Osteopathic Skills 2

Question 1

Anterior displacement of the vertebrae is know as?

Answer 1

spondylolisthesis

Question 2

Spondylosis involves the separation of the?

Answer 2

pars interarticularis

Question 3

Posterior displacement of the vertebrae is known as?

Answer 3

retrolisthesis

Question 4

Inflammation and fusion of the vertebral bodies is known as?

Answer 4

Ankylosing spondylitis

Question 5

osteoarthritis is associated with the formation of bone spurs called?

Answer 5

Osteophytes

Question 6

Before you lengthen a muscle you always?

Answer 6

Strengthen

Question 7

What does the acronym S.T.A.R.T stand for?

Answer 7

S.ymptom Reproduction/Sensitivity 
T.enderness
A.sympetry 
R.estriction of ROM
T.issue Texture

Question 8

What factors impact tissue health?

Answer 8

Sleep!

Perception of Pain
Sleep deprivation can change the circuitry in the brain in ways that amplify pain, a new study from the University of California has found. For instance, people who develop chronic pain often lose the ability to sleep well, and quickly point to a bad back, sciatica or arthritis as the reason

Directly effects growth and stress hormones, cardio vascular health and arterial supply.

Hormone
Prolactin is released as we sleep by the pituitary gland
Prolactin helps to regulate inflammation
*The rule of the artery rains supreme *

Growth Hormone is produced by the pituitary gland
GH stimulates whole-body protein accretion with protein synthesis occurring in muscular

Arterial
Sleep influences cardiovascular health by regulating hypocretin production in the brain.

(profusion of blood to the tissue, carrying oxygenated blood and fresh nutrients to aim in recovery/maintenance and growth)
------------------------------------------------------------------------------
Congenital factors (Scoliosis) idiopathic/functional

Dietary (intolerance/deficiencies)

Overuse, misuse and abuse (and disuse) factors
(Hypertrophy/Atrophy)

Postural stresses (work/sport/lifestyle related) 
(Ergonomics/Postural adaptations/Imbalances/antalgic)

Psychological factors
(Anxiety and depression)

Neurological deficit 
(Superior Gluteal Nerve L4,5,S1)

Trigger points, OSD
Pathology to the hip may cause the muscles which enclose and surround the joint to guard causing imbalances

Question 9

Describe the techniques used to administer NMT

Answer 9

Longitudinal: Direct pressure along the line of axis of stress/muscle fibres (consider fascial planes of tension)

Cross-fibre Direct pressure against the line of axis of stress/muscle fibres

Traction on fascial tissue
Inhibition: Maintained superficial and deep pressure sustained and firm stretch produces inhibition of muscle response

Question 10

What are the Neurological effects of NMT?

Answer 10

Decrease neuromuscular excitability
Decrease pain (through modulation / non-noxious stimulous)
Decrease muscle tension/spasm by influencing muscle spindles/golgi tendons

Question 11

What are the Psychological effects of NMT?

Answer 11

Increased relaxation

Reduced anxiety

Question 12

What are the Physiological effects of NMT?

Mechanism: Changes in tissue or organ

Answer 12

Increase parasympathetic activity
Increase tissue/organ arterial supply, venous drainage, lymphatic drainage
Increase tissue permeability
Increase relaxation hormones (Seratonin/Oxytocin)
Decrease stress hormones (cortisol)

Question 13

What are the Biomechanical effects of NMT?

Mechanism: mechanical pressure on tissues

Answer 13

Decrease tissue adhesion
Increase muscle compliance
Increase ROM
Decrease passive resistance
Decrease active stiffness
Increase proprioception/muscle control
Increase micro-circulation by dilating blood vessels through stretch

Question 14

What is a neuromuscular lesion?

Answer 14

1. Congestion of the local connective tissues
2. Disturbance of the acid-base balance of the connective tissues
3. Fibrous infiltration (adhesions)
4. Chronic muscular contractions, or hypertonic or hypotonic changes.

Question 15

What are Muscle spindles? How do they work?

