Flashcards in Exam #1 Deck (95):
1.) Date when osteopaths attempt to gain licensure, vetoed
2.) Legislation passed
State to first license DO's?
AOS did not teach surgery until after _____?
AOA (American Osteopathic Association) formed in _____?
ACO (Associated Colleges of Osteopathy) formed in _____?
When did the ACO set a mandatory three-year program?
Symbol of DO?
Rod of asclepius: Cedar staff (long lived, durable) and snake (wisdom, energy, healing forces).
When was AT Stills lifespan?
When did Still sever ties to regular medicine?
In what year did Still "[fling] to the breeze the banner of osteopathy"?
First osteopathy school started in what year?
What was the name/date of the first DO school?
ASO in 1892, revised in 1894
Who studied the concept of facilitated segment in 1945?
Who studied the characteristics of muscle activity in relation to palpatory diagosis?
J.S. Denslow in 1939
Missouri was the ____ state to license DOs
What are the four principles of osteopathy?
1.) The human body is a dynamic unit of function.
2.) The body possesses self-regulatory mechanisms that are self-healing in nature.
3.) Structure and function are interrelated at all levels.
4.) Rational treatment is based on these principles.
What is the classic osteopathic definition of health?
A natural state of harmony.
What is the equation given in the slides for health? Which component contains health?
(HOST) Patient + disturbance = dysfunction
-Health is contained in the host
Define the components of an individual (3)
2.) Structure + Function
3.) Self-healing and Self-regulation
What are the five models of manipulation? Define the goals of each.
1.) Biomechanical model: Structural, posture, most commonly used.
a.) Optimize function/structure
b.) Improvement of motion
c.) Relief of pain
2.) Respiratory/Circulatory model: Emphasis on movement of fluids, e.g. lymph, blood, CSF, etc. *Focus on CELLULAR respiration*
a.) Improve respiratory capacity
b.) Reduce work of breathing
3.) Neurological model: ANS.
a.) Structure and function of nervous system
4.) Metabolic-Energy model: Focus on inherent energies and forces of the body.
a.) Cranial sacral motions
b.) Fluid fluctuations
c.) Brain functioning
d.) Conservation of energy
5.) Behavioral model: Awareness of how the psyche affects our lives. *Interplay of mind body and spirit*
a.) Emotional release with treatment.
What concept pervades all of the 5 models of manipulation?
What is the carrying angle? What is the normal carrying angle? Who has greater carrying angle, women or men?
-Angle between humerus and forearm.
-Normal is 10-15 degrees.
-Women have greater carrying angle than men because of wider pelvis.
1.) What would VARUM correspond with in the knees?
What disorder will increase the spinal curves?
Define the parameters of somatic dysfunction
1.) Position: of the element as determined by palpation. SEGMENTAL PALPATION.
2.) Restriction of motion, i.e. in the direction of the restrictive barrier.
3.) The direction in which the motion is freer: The direction the vertebra with a somatic dysfunction will move into.
If a vertebra is rotated right, in which direction is the SP rotated?
To the left
Describe a right rib hump in terms of spinal convexity/concavity, vertebral rotation, and side bending.
Concave left, convex right. Right vertebral rotation. Side-bent to the LEFT.
Who developed the principles for spinal mechanics? What are they called?
Fryette --> Fryette's principle (Type I and Type II mechanics)
Which axis/plane do the following movements take place?
1.) Rotation: Around vertical axis, within a horizontal plane.
2.) Sidebending: Around A-P axis, within a coronal plane.
Give a general example of notation for a type I diagnosis at L1-3, side bent right.
For diagnosis of somatic dysfunction within Type I mechanics, complete the following:
1.) Apply motion testing in a ______ direction.
2.) Sidebending named for which way?
3.) ______ side indicates direction of side bending.
2.) Side bending named for THE WAY IT WANTS TO GO.
3.) Concave side
Somatic dysfunction is named for what?
The way a segment will move.
In a type 1 group curve, how will flexion and extension affect the orientation of the TPs?
It will not affect them. They will remain in the same position
Where is a type II dysfunction found?
At the apex (midway in the curve) or extremes of Type I curves at transitional areas or by themselves.
