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96 Cards in this Set
- Front
- Back
superior articular facet is (concave/convex)
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concave
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inferior articular facet is (concave/convex)
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convex
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facets of lumbar spine are at this angle
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45 degrees
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most common complaint in a family practitioner's office
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lower back pain
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acute low back pain
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less than 3 months duration
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cauda equina syndrome
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medical emergency. secondary to massive central disc herniation (disc has herniated straight back). Symptoms: saddle anesthesia, urinary retention/incontinence, anal sphincter laxity, neurological defecits in lower extremities, motor weakness
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research - hospital stay
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when OMT added to treatment, hospital stay length decreased by 24% for pts admitted with low back pain.
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this nerve root crosses 2 discs
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L5. (L4-5, L5-S1)
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this nerve root crosses only one disc level
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S1. (L5-S1)
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motor test for S1?
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toe walk
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reflex test for S1?
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achilles reflex
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sensation test for S1?
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outside of foot
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motor test for L5?
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extensor digitorum longus, extensor hallucis longus
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sensory test for L5?
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dorsal foot - strip down the middle
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motor test for L4?
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tibialis anterior - have pt internally rotate foot. OR walk on heels --> foot drop
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reflex test for L4?
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patellar tendon
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straight leg-raising test
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if positive, indicates neuritis. Possible compression. Check neurologic signs to rule out radiculopathy.
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red flags for back pain
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tumor, kidney stone, infection, cauda equina (herniated disc)
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neurogenic claudication
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leg symptoms worsen when walking and improve by squatting, sitting, lying down
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how do you rule out a herniated disc?
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herniated disc will cause neurologic malfunction
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spondylosis
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osteoarthritis of the spine. Can see bridging
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vertebral hyperostosis causesq
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ankylosing spondylitis, arthritis (psoriatic, reactive, gouty) Vitamin A toxicity, repetitive microtrauma, diffuse idiopathic skeletal hyperostosis (DISH)
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benefits of professional touch
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decreased HR, decreased BP, decreased muscle tension, decreased pain perception, improved immune function
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bilateral UPL5 tenderpoints indicate
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iliolumbar ligament syndrome
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spondylolisthesis
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spondylolysis leads to anterior slippage of one vertebral body on another. Can lead to lumbar spinal stenosis
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spondylolysis
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pars interarticularis defect. Can lead to spondylolisthesis
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step-off sign
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one vertebral body = so anterior to another, the spines are not continuous. One is "missing'
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lumbar strain
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spasm of mm. most common cause of lower back pain, "mechanical" non-radiating back pain, secondary to overuse, muscle strain, or HNP. Treatment: bed rest for 2 days, stretch first, then strengthen
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piriformis
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superior to the sciatic nerve
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syndrome
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set of detectable characteristics that occur together.
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coccydynia
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tender coccyx that creates pelvic pain, coccyx flexion. Can be due to glut max strain, pelvic floor spasm, coccyx flexion.
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hyperlordosis
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exaggerated lower back curve. Can be due to postural decompensation
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iliolumbar ligament syndrome
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either unilateral or bilateral. Can present with radiating pain in pelvis. Unilateral due to short leg (anatomical or func.) or sacroiliitis. Bilateral due to hyperlordosis (due to postural decomp), overuse strain, spondylolysis/spondylolysthesis
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pelvic tilt
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stretching exercise, helps iliolumbar ligament syndrome
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pelvis pain
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indicated by anterior pelvic tenderpoints. Can be a cause of chronic back pain.
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postural decompensation
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gradual loss of fast twitch fibers. Worse with postural immobility, causes increased lordosis, increased thoracic kyphosis. Stretch (pelvic tilt, lumbar extensor), then strengthen (abs and lower back)
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psoriatic arthritis
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autoimmune problem that affects joints and the skin
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retinoid toxicity
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vitamin A can cause vertebral hyperostosis
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sacroilitis
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ASIS compression worsens, diffuse SI tenderness
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LVHA
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low velocity high amplitude. Goal is to increase range of mvmt. Activating force is either repetitive springing motion or concentric mvmt of joint through restrictive barrier. E.g. OB roll
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cavitation
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articular release. Immobility of joint creates a partial vacuum, increased pressure causes gas bubbles (CO2, N2) to form in joint fluid. Joint separation causes collapse of vapor cavities
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HVLA contraindications
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lumbar spinal stenosis, acute sprain or fracture, DVT, vascular instability, radiculopathy
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radiculopathy
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nerve root pathology/disorder. Caused by herniated discs.
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research - manipulation and medication use
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patients who received OMT in low back pain treatment required fewer medications and used less physical therapy. (Outcomes such as pain, range of motion, leg raising were the same as std med therapies)
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herniated disc
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can cause lumbar spinal stenosis.
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low back pain
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most common cause of disability in people less than 45
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lumbar spinal stenosis
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narrowing of the spinal canal with impingement of the cord and/or spinal roots. Presents in males, nonspecific low back pain with parethesias in both legs. Neurogenic claudication. HVLA = contraindicated
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neurologic examination
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do on every patient first presenting with low back pain. DTR, straight leg raise, sensory and motor testing
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fryette's law 3
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initiating motion of a vertebral segment in any plane of motion will modify the mvmt of that segment in other planes of motion. Corrective force only needs to apply in one plane of motion.
