October Exam II

Question 1

Who invented counterstrain technique? What is it also known as?

Answer 1

Lawrence Jones D.O. Treated a young man by putting him in a position of comfort and fixed his long term pain. Strain counterstrain SCS

Question 2

Define counterstrain and describe the treatment sequence

Answer 2

1) A system of diagnosis and treatment that considers the dysfunction to be a continuing, inappropriate strain reflex

2) The reflex is inhibited by applying a position of mild strain in the direction exactly opposite to that reflex

3) This is accomplished by specific directed positioning about the point of tenderness to achieve the desired therapeutic response.

SCS is sometimes referred to as indirect method though it does not involve positioning relative to a barrier

Question 3

Summarize the main points in the proposed mechanism for counterstrain

Answer 3

1. Use indirect positioning to shorten the tissues/muscles associated with the tender point
2. Normalize neurophysiologic functioning
3. Correct a somatic dysfunction
4. Reduce/minimize pain

Question 4

Describe the indications and contraindications of counterstrain

Answer 4

Indications
•Acute or chronic somatic dysfunctions
•Somatic dysfunctions with a neural component, e.g., a hypershortened muscle
•As a primary treatment or in conjunction with other approaches
•Somatic dysfunction in any area of the body.

Contraindications

–Absence of somatic dysfunction
–Traumatized (sprained or strained) tissues, which would be negatively affected by the positioning of the patient
–Treating around open wounds or fractures
–Severe degenerative spondylosis with local fusion and no motion at the level where treatment positioning would occur
–Vascular or neurologic syndromes, such as basilar insufficiency or neuroforaminal compromise whereby the position of treatment has potential to exacerbate the condition.
–Lack of patient consent and/or cooperation

Question 5

What are the basic treatment steps related to SCS?

Answer 5

Find the somatic dysfunction

2. Find a significant tenderpoint
3. Establish a pain scale
4. Patient to position of comfort
5. Reduce pain by at least 70% with small arcs of motion
6. Hold for 90 seconds
7. Passively return patient to neutral
8. Recheck the tenderpoint

Question 6

In a basic sense how does the SCS help decrease the firing pattern of the motor neuron?

Answer 6

• Placing the patient into a position of ease usually shortens the muscle spindle
• This allows the muscle spindle to slow down and resume normal firing patterns
• CNS can now interpret the signals properly, so it can reset the gamma motor neurons

Question 7

5 Models of Osteopathic care?

Answer 7

Biomechanical

Respiratory-Circulatory

Neurologic

Metabolic-Energy

Behavioral

Question 8

Explain the concept of joint motion and barriers, with and without somatic disfunction.

How do we simplistically define direct and indirect technique?

Answer 8

At the edge of active range of motion is a physiologic barrier

At the edge of passive ROM is the anatomic barrier

If you have a disfunction your active range of motion will decrease to a restrictive, rather than a physiologic, barrier.

Moving in relation to this restrictive barrier define whether you are using an indirect or direct technique.

Question 9

Define the theraputic philosophy of the direct method in relation to a restrictive barrier

Answer 9

—Engage restrictive barrier so that your activating force can carry the dysfunctional component through the restrictive barrier.

Question 10

When you treat with the combined method techniques are used in which order?

Answer 10

indirect and then direct esp for myofascial

Question 11

Define activating force

Answer 11

—An activating force is a force used therapeutically to effect change in the body, through osteopathic manipulative treatment (OMT).
This applies to both joint and soft tissue treatment

Question 12

When do we talk about the point of balanc ligamentous tension?

Answer 12

This is the point, or direction of ease, described when treating with an indirect method

Question 13

What are some ways to use respiratory force in OMT?

Answer 13

Use as articulatory activating force

Hold breath as long as possible “air hunger”

Use a cough-produce respiratory impulse to assist in release of restrictions

Question 14

Describe a motor unit. How does their composition change based on the type of muscle action required?

Answer 14

• The smallest functional unit of movement is a Motor Unit
• All muscle fibers are innervated by a single nerve fiber

Fine control=few muscle fibers are innervated

Gross action=great number of muscle fibers are activated

This fibers are spread out through out the muscle.

Question 15

What are some factors that affect force production by individual muscle fibes?

What are some factors which affect the number of fibers activated during contraction?

Answer 15

–Fiber cross-sectional area
–Length/tension relationships
–Summation
–Fiber type (fast-twitch Type II, slow-twitch, Type I)

All the muscles fibers innervated by a motor unit will be the same type

Motor unit recruitment patters (small and weak first, large and strong second), and increaing the frequency of activation

Question 16

Describe the surface electromyograph and some of its limiations

Answer 16

•Non-invasive technique
•Skin electrodes acquire electrical signals from active muscle fibres
•It is the sum of activated motor units (MU)
Smaller units are more excitable and are recruited first

Question 17

How do you sustain the force of a muscle contraction and resist fatigue?

