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OMM BOARD REVIEW THE BASICS

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OMM BOARD REVIEW. THE BASICS. THE OSTEOPATHIC PRINCIPLES. The body is a unit. Structure and function are reciprocally related. The body possesses self-regulatory mechanisms The body has the inherent capacity to defend itself and repair itself. - PowerPoint PPT Presentation

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Page 1: OMM BOARD REVIEW

OMM BOARD REVIEW

OMM BOARD REVIEWTHE BASICS

Page 2: OMM BOARD REVIEW

THE OSTEOPATHIC PRINCIPLES

THE OSTEOPATHIC PRINCIPLES

The body is a unit. Structure and function are reciprocally related. The body possesses self-regulatory mechanisms The body has the inherent capacity to defend itself

and repair itself. When normal adaptability is disrupted, or when

environmental changes overcome the body’s capacity for self maintenance, disease may ensue.

Page 3: OMM BOARD REVIEW

THE OSTEOPATHIC PRINCIPLES

THE OSTEOPATHIC PRINCIPLES

Rational treatment is based on the previous principles

Movement of the body fluids is essential to the maintenance of health.The nervous system plays a crucial part in controlling the body.There are somatic components to disease that are not only manifestations of disease but also are factors that contribute to maintenance of the diseased state.

Page 4: OMM BOARD REVIEW

SOMATIC DYSFUNCTION

SOMATIC DYSFUNCTION

An impairment or altered function of related components of the somatic (body framework) system: Skeletal, Arthroidial, and Myofascial structures and related vascular, lymphatic, and neural elements.

Somatic Dysfunction is a Restriction in joints muscles, or fascia that may affects blood supply, lymph flow, and nervous function.

Page 5: OMM BOARD REVIEW

SOMATIC DYSFUNCTION

SOMATIC DYSFUNCTION

Diagnostic Criteria:

Tenderness

Asymmetry

Restriction

Tissue Texture Changes

Page 6: OMM BOARD REVIEW

SOMATIC DYSFUNCTION

SOMATIC DYSFUNCTION

TendernessMay be produced during palpation of tissues where

it should not occur if there was no somatic dysfunction.

Page 7: OMM BOARD REVIEW

SOMATIC DYSFUNCTION

SOMATIC DYSFUNCTION

Asymmetry

Bones, muscles, or joints may feel asymmetric to corresponding structures.

Page 8: OMM BOARD REVIEW

SOMATIC DYSFUNCTION

SOMATIC DYSFUNCTION

Restriction

In somatic dysfunction, a joint will have a restrictive (pathologic) barrier. A restrictive barrier lies before the physiologic barrier.

Page 9: OMM BOARD REVIEW

Barriers to MotionBarriers to Motion

Physiologic Barrier:

A point at which a pt can actively move a given joint.

Anatomic Barrier:

A point at a physician can passively move a given joint.

Motion beyond the anatomical barrier will cause skeletal injury.

Page 10: OMM BOARD REVIEW

Acute VS Chronic Somatic Dysfunction

Acute VS Chronic Somatic Dysfunction

Findings Acute Chronic

Tenderness Severe, Sharp Dull, Achy, Burning

Asymmetry Present Present with compensation in other areas

Restriction Present, painful ROM Present, dec. or no pain w/ROM

Tissue Texture Changes Edema, erythema, boggy, Inc. tone, Inc. moisture

Decreased or no edema or erythema. Cool dry skin, flaccid tone, fibrotic

Page 11: OMM BOARD REVIEW

Fryette’s Principle’sFryette’s Principle’s Principle I

If the spine is in neutral position (no flexion or extension) and if sidebending is introduced, rotation would then occur to the opposite side.

Page 12: OMM BOARD REVIEW

Principle IPrinciple I

In the Neutral position: Sidebending precedes rotation. Sidebeding and rotation occur in opposite directions.

e.g.: NSLRR

Typical of a group dysfunction

Page 13: OMM BOARD REVIEW

Principle IIPrinciple IIIf the spine is in a non neutral position (flexed or extended) and rotation is introduced, sidebending would then occur to the same side.