Give an example of type II diagnoses
Tx F/E Rx Sx
T = vertebral level
F/E = is symmetry regained during flexion or extension?
Rx = Rotated which way?
Sx = Side bent which way?
What is the third principle of spinal mechanics?
When motion occurs in any one plane within a joint or region, ***motion in all other planes of that joint will be influenced***
Which muscles are largely responsible for a type II somatic dysfunction?
Which muscles are largely responsible for a type I somatic dysfunction?
Erector spinae (hypertonic)
Give six examples of soft tissue
What is a purpose of fascia as it relates to muscles?
Contraction and motion of the muscles are guided by fascia
What type of fibers allow the tendons to attach to their insertions in the bone?
Give the locations of these receptors. What do they do?
1.) Muscle Spindle
2.) Golgi tendon organ
*They provide continuous feedback and adjustment of muscular tone*
1.) Belly of muscle
2.) Myotendinous junction
What does a muscle spindle do?
When a muscle lengthens or shortens, the spindle conveys information which results in contraction OR inhibition of the involved muscle.
Regarding muscle spindles...1.) Lengthening leads to _______.
2.) Shortening leads to _______.
3.) According to video, muscle spindle is all about _________.
3.) RATE of change in length.
How do lateral curves relate to landmarks?
1.) Suprasternal/jugular notch
2.) Angle of Louis
3.) Xiphiod process
5.) Iliac crest
6.) Inferior angle of scapula
7.) Spine of scapula
1.) Anterior to T2
2.) Anterior to T4
3.) Anterior to T9
Where do fryettes mechanics apply?
Thoracic and lumbar (not cervical)
What causes increased kyphosis or lordosis?
1.) osteoporosis, compression, degeneration
2.) obesity, pregnancy, high heels
3.) unequal use, genetic growth
Plum line, what, where does it pass through (7)?
Posterior to apex of coronal suture, External Auditory Meatus, Humeral Head, Middle of L-3 Vertebra, Femoral head, Just behind mid-knee, Just anterior to lateral malleolus
Where does the gamma motor neuron (efferent) go?
To intrafusal fibers in ***muscle spindle***
Where do alpha motor neurons go? What does it make muscles do?
To extrafusal muscle fibers. Instructs muscle to contract.
The central region of a muscle spindle LACKS ______ and ______ contract.
The central region of a muscle spindle LACKS MYOFIBRILS and DOES NOT contract.
Golgi tendon provides 1.)________ that prevents too much 2.)______ in the muscle.
1.) negative feedback
What type(s) of muscle fibers conduct 1.) Muscle spindle 2.) Golgi tendon
1.) 1a and 2
The Golgi tendon is stimulated when this small bunch of muscles is "______", by _______ or _______ the muscle. The Golgi detects ______.
"tensed," by CONTRACTING or STRETCHING the muscle. The Golgi detects TENSION.
1.) The lengthening reaction excites a single a.) _______ interneuron that affects the individual muscle without b.) _________.
2.) This decreases the _______ impulses from the alpha motor neuron to the involved muscle.
1.) a.) inhibitory b.) affecting adjacent muscles
Define direct vs indirect, passive vs active
1.) Into the barrier
2.) Away from the barrier
3.) Involves patient muscle contraction
4.) Involves no patient activity
Acute (8) vs chronic (14) – characteristics of each
Acute: sharp pain, warm moist, inflammation, ROM not nessisarily affected, muscle hypertonicity, boggy, edeminous, somatoviceral effects are minimal.
Chronic: dull pain, cool, dry, scaley, decreased sweating, blemished skin, limited ROM, fibrotic, ropey, doughy, flaccid, poor lymphatic pump, somatoviceral effects are common
What is the ultimate goal of manipulative treatment?
Help restore the capacity of the tissue to respond to stressors
Goal of myfascial treatment (4)?
1.) Relaxation of contracted muscles
a. Decreases pain
b. Allows for normalized range of motion across a joint.
c. Decreases the oxygen demand of the muscle
2.) Increase circulation to an area of ischemia
a. Supplying blood carrying oxygen and nutrients to the tissues
3.) Increased venous and lymphatic drainage
a. Decreases local swelling and edema
b. Removes harmful metabolic waste products
4.) A stimulatory effect on the stretch reflex in hypotonic muscles
What is a direct technique? Indirect?
