PPOM 2 Block 2 OMM

What type of reflex is a Chapman’s reflex?

Viscerosomatic reflex.

B

Normal versus dysfunctional joint end-feel?

Normal = soft, springy. Dysfunctional = hard, guarded, loss of spring.

What is the treatment sequence for the area of greatest restriction?

Find regional restriction → diagnose segmental restriction → treat → rescreen.

What is mechanotransduction?

Mechanical forces trigger cellular signaling that can alter gene expression.

What does Wolff's law state?

Bone remodels over time in response to mechanical stress.

What happens to Type II phasic muscles during muscle imbalance?

Fast-twitch muscles become inhibited and functionally weak → Strengthen.

What are the four classic muscle groups involved in lower crossed syndrome?

Tight iliopsoas + tight lumbar erector spinae + weak abdominals + weak gluteals.

What causes increased lumbar lordosis in lower crossed syndrome?

Shortened iliopsoas anteriorly tilts the pelvis, while tight lumbar extensors reinforce the imbalance.

Excessive subtalar pronation is associated with what additional mechanical problems?

Genu valgum and increased mechanical stress at the knee, hip, and lumbar spine.

What is tensegrity?

Tension + integrity; interconnected structural stability through fascial and musculoligamentous tension.

How does the tensegrity model explain regional somatic dysfunction?

Hypomobility in one region may produce compensatory hypermobility elsewhere, and vice versa.

“Sudden unloading of muscle spindle fibers results in the quieting of gamma motor gain to the muscle spindle, leading to the resetting of the tension of the hypertonicity of muscle fibers”

Proposed mechanism of fascinated positional release

Neutral position then facilitating force, body part moved to ease, then hold for a few seconds then return to neutral

Steps of facilitated positional release

How do you distinguish thoracic vertebral dysfunction from rib cage dysfunction during palpation?

Worse medially = thoracic vertebral dysfunction. Worse laterally = rib cage dysfunction → evaluate the key rib.

What does unilateral lumbar paravertebral tightness with a more pronounced standing forward-bending test suggest?

Ipsilateral lower-extremity dysfunction → screen the hip, fibular head, tibial rotation, ankle, and foot.

What is the positioning for lumbar flexion dysfunction using facilitated positional release?

Prone → pillow under abdomen → hip flexion, adduction, internal rotation → superior compression for 3–5 seconds.

How is lumbar extension dysfunction treated with facilitated positional release?

Prone → pillow under abdomen → extend and internally rotate hip → extend leg → hold 3–5 seconds.

What is he treating

Facilitated positional release for lumbar spine flexion dysfunction

What’s he treating

Facilitated Positional Release for Lumbar extension dysfunction

medical student has rounded shoulders, forward head posture, and tight pectoral muscles. An exercise program is prescribed to correct upper crossed syndrome.

Which muscle group should primarily be strengthened?

Deep neck flexors (this is upper crossed syndrome)

Type I vs. Type II muscles in crossed syndromes — stretch or strengthen?

Type I (postural): Tight → Stretch.

Type II (phasic): Weak → Strengthen.

Where should lymph pumps be applied after clearing downstream restrictions?

Over the swollen region to promote lymph formation and drainage.

Costoclavicular space boundaries:

Superior: Clavicle

Inferior: First rib

Anterior: Subclavius

Posterior: Anterior scalene

• One inch superior and lateral to the umbilicus —

• kidney

• Inner edge of the pubic ramus —

• urethra

• Lateral margin of the pubic symphysis —

• prostate

• Greater trochanter —

• cecum/ileocecal valve region.

Where is the anterior Chapman point for the urinary bladder?

Midline between the umbilicus and pubic symphysis.

Colonic stimulation progresses through three starting positions:

Splenic flexure → Descending colon

Hepatic flexure → Transverse → Descending colon

Cecum → Ascending → Transverse → Descending colon

What is treated in somatovisceral, viscerosomatic, and viscero-visceral reflexes?

