Four Tenets of Osteopathic Medicine
- The Mind, Body and Spirit are a Unit
- The Body is Capable of Self-Regulation, Self-Healing, and Health Maintenance
- Structure and Function are Reciprocally Interrelated
- Rational Treatment is Based Upon Understanding & Implementing the other 3 Tenets
Somatic Dysfunction
Definition?
What anatomical components are included in SD?
It is treatable using what?
- Impaired or altered function of somatic (body framework) system:
- Skeletal, Arthrodial, Myofascial Structures (SAM) and related:
- Vascular, Lymphatic, Neural Elements (VLAN)
- Skeletal, Arthrodial, Myofascial Structures (SAM) and related:
- Osteopathic Manipulative Treatment
Osteopathic Manipulative Treatment (OMT)
Definition
Therapeutic application of manually guided forces to improve physiologic function and/or support homeostasis altered by SD
Acute Somatic Dysfunction
Definition
Characterized by?
- Immediate/Short-Term impairment/altered function
- Characterized by:
- Vasodilation
- Edema
- Tenderness/Pain
- Tissue contraction
Chronic Somatic Dysfunction
Definition
Characterized by?
- Impairment/Altered Function
- Characterized by:
- Tenderness
- Itching
- Fibrosis
- Paresthesias
- Tissue contraction
Diagnostic Criteria for Somatic Dysfunction
T.A.R.T.
Which are Palpated and which are Elicited?
Tissue texture abnormalities (Palpated)
Asymmetry of structure or motion (Palpated)
Restriction of motion (Palpated)
Tenderness (Elicited)
Tissue Texture Abnormality
Definition
Types
Signs (Physical)
Symptoms (Patient Experiences)
Palpable change in tissues from skin to periarticular structures
Bogginess, Thickening, Stringiness, Ropiness, Firmness, Temperature change, Moisture change
Vasodilation, Edema, Flaccidity, Hypertonicity, Contracture, Fibrosis
Itching, Pain, Tenderness, Paresthesias
Bogginess
Palpable sponginess in tissue resulting from congestion due to increased fluid content
TTA Terms
Tone and different types
Contraction
Contracture
Spasm
Ropiness
- Normal feel of muscle in relaxed state
- Hypertonicity (at the extreme = spastic paralysis)
- Hypotonicity (flaccid paralysis when no tone at all)
- Normal tone of muscle when it shortens or is activated against resistance
- Abnormal shortening of muscle due to fibrosis
- Abnormal contraction maintained beyond physiologic need
- Hard, firm, rope-like or cord-like muscle tone
Tissue Texture Changes
Vascular (Acute and Chronic)
Sympathetic (Acute and Chronic)
Musculature (Acute and Chronic)
- Vascular
- A: Inflamed vessel wall injury
- C: Sympathetic tone increases vascular constriction
- Sympathetic
- A: Local vasoconstriction overpowered by local chemical release –> Vasodilation
- C: Vasoconstriction, hypersympathetic tone, may be regional
- Musculature
- A: Local increase in tone, muscle contraction, spasm - mediated by increase spindle activity
- C: Decreased muscle tone, flaccid, limited ROM due to contracture
Asymmetry
Defintion
How is it determined?
Absence of symmetry of position or motion
Determined by vision or palpation
Restriction of Motion
Anatomic Barrier
Physiologic Barrier
Elastic Barrier/Range
Restrictive Barrier
Resistance or impediment to movement
Motion limit due to anatomic structure; Limit of passive motion
Limit of active motion
Range between PB and AB in which passive stretching occurs before tissue disruption
Functional limit abnormally diminishing normal physiologic range
ROM Assessment
AROM vs PROM
Blocking Linkage
AROM (Patient initiated) < PROM (Examiner initiated)
Stabilization of associated/adjacent structures to focus movement to only joint/s being assessed
Barrier “End Feel”
Examples of Restricted ROM & Abnormal End-Feel
Palpatory experience or perceived quality of motion when joint is moved to its limit
- Early muscle spasm (protective spasm after injury) - Empty end-feel or guarding
- Late muscle spasm (chronic spasm)
- Hard capsular (frozen shoulder)
- Soft capsular (synovitis)
Tenderness Definition
Pain definition
Discomfort/pain elicited through palpation
Unpleasant sensation induced by noxious stimuli and generally received by specialized nerve endings
Pain (Acute and Chronic)
Visceral Function (Acute and Chronic)
Visceral Dysfunction (Acute and Chronic)
- Pain
- A: Sharp, severe, cutting
- C: Dull, ache, paresthesias
- Visceral Function
- A: Minimal somatovisceral effects
- C: Somatovisceral effects common
- Visceral Dysfunction
- A: May or may not be present (present w/ severe trauma)
- C: Often involved in somatic dysfunction
TART (Acute vs Chronic)
TTA
Asymmetry
Restriction
Tenderness
- TTA
- A: Red, Swollen, Boggy, Increased Tone
- C: Dry, Cool, Ropy, Pale, Decreased Tone
- Asymmetry
- A: Present
- C: Present, Compensation Occurs
- Restriction
- A: Present, Painful with Motion
- C: Present, maybe not. Guarded or “Empty”
- Tenderness
- A: Sharp pain
- C: Dull, Achy pain
Tenderpoints
Trigger Points
Hypersensitive areas within myofascial structures that results in localized pain
Hypersensitive areas within myofascial structures - palpation causes referred pain away from site
Naming Somatic Dysfunction
SDs named for position of ease
What is the goal of OMT?
Remove SD and restore homeostasis
OMT
Indications
Adverse Reactions
Precautions
Recommendations
Contraindications
- SD and/or Visceral Dysfunction
- Soreness similar to workout or massage soreness; other Sx similar to acute illness; exacerbation of current physical complaints
- Cancer; Frailty due to severity of disease, youth, and/or elderly
- Rest (1-4 days); Hydration (1-2 L/day)
- Different techniques have different contraindications
- General: Cancer; RA; Fractures; Severe Frailty
- Direct Techniques contraindicated in ligamentous laxity states (including RA)
Role of OMT in the 5 Models
Biomechanical
Neurological
Respiratory/Circulatory
Metabolic
Behavorial
Myofascial & Joint functional optimization
Remove neurologic imbalances; address nociception
Maximize function
Structure & function are reciprocally related
More of cause than effect; how time is spent affects other 4; Exercise Rx teaches patients to treat themselves
Direct Techniques
Indirect Techniques
Engage restrictive barrier directly
Positioning away from restrictive barrier