Answer 15

Muscle spindles are stretch receptors within the body of a muscle that primarily detect changes in the length of the muscle.
They convey length information to the central nervous system via afferent nerve fibers. This information can be processed by the brain as proprioception.

Question 16

What are Golgi tendon bodies?

Answer 16

Stretch receptors called Golgi tendon organs are found within the collagen fibers of tendons and within joint capsules.

It responds to increased muscle tension or contraction as exerted on the tendon, by inhibiting further muscle contraction.

Question 17

Which NMT technique influances Golgi tendons?

Answer 17

(particularly in the case of longitudinal stroke towards the muscle belly – i.e. away from the insertion)

Question 18

Explain how NMT works?
Compression
Golgi tendon bodies 
Muscle spindles 
Pain Modulation

Answer 18

Compression
General compression reduces the sensitivity of the γ -efferent control of muscle spindles, leading to a decreased tendency to muscle shortening

Direct pressure or longitudinal stretch of Golgi Tendon Bodies leads to muscle relaxation(particularly in the case of longitudinal stroke towards the muscle belly – i.e. away from the insertion)

Muscle spindles are stretch receptors within the body of a muscle that primarily detect changes in the length of the muscle.

They convey length information to the central nervous system via afferent nerve fibers. This information can be processed by the brain as proprioception.

Pain modulation
Possible modulation of pain at the spinal cord level (pain gate theory)

Question 19

How can you optimism application of the technique?

Answer 19

Maintain your ATTENTION, CONCENTRATION, AWARENESS of the tissue condition and response (and the patient)

Vary the contact accordingly: thumb, fingers, pisiform, thenar eminence, knuckles, forearm, elbow

Use passive limb movement to improve the technique if possible (e.g. rotatingthe hip to produce hamstring cross fibre strokes, or abducting the arm to open the intercostals space)

Your body position and posture is key – you must adjust the bench as necessary.

Question 20

Trapezius
0rigin
Inerstion
Action
Nerve innervation
Level
Arterial

Answer 20

Origin	
Superior nuchal line
external occipital protuberance
spinous processes of vertebrae C7-T12, 
Nuchal ligament

Insertion posterior border of the lateral one-third of the clavicle
Acromion process
spine of scapula

Artery
superficial branch of transverse cervical artery or superficial cervical artery

Nerve
Accessory nerve (motor)
cervical spinal nerves C3 and C4 (motor and sensation)

Actions
Rotation, retraction, elevation, and depression of scapula

Question 21

Levator Scapulae 
0rigin
Inerstion
Action
Nerve innervation
Level
Arterial

Answer 21

Origin
Posterior tubercles of transverse processes of C1 - C4 vertebrae

Insertion
Superior part of medial border of scapula

Artery
dorsal scapular artery

Nerve
Dorsal scapular nerve (C5)
cervical nerve (C3, C4)

Actions
Elevates scapula and tilts its glenoid cavity inferiorly by downwardly rotating the scapula

Question 22

Latissumus Dorsi
0rigin
Inerstion
Action
Nerve innervation
Level
Arterial

Answer 22

Origin
Spinous processes of vertebrae T7-L5
Thoracolumbar fascia
iliac crest
inferior 3 or 4 ribs 
inferior angle of scapula

Insertion
Floor of intertubercular groove of the humerus

Artery Thoracodorsal branch of the subscapular artery

Nerve	
Thoracodorsal nerve (C6, C7, C8)

Actions
Adducts, extends and internally rotates the arm when the insertion is moved towards the origin.

When observing the muscle action of the origin towards the insertion, the lats are a very powerful rotator of the trunk.

