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Flashcards in Required Reading Assignments Deck (86):

What is the definition of palpation?

The application of variable manual pressure to the surface of the body for the purpose of determining the shape, size, consistency, position, inherent mobility, and health of tissue beneath the skin


Describe a kypholordotic posture.

Head forward, increased lordosis of cervical spine, kyphotic T spine, scapula abduct, increased lordosis of L spine, anterior pelvic tilt, hip slight flexion, knee joint extend, anterior bulging abdomen


Describe the swayback.

head forward, increased lordosis of C spine, kyphotic T spine, decreased lordosis of L spine, post pelvic tilt, hip/knee joint hyper extended.


Describe flat back

head forward, increased lordosis C spine, kyphotic T spine, flat lower T spine, flat L spine, extended hips/knees


Describe Military-bearing posture.

Chest out, stomach in. Head posterior, C/T spine normal. Chest elevated causing anterior C spine and posterior T spine deviation. Increased L spien lordosis, anterior pelvic tilt, knee extend.


Describe anterior postural deviation.

entire body is anteriorly shifted from the plumb line


Describe a posterior postural deviation.

entire body is posteriorly shifted from the plumb line.  lordosis of mid-thoracic spine inferior


What is this postural defect?

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Sway back


What is this postural defect classified as?

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What is this postural defect classified as?

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Posterior postural deviation


What is this postural defect classified as?

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Military-bearing posture


What is this postural defect classified as?

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What is this postural defect classified as?

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What is this type of postural defect?

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Anterior Postural Deviation


What should you feel if a person has an AGRin the cranial region during the AGR screening?

  1. AGR presence will have a leathery like feeling. Will not be hard bony end-feeling.


How will an evaluation feel if there is positive AGR in the cervical, thoracic, lumbar, sacral regions of spine?

  1. AGR regions will have a harder bony end-feel. 
  2. viscero-somatic reflex will have a rubbery end-feel.


What will a rubbery end feel, be indicative of?

Can indicate corresponding viscero-somatic reflex secondary to organ pathology


What is the scale of grading used to classify the AGR of certain regions?

1-3, where 1 is slight restriction and 3 is unmovable.


Fryette's first principle.

  1. With regards to the T/L spine only.
  2. In neutral position (facets are idle, not engaged) sidebending will induce contralateral rotation.
  3. Applies to long parapsinal musculature and therefore 3+ vertebral bodies.


Fryette's second principle.

  1. SD in one vertebral body that is acute and affects only deep paraspinal muscules spanning 1-2 segments. 
  2. Found in Flexed/extended position with ipsilateral sidebending and rotation.
  3. Applies to T-/L-spine only


Fryette's third principle.

Applies to all joints across the entire body.  Initiation of movement in any plane will modify the movement of that segment in other planes of motion.


When should the scoliosis screening exam be performed?

On all pediatrics and anyone suspected of scoliosis based on AGR exam


What are the steps to perform the Scoliosis screening exam?

  1. Pt stand with feet shuolder width apart, and even distribution of weight. 
  2. Stand behind patient
  3. Pt bend forward at the waist with arms relaxed.
  4. Look for asymmetries or paravertebral fullness in the spine and rib cage. (palpate)
  5. Discovery of lateral curve indicates patient to flex until motion is palpated at that level.
  6. support pt's shoulders, while passively sidebending the upper body toward the convexity.
  7. structural scoliosis will not improve with OMT. Functional scoliosis will improve with OMT.


Is OMT to a structural scoliosis curve sitll beneficial to the pt?

yes, it will not be completely resolved but can be beneficial.


List OMT modalities that utilize direct engagement of restrictive barriers.

  1. Articulatory technique
  2. General osteopathic technique
  3. high veolcity low amplitude
  4. muscle energy technique
  5. soft tissue
    1. all mobilize the tissue into the region where it does not want to go.


List the indirect OMT methods of treatment.

  1. Counterstrain (CS)
  2. Facilitated positional release (FPR)
    1. these will both disengage the restrictive barrier and move into position of motion. Allows the tissue to relax and release allows increased motion.


