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OPP exam 2 > Mechanisms of Activating forces > Flashcards

Mechanisms of Activating forces Flashcards

1
Q

what is somatic dysfunction?

A

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

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2
Q

what type of texture does a viscerosomatic SD typically have?

A

rubbery

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3
Q

what is tissue texture of arthrodial SD?

A

bony end feel at the restrictive barrier

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4
Q

what is the feel of Muscular SD

A

tense end feel
ropey
tight

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5
Q

what does SD associated wtih strain/counterstrain have?

A

tender points have more tenderness

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6
Q

what are factors that predispose people to SD?

A

posture

gravity

anatomical anomalies

transitional areas

muscle hyperirritability (emotional stress, infection)

trauma

compensation for other structural deficits (short leg, muscle imbalance)

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7
Q

what do DO’s call arthrodial somatic dysfunction?

A

won’t complete full motion

NOT “subluxed” “out of place” “out of joint”

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8
Q

2 main theories of why we have SD?

A

Proprioceptive
Nociceptive

usually combo of the two

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9
Q

what did Korr have to say about proprioceptive theory

A

“A muscle, by changes in the degree of activation and deactivation of its contractile mechanisms, becomes the major and highly variable impediment to mobility of the lesioned joint.”

alteration in both intrinsic and extrinsic reflexes

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10
Q

what is gamma gain

A

inappropriate activity which creates inappropriate muscle length and tone
resulting in a functionally imbalanced joint

can be helped with OMT

it is one of the determinants of the physiological motion barrier and the motion barrier of SD

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11
Q

what are the three types of neural feedback that provide proprioceptive input to the spinal cord about muscle length and tension in the musculoskeletal system?

A

Primary annulosprial endings of afferent fibers (muscle spindle)

secondary flower spray endings (muscle spindle)

golgi tendon organs

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12
Q

what do primary annulospiral endings transmit ?

A

info on the length and rate of change in length of muscles

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13
Q

what is the muscle spindle?

A

connective tissue sheath that encloses intrafusal muscle fibers with each end of the spindle attached to extrafusal muscle fibers

innervated by a single group Ia afferent fiber and a single group II afferent fiber

DOES NOT transmit info about absolute length of the muscle, just the length of the spindle relative to the length of the muscle

connected in PARALLEL

intrinsic (in the muscle itself)

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14
Q

what do secondary flower spray endings transmit info about?

A

relative muscle length

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15
Q

what are golgi tendon organs

A

specialized stretch receptors located in tendons that transmit info on muscle tension

connected in series with extrafusal fibers

contraction induces firing of the golgi tendon organs and this sends info into the spinal cord

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16
Q

what is the extrinsic reflex system?

A

anterior horn cells of the alpha and gamma efferents to the muscle receive synaptic impulses from sensory nerves originating in other muscles or organs

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17
Q

what supervises both intrinsic and extrinsic reflex systems?

A

suprasegmental reflex systems = cerebral cortex

this system is probably what is responsible for us not getting more SD than we have as well as activities of daily living

in SD the muscles and reflex activity have isolated themselves from the suprasegmental control.

example?
reciprocal inhibition of antagonist muscles (biceps/triceps)

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18
Q

what is spinal facilitation

A

areas of the spinal cord will stay hyperexcitable and hyperirritable playing a role in SD

muscles in this area of hypertonic

these areas sometimes have increased muscle activity as well as pain and tenderness when palpated

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19
Q

somatosomatic reflexes

A

defensive reflex

info coming through soma and causes reflex and get response back through motor neurons to other area of body (example→ defensive reflex such as stepping on a nail) (effecting body part and going back out and affecting another body part)

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20
Q

viscerovisceral reflexes

A

organ to another organ

digestion→ when we eat, distention of the gut causes increased contraction of the gut muscle

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21
Q

somatovisceral reflexes

A

info in from soma and affects visceral organ

irritate abdominal skin it slows down digestion→ in rats

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22
Q

viscerosomatic reflexes

A

problem in the viscera, input that goes from that organ into the spinal cord and causes reflex muscular activity of the paraspinal levels at that level of the spinal cord

example upper back pain with an MI (will probably feel tight muscles, ropey)

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23
Q

nociceptive theory

A

noxious stimulus comes in and stimulates the nociceptor

the nociceptor can then stimulate sypathetic activation, which leads to visceral effects or immune effects

the nociceptor can also stimulate spinal cord nocifensive reflexes –> leading to shortened skeletal muscle –> maintained shortened muscle–> connective tissue reorganization in shortened form (scar tissue)

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24
Q

why is pain generated by parts of the body that are adapting and not by parts that have impaired function?

A

Nociceptors are more likely to be stimulated by joint movements especially abnormal movements from adaptation or hypermobility, than by joint restriction.

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25
Q

how does OMT work?