Page 14: OMM BOARD REVIEW

Type II Somatic Dysfunction

Type II Somatic Dysfunction

In a non neutral position:Rotation precedes sidebending,

sidebending and rotation occur to the same side.

e.g.: FRRSR

Principle II is typical of a single vertebral dysfunction

Principles I and II do not apply to cervical vertebral motion.

Page 15: OMM BOARD REVIEW

Principle IIIPrinciple III

Initiating motion of any vertebral segment in any one plane of motion will influence the mobility of that segment in the other two planes of motion.

Eg: Forward bending will decrease the ability to sidebend and rotate.

Page 16: OMM BOARD REVIEW

Naming Somatic Dysfunction

Naming Somatic Dysfunction

Somatic Dysfunctions are always named for their FREEDOM OF MOTION.

When referring to segmental motion, it is traditional to refer to motion of the segment above in a functional vertebral unit.

e.g.: If L2 is restricted in the motions of flexion, sidebending to the right and rotation to the right, then L2 is said to be extended, rotated and sidebent to the left on L3……L2 is ERLSL.

Page 17: OMM BOARD REVIEW

Evaluating Somatic DysfunctionEvaluating Somatic Dysfunction Thoracic and Lumbar Spine

Assess rotation by placing the thumbs over the transverse processes of each segment (posterior thumb).Then check the rotation of the segment.– Flexion– Extension– NeutralSomatic dysfunction is named for freedom of motion

Page 18: OMM BOARD REVIEW

Evaluating Somatic Dysfunction

Evaluating Somatic Dysfunction

Motion Testing of the Cervical Spine

Translation– Best for evaluation of the OA. Right translation will induce left sidebending.Rotation– Best for evaluation of the AA. Remember to flex the neck 45* to lock out C2-C7.C2-C7—Typically evaluated with translatory force directed at the articular pillars

Page 19: OMM BOARD REVIEW

Facet OrientationFacet OrientationREGION Facet Orientation Main Motion

Cervical Backward, upward, medial(C2-C7)

OA-flexion/extensionAA-rotationC2-C7—rotation/SB

Thoracic Backward, upward, lateral

Rotation

Lumbar Backward, medial Flexion/Extension

Page 20: OMM BOARD REVIEW

Physiologic MotionPhysiologic Motion

Motion Axis Plane

FLx’n/Ext’n Transverse Sagittal

Rotation Vertical Transverse

Sidebending A/P Coronal

Page 21: OMM BOARD REVIEW

Osteopathic Treatment

Osteopathic Treatment

GOAL: To eliminate restrictive barriers and restore equilibrium and symmetry within the body.

Treatment techniques are aimed at improving quality and range of impaired movements, softening fibrotic areas, relieving muscle spasm, and mobilization of joints.

Page 22: OMM BOARD REVIEW

Direct VS IndirectDirect VS Indirect Direct Treatment: the

practitioner engages the restrictive barrier

eg; T3 FRRSR: TX: extension, left rotation and sidebending.

Indirect Treatment: the practitioner moves tissues and joints away from the restrictive barrier.

eg; T3 FRRSR : TX: flexion right rotation and sidebending

Page 23: OMM BOARD REVIEW

Active VS PassiveActive VS Passive Active Treatment: the pt

will assist in the treatment, usually in the form of isometric or isotonic contraction

Passive Treatment: the pt relaxes and allows the practitioner to to move the body tissues.

Page 24: OMM BOARD REVIEW

Myofascial ReleaseMyofascial Release Can be either direct or indirect, passive or active

Palpate restrictionApply compression (indirect) or traction (direct)Add twisting or transverse forcesUse enhancers---respiration, eye movement, muscle contraction.Await release

Indications: acutely ill, elderly who cannot tolerate much movement. CHF, Asthma, COPD

Contraindications: Cancer, Sepsis, osseous fracture, traumatic disruption of viscera.

E.g. Diaphragm Release

Page 25: OMM BOARD REVIEW

CounterstrainCounterstrain Passive, indirect technique. Extremely gentle technique where “tenderpoints” are

treated at a point of balance, or ease. Positioning is aimed at shortening the muscles around

the tenderpoint and held for 90 seconds.* Body part is then returned to resting position, passively.

Treat the most tender area first.Know specific tenderpoints!

