Documente Academic
Documente Profesional
Documente Cultură
May 1, 2015
The Class of 2017
NSU-COM
Somatic Dysfunction
Impaired or altered function of ANY part
of the soma -- skeletal, myofascial, and
related vascular, lymphatic, and neural
elements
Diagnosed via PALPATION - restricted
vs. freedom of motion
Somatic dysfunctions are always named
from the FREEDOM (ease) of motion!
Diagnosis of Somatic
Dysfunctions
T. -- tenderness
A. – asymmetry (a static finding)
R. -- restricted range of motion
(a dynamic finding)
T. -- tissue texture changes
… or S.T.A.R. ( S. is for
sensitivity)
Somatic Dysfunction
Acute Chronic
immediate long standing
vasodilation fibrosis
edema “itchiness”
increased skin cool (decreased
moisture temperature)
heat/redness *ropy tissue (can be
rough texture acute as well)
swelling dryness
“boggy” tissue thin texture
stringiness
Barriers to Motion
Anatomic Barrier
the limit of motion imposed by anatomic
structure (limit of passive motion)
Physiologic Barrier
the limit of active motion
Restrictive Barrier
the functional limit within the anatomic and
physiologic range of motion which
abnormally diminishes the normal
physiologic range of motion
Pathologic barrier
Permanent restriction of joint motion
associated with pathologic changes of
tissues (e.g. osteophytes, contracture)
Type I vs. Type II
Type I: Type II:
neutral hyperflexion/
long restrictors hyperextension
several segments (3 short restrictors
or more) 1-2 segments
sidebending/rotation sidebending/rotation
opposite to the same side
rotation into the rotation into the
convexity of the concavity
curve traumatic
postural
3rd Law of Physiologic
Motion
Inducing motion in one plane reduces or
modifies the motion in the other two planes
Other pearls:
FRS and ERS terminology
FRS left (FRSL)
– Flexed, rotated and sidebent left
ERS right (ERSR)
– Extended, rotated and sidebent right
Autonomics
Sympathetics: T1-L2
Parasympathetics: CN III, VII, IX, X
and S2-4
ANS techniques
OA decompression – normalizes vagal
tone
Sacral rocking – increases
parasympathetics
Sacral inhibition – decreases
parasympathetics
Rib raising – increases sympathetics
(typically less than 90 sec)
Paraspinal inhibition – decreases
sympathetics
Osteopathic Planes of
Motion
Motion: Plane:
Rotation Horizontal
(transverse)
Sidebending Coronal
(frontal)
Flexion/extension Sagittal
Vertebral Unit
Two (2) vertebral segments and their
spinal and extraspinal articulations, and
the intervertebral disc
Motion of a vertebra is named from the
motion of the upper vertebra in relation
to the one below
Naming S.D.
“ T7 rotated right” means T7 is rotated
right in relation to T8.
Rotation is named from a point on the
anterior/superior surface of a vertebral
body.**
Techniques
Direct
toward the barrier
the barrier is “engaged”
Indirect
away from the barrier
the barrier is “disengaged” and moved to a
point of balance (new neutral position)
Barriers to Motion
Techniques
Passive treatment
A technique in which the patient refrains
from voluntary muscle contraction
Active treatment
A technique in which the patient performs
voluntary muscle contraction
Direct Techniques Indirect Techniques
HVLA Counterstrain
Muscle Energy Myofascial Release
Articulatory Cranial
Springing Facilitated Positional
LVMA Release
Cranial Still
Myofascial Release LAS/BLT
Still Functional
Soft Tissue
LVMA
Low velocity/moderate amplitude
Also known as articulatory techniques
Rib raising
Greater than 90 seconds will decrease
sympathetic activity
Less than 90 seconds will increase sympathetic
activity
Spencer techniques (for the shoulder) can be
LVMA as well as Muscle Energy
Functional Technique
Using palpatory information gained from
assessing all planes of motion around a
segment or dysfunction looking for ease
and restriction at that dysfunction
Diagnosis is made by assessing for all
planes of “ease” including what the
tissues feel with respiration
Physician needs continuous feedback of
the response to motion
Functional Technique
continued
An indirect method of treatment
Looking for the “ease” (compliance) of
the tissues vs. the “bind” (resistance) of
the tissues
Soft Tissue
Effleurage
Stroking movement to move fluids
Pettrisage
Deep kneading or squeezing to express
swelling
Tapotement
Striking the belly of a muscle to increase it’s
tone/arterial perfusion
Soft Tissue
Need to monitor response to tissues for
length of use
Aids in circulation/movement of fluids
Relief of muscle spasm
NO specific joint correction
Mostly a direct treatment
Galbreath’s technique
AKA :Mandibular drainage
To increase drainage of middle ear
structures via eustachian tube
Good for children with otitis media
Muscle Energy
Pt. uses his/her muscles on request
from a certain controlled position
To test, we perform the opposite
function of the muscle
The patient will then perform the
function of the muscle
Mechanism via the Golgi tendon reflex
Isometric
change in muscle tension without
approximation of origin/insertion
Isotonic
approximation of origin/insertion without a
change in muscle tension
Isolytic
contracture of muscle with forced
lengthening
Concentric contraction
Contraction where the origin and insertion
of a muscle approximate
Eccentric contraction
Contraction where the origin and insertion
of a muscle separate or lengthen
Isokinetic contraction
Contraction of the muscle at a constant,
controlled speed
Reciprocal Inhibition
Goal: To lengthen a contracted muscle
due to spasm
When a gentle contraction is initiated in
the agonist muscle, there is a reflex
relaxation in the muscle’s antagonistic
group
Muscle energy
Contraindications
Muscle tear
Fracture
Severely ill (ICU or post-surgical pts.)
