch pushing inferiorly
T2 - middle of manibrium
T3-4 - sternum @ level of corresponding rib insertion
T5 - 1'' above the xyphosternal junction or at rib 5 cartilage bilateral
T6 - xiphisternal junction or rib 6 cartilage bilateral
T7 - tip of xiphoid process or rib 7 cartilage bilateral
T8 - 1.5'' below xiphoid process or at chondral mass

Front 213

Rib Angle Tenderpoints
Posterior:

Rib1 - lateral shaft anterior to trapezius muscle

Rib 2-7 - rib angles with scapula rotated away by flexing and adducting arms

Ribs 8-10
rib angles which are more lateral with each lower rib

Back 213

Anterior Ribs

rib 1 - inferior to medial clavicle, lateral to sternum

rib 2 - rib shaft in mid-clavicular line

rib 3-10: rib shaft in anterior axillary line or mid-axillary line

Front 214

What are the treatments fpr Rib subluxation Muscle energy?

Posterior subluxation
Anterior subluxation

Back 214

Posterior - push the rib angle anteromedially
ask the pt to push her elbow medially

Anterior - push the costotransverse articulation posterior medially.
Have pt push elbow laterally

Front 215

If a person has a rib exhalation restriction use rib inhalation muscle energy

Back 215

for ribs 2-5 push inferiorly on rib shaft in the anterior axillary line.

For Ribs 6-10 push inferiorly on rib shaft in the mid axillary line

Ask the pt to inhale deeply while you resist superior rib movement
During exhalation push the rib more inferiorly as you flex and sidebend the neck and thorax

**Sidebend toward and Rotate away**

Front 216

For rib exhalation muscle energy:
Rib inhalation restriction - always tx the superior rib***

Back 216

Rib 2 - flex the head which is rotated slightly away (this is the Oh my look)
Rotate the head away*

rib 3-5 - push the elbow of the abducted arm across the chest
pectoralis minor contraction

ribs 6-10 push the abducted arm down toward the side
serratus anterior contraction

Front 217

What muscles of the glenohumeral joint function in:
Abduction
Adduction
Flexsion
Extension
External Rotation
Internal Rotation

Back 217

Abduction - Supraspinatus, middle portion of the deltoid

Adduction - Pectoralis major, latissimus dorsi, teres major, subscapularis

Flexsion - Coracobrachialis, anterior portion of deltoid

Extension - Posterior deltoid, latissimus dorsi

External rotation - Infraspinatus, teres minor, posterior portion of deltoid

Internal rotation - Subscapularis, teres major, pectoralis major, anterior portion of deltoid

Front 218

You need to know the muscles for movements of the scapula:
elevation
depression
protraction
retraction
upward rotation
downward rotation

Back 218

Elevation - Trapezius (superior part), levator scapula, rhomboids

Depression - Gravity, pectoralis major (inferior sternocostal head, latissimus dorsi, trapezius (inferior part)

Protraction - Serratus anterior, pectoralis minor, pectoralis major

Retraction - Trapezius (middle portion), rhomboids, latissimus dorsi

Upward Rotation - Trapezius (superior part), serratus anterior (inferior part), trapezius (inferior part)

Downward rotation - Latissimus dorsi, gravity, pectoralis major

Front 219

Know the different locations of the C1 tender points

Back 219

Anterior C1
1. tip of C1 transverse process
2. posterior mandible angle

Front 220

Don’t forget about anterior C7 and C8 Yx

Back 220

Anterior C7 - lateral sternocleidomatoid muscle
just superior to clavicle

Anterior C8 - just superior to medial clavicle

Front 221

Posterior C2-C7 and anterior C2-6 and C8 Tx

Back 221

Posterior C2-C7: midline spinous processes and lateral at articular pillar at facet joint.

Tx: SARA (sidebend away rotate away)

Front 222

Anterior C7 Tx

Back 222

STAR (sidebend toward away rotate)

Front 223

Review the treatment set up for rotation and sidebending muscle energy treatments in the cervical spine

Back 223

Sidebending: Rotate the head away from sidebending restriction.
Asj pt to sidebend head away from restriction

Rotation: Sidebend head away from rotation restriction
Ask pt to rotate head away from the restriction

Front 224

Review treatments for elevated first ribs

Back 224

Rib 1 counterstrain:
TP is on shaft of 1st rib at the lower neck just anterior to the upper trapezius muscle. Place foot on table and sidebend the head toward the tenderpoint

Rib 1 Articulatory:
hold pts head with one hand and place the 1st MCP joint of your other hand on the posterior aspect of the elevated rib, push inferiorly and mediallywhile you articulate around the joint.

Front 225

There are 3 different Muscle energys for rib 1, what are they?

Back 225

Supine - push rib anteromedial and inferior as you sidebend the head around your MCP jt and rotate the head to the opposite side**

Prone - reach across the pt as she lay prone and use your thenar eminence on the post aspect of the elevated rib, push toward ASIS on SAME side. Sidebend head away

Seated: place 1st MCP jt on the rib and lean pt on your knee, push anteromedial and inferior, sidebend the head toward the elevated rib and apply short thrust toward the opposite axilla.