Answer 17

During fatigue there is a decreased conduction velocity to the muscles and thus a reduced force of contraction.
This can be mitigated by recruiting more MU to maintain the desired force of contraction.

Question 19

What are the primary motions of the lumbar spine?

What are the most common locations for herniations of the IV disks?

Answer 19

Flexion and extension, facet orientaion discorages SB and rotation

L5 and S1 nerve root (above vertebrae named)

Question 20

What are the most common congenital lumbosacral abnormalities and can you identify them?

Which is common to spinal bifida?

Answer 20

1. Batwing of the transvers process of L5 (not attached to sacrum)
2. L5 transverse process is attached on one side to the sacrum
3. S1 becomes a sixth lumbar vertebrae (not attached to sacrum)
4. L5 becomes attached to the sacrum
5. L4 facets face different directions-sagittal and coronal
6. Incomplete fusion of L5 and S1 laminae (common with spinal bifida as it allows a space for the spinal cord to herniate)

Question 21

What are Fryette’s laws?

Answer 21

Law I: In the neutral position sidebending and rotation will be in opposite directions

Law II: If in a non neutral position (flexion or extension), then sidebending and rotation will be in the same direction (this will be seen in one vertebral segment). Rotation preceeds SB.

Law III: motion of any vertebral seg in one plane will modify its mobility in the other two planes.

Question 22

Fryetts’s principles apply to which areas of the spine?

What’s a type I somatic disfunction?

Answer 22

Thoracic and lumbar only!

SB and Rotation occur to opposite sides (group)

Common cause- Erector spinae hypertonicity: errector spinae muscle + serratus posterior inferior, and spinalis thoracis.

Fryette’s first principle

Question 23

How do you name a type I somatic dysfunction?

Type II?

Answer 23

1. ›Name from the top of curve to the bottom: ex., L1-L5
2. ›Denote that it is Neutral: ex., L1-L5 N
3. ›Denote sidebending component followed by rotational component: ex., L1-L5 N SL, RR.

Type II

1. ›Locate spinal vertebral unit in dysfunction and ascertain its spinal level. Ex., L3
2. ›Naming is always in the direction of ease. If there is more ease of motion in extension vs. flexion we call this segment Extended, or L3 E.
3. ›If there is easier motion with rotation to the right we designate it rotated right or L3 E RR.
4. ›If the vertebrae sidebends easier to the right, it is sidebent right. The official complete nomenclature of our segment is L3 E RR SR, or L3ERSR.
5. ›In Type II Somatic Dysfunction the rotational component precedes the sidebending component.

Question 24

Describe a Type II somatic disfuction including muscles affected

Answer 24

Side bending and rotation on the same side

Multifidus, Transversospinalis, rotatores, and short seg muscles

single segment

Fryettes Law II

Question 25

What is the location of the most common ligament to become tender to palpation with lumbosacral stress?

Answer 25

Ilio-lumbar ligament

Tender point L4-L5 anterior and posterior to the sacroiliac joint

Question 26

Why is the Quadratus Lumborum important to consider when using osteopathic techniques?

Answer 26

It is the functional extension of the abdominal diaphram (assists in breathing) and functions to depresses the ribs and assists in truck flexion and sidebending.

The diaphram can create cervical or lumbar vertebal somatic dysfunction (phrenic nerve C3-5)

This muscle helps facilitate respiratory assist techniques and the flow of lymphatics.

Question 27

Where do the abdominal and pelvic viscera drain their lymphatic supply?

Answer 27

Into the cisterna chyli NOT the inguinal region (the whole body below the diaphram drains into the cisterna chyli)

Question 28

Your patient complains of headache secondary to a cervical spine dysfunction what may be the cause of the headache?

Answer 28

increased venous pressure

Question 29

Explain dysfunction related to dermatomes myotomes and sclerotomes

Answer 29

•Skin pain/paresthesias follow dermatomal pattern
•
•Myotomal pain-cramps, weakness & myofascial trigger points
•
•Sclerotomal pain-vague, deep, toothache-like pain

Question 30

You have a patient with a sero negative chronic inflammatory condition that refers pain to the lumbar spine. What’s the likely cause of this refered pain?

Answer 30

Irritable or inflammatory bowel disease such as crohns

Question 31

Longissimus thoracis requires treatment where and what are the indications for this treatment?

Answer 31

Medial aspect of the ribs posteriorly

Patients present with LBP

or no pain, but present with GERD or IBS (pain referes to this area)

• Stand at side of tender point
• Sidebend patient toward physician
• Extend thigh until find mobile point
• May use knee to support leg

Question 32

How do you use Counter Strain to treat P1-5 L SP and P 1-3 L TP?

Answer 32

Find tender point

stand opposite TP

Pull ASIS and hip toward you to rotate and SB