Direct vs Indirect

Question 1

Vertebral Segment

Answer 1

Single vertebrae

Question 2

Vertebral Unit

Answer 2

2 adjacent vertebrae and their associated elements

Question 3

Associated elements of vertebral unit

Answer 3

1. Ligamentous
2. Intervertebral disk
3. Arthrodial
4. Muscular
5. Neural
6. Vascular, including lymphatics

Question 4

How do we name vertebral motion?

Answer 4

In relation to segment below and for movement of a point on the anterior/superior portion of the vertebral body

Question 5

What does the posterior component refer to? Anterior?

Answer 5

Prominent transverse process; less prominent

Question 6

Fryette 3rd Law of Motion

Answer 6

When one motion is introduced, it reduces the amount of the other motions

Question 7

What are atypical vertebrae

Answer 7

Do NOT follow Fryette’s rules due to their anatomy

Question 8

What is AT Still’s birthday? Where was he born?

Answer 8

August 6th, 1828 - Virginia

Question 9

AT Still’s letters after his name. Where did he study medicine?

Answer 9

MD, DO - Kansas City School of Physicians and Surgeons

Question 10

AT Still’s dad’s professions

Answer 10

Farmer, physician, and minister

Question 11

What are the 3 atypical vertebrae?

Answer 11

1. OA - occiput on atlas (C0 on C1)
2. AA - atlas on axis (C1 on C2)
3. Sacrum

Question 12

What are all techniques based off of?

Answer 12

The Barrier Concept

Question 13

What does The Barrier Concept describe? Contain?

Answer 13

Describes motion in a joint or in a tissue in ONE plane; contains neutral point along with barriers

Question 14

What do we have in SD in relation to Barrier Concept?

Answer 14

Additional barriers and pathological neutral

Question 15

Barrier defines what?

Answer 15

Limit of motion

Question 16

What makes up normal joint motion and barriers to that motion?

Answer 16

1. Balance point - O
2. Physiological barrier - PB
3. Anatomical barrier - AB

Question 17

What is the balance point?

Answer 17

Midline between physiologic barriers

Question 18

What can be altered by warm up?

Answer 18

PB

Question 19

When does tissue disruption occur?

Answer 19

Beyond the AB

Question 20

What is a Restrictive Barrier?

Answer 20

Change in ROM

Question 21

What happens because of a RB?

Answer 21

Pathologic neutral (asymmetric point of balance)

Question 22

What makes up somatic dysfunction and barriers to motion?

Answer 22

1. O - balance point
2. PB
3. AB
4. RB
5. SD

Question 23

Full definition of Restrictive Barrier

Answer 23

A functional limit within the anatomical ROM, which abnormally diminishes the normal physiologic range

Question 24

What is another term for the ROM?

Answer 24

Quantity; tissue motion

Question 25

What is the Quality of motion?

Answer 25

Endfeel

Question 26

What is the Endfeel of motion?

Answer 26

Perceived as an anatomic or physiologic barrier as approached

Question 27

What is Endfeel used for?

Answer 27

Describe osteopathic manipulative procedures

Question 28

How do we tell what the tissues are doing?

Answer 28

Based on what our hand FEEL

Question 29

3 examples of "End Feel" descriptions

Answer 29

Firm, rubbery, boggy

Question 30

Diagnosis with TART

Answer 30

1. What you feel 2. What you see 3. How it responds to motion testing 4. Tender?

Question 31

Is TART equal?

Answer 31

No; some more equal than others depending on which technique to choose

Question 32

What skill is needed for to define Barrier Mechanics?

Answer 32

Restriction in Motion

Question 33

What is the Manipulative Description?

Answer 33

1. Your goal? 2. Which technique? 3. How much? 4. How often?

Question 34

How do we choose the right technique?

Answer 34

1. Initial positioning | 2. Find activating force

Question 35

Definition of "Direct Treatment"

Answer 35

A manipulative technique where the restrictive barrier is engaged; the dysfunctional body part is moved into the restrictive barrier until tissue tension is localized in all planes and directions, then an activating force is used to either move through the barrier or release the barrier in increments

Question 36

3 main points with Direct Treatment

Answer 36

1. Position in restrictive barrier 2. Localize in all planes 3. Utilize activating force

Question 37

Definition of "Indirect Treatment"

Answer 37

A manipulative technique where the restrictive barrier is disengaged; the dysfunctional body part is moved away from the restrictive barrier until tissue tension is equal in one or all planes and directions

Question 38

3 main points with Indirect Treatment

Answer 38

1. Position in direction of freer motion 2. Balance tension on all sides, hold 3. Released via inherent forces

Question 39

Definition of inherent force?

Answer 39

Using the body's natural tendency to seek homeostasis, inherent force is the rhythmic activity in all tissues that work to improve the hydrodynamics and bioenergetics factors around the restricted tissues and articulations

Question 40

Direct engages what? What about its Activating Forces?

Answer 40

Restrictive (pathological) barrier; its activating forces vary

Question 41

Indirect engages what?What about its Activating Force?

Answer 41

Moves away from restrictive barrier to a point of ease (new pathological neutral); the activating force is the inherent force of the body

Question 42

6 Direct Techniques

Answer 42

1. Direct Myofascial Release (D-MFR) 2. Articullatory (ART) 3. Muscle Energy (ME or MET) 4. Soft Tissue (ST) 5. High Velocity, Low Amplitude (HVLA) 6. Direct Osteopathic Cranial Manipulative Medicine (OCMM)

Question 43

6 Indirect Techniques

Answer 43

1. Counterstrain (CS) 2. Indirect balancing 3. Faciliated Postural Release (FPR) 4. Balanced Ligamentous Tension (BLT) 5. Osteopathic Cranial Manipulative Medicine (OCMM) 6. Indirect Myofascial Release (I-MFR)

Question 44

What is the "Combined Technique"

Answer 44

First INDIRECT, then direct

Question 45

3 Activating Forces in Direct Technique

Answer 45

1. Operator induced 2. Patient activated 3. Inherent force

Question 46

Activating Force in Indirect Technique

Answer 46

1. Inherent forces

Question 47

Describe Soft Tissue Treatment. What is its Activating Force?

Answer 47

Direct. Directed toward tissues other than skeletal or arthrodial elements, which involves lateral/linear stretching, deep pressure, traction and/or separation of muscle origin and insertion while monitoring tissue response and motion changes by palpation Activating Force: intermittent engagement and release of the restricted tissues

Question 48

Describe Direct Muscle Energy Technique. What is its Activating Force?

Answer 48

Patient voluntarily moves their body from a precisesly controlled position against a controlled resistance applied by the physician Activating Force: patient induced

Question 49

Describe Indirect Counterstrain. What is its Activating force?

Answer 49

A treatment form in which a tender point is monitored for continual palpatory feedback as the patient is positioned to a “point of ease” and held for 90 seconds to achieve release of myofascial tissues; the patient is passively returned to the “normal” position. Activating Force: inherent force

Question 50

Describe Indirect Myofascial Release. What is its Activating Force?

Answer 50

A treatment form which engages continual palpatory feedback to achieve release of myofascial tissues; with indirect MFR the myofascial tissues are moved to the balance point or “point of ease” in ALL planes of motion until a tissue release occurs. Activating Force: inherent

Question 51

Describe the Still Technique. Activating Force?

Answer 51

Combined. Indirect-Direct. A technique where the initial movements are indirect; as the technique is completed the movements change to direct forces Activating Force: 1) the inherent release within the soma and 2) the physician’s slow, gentle force through the restrictive barrier