What OMT techniques are considered direct/indirect modalities?

  1. Balanced ligamentous tension
  2. Myofascial release
  3. osteopathy in the cranial field.


What is the technique for articulatory technique?

  1. Low velocity, high amplitude.
  2. engage restrictive barrier
  3. bring body part through barrier for 1-2 seconds with firm force
  4. Relax area for 1-2 seconds, just short of barrier
    1. causes restrictive barrier to shift with treatment and increases motion
  5. re-engage new barrier until progress is no longer made


What is the first step in using balanced ligamentous tension?

Must establishbalanced tension by the following:

  1. Exaggeration: exaggerate dysfunction; cause tissue relaxation and rebalance (indirect)
  2. Direct action: strained articulation is moved towards the restrictive barrier without engaging it until balance is established.
  3. Decomprression: reduce compressive force on area. 
  4. Molding: fluid technique using hydraulic forces to the tissue to create balanced tension.


What are the two major proprioceptive receptors in muscle?

  1. Golgi tendon organ (afferent Ib fibers)  

Muscle spindles (intrafusal fibers) which lie parallel to extrafusal fibers. 


Muscle spindles respond to what innervation?

  1. innervated by alpha-motor neurons
  2. Relay information about length and rate of length change via Group Ia and II afferent fibers.


What provides motor innervation to muscles?

Gamma-motor neurons under control by CNS.  


What is gamma-gain?

Increased activation of the gamma-motor neurons leads to contraction of the muscle spindle fibers which increases the responsiveness to stretch.


Golgi tendon organs are stretch and transmit signals via what?

Afferent group Ib fibers increase freqeuncy when golgi tendon organs are stretched, and inhibit the alpha-motor neuron signaling; preventing muscle activation and promoting activation of antagonist muscles. 


Describe the afferent fibers, efferent, and action that occurs during contraction of spindle (intrafusal) fibers.

  1. Afferent fibers: Group Ia, II
  2. Efferent fibers: Gamma-motor neurons
  3. Contraction: reduced length, reduce afferent firing, reduce alpha-motor neuron firing.


Describe the afferent fibers, efferent, and action that occurs during contraction of Golgi Tendon Organ

  1. Afferent: group Ib fibers
  2. Efferent: non-existant
  3. Action during contraction: increase in length, increase afferent Ib firing, inhibit the agonist, facilitate the antagonist


Describe the afferent fibers, efferent, and action that occurs during contraction of extrafusal fibers.

  1. Afferent: none
  2. Efferent: alpha-motor neurons
  3. During contraction: extrafusal fibers decrease in length.



Distance between origin and insertion is constant. Patient contracts muscle while physician equally matches force.


Concentric Isotonic

Origin and insertion approximate while maintaining constant tension. Force from muscle is larger than the extrinsic force (pt wins)


Eccentric Isotonic

Origin and insertion separate while maintaining constant tension. Extrinsic force is much greater than muscle force.



Isotonic motion where length changes occur at constant velocity



Non-physiologic motion where pt attempts concentric isotonic contraction but physician applies larger external force in opposite direction.


What are common force effects generally presenting as TART, causing SD that can be treated with Myofascial Release?

  1. plastic deformation
  2. elastic deformation
  3. viscosity
  4. stress
  5. strain
  6. creep
  7. hysteresis/stress-strain


Plastic Deformation

Stressed, formed or molded tissue preserves its new shape


Elastic deformation

Stressed, formed, or molded tissue is able to recover it's original shape



Capability of a solid to continually yield under stress with a measurable rate of deformity



The effect of force normalization over an area



Change in shape as a result of stress



The continued deformation of a viscoelastic material under constant load over time.



A connective tissue resposne to loading and unloading where the restoration of the final length of tissue occurs at a rate and to an extend less than during deformation; represents energy loss into the connective tissue.


What is the definition of soft tissue technique?

  1. direct technique usually involving lateral stretching, linear strecthing, deep pressure, traction/separation of muscle origin and insertion while monitoring tissue response and motion changes by palpation.


When is soft tissue technique most often used?