A

omt tends to actively stretch the CT tissues in joint capsules, tendons, muscles and ligements in restricted motion

BUT stretching would make SD worse b/c it increases the proprioceptive and nociceptive drives

SOOOOO OMT must FIRST DECREASE OR OVERRIDE THESE DRIVES prior to stretching the tissue

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26
Q

HVLA

A

employs a rapid, therapeutic force of brief duration
elicits release of restriction

best suited to SD with restricted motion with a hard boney end feel

useful when not much time is available

discouraged to treat the same segment more than once a week due to the possibility of causing joint hypermobility

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27
Q

what is end feel

A

quality of motion at is final barrier

what the barrier feels like!

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28
Q

how does HVLA work. what are the steps?

A

doc places pt’s restricted joint to the restrictive barriers of the SD by stacking in each plane of the SD

a short (low amplitude) quick (high velocity) force is applied to the joint to move it through the restrictive barrier (NO BACKING OFF OR WINDING UP)

the joint resets itself and appropriate physiological motion is restored

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29
Q

HVLA mechanisms (direct technique)

A

abnormal muscle activity maintains joint restriction

when treating joint, there is an immediate change in the muscles and the quality and quantity of motion, which suggests an immediate change in neural activity

sudden stretch or change of position (as with HVLA) alters the AFFERENT OUTPUT of the mechanoreceptors in the joint capsule

reflexively switches off muscles that are tight in that area (release of hypertonicity)

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30
Q

do you need the snap, crackle or pop for successful treatment?

A

no

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31
Q

HVLA contraindications

A 
Rheumatoid arthritis 
Down syndrome 
Achondroplastic dwarfism 
Chiari malformation 
Fracture / dislocation / spinal or joint instability 
Ankylosis / Spondylosis with fusion 
Surgical fusion 
Klippel-Feil syndrome 
Vertebrobasilar insufficiency 
Inflammatory joint disease 
Joint infection 
Bony malignancy 
Patient refusal
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32
Q

what is MET (direct technique)

A

using patient’s muscles on request, from controlled position, in a specific direction, against a distinctly executed physician counterforce

important in the treatment of edema and congestion

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33
Q

what are the steps of MET

A

find restricted joint
take joint to restricted barrier (take joint where it doesn’t want to go)
have the patient apply counterforce to EASE for 5 seconds
pause for 2-3 seconds for neuromuscular adaptation

resposition to the new restrictive barrier
repeat until no further change is obtained
REASSESS
(this is isometric, muscle stays the same length)

34
Q

what are the MET types of therapeutic muscle contractions?

A

Isometric - no length change (most common)

Isotonic - length change (good for hypotonic), reflexively inhibited muscles

  • concentric
  • eccentric
  • isolytic eccentric
  • isokinetic
35
Q

concentric ?

A

shortening

“the patient wins”

36
Q

eccentric?

A

lengthening “the doc wins”

37
Q

isolytic eccentric

A

quick movement

used to treat fibrotic or chronically shortened myofascial tissues

38
Q

isokinetic

A

concentric or eccentric

where the length change occurs at a constant velocity/pace

39
Q

Post-isometric relaxation

A

the pause during MET

this is immediately after an isometric contraction, the neuromuscular apparatus is in a refractory state during which passive stretching may be performed without encountering strong myotatic reflex opposition (the nervous system isn’t guarding)

this is where the treatment is taking place and not in the contraction itself

40
Q

MET mechanisms by type of activating force

A 
post-isometric relaxation
joint mobilization using muscle force
respiratory assistance 
oculocephalogyric relfex
reciprocal inhibition
crossed extensor reflex
41
Q

joint mobilization using muscle force

A

using alot of force to do the MET contraction

releases joint surfaces

42
Q

respiratory assistance

A

using their breathing to provide activating force of treatment

43
Q

oculocephalogyric reflex

A

using the eye muscles

and their is a reflex that goes to upper neck muscles

GOAL= to effect reflex muscle contractions using eye motion
exceptionally gentle force of contraction

44
Q

reciprocal inhibition

A

when a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of that muscle’s antagonistic group

GOAL–> to lengthen a muscle shortened by a cramp or acute spasm

very gentle force of contraction

good for acutely injured or painful muscles

45
Q

crossed extensor reflex

A

When the flexor muscle in one extremity is contracted voluntarily, the flexor muscle in the contralateral extremity relaxes and the extensor contracts.

Used in the extremities where the muscle that requires treatment is in an area so 
severely injured (e.g., fractures or burns) such that manual contact with the affected limb is inadvisable.

very gentle force of contraction

46
Q

Absolute contraindications for MET

A

Absence of somatic dysfunction
Lack of patient consent and/or cooperation
Oculocephalogyric reflex technique in someone with recent eye surgery or trauma

47
Q

what are the absolute contraindications for MFR?

A

absence of somatic dysfunction

lack of patient consent and or cooperation

48
Q

what are the contraindications for doing OCF

A

increased intracranial pressure

acute intracranial bleeding

skull fracture

scute cerebrovascular accident

49
Q

what is strain /countersrain technique?

A

it is an indirect technique

SD diagnosed by myofascial tender point, is treated by using a position of spontaneous tissue release while simultaneously monitoring the tender point

50
Q

steps of Strain/Counterstrain

A

Palpate for areas of increased sensitivity (tenderpoints)

Establish a pain scale (“this is a 10”)

Place the patient passively in a position that will eliminate this tenderness (pain scale 3 or less)

Maintain this position for 90 seconds while continuously monitoring the point (light touch) (let up on the pressure so you may palpate the pulsation)

Passively return the patient’s body to its original position

Recheck the tenderpoint

51
Q

how is a tender point formed?

