Direct & Indirect Techniques

Question 1

When to Do OMT

Answer 1

• MSK pain: acute injury, overuse and chronic disorders
• Headaches
• Visceral support: asthma, pneumonia, constipation
• Lymphatic support: upper respiratory tract infections, lymohedema, otitis media
• Pregnancy pain management

Question 2

Acute SD Findings

Answer 2

• Vasodilation / erythematous
• Edema (bogginess)
• Relative warmth
• Tissue contraction
• Increased moisture

Question 3

Chronic SD Findings

Answer 3

• Blanching / pallor
• Fibrosis / scar
• Coolness
• Tissue contracture / doughy
• Tissue dryness

Question 4

Type 1 SD

Answer 4

• Muscles: semispinalis and multifidus contracted
• Facets: not engaged (unchanged with flexion or extension)
• typically involves span of vertebra

Question 5

Type 2 SD

Answer 5

• Muscles: rotatores contracted (sidebend and rotate same)
• Facets: open (flexion) or closed (extension)

Question 6

Articular - Extension Type 2 SD

Answer 6

• ipsilateral facet stuck closed
• ipsilateral rotatores muscle contracted
• same side sidebending and rotation
• resolves with extension (tissue texture improves as rotatores relax)
• worsen with flexion

Question 7

Articular - Flexion Type 2 SD

Answer 7

• contralateral facet stuck open
• contralateral rotatores muscle contracted
• same side sidebending and rotation
• resolves with flexion (tissue texture improves as rotatores relax)
• worsen with extension

Question 8

Active ROM -> ___ Barrier

Answer 8

Physiological Barrier

Question 9

Passive ROM -> ___ Barrier

Answer 9

Elastic Barrier

Question 10

Direct OMT Techniques:

Answer 10

• MET
• ART
• MFR (both!)

Question 11

Indirect OMT Techniques:

Answer 11

• BLT
• FPR
• Stills
• MFR (both!)

Question 12

Applying Activating Force: Soft Tissue

Answer 12

• Localization: engaged soft tissue dysfunction by direct localization
• Amplitude/Direction: applied appropriate amplitude and direction of activation force
• Timing: rhythmically kneaded or held soft tissue at the direct barrier until release

Question 13

Applying Activating Force: MFR

Answer 13

• Localization: engaged fascial dysfunction by direct or indirect
• Amplitude/Direction: dynamically followed fascia to new restrictive barriers (direct) or positions of ease (indirect)
• Timing: followed barriers until no more creep (direct) or release (indirect) is palpable, OR use a release enhancing technique = respiratory force

Question 14

Applying Activating Force: MET

Answer 14

• Localization: engaged articular dysfunction by direct localization
• Amplitude/Direction: Post Isometric Relaxation – patient asked to contract toward neutral; physician’s counterforce matched patients force to hold at direct barrier, moved to next direct barrier after patient relaxation
• Timing: Post Isometric Relaxation – contract for 3-5 sec and relax for 1-2 sec; repeat 3-5x

Question 15

What two variants of MET let the patient “win”?

Answer 15

• Isolytic Lengthening
• Isokinetic Strengthening