Mechanisms of activating forces

Question 1

Describe the various factors that predispose someone to a somatic dysfunction.

Answer 1

1) **Posture: habitual, occupational, sport
2) Transitional areas (OA, thoracic inlet, TL juctions, LS junction)
3) Emotional stress
4) not stretching after exercise

Question 2

Intrinsic reflex system

Answer 2

Muscle spindle that is located w/in the muscle belly
Provide proprioceptive input
transmit info about the length of spindle fibers relative to the length of muscle (**relative length)
–> measure stretch

Question 3

Proprioceptive theory

Answer 3

alteration in both intrinsic and extrinsic reflexes

The alpha motor neuron activity has been abnormally reset to a higher gamma gain, keeping the muscle’s resting length abnormally short

Question 4

GTO

Answer 4

in the tendon, in series with the muscle
tells CNS about relative length CHANGES
to avoid tearing

Question 5

Extrinsic Reflex system

Answer 5

everything spinal cord and in the cerebral cortex. Brain is keeping track of what is going on, sends coordinated signals to the SC which transmits signals to coordinate muscle activities.

Problems arise when brain has not prepped the body for an unexpected movement –> muscle tears

Ex: reciprocal inhibition of agonist/antagonist muscle pairs and visero-somatic muscle guarding

Question 6

gamma gain

Answer 6

determinant of physiological/SD barrier of the SD

reset when muscle movements establish a positive feedback loop which increases gamma gain–>hypertonicity

Question 7

Somatosomatic reflex

Answer 7

e.g. defensive

info from body–>reflex via motor neuron in another body bart (think stepping on a nail)

Question 8

Viscerovisceral reflex

Answer 8

distension of gut causing contraction of the gut muscle

organs–>SC–> output to same or other organs

think food enters gut and stimulates contraction to move bolus

Question 9

Somatovisceral

Answer 9

stimulation of abdominal skin inhibits gut activity

Question 10

Viserosomatic

Answer 10

problem in viscera can cause SD in paraspinals

Not usually resolved after initial tx

Question 11

How does OMT work

Answer 11

override overactive protective mechanisms in a shortened muscle, then actively stretch CT

Question 12

HVLA

Answer 12

Very quick, over short distance that engages the restrictive barrier to release this barrier

Best suited to an SD with restricted motion with a hard/distinctive/firm/bony end feel
(Arthordial SD)

Sudden stretch or change of position of the joint alters the afferent output of the mechanoreceptors in the joint capsule, resulting in release of muscle hypertonicity

the sicker the patient, the lower the dose

Question 13

HVLA contraindications

Answer 13

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

Question 14

MET Contraindications

Answer 14

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

Question 15

MFR Contraindications

Answer 15

absence of SD

lack of pt consent or cooperation

Question 16

OFC contraindication

Answer 16

Increased intracranial pressure
Acute intracranial bleeding
Skull fracture
Acute cerebrovascular accident

Question 17

S/CS contraindications

Answer 17

absence of Sd

lack of pt consent/cooperation

Question 18

Lymphatic technique contraindications

Answer 18

aneuresis if not on dialysis
necrotizing fascitis of area involved
lack of pt consent or cooperation

Question 19

MET

Answer 19

patient’s muscles are actively used on request against a physicians counterforce in order to correct the dysfunction of the joint

can be used at any joint that is crossed by skeletal muscle
** important of edema or congestion
**direct technique
take joint where it does not want to go

Question 20

Isometric MET contractions

Answer 20

no length change, most common

Question 21

Isotonic

Answer 21

Tone is constant, but length change, the counterforce moves

good for hypotonic reflexively inhibited muscles

Question 22

Concentric

Answer 22

shortening, the patient wins

Question 23

eccentric

Answer 23

lengthening, the doc win s

Question 24

isolytic eccentric

Answer 24

quick movement, used to treat fibrotic myofascial tissues

Question 25

isokinetic

Answer 25

concentric or eccentric where the length change occurs at constant velocity

Question 26

Post isometric relaxation

Answer 26

delay after the pt is pushing against you when you can push the muscle past the original barrier without the CNS restricting motion with guarding **critical to wait 2-3 seconds Goal: To accomplish muscle relaxation --> increased ROM Force of Contraction: Sustained gentle pressure

Question 27

Joint mobilization using muscle force

Answer 27

Goal: To accomplish restoration of joint motion in an articular dysfunction Force of Contraction: Maximal muscle contraction that can be comfortably resisted by the physician thought to push out fluid etc

Question 28

Respiratory assistance

Answer 28

breathing to provide active force good for ribs etc Goal: To produce improved body physiology using the patient’s voluntary respiratory motion. Force of Contraction: Exaggerated respiratory motion

Question 29

Oculocephalogyric reflex

Answer 29

uses eye muscles that reflexes back to neck muscles Goal: To effect reflex muscle contractions using eye motion. Force of Contraction: Exceptionally gentle

Question 30

Reciprocal inhibition

Answer 30

using contraction of agonist to relax the antagonist Goal: To lengthen a muscle shortened by cramp or acute spasm. Force of Contraction: Very gentle

Question 31

cross extensor reflexes

Answer 31

agonist on one side to relax on the other side Goal: 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. Force of Contraction: Very gentle

Question 32

Steps to S/CS

Answer 32

1) Palpate for areas of increased sensitivity (tenderpoints) 2) Establish a pain scale (“this is a 10”) 3) Place the patient passively in a position that will eliminate this tenderness (pain scale 3 or less) ---> motion depends on the area involved 4) Maintain this position for 90 seconds while continuously monitoring the point (light touch) 5) Passively return the patient’s body to its original position Recheck the tenderpoint

Question 33

formation of a tenderpoint

Answer 33

**Development of an inappropriate proprioceptive reflex caused by the gamma system caused by rapid lengthening of the antagonist muscle in response to abnormal lengthening of myofascial tissue nociceptive feedback from the antagonist upregulated gamma gain due to rapid myofascial length change that causes an inappropriate reflex on the agonist muscle that when stimulate sends nociceptive signals to the brain which are interpreted as stretch, when there is none.

Question 34

lymphatic techniques

Answer 34

remove impediments to lymphatic circulation and promote and augment flow of lymph if pt has edema, infection, or cold to improve the immune response

Question 35

ST contraindications

Answer 35

absence of SD | lack of pt consent and/or cooperation