Term
| What are the two principles of treatment that can describe various treatment types? |
|
Definition
1. position of the patient relative to the barrier
2. final activating force |
|
|
Term
|
Definition
| the restrictive barrier is engaged and a final activating force is applied to correct somatic dysfunction |
|
|
Term
|
Definition
| the dysfunctional body part is moved away from the restrictive carrier until tissue tension is equal in one or all planes and directions |
|
|
Term
|
Definition
| technique in which the person voluntarily performs a physician-directed motion |
|
|
Term
|
Definition
| based on techniques which the patient refrains from voluntary muscle contraction |
|
|
Term
|
Definition
the QUALITATIVE description of the cessation of motion
can be described at "Firm", "Rubbery", or "Boggy" |
|
|
Term
|
Definition
Tissue texture change
Asymmetry of position
Restriction of motion
Tenderness |
|
|
Term
|
Definition
| force that, once the patient has been properly positioned, results in the therapeutic effect of the technique |
|
|
Term
| description of final activating force of direct technique |
|
Definition
1. Amplitude = the distance over which the force is applied
2. Velocity = the speed with which the force is applied |
|
|
Term
| OMT techniques (listed from most aggressive to least aggressive) |
|
Definition
1. High velocity low amplitude
2. articulation
3. soft tissue
4. Direct fascial release
5. muscle energy
6. counterstrain
7. facilitated positional release
8. indirect fascial release
9. Indirect cranial |
|
|
Term
| examples of direct technique |
|
Definition
soft tissue
articulatory treatment
springing
myofascial release
muscle energy
high velocity low amplitude (HVLA) |
|
|
Term
|
Definition
directed at tissues other than skeletal or arthrodial
usually involves lateral/linear stretching, deep pressure, traction and/or separation of muscle origin and insertion while monitoring tissue response and muscle changes by palpation |
|
|
Term
| therapeutic goal of soft tissue technique |
|
Definition
| muscular and fascial relaxation |
|
|
Term
| proposed mechanisms of soft tissue technique |
|
Definition
1. relaxes hypertonic muscles and reduces spasms
2. stretches and increases the elasticity of shortened fascial structures
3. enhances circulation to local myofascial structures
4. improves local tissue nutrition, oxygenation, and removal of metabolic wastes
5. improbes abnormal somato-somatic and somato-visceral reflex activity, thus improving circulartion in areas of the body remotes from the area being treated
6. identifies areas of restricted motion, tissue texture changes and sensitivity
7. improves local and systemic immune response
8. Provides a general state of relaxation
9. provides a general state of tonic stimulation by stimulating the stretch reflex in hyotonic muscles |
|
|
Term
| indications of soft tissue technique |
|
Definition
1. somatic dysfunction of the soft tissues of the body including hypertonic muscles, excessive tension in fascial structures and abnormal somato-somatic and somato-visceral reflexes
2. Clinical conditions that would benefit from enhanced circulation to myofascial structures; improved locaal tissue nutrition, oxygenation and removal of metabolic wastes; and improved local and sytemic immune responsiveness
3. As an adjunct to additional manipulative treatment |
|
|
Term
| contraindications of soft tissue technique |
|
Definition
1. absence of somatic dysfunction (absolute)
2. lack of patient consent and/or cooperation (absolute)
3. skin disorders
4. acute fascitis or fascial tears
5. acute muscle strains, acute myositis, muscle neoplasms
6. acute ligamentous sprain, acute ligamentous inflammatory disorders
7. long-standing rheumitoid arthritis
8. acute bone fractures, osteoporosis, bone tumors/cancer
9. infections of the viscera
10. hematoma, DVT, uncontrolled bleeding disorders
11. Down's syndrome |
|
|
Term
| 3 basic mechanisms used in applying soft tissue technique |
|
Definition
1. Tractional technique
2. Kneading
3. Inhibition |
|
|
Term
| other mechanisms of soft tissue technique (developed from European message movement) |
|
Definition
1. Effleurage
2. Petrissage
3. Tapotement
4. Skin Rolling |
|
|
Term
|
Definition
| system of diagnosis and treatment which engages continual palpatory feedback to achieve release of myofascial tissues |
|
|
Term
| two types of myofacial release |
|
Definition
| Direct and Indirect myofacial realease |
|
|
Term
| direct myofascial release |
|
Definition
| myofascial tissue restrictive barrier is engaged for the myofascial tissues and tissue is loaded with a constant force until tissue release occurs |
|
|
Term
| indirect myofascial release |
|
Definition
| the dysfunctional tissues are guided along the path of least resistance until free movement is acheived |
|
|
Term
| proposed mechanisms of myofascial release |
|
Definition
1. fascia is capable of changes in length with associated changes of energy content
2. provides peripheral neuroreflexive alterations in muscle tone and neural facilitation
3. allows for CT plastic changes which are associated with release of energy
