4 osteopathic tenets
- Body is unit
- Body self regulating and self protecting
- Structure and function are interrelated
- Rational treatment based on the 3 principals
What is somatic dysfunction?
- impaired or altered function of related components of the somatic system (skeletal, arthrodial, myofascial, vascular, lymphatic, neural)
- treatable using OMT
What is OMT?
-therapeutic application of manual forces used to improve physiologic function and support homeostasis
What does TART stand for?
Tissue texture change
Asymmetry
Restriction of motion
Tenderness
Tissue Texture Change
- Skin= warm/moist/red (acute) or cool/pale with trophic changes-dry/scaly/hairless/shiny/folliculitis (chronic)
- Tissue= boggy/edema/fluid (acute) or doughy/stringy/fibrotic/ropy/thickened/contractures (chronic)
- Vascular= inflammation (acute), sympathetic tone/vascular constriction (chronic)
- Sympathetics= local vasoconstriction overpowered by chemical release (acute) or vasoconstriction (chronic)
- Musculature= increase muscle tone/contraction/spasm (acute) or decrease tone/flaccid/mushy/contracture (chronic)
Restriction of Motion: mobility
- acute= range of motion sluggish and guarded to prevent pain
- chronic= limited ROM but motion itself normal
AROM (active) vs PROM (passive)
- patient demonstrates activity= active
- Patrice is not active, examiner takes relaxed limb through its complete range= passive
Which allows the greater ROM active or passive?
- PROM is greater ROM because no muscles in use only ligaments to stop motion
- AROM patient uses their own muscles and agonist and antagonist are both in use so there is less ROM
What is the “end feel”
- palpatory experience or perceived quality of motion when a joint is moved to its limit (barrier is approached)
- normal end feel examples= bone to bone (elbow extension), soft tissue (knee flexion), tissue stretch (ankle dorsiflexion, finger extension)
What are abnormal end feel?
- early (protection post injury) and late (chronic) muscle spasm
- hard capsular (frozen shoulder)
- soft capsular (synovitis)
What are the 5 osteopathic barrier concepts?
- Anatomic
- Physiologic
- Restrictive
- Elastic
- Pathologic
Anatomic barrier
- limit of motion imposed by anatomic structure
- just beyond limit of PROM
Physiologic barrier
-limit of AROM
(Can increase ROM by warm ups/stretching)
-as far as you can go by yourself
Restrictive barrier
- functional limit within anatomic ROM which abnormally diminishes the normal ROM so cannot achieve full range (lost ROM)
- unable to reach full motion with appropriate effort
Elastic barrier
- range between physiologic and anatomic barrier or motion in which passive ligamentous stretching occurs before tissue disruption
- stretch between AROM and PROM
Tenderness
- discomfort or pain elicited by physcian X through palpate on
- unusual sensitivity to touch or pressure
- acute= sharp/severe/cutting
- chronic= dull/ache/paresthesias(tingle/burn/itch)
What is acute TART?
- tissue texture= red/boggy/swollen/increased tone
- asymmetry= present
- restriction= present/painful with motion
- tenderness= sharp pain
What is chronic TART?
- tissue texture= dry/cool/ropy/pale/decreased tone
- asymmetry= present (compensation occurs)
- restriction= present maybe not guarded
- tenderness= dull, achy pain
How are somatic dysfunctions named?
- position of ease? Where they live
- if a body segment freely rotates to the left but restricted to the right the dysfunction is named: Rotated Left
