Lecture 2: Foundations of Osteopathic Medicine II

somatic dysfunction (SD)

impaired/altered function of related components of the somatic system

acute SD

immediate, short-term

chronic SD

prolonged, lasts more than 3 months

primary SD

often traumatic, caused by direct impact - sudden trauma, postural imbalances, microtrauma, repetitive trauma

if SD is treated, further testing is done, and the tests come back normal, the SD was most likely _______

primary

secondary SD

a response to something - caused by compensation to the primary, musculoskeletal problem, reflex response to viseral or emotional

if SD is treated, further testing is done, and tests continue to be abnormal, the SD was most likely _________

secondary

physical exam criteria for SD

TART - tissue texture changes, asymmetry, restricted range of motion, tenderness (pain)

which physical exam criteria for SD is most important?

restricted range of motion

which physical exam criteria for SD is most subjective

tenderness/pain

why is pattern recognition important?

used to develop techniques, by recognizing a pattern you can have a better idea of where to start in treatment

which physical exam criteria for SD may not always be relevant and why?

asymmetry; there is normal asymmetry in everyone and does not always need to be corrected unless indicated in clinical history or context

your body being well compensated to asymmetry means that

the asymmetry does not need to be corrected

inherent motion

spontaneous motion of cells/organs/etc. in body

physiologic motion

changes in position of body structures within normal range

respiratory motion

breathing

active motion

voluntary movement done by patient

passive motion

involuntary movement induced by physician while the patient remains relaxed

in restricted range of motion (RROM), it is important to determine

how much does it move and how well does it move

to know ______, you must first know __________. which side should you check first during an evaluation?

abnormal; normal - you must check the good side first

you should always evaluate and treat ________________ the SD

above and below the SD

what is the most important thing to do prior to touching a patient?

ask for consent

2 different types of tenderness

palpatory and subjective

when evaluating tenderness, you should ask the patient these two questions, and have them do what?

where does it hurt? where does it feel the most locked up?; have them localize the pain with their hands

allostasis

physiological costs of chronic exposure to fluctuating/heightened neural or neuroendocrine response resulting from repeated or chronic stress

frequent activation of the body's __________ can cause ___________

stress response; damage

allostasis is _________, and is the opposite of

unbalanced; opposite of homeostasis

the SD is an _______________ on the body, and depletes

allosteric load on the body; depletes energy efficiency

to treat the SD, you are

decreasing allostasis and improving energy efficiency

what is the clinical goal of treating SD with OMT?

restore normal arterial-venous-neural-lymphatic channels to decrease pain and improvate overall anatomic-physiologic function

rotation

occurs within the transverse plane around vertical axis - Y axis

flexion/extension

occur within the saggital plane around transverse axis - X axis

side bending

occurs withiin the frontal-coronal plane around anterior-posterior axis - Z axis

translation

can occur lateral to medial, medial to lateral, anterior to posterior, or posterior to anterior

right translation

left to right = left side bending

left translation

right to left = right side bending

restrictive barrier (RB)

functional limit that abnormally diminishes normal physiological motion (a decrease in normal limits)

anatomic barrier

limit imposed by anatomy - limit of passive motion - going beyond can cause serious injury

elastic barrier

range between physiologic and anatomic barriers that can only be assessed with passive motion - the limit of passive motion

pathologic barrier

restricted motion associated with pathologic change

physiologic barrier

normal motion - limit of active motion

when you are treating the _______ with OMT, you are treating the __________

SD; the SD's RB

OMT

therapeutic application of manually guided forces by a physician to improve physiologic function, decrease pain, and support homeostasis that was altered by SD

SD can be treated in 2 ways

directly or indirectly

direct OMT technique

directly engages the RB and a final activating force is applied to correct SD

indirect OMT technique

goes away from the RB to disengage it so that inherent forces can correct the SD - "taking it to where it lives"

how is SD named

named for the direction of ease, where it lives, and for where it can go - (what it can do and where it lives)

if the right radial head prefers posterior motion, and the RB is going into anterior glide, the SD is named

right posterior radial head

if the right fibular head prefers anterior motion and the RB is going into posterior glide, the SD diagnosis is

right anterior fibular head

allopathy

disease is treated by procedures that produce a second condition that is incompatible with or antagonistic to the first