OPP 5 Modalities

Somatic Dysfunction

impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, myofascial structures and related vasculature, lymphatic, and neural elements

Somatic dysfunction S/S

• abnormal function of somatic structures

  • palpatable

• seems neurophysiological

• improves w OMT

Somatic dysfunction misconceptions

Fixes fractures + degenerative and inflammatory processes

Components of TART

• tenderness

• asymmetry

• restricted ROM

• tissue texture changes + abnormalities

Tenderness S/S

Pain w palpation or motion

Asymmetry S/S

uneven positioning of vertebra and other paired structures

Restricted ROM S/S

• minor motions within bounds of physiologic barrier in 1+ planes of motion

Tissue texture changes + abnormalities S/S

palpable changes in skin + fascia + muscle

Acute dysfunction S/S (9)

• pain

• erythema (redness)

• warmth

• moisture

• bogginess

• vasodilation

• edema

• tenderness

• tissue contraction (rigidity)

Chronic dysfunction S/S (8)

• itching

• paresthesia (numbness)

• dryness

• coolness

• fibrosis

• tenderness

• pallor (paleness)

• tissue contraction (ropey + stringy)

Viscerosomatic dysfunction

localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures

Physiologic barrier

pt max active ROM

Anatomic barrier

pt max passive ROM

• limited by bone + ligament + tendon

Restrictive barrier

abnormal restriction within physiologic barrier caused by muscle spasms

Pathologic barrier

abnormal restriction within physiologic barrier caused by pathogens + trauma

Somatic Dysfunction naming convention

named for ease of motion

Goals of OMT (6)

• reduce pain

• increase function

• normalize muscle tone

• improve blood supply + nutrition

• increase venous + lymphatic return

• remove impediments to normal nerve transmission

Manipulation Modalities

• active vs passive

• direct vs indirect

Active manipulation

• pt participation

• physician guided

Passive manipulation

• no pt participation

• physician control

Direct manipulation

joint + tissue taken into restriction

Indirect manipulation

joint or tissue away from restriction

Combination manipulation

direct + indirect manipulation

Active direct examples (3)

• contract involved muscle

• use Golgi tendon organ reflex

• apply resistance to contraction

Active indirect examples (3)

• contract ipsilateral antagonist muscle

• contract contralateral similar muscle

• apply isokinetic resistance

Counterstrain steps

Passive + indirect

1. diagnose tenderpoint

2. passively place pt to position of ease

3. hold for 90 seconds

4. passively return pt to neutral position

5. reassess tenderpoint

Counterstrain contraindications

Absolute

• severe illness + trauma

• instability

• vascular + neurologic syndromes

• severe spondylosis

Relative

• inability to relax

• pt noncompliance + intolerance

• exacerbation of underlying condition

Balanced Ligamentous Tension (BLT) steps

1. disengagement (compression or traction)

2. exaggeration (into ease)

3. balance

Facilitated positional release (FPR) steps

Passive + indirect

1. neutral

2. compress

3. ease

osteopathic method of treatment which utilizes continual palpatory feedback to alleviate restriction of the somatic dysfunction and its related fascia and musculature

Myofascial Release

List of direct techniques (7)

• soft tissue technique

• direct inhibitory technique

• articulatory technique

• muscle energy

• high velocity low amplitude technique

• Still technique

• osteopathy in the cranial field

Soft tissue technique steps

passive + direct technique

1. apply direct pressure to tissues

• lateral stretching

• linear stretching

• deep pressure

• traction and/or separation of muscle origin + insertion

Soft tissue mechanism

• relax hypertonic muscles by decreasing alpha motor neuron activity + Hoffman reflexes

• stretch + increase elasticity of shortened fascial structures

• improve circulation to local myofascial structures

Direct inhibitory technique steps

passive + direct

1. apply steady pressure to specific/localized soft tissues

Articulatory technique steps

passive + direct

1. place joint or dysfunctional area into restriction

2. apply moderate-to-high velocity low amplitude springing force

form of osteopathic 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

Muscle energy definition

Muscle energy active forces (4)

• post isometric relaxation

• reciprocal inhibition

• oculocephalogyric reflex

• respiratory assist

Post isometric relaxation

relaxation of agonist muscle after sustained isometric contraction

Reciprocal inhibition

inhibition of antagonist muscle when agonist is stimulated

Oculocephalogyric reflex

automatic movement of eye + head

Respiratory assist

muscle tone generally decreasing w each exhalation

osteopathic method in which the restrictive barrier is engaged in one or more planes of motion and a rapid therapeutic force of brief duration traveling a short distance is applied within the anatomic range of motion

High Velocity Low Amplitude (HVLA)

HVLA steps

1. localize dysfunctional segment or joint and establish a fulcrum

2. place pt tightly into pathologic barrier

3. apply short-distanced + purposeful + fairly powerful thrust directed along anatomic articulation of joint

4. return pt to neutral position

HVLA contraindications

• fracture

• neurological symptoms present w localization + testing

• severe rheumatoid arthritis

• cancer in dysfunctional region (primary or metastatic)

• medicolegal situations

HVLA Precautions

• do not disengage pathologic barrier once found

• localize force

• avoid excessive thrust

• be aware of hypermobility

Still Technique steps

indirect to direct

1. place joint or segment in ease of motion

2. add distracting force

3. place dysfunction into barrier while maintaining distraction

4. remove distraction

5. return to neutral

• diagnosis + treatment of strain patterns developed btwn bones of skull to sacrum

  • describes motion btwn intracranial + intraspinal membranes

Osteopathy in the Cranial Field (Cranial)

Cranial indications

• plagiocephaly (asymmetry of head)

• feeding abnormalities in infants

• headaches

• tinnitus

• vertigo