4. external forces applied to fascia facilitate restoration of normal structure and function
5. tensegrity principles coupled with fascial bioelectric properties influence anatomical and physiological responses of tissue |
|
|
Term
| indications of myofacial release |
|
Definition
| used to treat somatic dysfunctions involving myofascial or other CTs |
|
|
Term
|
Definition
1. absence of somatic dysfunction
2. lack of patient consent or cooperation
3. extreme caution should be used with pts with:
- fractures
- open wounds
- acute thermal injury
- soft tissue or bony infections
- abscesses
- DVT
- anticoagulation
- disseminated or focal neoplasm
- recent post-operative states (wound dehiscence)
- aortic aneurysm |
|
|
Term
| indirect MFR principles of treatment |
|
Definition
| movement of a pt by the physician into the position of ease for all planes, following and tissue release or fascial unwinding until completed |
|
|
Term
| techniques that can be employed to enhance tissue release in Indirect MFR |
|
Definition
1. regional compression, distraction or torsion
2. tissue inhibition or traction
3. respiratory cooperation in the phase with encourages tissue relaxation
4. eye, tongue, jaw, head or limb movements |
|
|
Term
| techniques used to employ tissue release in direct MFR |
|
Definition
1. respiratory cooperation in the phase with encourages tissue tension
2. Tissue inhibition
3. Oscillation
4. eye, tongue, jaw, head or limb movements |
|
|
Term
| Direct MDR principles of treatment |
|
Definition
| movement of a patient by the physician into the restriction for all planes, apply a steady force until tissue release or fascial unwinding is complete |
|
|
Term
| special considerations of myofacial release |
|
Definition
- may be performed on various tissues including fascia, tendons, cicatrices (scars), internal organs, or visceral suspensory ligments
- decreases myofascial tone at a segmental level in treating spinal somatic dysfunction |
|
|
Term
| articulatory treatment (ART) |
|
Definition
low velocity/high amplitde
technique in which an articulation is taken through its full range of motion with specific attention directed a the dysfunctional barrier |
|
|
Term
| therapeutic goal of articulatory treatment |
|
Definition
| increased freedom of articular motion |
|
|
Term
|
Definition
low velocity/high amplitude
technique in which the restrictive barrier is engaged repeatedly to produce an increased freedom of motion |
|
|
Term
| therapeutic goal of springing technique |
|
Definition
| increased freedom of articular motion |
|
|
Term
|
Definition
| manipulative diagnosis and treatment in which the patient's muscles are actively used on request from a precisely controlled position, in a specific direction and against a distinctly executed physician counterforce |
|
|
Term
| proposed mechanism of muscle energy |
|
Definition
| use to treat a specific mechanical diagnosis; can be used to restore normal muscle tone and/or improve joint mechanism |
|
|
Term
| 6 anatomic/physiologic principles of muscle energy (listed) |
|
Definition
1. post-isometric relaxation
2. joint mobilization using muscle force
3. respiratory assistance
4. oculocephalogyric reflex
5. reciprocal inhibition
6. crossed extensor reflex |
|
|
Term
| post-isometric relaxation |
|
Definition
**most commonly used in practice
goal = to accomplish muscle relaxation
phsyiologic basis = after isometric contraction, the muscle has a refractory state in which passive stretching can occur
force of contraction = sustained gentle pressure |
|
|
Term
| joint mobilization using muscle force |
|
Definition
goal = to accomplish restoration of joint motion in an articular dysfunction
physiologic basis = articulatory dysfunction can lead to hypertonicity of the musculature --> compression of the joint and decreased motion; restoration of motion results in gapping or reseating of the distorted joint with reflex relaxation of the hypertonic muscle
force of contraction = maximal muscle contraction that can be comfortably resisted by the physician |
|
|
Term
| respiratory assistance (in muscle energy |
|
Definition
Goal = to produce improved body physiology using the patient's voluntary respiratory motion
physiologic basis = muscular forces are generated by the simple act of breathing; physician usually applies a fulcrum against which the respiratory forces can work
force of contraction = exaggerated respiratory motion |
|
|
Term
|
Definition
goal = to affect reflex muscle contraction using eye motion
physiologic basis = voluntary eye movements that reflexively affect the cervical and truncal musculature
force of contraction = exceptionally gentle |
|
|
Term
| reciprocal inhibition (in muscle energy) |
|
Definition
goal = to lengthen a muscle shortened by cramp or acute spasm
physiologic basis = when a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of the muscle's antagonistic group
force of contraction = very gentle |
|
|
Term
|
Definition
goal = used in the extremities where the muscle that requires treatment is in an area so severely injured such that manual contact with the affected limb is inadvisable