  1. addressing muscular and fascial structures as well as their associated neural and vacular elements.
  2. Used before other techniques to facilitate other technique treatment.


What are the principles of the soft tissue technique?

  1. apply gentle force with low amplitude
  2. Increase force accordingly, with 1-2 seconds of engagement followed by 1-2 seconds of relaxation.
  3. Continue until no further changes are felt.


What are the 1) absolute and  2) relative contraindications for soft tissue technique?

  1. no consent, no SD, Fx/dislocation, neurologic entrapment, malignancy, bleeding, vascular compromise
  2. Use caution with delicate patients.


What is the mechanism of suboccipital release?

Utilizes principles similar to direct MFR. Anterior pressure is used to stretch the suboccipital muscles and adjustments are made in all planes to relieve restrictive barrier.


Explaint he 7 step procedure for suboccipital release.

  1. place finger pads over suboccipital muscle, inferior to lower edge of occiput, bilaterally, allowing head to rest in your palms
  2. Apply anterior pressure into the suboccipital muscles, bringing elbows close together and moving finger pads laterally. Head tilt posteriorly towards the table.
  3. Minor adjustments in all planes to engage restrictive barrier.
  4. Take up slack as tissue softens.
  5. Repeat 3-4 until no more slack is noted.
  6. Return C spine and head to neutral.
  7. Reassess.


What is the procedure for the occipitatlantal decompression (OA)?

Setup same as suboccipital release however uses distraction to decompress the OA while stretching the suboccipital muscles.

  1. place finger pads bilaterally ove suboccipital muscles, below edge of occiput. Head rest in palm of hands.
  2. Anterior pressure to the muscles, with finger movement laterally. Head should fall posteriorly to table.
  3. Direct forces towards occipital condyles
  4. Superior traction to occiput in order to distract CV1 from occiput
  5. take up slack
  6. repeat 4-5 until no changes. 
  7. return head to neutral
    1. reassess


What is the mechanism of crossed arm cervical oscillation?

  1. oscillation is a technique similar to articulation but utilize rhythmic back and forth motion to engage the restrictive barrier
  2. Used for cervical paravertebral muscle hypertonicity.


What is the proper procedure for crossed arm cervical oscillation technique?

  1. Cross forearms and place hands on pt shoulder. Supporting pt head with 4arm.
  2. stretch C spine muscles by standing upright to bring the pt head and neck into flexion. Brace forearms against the abdomen to better support pt weight.
  3. apply rhythmic stretching to stabilize the pt shoulder and oscillate head towards their feet.
  4. Adjust 4arm and hand to bring pt head into slight right rotation and sidebending to stretch left muscles. 
  5. Repeat step 3.
  6. adjust forearms to cuase sidebending and rotation to left.
  7. repeat step 3.
  8. return to neutral and reassess


What is the mechanism of cervical kneading?

  1. Technique uses firm, gentle pressure to stretch muscles. Forces are perpendicular to muscle fiber.


What are the steps for cervical kneading (6)?

  1. place caphalad hand over the pt forehead for stabilizaiton
  2. hook finger pads of cuadal hand around the pt L cervical paravertebral muscles.
  3. Apply anterior/lateral pressure with caudal hand, stretching left paravertebral muscles.
  4. Repeat step 3 until tissue releases.
  5. Return neck to neutral
  6. reassess


Where does sympathetic to the head and neck come from?



Where do sympathetics to the heart and lungs come from?



Where will sympathetics from the stomach, duodenum, liver, gallbladder, pancreas and spleen come from?



Where do sympathetics to jejunum, ileum, kidneys, ureters, gonads, and right colon come from?



Where do syympathetic fibers going to the left colon and pelvic organs arise from?




Convexity is to the right, with left sidebending



Convexity to the left with sidebending to right


WHat is the proper procedure to asses T spine joints?

  1. stand behind seated pt, placing 2nd and 3rd fingers on Transverse processes of affected vertebra.
  2. Place physician axilla and hand of other arm on the pt shoulders by reaching across the pt chest. 
  3. Allows movement in all planes while pt remains passive. 


