OPP 2 PIAT Study Guide Written Exam 3: Osteopathic Concepts

Osteopathic Concepts

• For any disease state, the patient must be stable before performing OMT.
• Gentler techniques (e.g., rib raising, BLT, MFR, soft tissue) should be used for sicker/weaker/more injured patients.
• Somatic dysfunction can occur at sympathetics, parasympathetic, and soma levels.
• Viscerosomatic reflexes occur at sympathetics and parasympathetic levels.
• Facilitated segments only occur at sympathetics levels.

Important Concepts

• Most commonly used form of contraction in muscle energy is isometric contraction.
• Translation to the right = left side-bending, and translation to the left = right side-bending.
• C3,4,5 keeps the diaphragm alive, and innervates the thoracoabdominal diaphragm.
• Soft tissue techniques are diagnostic as well as therapeutic.
• Feather's Edge refers to the perceived quality of motion at the restrictive barrier.
• Indication for HVLA is a distinct, solid barrier, requiring a firm end-feel.
• Sympathetic innervation to the head and neck is T1-T4.
• Upper cervical area and sacrum are connected by dural connections.
• AA (C1 on C2) accounts for 50% of the cervical spine's rotational motion.
• OA (C0 on C1) accounts for 50% of the cervical spine's flexion/extension motion.
• Spurling test assesses for neural foraminal narrowing.
• Sternocleidomastoid muscle will rotate and side-bend the neck in opposite directions.
• Occiptomastoid suture dysfunction can cause nausea and vomiting.
• Avoid upper cervical direct manipulation (HVLA, articulatory, etc.) on upper cervical spine in rheumatoid arthritis, Down Syndrome, and ligamentous instability.

Somatic Dysfunction

• Somatic dysfunction is an impaired or altered function of related components of the somatic system.
• Diagnosed by T.A.R.T.T: Tissue Texture Changes, Asymmetry, Restriction of motion, Tenderness.
• Always named for the way it likes to go.
• In axial spine, the reference point is the superior/anterior aspect of the vertebra.
• Not all somatic lesions are somatic dysfunctions; fractures, sprains, degenerative processes, and inflammatory processes are not somatic dysfunctions.

Osteopathic Models

• Biomechanical (structural, postural): focuses on anatomy, posture, motion, and normalizing mechanical somatic dysfunction.
• Neurological: emphasizes CNS, PNS, and ANS that control, coordinate, and integrate body functions.
• Respiratory/circulatory: emphasizes pulmonary, circulatory, and fluid systems.
• Metabolic/Nutritional: regulates through metabolic processes.
• Behavioral (psychobehavioral): focuses on mental, emotional, social, and spiritual dimensions related to health and disease.

Palpating Somatic Dysfunction

• Acute: recent history, sharp/severe pain, warm/moist skin, boggy tissue, erythematous, increased muscle tone, normal/sluggish ROM.
• Chronic: long-standing, dull/achy pain, cool/smooth skin, atrophy, fibrotic tissue, decreased muscle tone, restricted ROM.

Triggerbands (TB)

• Body language: sweeping motion with fingers.
• Verbal description: burning, pulling, tethering, restricted motion, tightness.
• Key words: "pulls", "heard it snap".
• Treatment: recognize body language, find discrete starting and ending points, use thumb tip to "iron out" twisted fascial band, treat the entire pathway.

Herniated Trigger Points (HTP)

• Body language: pushes with fingers or fist into non-jointed area.
• Verbal description: aching or tightness in soft tissue.
• Key words: "feels tight", "stiff", or "pinches".
• Treatment: observe patient gesture, palpate HTP, verify most tender area, reduce protruding tissue below fascial plane, palpate for firm residual edges.

Continuum Distortions (CD)

• Body language: points to one or more spots of pain.
• Verbal description: hurts in one spot.
• Key word: "just that one spot".
• Treatment: reduction of shifted continuum material by application of pressure from the tip of thumb.

Folding Distortions (FD)

• Body language: places hand over a joint; cupping area.
• Verbal description: aches deep in the joint, feels unstable.
• Key words: "unstable", "changes with the weather".
• Treatment: recreates the mechanism of injury, should be painless.

Cylinder Distortions (CYD)

• Body language: squeezes or rubs with hands.
• Verbal description: pain that wakes me up, comes and goes, numbness, tingling, paresthesias.
• Key words: "weakness", "feels numb", "weird", "spaghetti legs".
• Treatment: recognizes body language, verbal description, and treats separate coils via manual techniques and/or assistive devices.

Tectonic Fixations (TF)

• Body language: difficulty moving joint, looks and feels stiff.
• Verbal description: feels like it's stuck, feels like it needs to pop.
• Key words: "stiff", "tight", "in joints".
• Treatment: recognizes may not have specific body language, restores the gliding quality of the affected tissue, may help with heat application.

Side Effects of Treatment

• Pain/discomfort during treatment.
• Erythema of the skin.
• Bruising.
• Hemorrhagic petechiae.
• Rebound tenderness.

Relative Contraindications to FDM

• Poor doctor/patient rapport.
• Bleeding disorders.
• Open wounds.
• Skin infections.
• Previous stroke.
• Pregnancy (abdomen or pelvis treatment).
• Vascular diseases.
• Arteriosclerosis.
• Collagen vascular disease.
• Aneurysms.
• Edema.
• Phlebitis.