Goes through the restrictive barrier to establish a normal ROM back to the physiologic barrier.
Indirect technique is the opposite, it shortens and goes away from the restrictive barrier.
Kneading, lateral stretch definition?
Go SLOW, muscle spindle responds to muscle length and rate of change in length – don’t want to invoke reflex.
Lateral stretch is at 90 degrees from muscle origin and insertion.
Initial set up position of treatments – towards diagnosis or barrier?
3.) Muscle Energy
1.) to barrier
2.) to freedom
3.) to barrier
4.) to barrier
Treating with reciprocal inhibition – what is it?
If you contract the antagonistic muscle it leads to relaxation of the opposing muscle. For example, contraction of the quad would lead to relaxation of the hamstring.
What does the thoracic duct drains into?
Left subclavian vein - Left side of head, LUE and cysterna chyli feed thoracic duct which passes through the thoracic outlet.
At what age does a child develop a normal lordotic curve?
Discuss the rule of 3's, T1-T12
Regarding the SP's
T1-T3: Same vertebral level
T4-T6: project 1/2 segment below
T7-T10: One full segment below
T11: 1/2 below
T12: Same vertebral level
Distinguish difference between trigger point and tender point?
Trigger point: Taut band of skeletal muscle with hyperirritable focus palpated as discrete nodule; referral pattern of pain.
Tender Point: a palpable tissue texture change. They are discrete, small, tense and edematous areas approximately the size of a dime. It is tender to an amount of pressure that would not normally cause pain. They can be anterior or posterior. Tender points can be located in ligaments, tendons, muscle or fascia.
Know chart of somatic disorder locations
T1-T6 - Organs above diaphragm (lungs, heart, eyes)
T5-T9- Organs just under the diaphragm (stomach, gall bladder)
T9-T12 - Organs in between T5-T9 and T12-L2 (ovaries, upper ureter)
T12-L2 - Organs just above pelvic diaphragm (sigmoid colon, bladder, uterus)
When motion of the spine become fixed, _____ results.
Where would type II's be found. When should they be treated in relation to the type I?
At the apex or extremes of a group curve. Type II's should be treated first.
What is the appendicular fascia layer?
Each muscle is surrounded by appendicular fascia (deep investing fascia). This fascia passes between the pannicular and the axial fascial layers until they can make an attachment in the midline (spinous processes and sternum or ribs). The axial fascia is divided into hypaxial which is the anterior tube and epaxial which is posterior tube.
Contraindications of 1.) Counterstarin and 2.) HVLA?
1.) Counterstrain: Absence of somatic dysfunction, Lack of patient consent or cooperation, Presence of fracture in the area of treatment, Presence of a torn ligament in the area of treatment, Patient who cannot voluntarily relax, Children who are unable to remain passive, Severely ill patient, Vertebral artery disease-esp. with marked rotation & hyperextension, Severe osteoporosis (usually not a problem)
2.) HVLA: Absolute contraindications include; Upper cervicals Rheumatoid arthritis, Down Syndrome (odontoid ligament instability w/ RA and trisomy 21 causing ligament rupture), Achondroplastic dwarfism, Chiari malformation, Fracture, dislocation, joint instability, Ankylosis, spondylosis w/ fusion, Surgical fusion, Klippel-Feil syndrome, Vertebrobasilar artery insufficiency, Inflammatory joint disease, Joint infection, Bony malignancy and Patient refusal. Some relative contraindications include; Acute herniated nucleus pulposus, Acute radiculopathy, Acute whiplash, severe muscle spasm, strain/sprain, Osteopenia, osteoporosis, Spondylolithesis, Metabolic bone disease and Hypermobility syndromes.
What are the four layers of fascia?
1.) Pannicular: Superficial, covers entire body. Highly variable fat content.
2.) Axial and Appendicular: Extremity and core fascia. Deep to pannicular. Regional names.
3.) Meningeal: Brain and spinal cord.