Question 23

Rhomboids
0rigin
Inerstion
Action
Nerve innervation
Level
Arterial

Answer 23

Origin
Nuchal ligaments
Spinous processes of the C7 to T5 vertebrae

Insertion
Medial border of the scapula

Artery dorsal scapular artery
Nerve dorsal scapular nerve
Actions
Pulls scapulae medially, rotates scapulae, Holds scapluae into thorax wall

Question 24

Teres Major 
0rigin
Inerstion
Action
Nerve innervation
Level
Arterial

Answer 24

Origin
Posterior aspect of the inferior angle of the scapula

Insertion
Medial lip of the intertubercular sulcus of the humerus

Artery
Subscapular and circumflex scapular arteries

Nerve
Lower subscapular nerve (segmental levels C5 and C6)

Actions adduct the humerus, Internal rotation (medial rotation) of the humerus, extend the humerus from flexed position, Depress shoulder

Question 25

``` Teres minor 0rigin Inerstion Action Nerve innervation Level Arterial ```

Answer 25

Origin lateral border of the scapula Insertion inferior facet of greater tubercle of the humerus Artery posterior circumflex humeral artery and the circumflex scapular artery Nerve axillary nerve (C5-C6) Actions laterally rotates the arm, stabilizes humerus

Question 26

``` Infraspinatus 0rigin Inerstion Action Nerve innervation Level Arterial ```

Answer 26

Origin infraspinous fossa of the scapula Insertion middle facet of greater tubercle of the humerus Artery suprascapular and circumflex scapular arteries Nerve suprascapular nerve Actions External rotation of arm and stabilization of glenohumeral joint

Question 27

``` Supaspinatus 0rigin Inerstion Action Nerve innervation Level Arterial ```

Answer 27

Origin supraspinous fossa of scapula Insertion superior facet of greater tubercle of humerus Artery suprascapular artery Nerve suprascapular nerve Actions abduction of arm and stabilizes humerus see part on controversy of action.

Question 28

``` subscapularis 0rigin Inerstion Action Nerve innervation Level Arterial ```

Answer 28

Origin Subscapular fossa Insertion Lesser tubercle of humerus Artery subscapular artery Nerve Upper subscapular nerve, lower subscapular nerve (C5, C6) Actions Internally rotates and adducts humerus; stabilizes shoulder

Question 29

``` Deltoid 0rigin Inerstion Action Nerve innervation Level Arterial ```

Answer 29

Origin the anterior border and upper surface of the lateral third of the clavicle, acromion, spine of the scapula Insertion deltoid tuberosity of humerus Artery thoracoacromial artery, anterior and posterior humeral circumflex artery Nerve Axillary nerve Actions shoulder abducti

Question 30

``` Pectoralis Major 0rigin Inerstion Action Nerve innervation Level Arterial ```

Answer 30

Origin Clavicular head: anterior surface of the medial half of the clavicle. Sternocostal head: anterior surface of the sternum, the superior six costal cartilages, and the aponeurosis of the external oblique muscle Insertion Lateral lip of the bicipital groove of the humerus (anteromedial proximal humerus) Artery pectoral branch of the thoracoacromial trunk Nerve lateral pectoral nerve and medial pectoral nerve Clavicular head: C5 and C6 Sternocostal head: C7, C8 and T1 Actions Clavicular head: flexes the humerus Sternocostal head: horizontal and vertical adduction, extension, and internal rotation of the humerus Depression and abduction of the scapula.[1]

Question 31

``` Pectoralis Minor 0rigin Inerstion Action Nerve innervation Level Arterial ```

Answer 31

Origin Third to fifth ribs, near the costochondral junction Insertion Medial border and superior surface of the coracoid process of the scapula Artery Pectoral branch of the thoracoacromial trunk Nerve Medial pectoral nerve (C8) Actions Stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall, raises ribs in inspiration

Question 32

``` serratus anterior 0rigin Inerstion Action Nerve innervation Level Arterial ```

Answer 32

Origin fleshy slips from the outer surface of upper 8 or 9 ribs Insertion costal aspect of medial margin of the scapula Artery lateral thoracic artery, superior thoracic artery (upper part), thoracodorsal artery (lower part) Nerve Long thoracic nerve (from roots of brachial plexus C5, 6, 7) Actions Protracts and stabilizes scapula, assists in upward rotation.