Somatovisceral → Responsible somatic structure

Viscerosomatic → Involved viscera

Viscero-visceral → Both involved viscera

• First rib near the sternum —

• pharynx

weightlifter develops unilateral arm swelling, cyanosis, and heaviness after strenuous overhead exercise.

Which structure is most likely compressed?

Subclavian vein

Ulnar nerve compression at the elbow.

Cubital tunnel syndrome

A 35-year-old man presents with unilateral hand coldness, pallor, and a diminished radial pulse. Imaging reveals a cervical rib.

Which condition is most likely?

Arterial thoracic outlet syndrome

“Tightness can compress the brachial plexus or subclavian artery, producing paresthesia and decreased radial pulse during Adson's test.” Which muscles are affected?

Anterior and middle scalene muscles

Forms the anterior boundary of the costoclavicular space.

Subclavius

The _____forms the anterior boundary of the subcoracoid space. Tightness can compress the brachial plexus and axillary vessels.

Pec minor

ART Indications:

Restricted motion in the presence of articular and/or myofascial

somatic dysfunction (especially in the frail or elderly)

• Circulatory and lymphatic congestion

2nd intercostal space is home to which Chapman points

BETH

Bronchus, esophagus, thyroid, and heart

Upper respiratory Chapman points

T1-4

Lateral femur chapmans points

Broad Ligament-Outer Femur (B)

• Prostate-Outer Femur (P)

• Colon-Anterior Outer Femur (C)

• “Sciatic Neuritis” (aka Lumbosacral radiculopathy)-Posterior

Outer Femur (S)

“Back Pain Causes Spasm”

Order of treating chapmans points

1. Pelvis

2. Anterior points on ganglion

3. Rotary force applied anywhere from 10 sec to 20 min

4. Posterior reflexes if needed

Otitis media chapmans point

Anterior clavicle upper edge beyond crossing the first rib

Posterior: transverse process of C1

What is the fundamental osteopathic principle behind visceral manipulation?

Improved visceral motion leads to improved physiologic function.

What is treated in a somatovisceral reflex causing visceral dysfunction?

The responsible somatic structure.

What is treated in a viscerosomatic reflex causing somatic dysfunction?

The involved viscera.

What is treated in a viscero-visceral reflex?

Both involved viscera.

What force is applied during visceral manipulation?

A force matched to the dysfunctional strain in magnitude, direction, and speed, intended to restore normal tissue distensibility.

Where are the three abdominal collateral ganglia located for ganglia release?

Celiac: Below xiphoid

Superior mesenteric: Halfway between xiphoid and umbilicus

Inferior mesenteric: Just above umbilicus

What is the contraindication to abdominal ganglia release?

Postoperative midline abdominal scar.

What is the key difference between liver pump and splenic pump positioning?

Liver pump: Physician on right, hands above and below right rib cage

Splenic pump: Physician on left, patient's left arm abducted 90°, pressure over left lower costal cartilages

What frequency and duration are used for the splenic pump?

Frequency: 2 compressions per second

Duration: 30 seconds to several minutes

What is the hand placement for the splenic pump?

Right hand: Abducts patient's left arm to 90° with gentle traction

Left hand: Over the lower costal cartilages covering the spleen, fingers following intercostal spaces

What are the contraindications to the splenic pump?

Infectious mononucleosis

Splenic enlargement

Neoplasms infiltrating the spleen

What frequency and duration are used for the liver pump?

Frequency: 2 compressions per second

Duration: 30 seconds to several minutes

what direction is force applied during the liver pump?

Toward the center of the patient's body, springing the ribs inward.

In what direction should pressure be applied during colonic stimulation?

In the direction of normal colonic flow.

High-yield sequence: Cecum → ascending colon → transverse colon → descending colon → sigmoid colon.

What is the sequence of colonic stimulation?

Splenic flexure → descending colon

Hepatic flexure → transverse → descending colon

Cecum → ascending → transverse → descending colon

What are the three contraindications to colonic stimulation?

Bowel obstruction

Abdominal neoplasms

Undiagnosed abdominal pain

Where are the physician's fingers initially placed during abdominal lifts?