4.) Visceral: Inside the trunk, surrounds body cavities.
Most areas of fascial or bony restrictions are found where?
Transitional zones, e.g. thoracolumbar, lumbosacral, etc.
What type of technique is counterstrain?
Indirect, passive technique
Muscle energy and HVLA are _______ techniques.
Direct techniques are when the patient is positioned _______ the barrier. How is this related to the side of the diagnosis/somatic dysfunction.
TOWARDS THE BARRIER, opposite to the diagnosis/somatic dysfunction.
Muscle energy can be used for what?
To restore normal muscle tone and/or improve joint mechanics.
During muscle energy, in what dimensions is the patient engaged?
All 3 dimensions.
Muscle energy technique is directed in the direction of _______.
Contraction (toward the freedom)
1.) AT Still born
2.) moved to Missouri
3.) meningitis epidemic, 3 daughters died
4.) experimented with different fields of medicine (homeopathy, hydrotherapy, bone setting, magnetc therapy, etc)
5.) severes ties to traditional medicine
6.) “flung the banner of osteopathy”
7.) moves to Kirksville, MO
8.) clinic in Kirksville is stable
9.) first school chartered
10.) school charter revised
11.) publishes “Philosophy of Osteopathy…”
1.) 1828, Lee County Virgina – AT Still born
2.) 1837 – moved to Missouri
3.) 1864 – meningitis epidemic, 3 daughters died
4.) 1864-1870 – experimented with different fields of medicine (homeopathy, hydrotherapy, bone setting, magnetc therapy, etc)
5.) 1874 – severes ties to traditional medicine
6.) 1874, June 22 – “flung the banner of osteopathy”
7.) 1875 – moves to Kirksville, MO
8.) 1889 – clinic in Kirksville is stable
9.) 1892 – first school chartered
10.) 1894 – school charter revised
11.) 1902 – publishes “Philosophy of Osteopathy…”
The widely held theory is that counterstrain is the _________
Activation of the muscle spindle
In counterstrain, the amount of pressure needed to elicit a tender point is equivalent to.....
The amount of pressure required to blanch the nail bed of the diagnosing finger
What is the difference in pain between a trigger point and a tender point?
Trigger = radiation of pain
Tender = no radiation
In counterstrain, the goal % of pain reduction is what?
What is the therapeutic pulse?
A pulse at the tender point that is of the same frequency as cardiac rate. It is NOT present before positioning the patient. It disappears as the myofascial tissue relaxes.
In scoliosis, a curve that is sidebent left is called a ______
Right scoliosis, or dextroscoliosis because the CONVEXITY IS TO THE RIGHT!
How is scoliosis classified (4)?
1.) Its reversibility
Define the treatment/results of the following angles
4.) Progression of ____ is an indication for treatment
1.) Should be treated
2.) compromises resp function
3.) compromises cardiovascular function
What are the three lines to evaluate leg length?
1.) Iliac crest
2.) Sacral base
3.) Femoral heads
Name and describe the common causes for 3 types of scoliosis in order of decreasing frequency
1.) Ideopathic: Appear at 10-15 years of age. More in women.
2.) Congential: Present at birth, may be myopathic or neuropathic.
3.) Acquired: May result from OSTEOMALACIA, Vit D deficiency.
1.) _____ in every _____ children are diagnosed with scoliosis by the age of _______.
2.) Only 1 in _______ will have clinical symptoms.
3.) Curvatures in _____ are ______x more likely to progress, especially during periods of rapid growth.
1.) 10 in every 200 children. By the age of 15
2.) 1 in 200
3.) girls, 3-5x more likely
List the locations of scoliosis (5), starting with the most common
1.) Double major
2.) Single thoracic
3.) Single lumbar
4.) Junctional thoracolumbar
5.) Junctional cervicothoracic
Where is the most common location for short leg pain in scoliosis?
Illiolumbar ligament on the short leg side
If the scoliosis is removed but a leg is still short, what are the possible ddx (3)?
1.) Anatomical short leg (deltaFHU)
2.) Short seated hemipelvis (deltaSeHP)
3.) Ideopathic sacral base unleveling (deltaSBU)