Page 26: OMM BOARD REVIEW

Facilitated Positional Release

Facilitated Positional Release

Passive, indirect techniqueThe component region of the body is placed into a neutral position, diminishing tissue and joint tension in all planes.A facilitating force, either compression or torsion, is then added to place a joint or muscle into it’s ease of motion.Used to treat superficial muscles, and deep intervertebral muscles to influence spinal motion.

Page 27: OMM BOARD REVIEW

Muscle EnergyMuscle Energy An Active, direct technique.**

Involved joint’s restrictive barrier is engaged.The pt is directed to gently push in the direction of freedom for about 3-5 sec and then relax the contracted muscle(s)Physician engages new barrier.Process is repeated for a total of 3 times.Don’t forget the passive stretch.

** postisometric relaxation

Page 28: OMM BOARD REVIEW

High Velocity Low Amplitude

High Velocity Low Amplitude

A passive and direct technique The force is applied very quickly and the distance

moved is very small. The physician directs a quick controlled force through

the joint to move it. Absolute Contraindications:

Sever RAOsteoporosisFracturesOsteomyelitisBone metastases

Most common overall complication: Vertebral artery injury.

Page 29: OMM BOARD REVIEW

Methods of TreatmentMethods of Treatment

Treatment Direct or Indirect Active or Passive

Myofascial Release Both Both

Counterstrain Indirect Passive

FPR Indirect Passive

Muscle Energy Direct (rarely indirect) Active

HVLA Direct Passive

Page 30: OMM BOARD REVIEW

Choice of TreatmentChoice of Treatment Elderly pts and hospitalized patients typically

respond better with indirect techniques. The use of HVLA in a pt with advanced

osteoporosis my lead to pathologic fractures. Acute neck strain/sprains are often treated with

indirect techniques to prevent further strain. Pts with advanced stages of cancer should not

be treated with lymphatic techniques due to increased risk of lymphogenous spread

Page 31: OMM BOARD REVIEW

Dose and Frequency Dose and Frequency The sicker the pt, the less the dose. Allow time for the patient to respond to treatment Chronic disease requires chronic treatment Pediatric pts can be treated more frequently;

geriatric pts need longer interval to respond to treatment.

Acute cases should have a shorter interval between treatments; as they respond, the interval is increased.

Page 32: OMM BOARD REVIEW

Sequence of Treatment

Sequence of Treatment

For low back pain with psoas involvement, treat the lumbar spine first.

Treat the upper thoracic spine and ribs before treating the cervical spine.

Treat the T-spine before treating specific rib dysfunctions. For very acute SD, treat secondary areas to allow access

to the acute area. For extremity problems, treat the axial skeleton

components first (spine, sacrum, ribs).

Page 33: OMM BOARD REVIEW

Question 1Question 1

Which one of the following is not a diagnostic characteristic of somatic dysfunction?

A. EdemaB. Temperature changeC. TendernessD. Full range of motionE. Asymmetry

Page 34: OMM BOARD REVIEW

Question 1Question 1

Which one of the following is not a diagnostic characteristic of somatic dysfunction?

A. EdemaB. Temperature changeC. TendernessD. Full range of motionE. Asymmetry

Page 35: OMM BOARD REVIEW

Question 2Question 2While evaluating a pts upper back you notice T2 is rotated

right. Flexing causes T2 to further rotate right. Extending the pts back cause T2 to return to neutral position. Which best describes this dysfunction?

A. ERRSR

B. FRRSR

C. ERRSL

D. FRRSL

Page 36: OMM BOARD REVIEW

Question 2Question 2While evaluating a pts upper back you notice T2 is rotated

right. Flexing causes T2 to further rotate right. Extending the pts head cause T2 to return to neutral position. Which best describes this dysfunction.

A. ERRSR

B. FRRSR

C. ERRSL

D. FRRSL

Page 37: OMM BOARD REVIEW

Question 3Question 3

Which cervical segment is best evaluated by flexing the neck 45* and rotating the head?

A. OAB. C1

C. C2

D. C3

E. C4

Page 38: OMM BOARD REVIEW

Question 3Question 3

Which cervical segment is best evaluated by flexing the neck 45* and rotating the head?

A. OAB. C1

C. C2

D. C3

E. C4