A

Development of an inappropriate proprioceptive reflex caused by the gamma system

Rapid lengthening of myofascial tissuse –> afferent feedback indicates possible damage from a strain > the body tries to prevent damage by rapidly contracting the myofascial tissue –> this causes the antagonist muscle to rapidly lengthen and produces the inappropriate reflex and the tenderpoint

Nociceptive feedback from the antagonist muscle is interpreted as a muscle strain (although one hasn’t occurred) –> hypertonic myofascial tissue and restricted motion (SD)

A guarding reflex by the patient, without actual trauma, may also produce the inappropriate reflex.

52
Q

what are the S/CS mechanics?

A

The already shortened and restricted tissues are initially further shortened, removing all internal stresses and resetting gamma gain and deactivating the nociceptors

Maintaining the comfortable position for 90 seconds allows local circulation to improve due to reduction of chronic sympathetic stimulation

Local inflammation and edema decrease as the noxious chemicals are carried away

Slowly returning to neutral will passively stretch the connective tissues

53
Q

absolute contraindications to S/CS

A

Absence of SD

lack of patient consent

54
Q

Soft tissue absolute contraindications

A

absence of SD

lack of patient consent

55
Q

what are lymphatic techniques and their purpose?

A

are techniques that are designed to move the lymph

use them in times of the patient having infection, cold, edema, because it helps improve immune response

remove any central impediments first b/c it is a very low pressure system, and then move peripherally

56
Q

lymphatic technique steps

A

remove impediments to lympathic flow starting centrally and moving peripherally

utilize an extrinsic pumping motion that mobilizes lymphatic fluid through:
external pressure
changes in pressure gradients
oscillatory movements

57
Q

lymphatic technique absolute contraindications

A

aneuresis if not on dialysis
necrotizing fasciitis
lack of patient consent or cooperation

58
Q

what is soft tissue technique

A

A direct technique that usually involves lateral stretching, linear stretching, deep pressure, traction and/or separation of muscle origin and insertion while monitoring tissue response and muscle changes by palpation.

59
Q

what are the types of ST manipulation styles?

A 
stretching
kneading
inhibition
effleruage 
petrissage and skin rolling
tapotement (karate chop)
60
Q

what is the best technique for hypotonic muscles?

A

soft tissue technique because it create tonic muscle stimulating by activating the stretch reflex

61
Q

if you have a transverse process that is more posterior to the right what is its dysfunction called?

A

rotated right

62
Q

what if something prefers extension?

A

then you name it extension

63
Q

look at practice questions on fryette’s powerpoint

A

do it

64
Q

what is the goal of myofascial technique?

A

normalize range of motion

65
Q

Deformation of bone and connective tissue along lines of force is an example of what?

A

Wolff’s law

66
Q

pt has right hand contacting the back of his neck and brought to flexion of T6

A

so he is rotated right
and side bent right b/c it is type II

isolating T6

with muscle eneryg take patient into restriction, so we put him in flexion so he is named extension

put up hand on the side of the posterior process

67
Q

the 1st 30 degress of shoulder abduction primarily occurs at which joint?

A

glenohumeral joint

68
Q

which muscle primarily contracts and produces the 1st 30 degrees of shoulder abduction?

A

supraspinatous

69
Q

what muscle is most likely injured in someone with noted decreased external rotation?

A

infraspinatous
teres minor
or posterior head of deltoid

70
Q

subscapularis action?

A 
internal rotation
(medial)
71
Q

where will you most likely find a counterstrain tenderpoint in an injury to the infraspinatous?

A

infraspinous fossa

72
Q

what are you thinking posteriormedial border of the scapula?

A

rhomboids

73
Q

the arterial supply to his shoulder will most likely be improved by treating dysfunction at which levels? in a man who has right shoulder pain after his dog pulled his right arm and he has restricted motion in all directions

A

T2-T6

sympathetics towards the arm

74
Q

stage 1 of spencer’s technique is used to improve extension . so the patient primarily contracts which muscle

A

anterior deltoid

pushing the patient into the restrictive barrier

so they use their anterior deltoid to push into ease or flexion in this case

75
Q

what is an absolute contraindication for spencer’s techniques?

A

LOOK UP, page 31 of lab manual

one of them is septic glenohumeral joint

76
Q

if you have restricted flexion and right rotation what is the dysfunction?

A

E RSL (rotated and side bent left)

77
Q

if your L3 is extended and rotated to the right you would expect to find L3….

A

Side bent to the right

this is a type II dysfunction

78
Q

a fall on an outstretched hand onto palms puts the radial head in what position?

A

posterior

79
Q

if you have right medial elbow pain and on exam you find right wrist that is adducted and an increased carrying angle, what SD is present?

A

abducted ulna

80
Q

medial glide of olecranon (elbow)

A

is abduction of the forearm

wrist adduction

OPP exam 2 (7 decks)

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