What is the mechanism for seated MET upper T1-T4 TypeII SD?

engage feather edge barrier in all planes. Pt will provide isometric counterforce 3-5 sec. Pt relaxes allowing paraspinal muscles into refractory period. RE-engage the feather barrier in all planes and repeat until not further laxity is felt. 


What are the steps for seated MET T1-T4 Type II SD?

  1. Place index finger and middle finger posterior to TP of T1-T4
  2. Place left hand on head with elbow on pt shoulder.
  3. Move T1-T4 into barrier with head movement.
  4. Instruct pt to look towards ease of movement, with isometric counterforce 3-5 sec.
  5. Pt relax
  6. Re-engage 1-2 sec later
  7. Repeat 4-6 until no changes
  8. Return to neutral.
  9. Reassess.


What different regions should you use to manipulate a T1-T4 region versus a T5-T12 region?

  • T1-T4: head
  • T5-T12: shoulders.


What is the mechanism of thoracic kneading?

Use firm gnetle pressure to stretch muscles. Forces are perpendicular to muscle fibers/


What is the 5 step procedure for thoracic kneading?

  • place heel of hands over paravertebral muscles of spine, lateral to SP.
  • apply anterior/lateral pressure with both hands, and relax
  • Rpeat step 2, in rhythmic motion until releases.
  • Return pt to neutral.
  • reassess.


What is the mechanism for upper thoracic traction?

induce longitudinal stretch of muscle or groups.

seen with thoracic paravertebral muscle hypertonicity.


What is the procedure to perform upper thoracic traction?

  1. pt cross arms in front of them and resting forehaed on the forearms
  2. bilaterally contact upper T spine paraspinal muscles, by reaching under arms and over shoulders.
  3. Extend upper T spine by stepping backwards. 
  4. Use fingers to apply anterior, lateral, superior force to paravertebral muscles.
  5. Repeat 4 and 5 in rhythmic pattern until muscle release occurs. 
  6. Return pt to neutral
  7. reassess.


Where can L4 spinous process be found?

superior aspect of iliac crest.  Would be at same level as the TP.


What will produce a rubbery, non-distinct barrier on motion testing?

viscerosomatic reflex which can indicate some type of organ tissue dysfunction.


List dermatomes regions for L4, L5, S1.

  • L4: inner calf to medial portion of foot
  • L5: lateral lower leg, dorsum of foot, first 2 toes
  • S1: sole, heel, lateral edge of foot


What are important special tests in the lumbar region?

  1. straight leg raising test: testing sciatic nerve irritation by stretching dura.
  2. Contralateral straight leg raise:reproduces radicular symptoms. (disc herniation)
  3. Cauda equina syndrome: no single test, but is medical emergency.
  4. Thomas Test: positional test for tension in psoas major muscle.


What is the mechanism of lumbosacral release?

Uses disengagement and compression to release restrictions in the lumbosacral region while balancing the lumbosacral ligaments. Decompresses the lumbosacral


What is the step procedure for lumbosacral release?

  1. caudal hand under Pt sacrum with fingers pointing cephalad. Heel should be under the apex of the sacrum and fingers under sacral base. Arm placed between the legs depending on comfort of pt.
  2. cephalad hand at LV5 with palm on SP perpendicular to caudal hand
  3. caudal hand pushes anterioe and superior to disengage the ligamentous connection of sacrum.
  4. cephalad hand applies slight anterior and inferior compression
  5. find tension in all planes and hold until release


How can rotation be achieved for a neutral lesion with Lumbar somatic dysftunction?

anterior force directed to the pelvis, rotating the involved segment to the desired direction. Identical to on-side HVLA technique for type I L spine SD



What are the proper sequence of steps for Spencer's technique?

  1. extension
  2. flexion
  3. compressive circumduction
  4. traction with circumduction
  5. adduction and external rotation
  6. abduction
  7. internal rotation
  8. Traction with inferior glide (joint pump)


Why would you not want to perform pectoralis tractioning on COPD patient?

This technique can induce air trapping in the lungs.