physiologic basis = when the flexor muscle in one extremity is contracted voluntarily, the flexor muscle in the contralateral extremity relaxes and the extensor contracts
force of contraction = very gentle |
|
|
Term
| 3 types of muscle contraction |
|
Definition
1. isometric muscle contraction
2. isotonic muscle contraction
3. isolytic muscle contraction |
|
|
Term
| isometric muscle contraction |
|
Definition
- most commonly used contraction in muscle energy technique
- origin and insertion of the muscle are maintained in a stationary position while the muscle is contracted against resistance
- maintains constant muscle length (no winners) |
|
|
Term
| isotonic muscle contraction |
|
Definition
- basic principle applied to joint restriction by activation a specific muscle while fixing only one end of the muscular attachment, with the goal of restoring normal mechanics
- frequently used to treat hypotonic, reflexively inhibited muscles
- muscle length shortens (patient wins) |
|
|
Term
| isolytic muscle contraction |
|
Definition
- used for the treatment of fibrotic or chronically shortened myofascial tissues
- applied counterforce is greater than the patient force
- muscle length elongates (dr. wins) |
|
|
Term
| types of joint restrictors |
|
Definition
1. monoarticular muscles = short restrictors, considered key in maintaining Type II, segmental dysfuncitons
2. Polyarticular muscles = long restrictors, maintains Type I, group dysfunction |
|
|
Term
| indications of muscle energy |
|
Definition
| clinically relevant somatic dysfunction |
|
|
Term
| contraindications of muscle energy |
|
Definition
- absence of somatic dysfunction
- lack of patient consent or cooperation
- infection, hematoma, or tear in involved muscle
- fracture or dislocation of involved joint
- rheumatologic conditions causing instability of the cervical spine
- undiagnosed joint swelling of involved joint
- positioning that compromises vasculature |
|
|
Term
| special considerations of muscle energy |
|
Definition
- prototypical active, direct OMT
- can be used to treat any joint that is crossed by voluntary muscle
- it is a principle mechanism for promoting lymphatic and venous circulation (good for edema/congestion) = may result in secondary reduction of inflammation |
|
|
Term
| key organ of counterstrain |
|
Definition
|
|
Term
| key organ of muscle energy |
|
Definition
| golgi tendon (detects tension) |
|
|
Term
| physiologic process of muscle energy |
|
Definition
1. isometric contraction
2. neuromusculoskeletal appartus is in a refractory state = passive stretching is allowed (no myotatic reflex)
3. golgi tendon organ senses large amounts of tension and causes the muscle to relax
4. isometric contraction again and process repeats |
|
|
Term
|
Definition
High Velocity Low Amplitude
an osteopathic technique employing rapid, therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint = engages the restrictive barrier in one or more planes of motion to elicit release of restriction
"thrust technique" |
|
|
Term
| proposed mechanism of HVLA |
|
Definition
- restoration of joint motion
- vacuum theory/cavitation
- microadhesions
- decreases facilitaion/nociception/elevated mechanorecptors activity |
|
|
Term
|
Definition
- articular somatic dysfunction
- firm distinct articular barrier (need a solid end feel)
- movement focused in one localized area |
|
|
Term
| absolute contraindications of HVLA |
|
Definition
- rheumatorid arthritis
- down's syndrome
- achondroplastic dwarfism
- chiari malformation
- fracture/dislocation/spinal or joint instability
- ankylosis/spondylossi with fusion
- surgical fusion
- Klippel-Fiel syndrome
- vertebrobasilar insufficiency
- neurological symptoms during testing or localization
- inflammatory joint disease
- joint infection
- bony malignancy
- patient refusal
- medicolegal situations
**avoid high cervical (AA and OA) |
|
|
Term
| relative (regional specific) contraindications of HVLA |
|
Definition
acute herniated nucleus pulposus
acute radiculopathy
acute whiplash/ severe muscle spasm/ strain/sprain
osteopenia/ Ostoporosis
spondylolisthesis
metabolic bone disease
hypermobility syndromes
bleeding disorders (on coumadin, etc.) |
|
|
Term
| HVLA principles of treatment |
|
Definition
1. accurate diagnosis
2. choice of force vector (short or long)
3. Specific engagement of restrictive barrier
4. maintain localization throughout the thrust
5. apply HVLA thrust
6. minimal force, short distance, rapid acceleration / short duration without hesitation
7. re-assessment |
|
|
Term
|
Definition
DO NOT disengage the barrier
you must localize forces
excessive dosage = hypermobility
do not do this treatment daily (have to let the area heal first) |
|
|
Term
| motion in treatment techniques should be within both _____ and ______ limits |
|
Definition
| physiologic and anatomical |
|
|
Term
| should the restrictive barrier be engaged in HVLA? |
|
Definition
| yes, if tolerated (movement necessary to affect this barrier should be only 1-2 degrees of motion); physiologic barrier of normal motion may be 5-6 degrees further |
|
|
Term
| define somatic dysfunction |
|
Definition