Counterstrain
Find tenderpoint
Position of comfort (75-100%)
Hold for 90 sec. (120 sec. for ribs)
Slow, passive return to neutral
Recheck tenderpoint
**Remember-- ant. points usually treated with
flexion; post. points usually treated with
extension
**The further from the midline a tenderpoint is,
the more sidebending and/or rotation is needed
Counterstrain continued..
T3 = spine of scapula
7th rib = inferior angle of scapula
T2 = jugular notch
T4 = angle of Louis
Rib 2 = angle of Louis
T4 = nipple dermatome
T10 = umbilicus
Rules of Three
T1-3
spinous process horizontal - at level of
transverse process
T4-6
spinous process halfway between
transverse processes
T7-9
spinous process at level of transverse
process below
T10
like T7-9
T11
like T4-6
T12
like T1-3
Diagnosis of Thoracic/Lumbar
Dysfunctions
Prominent (shallow) TP = vertebral
rotation
Spinous process close to segment
above = flexed dysfunction
Spinous process close to segment
below = extended dysfunction
Scoliosis
Named for the convexity of the curve
Many times have 2 scoliotic curves (double
major)
scapula more prominent on convex side (rib
hump)
Convex side = vertebral rotation
treat apex of curve 1st
more common in women
Dx with Cobb Angle
5-15 degrees – mild
20-45 degrees – moderate
> 50 degress - severe
“Rotoscoliosis”
Term used to describe Type I curve –
rotation and sidebending of a group
(opposite directions)
Dextroscoliosis = right scoliosis
Levoscoliosis = left scoliosis
Motions of the Thoracic
Spine
Rotation is greatest
Extension is the least
inhalation restriction
exhalation SD
exhalation rib
** Treat most superior rib
depressed rib
Muscles used for Inhalation
Restricted Ribs
Rib 1 Ant./Middle Scalenes
Rib 2 Post. Scalene
Ribs 3-5 Pectoralis minor
Ribs 6-10 Serratus Anterior
Ribs 11-12 Latissimus Dorsi
or Quadratus
Lumborum
Bony Attachments of
Thoracoabdominal Diaphragm
Lower 6 ribs
L1-3 right
L1-2 left
xiphoid process
Reflexes
C5 - biceps
C6 - brachioradialis
C7 - triceps
Elbow continued..
Radial Head
posterior -- restricted in supination
anterior -- restricted in pronation
Nursemaid’s elbow -- subluxation of radial
head
Partial dislocation of radial head from annular lig.
Tennis elbow = lateral epicondylitis (pain with
wrist extension)
Golfer’s/little leaguer's elbow = medial
epicondylitis (pain with wrist flexion)
Humeroulnar somatic dysfunctions
Ulnar ABduction – increased carrying
angle
– Olecranon glides medially, and will not glide
laterally
wrist
Is
opposite
direction
of
distal ulna
Hand/Wrist
Carpal Tunnel Syndrome:
Phalen’s test
Tinel’s test
Allen test
To test patency of radial and ulnar arteries
Hand
DeQuervain’s tenosynovitis
+ Finkelstein test
Dupuytren’s contracture
Flexion contracture of MCP/PIP of ring and little
finger
Boutonniere deformity
Seen in RA – Flexion of PIP/extension of DIP
Swan neck deformity
Seen in RA – extension of PIP/flexion of DIP
Herberden’s nodes
DIP joint osteophyte – seen in OA
Bouchard’s nodes
PIP joint osteophyte – seen in OA
Wrist biomechanics
Wrist flexion = carpals glide dorsally
Wrist extension = carpals glide volarly
Wrist trauma
Most common wrist fracture
Scaphoid fracture (pain at anatomic
snuffbox)