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iliopsoas muscle
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psoas + iliacus mm.Psoas origin: T12-L4 vertebral bodies. Iliacus origin: iliac crest Insertion: lesser trochanter of the femur.
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latissimus dorsi muscle
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origin: thoracolumbar fascia, transverse processes of T7-T12 insertion: intertubercular groove of humerus. Adducts, extends, internally rotates arm
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multifidus muscle
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origin: sacrum, erector spinae aponeurosis, PSIS, iliac crest. Insertion: spinous processes. Spans 3 joint segments, stabilizes spine at each level.
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non-neutral SDs
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type II. Occur in extreme flexion and extreme rotation
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locked open facet
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SD flexion. Type II. Opposite of the rotated segment
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quadratus lumborum muscle
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origin: iliac crest insertion: 12th rib
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rectus abdominus muscle
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origin: pubic symphysis, insertion: xiphoid process, costal cartilages of ribs 5-7. enclosed in rectus sheath
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restrictive barrier
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initial patient positioning for ME.
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tri-planar motion
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flexion/extension/neutral, rotation, sidebending
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type I and type II SDs
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type I = group curve, occurs with "neutral" flexion and extension. Type II = single segment, occurs in extreme flexion or extension.
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viscerosomatic reflex, L1 and L2
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in lumbar spine - L1 and L2 = sympathetic innervation of distal colon, pelvic organs, lower extremity
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if you find a capsular pattern on a patient
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patient needs further diagnosis and treatment beyond OMT
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capsular pattern
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motion is restricted in both right and left rotation or in multiple planes. Seen in pathologic conditions such as arthritis
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locked closed facet
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SD extension. Type II - causes rotation and sidebending to same side. Same side as rotation.
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erector spinae muscles
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iliocostalis, longissimus, spinalis. Originate from sacrum, iliac crest, spinous processes of lower lumber vertebrae. Insertion: lower ribs, transverse processes of thoracic vertebrae
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tinnitus
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ringing in the ears, caused by CNVIII entrapment
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TMJ compression/decompression
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don’t do if there's pain with compression, inflammation. Compression - indirect. Decompression - direct
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trigeminal neuralgia
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CNV neuropathy. SBS strain, temporal rotation, maxilla rotation, manible rotation.
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trigeminal stimulation
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treats congestion by watering down mucus secretions (stimulates tear production)
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main causes of dizziness
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hypoglycemia (acc. By feeling faint), ataxia (w. mvmt), vertigo (spinning in space)
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OMT helps these kinds of headaches
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tension, migraine, mixed, post-concussive, cervicogenic, congestive (rhinitis, sinusitis)
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migraine headache: spinal manipulation more effective than __ for ___ treatment
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drugs (amitriptyline), prophylactic
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chronic tension headache: spinal manipulation more effective than __ for ____ treatment
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drugs, short-term treatment
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cervicogenic headache: spinal manipulation more effective than no treatment or massage for _______ treatments
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prophylactic and short-term
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TMJ syndrome
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jaw pain with eating, facial pain, headache. Restricted mobility, cartilage degeneration, subluxation. Treatment includes NSAIDs, orthodontic evaluation, OMT for cervical and cranial SD
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neuropraxia
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compression of nerve with NO neurological defecits. Structural problem
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axonotmetsis
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severe injury, causes neuropathy - nerve death. Abnormal neural exam. Can be regeneration.
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neurotmesis
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injury, degeneration, neuroma formation. Nerve = cut, no regeneration
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site for vesitbulocochlear nerve entrapment
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internal acoustic meatus
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headache treatment
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suboccipital inhibition, venous sinus drainage, CV-4. Ganglion stimulation for sinus headaches
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Meniere's syndrome
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treatable functional dysfunction. CNVIII neuropathy accompanied by tinnitus, vertigo, deafness
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benign positional vertigo
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feeling of spinning in space
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cephalagia
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headache
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cranial neuropathy
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trigeminal neuralgia, bell's palsy (VII), CNVIII (tinnitus, vertigo, deafness)
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facial effleurage
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soft tissue technique. Compress vascular structures to move fluid. Start by releasing thoracic inlet and treating neck. Then forehead, maxilla and mandible
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facial palsy
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CN VII neuropathy. Temporal rotation, SBS strains
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colic
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treat with occipital decompression, MFR abdomen. Could be due to entrapment or vagus overstimulation.
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cranial entrapment neuropathy
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skull bones become locked (cranial base compression)
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occipitomastoid decompression
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treats entrapment neuropathies - torticollis, otitis media, colic, plagiocephaly
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otitis media
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middle ear infection. Caused by impaired Eustacian tube drainage
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parallelogram head deformity
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positional plagiocephaly (benign). Can be due to SBS lateral strain. Named for side of flattened occiput
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plagiocephaly, deformational
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rule out synostotic plagiocephaly. Can lead to vision problems, TMJ, learning disorders.
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torticollis
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can cause plagiocephaly. Caused by ischemic SCM or entrapment. Treat with SCM MFR, cranial base compression
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OMT has cosmetic benefits for plagiocephaly until age
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6
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treat toricollis with
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occipital decompression, SCM MFR
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treat colic with
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occipital decompression, MFR abdomen
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treat otitis media with
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Galbreath mandibular drainage, temporal decompression, rib raising, MFR abdomen
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