| impaired or altered function of related components of the somatic system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic and neural elements |
|
|
Term
|
Definition
| a functional limit within anatomic ranges of motion, which abnormally diminishes the normal physiologic range |
|
|
Term
| what does a firm end feel tell you about the end of motion? |
|
Definition
| that it is less elastic at the end of motion |
|
|
Term
|
Definition
A manipulative technique where the restrictive barrier is disengaged
the dysfunctional body part is moved away from the restrictive barrier until tissue tension is equal in one or all planes and directions
takes the dysfunction the way it "likes" to go |
|
|
Term
| in indirect method, what facilitates the release of the muscle? |
|
Definition
| inherent forces (NOT physician forces) |
|
|
Term
| does indirect method engage or stay away from the restrictive barrier? |
|
Definition
stays away from restrictive barrier
follow the path of injury or lesion |
|
|
Term
| indications for indirect method |
|
Definition
- acute painful situations (trauma)
- hospitalized patients
- metastatic cancer
- arthritis (osteoarthritis, rheumetoid)
- osteoporosis
- limitations of patient positioning for other techniques
- patient's preference |
|
|
Term
| contraindications for indirect method |
|
Definition
- inability to position patient appropriately
- patient's preference
- fractures, open wounds |
|
|
Term
|
Definition
the natural tendency of hte body to seek homeostasis
rhythmic activity present in all living tissues
intrinsic force used in indirect method |
|
|
Term
| assistant activating forces in indirect method |
|
Definition
1. respiratory cooperation
2. respiratory force = pt inhales, exhales or holds his breath beyond his usual comfortable limits |
|
|
Term
| Spine demonstration for inhalation |
|
Definition
external rotation
spinal curves tend to flatten
muscles tighten |
|
|
Term
| Spine demonstration for exhalation |
|
Definition
internal rotation
spinal curves tend to increase
muscle tighten |
|
|
Term
| types of myofascial release |
|
Definition
1. ligamentous articular strain
2. balanced ligamentous tension
3. facilitated positional release
4. integrated neuromusculoskeletal release
5. fascial ligamentous release |
|
|
Term
| what we influence with MFR |
|
Definition
Connective tissues
ligaments
tendons |
|
|
Term
| which type of connective tissue is compressible and stretchable? Why? |
|
Definition
dense, irregular CT
has a significant amount of space within it = compressible and stretchable |
|
|
Term
| Is there lots of stretch or compression in ligaments? |
|
Definition
|
|
Term
|
Definition
| somewhere between ligaments and dense, irregular CT, more space and flexibility than ligament |
|
|
Term
|
Definition
CT covering over all surfaces in the body
envelops all fibers, muscles, tendons and organs
is a continuous sheet, NOT individual baggies for each organ |
|
|
Term
| restrictions in fascia can reduce flow in which structures? |
|
Definition
nerves
lymphatics
vasculature
(all course through the fascia) |
|
|
Term
|
Definition
most CT
moderate temp changes
light touch
nociception |
|
|
Term
|
Definition
acceleration receptor
subcutaneous tissue
joints
interosseous membranes |
|
|
Term
|
Definition
skin, joint capsules, tendons
dermal stretch receptors |
|
|
Term
|
Definition
|
|
Term
|
Definition
basement membrane
sense perpendicular indentation |
|
|
Term
| special considerations for myofascial release |
|
Definition
may be performed on various tissues including fascia, tendons, cicatries, internal organs, or visceral suspensory ligaments
decrease myofascial tone at a segmental level in treating spinal somatic dysfunction |
|
|
Term
| principles of treatment for myofascial release |
|
Definition
1. apply very gentle, yet firm contact
2. assess motion in three planes
3. guide fascia into direction of ease in all planes
4. find point of equal balance
5. don't go to the new barrier!
6. constantly rebalance
**may incorporate respiratory force and cooperation |
|
|
Term
| joint stacking (indirect joint guiding) |
|
Definition
- assess motion in all planes
- guide joint into direction of ease in all planes
- find point of equal balance
- constant rebalance
- may use respiratory force and allow intrinsic forces to work |
|
|
Term
|
Definition
| reciprocal inhibit = reflex mechanism whereby antagonist muscles are contracted (causing reflex stretch in agonist muscles) |
|
|
Term
|
Definition
| system of diagnosis and indirect treatment in which the patient's somatic dysfunction (myofascial tenderpoint), is treated by using a position of spontaneous tissue release while simultaneously monitoring the tenderpoint |
|
|
Term
| is counterstrain an indirect or direct technique? Does it go towards or away from the restrictive barrier? |
|
Definition
indirect technique
away from the barrier |
|
|
Term
| mechanism of treating a strain with counterstrain |
|
Definition
physician counters the strain by reintroducing the original strain (position of ease) = relaxes the muscle involved
**identify the tender points and position the pt to eliminate the tenderness |
|
|
Term
| who developed counterstrain? when? |
|
Definition
Laurence H. Jones, D.O.