Just superior to the inguinal ligament in the lower abdominal quadrant being treated

What is the direction of force for a RIGHT lower-quadrant abdominal lift?

From the right lower quadrant vertically toward the right upper quadrant.

What is the contraindication to abdominal ganglia release?

Postoperative midline abdominal scar.

What indicates successful completion of ganglia release?

Palpable softening or release of the underlying tissue resistance.

What are the main indications for abdominal lifts?

Abdominal visceral ptosis and congestion, including mesenteric congestion.

What is the patient position for abdominal lifts?

Supine with knees bent to 90° and feet flat on the table.

Theory of _____– Compressing muscles past their

neutral position results in a “quieting” of

gamma motor gain to the muscle spindle,

leading to a resetting of the tension and

hypertonicity of the muscle fibers.

Muscle Spindle Reflex in facilitated positional release

Side effects of facilitated positional release, like fatigue, soreness, and stiffness are caused by

restoration of circulation to previously

dysfunctional tissue and release of muscular waste products.

“Method - Neutralize, add facilitating force, guide

to freedoms, return to baseline, reassess” is the method for

Facilitated positional release

“Fast twitch muscles”

Type 2

Slow twitch muscles

Type 1

facet joint pain =

Epidural

Palliative test for cervical radiculopathy =

Shoulder abduction test.

Test to provoke radicular pain

Spurling

Which procedure is used to surgically replace a diseased cervical disc while preserving motion?

Cervical disc arthroplasty.

Which procedure removes a diseased cervical disc and fuses the adjacent vertebrae?

Anterior cervical discectomy and fusion.

Which imaging modality is preferred for evaluating cervical disc herniation and spinal cord compression?

Magnetic resonance imaging.

What are lymphangions, and what is their function?

Contractile lymphatic vessel segments containing smooth muscle and valves that propel lymph forward.

Where is the anterior Chapman point for the appendix?

Right tip of the 12th rib.

What happens to intrinsic lymphangion pacemaker activity without filling?

Pacemaker activity ceases because lymphangion stretch is required to stimulate contractions.

Which receptor-mediated response increases lymphangion contractility?

Alpha-adrenergic receptor stimulation.

Where is head and neck lymphatic drainage vulnerable to restriction?

Jugulodigastric region, between the mandible and first cervical vertebra

Spastic, stiff-legged gait with circumduction =

Upper motor neuron lesion.

Neurogenic thoracic outlet syndrome =

brachial plexus compression.

How long should pressure be maintained during anterior axillary fold release?

30-60 seconds

Which nerve root controls finger abduction?

T1

Which nerve root controls finger abduction?

C7

Which cervical nerve root controls finger flexion?

C8

Where is the anterior Chapman point for stomach acidity?

Left fifth intercostal space.

Where is the anterior Chapman point for stomach peristalsis?

Left sixth intercostal space.

The lecture uses BETH for this high-density Chapman region:

• Bronchus

• Esophagus

• Thyroid

• Heart

Abdominal visceral ptosis or congestion → indicated osteopathic technique?

Abdominal lift → addresses visceral ptosis and congestion to improve visceral motion.

Cervicogenic headache →

second to third cervical facet joint.

Ganglia release → anatomical landmarks for all three abdominal ganglia?

Celiac = below xiphoid. Superior mesenteric = between xiphoid and umbilicus. Inferior mesenteric = just above umbilicus. Patient supine; apply downward pressure until resistance is matched.

Direct technique + repetitive joint movement + restrictive barrier + rhythmic force every 1–2 seconds = ?

Articulatory technique → passive, direct, rhythmic movement through the joint's range of motion while engaging the restrictive barrier.

Myofascial facilitated release → direct or indirect? What are its activating forces?

Both direct and indirect. Activating forces: intrinsic, respiratory, patient cooperation, physician-guided force, and springing/vibration.

What type of technique is articulatory treatment?

Direct, joint-focused; low velocity and high amplitude.