DSA02L/03 - Osteopathic Manipulative Medicine: Still and Facilitated Positional Release Techniques

Physiologically, what causes an abnormal degree of muscle contraction?

Dysfunction of the gamma motor and alpha motor neuron loop reflex

Define Gamma motor neuron

a motor neuron that innervates the intrafusal muscle fibers (spindle fibers)

Define Alpha motor neuron

a motor neuron that innervates extrafusal muscle fibers (skeletal muscle fibers)

Describe the Stretch Reflex Pathway

1. Afferent input from sensory endings of muscle spindle fiber to Spinal Cord, and send signals to ALPHA MOTOR NEURON

2. Output through GAMMA MOTOR NEURON to INTRAFUSAL MUSCLE FIBERS (SPINDLE)

3. Output through ALPHA MOTOR NEURON to EXTRAFUSAL MUSCLE FIBERS (SKELETAL)

4. Descending pathways of signaling come to alpha and gamma motor neurons to co-activate

What causes the dysfunction between the gamma motor and alpha motor neuron loop reflex?

When muscle tone increases without increased stretch & is maintained

Define Facilitated Positional Release

Indirect technique to reduce abnormal muscle hypertonicity and restore lost motion to a restricted articulation

What are the steps of FPR ("Neutralize --> Compress --> Freedom")?

1. Diagnose somatic dysfunction

2. Place region into neutral position

3. Add activating force (compression, traction, or torsion) just down to dysfunctional segment

4. Take region to direction of ease (one plane at a time, staying localized)

5. Hold for 3-5 seconds

6. Return to neutral & release compression

7. Reassess

Explain how FPR "loosens muscle" physiologically

If the dysfunctional segment is positioned appropriately, the intrafusal fibers return to normal length ("zeroes out"/reset) --> decreases tension in extrafusal fibers --> reduces tension in muscle spindle --> decreases afferent impulses, allowing muscles to achieve normal length and tone

Stretching the muscle spindle (increases/decreases) the rate of firing, while shortening the muscle spindle (increases/decreases) the rate of firing

increases; decreases

What is the purpose behind the "compressive force" in FPR?

Unloads abnormal forces on a joint to change afferent input --> Causes neural feedback to rapidly normalize by localizing to the dysfunctional segment

For what groups is FPR often Indicated (need to adjust based on bone/muscle maturity or arthritic joints)?

-Pediatric patients

-Elderly patients

For what is FPR Contraindicated?

-Fracture

-Life OR Limb-threatening condition

Define Still Techniques

Specific, non-repetitive articulatory method of treatment that is indirect, then direct

What are the steps of the Still Technique ("Freedoms --> Compress --> Barriers")?

1. Make the Diagnosis

2. Place pt in INDIRECT position (ease)

3. Focus compression (or traction) on level of dysfunction

4. While maintaining compression, rotate in direction of restriction smoothly

5. Release compression and return region passively to neutral

6. Reassess

Explain how the Still Technique resolves somatic dysfunction physiologically

-Disarms the neurological protective mechanism, by placing them at ease --> relaxes the myofascial component

-Force vector allows repatterning of the neurofascial-vascular complex that occurred during trauma --> frees tissue from restriction

-Taking structure into barrier frees up remaining tissue restriction

How heavy should the force vector be in Still Technique?

Less than 5 pounds

What is the danger with excessive force through the vector?

Will lock the tissues and the treatment will cause discomfort

For what is Still's Technique Indicated?

-Articular Injuries

-Muscular Injuries

-Tendonous Injuries

-Ligamentous Injuries

-Soft Tissue Injuries

For what is Still's Technique Contraindicated?

-Pt cannot tolerate position

-Pt has orthotic (can't tolerate motion)

-Fracture present

-Osteomyelitis/Bone Tumor/Open Skin Lesion