1955 |
|
|
Term
| principles of treatment for counterstrain |
|
Definition
1. localize tender point
2. establish tenderness assessment/pain scale
3. place the patient passively in a position that results in the greatest reduction of tenderness at the point
4. maintain this position for 90 seconds while continuously monitoring the point
5. slowly return the patient passibley to neutral position
6. re-test for tenderness at the tender point |
|
|
Term
| in counterstrain, how do anterior and posterior points differ? |
|
Definition
anterior points = typically require flexion
posterior points = extension |
|
|
Term
| in counterstrain, how do midline and more lateral points differ in treatment? |
|
Definition
midline points = require primarily flexion or extension
lateral points = more sidebending and rotation is required |
|
|
Term
| when dealing with counterstrain, what does therapeutic pulse indicate? |
|
Definition
| good myofascial relaxation |
|
|
Term
| where are tenderpoints usually located? |
|
Definition
on the side opposite the area of complaint
**people do not usually complain of their tender points |
|
|
Term
|
Definition
afferent
annulospiral ending on the intrafusal muscle fiber
sensitive to degree of stretch (length) and particularly the rate of stretch |
|
|
Term
|
Definition
afferent
flower spracy endings at the ends of intrafusal muscle fibers
sensitive to only degree of stretch (length) |
|
|
Term
|
Definition
efferent stimulation (gamma gain)
controls the length of the polar ends of the intrafusal muscle fibers
helps regulate the muscle tone of the extrafusal fiber by changing the sensitivity of the type Ia and II fibers to stretch |
|
|
Term
|
Definition
1. muscle fiber stretch is sensed by the type Ia and II fibers
2. alpha efferent signal INCREASED in agonist muscle and alpha efferent signal DECREASED in antagonist muscle
3. gamma efferent signal (gamma gain) increased in agonist intrafusal fibers
4. stretch in agonist muscle? |
|
|
Term
| what happens to a joint under strain? |
|
Definition
one muscle is under load and stretched causing increased firing of the type Ia fibers --> reflex motor contraction of the agonist and increased gamma gain to protect against overstretch
second muscle is hyper-shortened showing decreased afferent signal since it is relaxed |
|
|
Term
| what happens to a joint with "counterstrain"? |
|
Definition
as the load is released in previously stretch muscle, it shortens quickly and joint direction reverses --> reduced afferent signal
previously shortened muscle is quickly lengthened. Type Ia fibers send a massive afferent burst as a protective mechanism to increase this muscle's gamma gain to protect against overstretch |
|
|
Term
| stretching a muscle increases/decreases firing? |
|
Definition
|
|
Term
| why type of firing occurs in hypershortened muscles? |
|
Definition
|
|
Term
| what mechanism of the muscle causes a strain? |
|
Definition
| strain produced from rapid stretching, followed immediately by a "panic reaction" = protective shortening of agonist muscle --> pathological alteration of the muscle spindle-spinal cord neural feedback mechanism from maintaining a hyper-shortened antagomist |
|
|
Term
| facilitated positional release (FPR) |
|
Definition
system of indirect myofascial release
OMT used to normalized hypertonic voluntary muscles |
|
|
Term
| principles of treatment for facilitated positional release |
|
Definition
1. starting position = neutral position
2. add compressing force for 3-5 seconds (may feel release of muscle)
3. place the dysfunction into its freedoms of motion |
|
|
Term
| is FPR supposed to be used for treatment of joint somatic dysfunction |
|
Definition
|
|
Term
| what is "neutral positioning" for use in FPR? |
|
Definition
- position between flexion and extension to approach neutral position as defined by Fryette
- in the spine = flatten the A-P curve
- for joints in extremities = will be placing them in "loose pack" positions |
|
|
Term
| where can the Still technique be used? |
|
Definition
| somatic dysfunction in joints and muscles |
|
|
Term
| How is Still Technique applied? |
|
Definition
1. area of the body must be locally at rest
2. tissue/joint placed in EASE of motion position
3. exaggerate position of ease
4. compression (or traction)= vector force (5 lbs) added
5. tissue/joint moved through restriction while maintaining compression (or traction) and force vector
5. Release compression (or traction)
7. return passively to neutral position |
|
|
Term
| indications for Still Technique |
|
Definition
hypertonic muscles and joint somatic dysfunction
pain
decreased range of motion |
|
|
Term
| contraindications of Still Technique |
|
Definition
|
|
Term
|
Definition
system of reflex points used by Frank Chapman, D.O.
Predictable anterior and posterior fascial tissue texture abnormalities caused by visceral disease (viscero-somatic reflex) |
|
|
Term
| what causes chapman's reflex points? |
|
Definition
| gangliform congestion = increased sympathetic tone in deep fascia or by periosteum, resulting in lymphatic edema and myofascial thickening |
|
|
Term
| how can Chapman's reflex points be described? |
|
Definition
painful nodule
small, smooth, firm, discreetly palpable
approximately 2-3mm in diameter |
|
|
Term
| Chapman's myocardial reflexes (locations) |
|
Definition
posterior = space between the transvers processes of T2 and T3; midway between the spinous process and tip of the transverse process
anterior = 2nd intercostal space at the sternal border |
|
|
Term
| Chapman's adrenal reflexes |
|
Definition
posterior = intertransverse spaces on both sides of T11-12; midway between the spinous processes and the transverse processes
anterior = lateral aspect of rectus abdominus at the level of the inferior margin of the costal margin |
|
|
Term
| How to treat Chapman's pulmonary reflexes |
|
Definition
anterior reflex = tender points are diagnostic of visceral disease
posterior = tender points are treatred by apply inhibitor pressure in slow circular fashion for 10-30sec |
|
|
Term
| Bronchial Chapman's reflexes |
|
Definition
anterior = intercostal spcae between 2nd and 3rd ribs close to the sternum
posterior = midway between the spinous process and the tips of the transverse processes at T2 |
|
|
Term
| Upper lung Chapman's reflexes |
|
Definition
anterior = intercostal space between 3rd and 4th ribs close to the sternum
posterior = midway between the spinous processes and the tips of the transverse processes of T3-4 |
|
|
Term
| Lower lung Chapman's Reflexes |
|
Definition
anterior = intercostal space between the4th and 5th ribs close to the sternum
posterior = midway between the spinous processes and the tips of the transverse processes of T4-5 |
|
|
Term
| Chapman's reflexes at 5th intercostal space |
|
Definition
right = liver
left = stomach acid |
|
|
Term
| Chapman's reflex in 6th intercostal space |
|
Definition
right = liver, gall bladder
left = stomach peristalsis |
|
|
Term
| Chapman's reflex at 7th intercostal space |
|
Definition
right = pancreas
left = spleen |
|
|
Term
| Appendix Chaptman's reflexes |
|
Definition
| tip of 12th rib on the right |
|
|
Term
| chapman's reflexes for colon |
|
Definition
|
|
Term
| treatment for Chapman's reflexes |
|
Definition
rub in a firm, circular direction for about 10-30 seconds
treatment can vary from 15 seconds to 2 minutes |
|
|
Term
| which structures are located in the gravitational line when body is in the ideal postural alignment? |
|
Definition
posterior to apex of coronal suture
external auditory meatus
humeral head
middle of L3 vertebra
femoral head
posterior to mid-knee
anterior to lateral malleolus |
|
|
Term
|
Definition
distance sensors
can orient posture and position very quickly |
|
|
Term
|
Definition
1. cervical lordosis (convex anterior)
2. thoracic kyphosis (convex posterior)
3. lumbar lordosis (convex anterior) |
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Term
| which muscles are considered phasic "postural" muscles? When are they active? |
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Definition
calves (gastrocnemius and soleus)
neck muscles
jaw muscles
**active during "resting" position |
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Term
| which parts of the body control postural compensation? |
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Definition
CNS = visual and vestibular functions
Spina compensation = proprioceptive info from muscles and tendons; vestibular info from semicircular canals; visual info |
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Term
| what areas of the spine are commonly susceptible to somatic dysfunction? Which changes occur here? |
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Definition
transition zones of spine
changes = bony changes to vertebrae, changes in sagittal plane, muscular and fascial changes
**also look at apex of curve for dysfunction |
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Term
| when are compensatory changes of the spine seen? |
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Definition
| compensatory changes in one sagittal plane curve results in changes to other curves |
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Term
| when is the primary onset of scoliosis seen? |
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Definition
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Term
| how does gender affect scoliosis? |
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Definition
occurs equally among both genders
BUT, females are 8x more likely to require treatment due to severity |
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Term
| classifications of scoliosis during physical exam |
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Definition
reversibility
severity
cause
location |
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Term
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Definition
1. Functional Scolotic curve = curve reduced with side bending, rotation or forward bending
2. Structural Scolotic curve = curve fixed and not reduced with side bending, rotation or forward bending |
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Term
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Definition
mild = 5-15 degress
moderate = 20-45 degrees
severe = >50 degrees (high probability of requiring surgical correction) |
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Term
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Definition
1. idiopathic (70-90%)
2. Congenital (2nd most common) = most progressive
3. Acquired (by other problem, i.e. short-leg syndrome) |
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Term
| what is the average width of a normal stride |
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Definition
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Term
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Definition
heel strike of one foot to heel strike of opposite foot
average = 15 inches |
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Term
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Definition
heel strike of one foot to heel strike of same foot
average = 30 inches |
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Term
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Definition
cadence = steps/unit of time
normal = 90-120 steps/min |
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Term
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Definition
1. stance phase = heel strike to toe off (60% of total cycle); foot in contact with ground at all times
2. swing phase = toe off to heel strike (40% of total cycle); foot does not contact ground at any time |
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Term
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Definition
heel strike
foot flat
midstance
heel off
toe off |
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Term
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Definition
acceleration
midswing
deceleration |
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Term
| parts of alternative system of stance phase |
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Definition
initial contact
loading response
mid stance = 100% of body weight on lower extremity
terminal stance = calf muscles at max contraction |
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Term
| parts of alternative system of swing phase |
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Definition
pre-swing
initial swing
mid swing
terminal swing |
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Term
| how does center of gravity change during gait cycle? |
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Definition
| center of gravity moves slightly higher and lower as well as vertically in phases of the gait cycle (highest in the upright position) |
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Term
| besides the lower extremities, which other body parts are involved in gait cycle? |
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Definition
pelvis = rotation and pelvic tilt
knee = flexion and extension
ankle = dorsi-flexion and plantar flexion
**called "determinants of gait" |
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Term
| muscle group actions of gait |
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Definition
pretibial group = max contraction during heel strike
quadriceps group = max contraction just after heel strike |
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Term
| hemiplegic neurologic gait |
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Definition
extensory synergies:
- hip extension and internal rotation
- knee extension
- plantar flexion and foot inversion |
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Term
| spastic diplegia neurologic gait |
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Definition
affects only the lower extremities
knee extended |
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Term
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Definition
| bipedal gait with movement only at the hip and ankle |
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Term
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Definition
| counteracting or avoiding pain = limp |
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Term
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Definition
small steps, shuffling gait (festinating gait)
stooped posture |
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Term
| gait caused by L5 rediculopathy or peroneal neuropathy |
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Definition
| gait with weak dorsiflexors of the foot |
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Term
| gait caused by polio or peripheral neuropathy |
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Definition
| swing leg lifted abnormally high (steppage gait) |
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Term
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Definition
- circumduction of the swing leg
- hip hiking of the swing leg
- vaulting on the stance leg |
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Term
| how should a cane be used to be most affective? |
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Definition
should rest on ground with elbow slightly bent when you are standing up straight
should be carried in hand opposite from your injured leg
move cane forward at the same time as swing phase of injured leg |
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Term
| where should crutches rest? |
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Definition
5 cm below axilla
adjust handles so thenar and hypothenar areas can take full weight while elbow is straight |
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Term
| three synovial joints of the shoulder complex |
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Definition
glenohumeral = ball and socket
sternoclavicular = saddle
acromioclavicular = planar
**scapulothoracic (functional joint) |
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Term
| when do limb buds develop during embryologic development? |
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Definition
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Term
| what compromises the pectoral girdle? |
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Definition
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Term
| what are the structural components of the shoulder? |
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Definition
thoracic cage
scapula
clavicle
humerus |
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Term
| what are the functional components of the shoulder? |
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Definition
scapulothoracic
acromioclavicular
sternoclavicular
glenohumeral |
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Term
| What are the 3 joints and 1 articulation of the shoulder? |
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Definition
3 joints = sternocalvicular, acromioclavicular and glenohumeral
1 articulation = scapulothroacic |
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Term
| movements of glenohumeral joint |
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Definition
flexion/extension
abduction/adduction
medial/lateral rotation
circumduction |
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Term
| where is the subacromial bursa located? What is its function? |
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Definition
deep to the deltoid, acromion, coracoacromial ligament and superficial to the supraspinatus tendon
function = reduces friction between the supraspinatus tendon and the coracoacromial arch |
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Term
| long thoracic nerve injury |
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Definition
| plegia (or paresis) of serratus anterior --> winged scapula |
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Term
| what are some signs of chronic somatic dysfunction? |
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Definition
| slight increase or decrease in temperature (cooling), smooth/thin or ropy/stringy texture, dry, tenderness, neovascularization, redness fades quickly or blanching occurs in erythema test, long standing, chronic/dull/aching pain, paresthesias (crawling, itching, burning), cool/pale skin, vasoconstriction due to hypersympathetic tone, decreased muscle tone, limited range of motion |
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Term
| what are some signs of acute somatic dysfunction? |
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Definition
| increased temperature, boggy/rough texture, increased moisture, tenderness, edema, venous congestion, redness lasts in erythema test, recent injury, acute/cutting/sharp pain, skin is warm/moist/red, local vasodilation, increased muscle tone/contraction and spasm |
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Term
| what are the seven stages (8 total steps) of the Spencer Technique? |
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Definition
1. shoulder extension with elbow flexed (ME)
2. shoulder flexion with elbow extended (ME)
3. circumduction with slight compression and elbow flexed (articular)
4. circumduction and traction with elbow extended (articulation)
5A. abduction with elbow flexed (ME)
5B. adduction and external rotation with elbow flexed (ME)
6. internal rotation with arm abducted, hand behind back (ME)
7. distraction, stretching tissues, and enhancing fluid drainage with arm extended (pulling up on shoulder when arm is extended) (Myofacial/Lymphatic)
8. REASSESS |
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Term
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Definition
glenohumeral joint
for chronic/recurring anterior dislocation
axillary nerve may be injured
test = arm abducted and elbow flexed to 90 degrees
positive = pt becomes very apprehensive fearing repeat dislocation
indicates GH instability/previous GH dislocation |
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Term
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Definition
entrapment of the nerves of the brachial plexus between clavicles and ribs or between the scalene muscles or pectoralis minor and ribs
aggravated by elevating arm
associated with pallor, coldness and numbness of the fingers |
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Term
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Definition
elevates vascular compromise originating in neck area
compression of the brachial plexus and subclavian artery between anterior and middle scalene
test = neck extended and turned toward affected side (narrows the interscalene space) |
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Term
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Definition
| assesses compression of neurovascular bundle between the clavicle and the first rib |
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Term
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Definition
| assesses compression of the neurovacular bundle between pectoralis minor muscle and thoracic cage (lift arm over head with elbow bent and arm abducted) |
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Term
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Definition
examiner stabilizes pts shoulder on top, and then passively forward flexes the arm above the shoulder level to fully flexed position
positive test = pain
indicated rotator cuff impingement path |
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Term
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Definition
examiner passively rotates humerus into IR while forward while forward flexing to 90 degrees in sagittal plane
positive = pain
indicates rotator cuff impingement path |
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Term
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Definition
Examiner externally rotates pt's arm against resistance
positive test = tendon will pop out of groove OR pain
indicates unstable biceps tendom or sublaxation |
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Term
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Definition
Pt elevates arm against resistance
positive test = pain in bicipital groove, indicating tendon path (tenditis) |
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Term
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Definition
tests supraspinatus
begin with arms overhead, hands back-to-back, ask pt to slowly lower arms to 90 degrees of vertical abduction and hold it
if pt cannot hold arm out to the side, suggests complete rotator cuff tear or nerve lesion, esp C5
get MRI and ortho consult |
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Term
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Definition
tests supraspinatus
probable full thickness RCT
get MRI and ortho consult |
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Term
| cross arm test (cross arm adduction) |
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Definition
examiner passively adducts pt's arm across the chest wall toward the opposite shoulder with humerus parallel to the floor
positive sign = pain in the AC joint at end range
indicates AC joint path
**DO NOT direct elbow toward opposite AC joint |
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Term
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Definition
pt's elbow is grasped and inferior traction applied
positive test = an indentation appears in the area beneath the acromion
indicates inferior instability, multidirectional instability |
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Term
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Definition
checks for disc and/or neurologic issues
extend pt's neck and rotate/side bend it to one side with axial compression (caudad) on the pt's head
positive sign = pain down ipsilateral arm from the neck
indicates cervical disc disease/nerve root irritation |
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Term
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Definition
Non-Neutral Mechanics (extremes of FB and BB)
Rotation “X” followed by sidebending “X”
Occurs at one segment
Commonly cause acute pain |
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Term
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Definition
in a neutral position, sidebending occurs 1st followed by rotation
SB and Rotation in OPPOSITE directions
applies to a group |
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Term
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Definition
0/4 = reflex absent; LMN injury
1/4 = decreased
2/4 = normal
3/4 = brisk
4/4 = brisk with clonus; UMN injury |
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Term
| neurological exam of C4 root |
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Definition
sensation = shoulder
motor = NONE
Reflex = NONE |
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Term
| neurological exam of C5 root |
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Definition
sensation = lateral elbow
motor = NONE
reflex = biceps |
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Term
| neurological exam of C6 root |
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Definition
sensation = thumb, index finger
motor = wrist extensors
reflex = brachioradialis |
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Term
| neurological exam of C7 root |
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Definition
sensation = middle finger
motor = triceps
reflex = triceps |
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Term
| neurological exam of C8 root |
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Definition
sensory = ring finger, pinky
motor = interossi
reflex = NONE |
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Term
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Definition
an increase in the carrying angle (abduction of arm) will cause adduction of wrist
a decrease in carrying angle (adduction of wrist) will cause abduction of the wrist |
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Term
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Definition
formed by the intersection of 2 lines. First line is the longitudinal access of the humerus and second line starts at the distal radial-ulna joint, passed through proximal radial-ulnar joint
normal = 5 degrees in men, 10-15 in women |
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Term
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Definition
carrying angle > 15 degrees
abduction of the ulna
adduction of wrist
medial glide of wrist
radius pushed distally |
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Term
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Definition
carrying angle is < 3 degrees
adduction of the ulna
abduction of wrist
lateral glide of olecranon
radius pushed proximally |
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Term
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Definition
FROM
Gravity
Full resistance |
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Term
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Definition
FROM
gravity
some resistance |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| spinal level of suprasternal notch |
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Definition
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Term
| spinal level of angle of louis |
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Definition
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Term
| spinal level of the xiphoid process |
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Definition
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Term
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Definition
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Term
| spinal level of inferior angle of scapula |
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Definition
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Term
| viscerosomatic reflexes of stomach |
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Definition
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Term
| viscerosomatic reflexes of gall bladder |
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Definition
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Term
| viscerosomatic reflexes of esophagus |
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Definition
T4-5 on right
T5-9 on left |
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Term
| viscerosomatic reflexes of heart |
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Definition
T1-5
referred pain to shoulder, neck, jaw |
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Term
| spinal level of viscerosomatic effects of asthma |
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Definition
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Term
| spinal level of viscerosomatic effects of appendix |
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Definition
T10-11
referred pain to periumbical region |
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Term
| spinal level of viscerosomatic effects of prostate |
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Definition
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Term
| chapman point at 2nd intercostal space |
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Definition
bronchus
myocardium
esophagus (acid reflex)
thyroid |
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