OMM 4- somatic dysfunction

4 principles of philosophy of osteopathic medicine
The body is 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 an understanding of the basic principles of body unit, self-regulation, and interrelationship of structure and function.
define somatic dysfunction
Somatic dysfunction: is AN IMPAIRED OR ALTERED FUNCTION OF RELATED COMPONENTS OF THE SOMATIC SYSTEM: SKIN, FASCIA, MUSCLE, ARTHRODIAL, AND RELATED VASCULAR, AND NEURAL ELEMENT.
TART
TART = Objective findings used in the diagnosis of somatic dysfunction;

Tenderness (or Sensitivity),
Asymmetry,
Restricted Motion (or ROM),
Tissue Texture Change

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how can sympathetic changes effect the body
decreased or increased sympathetic function also increased parasympathetic compensation
describe steps in vicious cycle of (pain) somatic dysfunction
describe steps in vicious cycle of (pain) somatic dysfunction
irritation
pain
increased muscle tension
inflammation- edema
fibrous reaction (from long term limited movement)
neural reflex cross talk
When afferent impulses from a muscle and an abdominal organ enter the spinal cord at the same level, there is crosstalk between the 2 reflexes.
In this way, reduction of muscle hypertonicity also reduces neural stress reflexes to the organ.
Abnormal activity in neural circuits is a fundamental of osteopathic practice.
facilitation (think physic action potential)
Palpation and identification
A pool of neurons (one or more segments of the spinal cord) in a sub-threshold state that less afferent stimulation is required to trigger the discharge of impulse.
Abnormal sensory impulses from the higher centers, viscera and from the soma(muscle spindles, golgi tendon ..)
symptoms of acute somatic dysfunction
history
pain
skin
mobility
musculature
tissues
visceral
Acute
History: Memory of an injury, recent . MORE TENDER

Pain: Acute sharp, severe
Skin: Warm, moist, acute red reflex, inflamed (vascular and chemical changes) (tissue texture changes)
Mobility: range not always restricted but sluggish.

Musculature: Muscle hypertonia

Tissues: Boggy, edematous congested soft tissue (Tissue texture changes)

Visceral : somatovisceral effects are minimal .

symptoms of chronic somatic dysfunction
history
pain
skin
mobility
musculature
tissues
visceral
Chronic
History: Long-standing impairment

Pain: Dull ache burning

Skin: cool, dry decrease sweating, scaly, pale itchy, blemished skin, thin pigmentation change ( tissue texture changes)

Mobility: Limited ROM due to chronic compensation, contracture or development of fibrosis

Musculature: contracture but decreased tone that feels mushy flaccid, fibrotic & ropy.

Tissues: chronic congestion doughy, (poor lymphatic pump)

Visceral: somatovisceral effects are common.

mechanism of positive acute red reflex
*Ti – L2 only!!!

Sympathetic response causes vasoconstriction.
However, this response is overridden by local biochemical responses, overpowered by braykinins so a local vasodilitation, leading to warmth and redness.
Indicates either acute S/D in that segmental area, or S/D secondary to visceral dysfunction innervating that segment.

what is motion loss a result of
Motion loss is a result of and maintained by the restrictive barrier.
The restrictive barrier is a result of somatic dysfunction.
3 parameters of somatic dysfunction
1. Position of the element as determined by palpation. Segmental Palpation
2. Restriction of Motion
i.e.. in the direction of the restrictive barrier
“going toward or up against the barrier”
3. The direction in which motion is freer.
The direction the vertebra with a somatic dysfunction will move into .
i.e.. less restricted.
“going away from the restrictive barrier”
This is our naming convention
how to test for somatic dysfunction in office
adams forward bending test

palpation of each vertebrae to look for rotation

freyettes principle type 1
FRYETTE’S PRINCIPLE (TYPE I and TYPE II MECHANICS)
TYPE I: When motion is introduced into the spine from a neutral position sidebending preceeds rotation, with rotation occuring to the side opposite sidebending.
Two or more segments involved
Example: L1-3NSxRy
what muscles are involved in a type 1
intervertebral muscles RMS

erector spinae

scalenes (from anterior of C vertebrae)

how to name a somatic dysfunction
You name your somatic dysfunction by the motion which is freer- so if I pulled my lower back and was crouched over in a flexed position unable to extend then flexed is my somatic dysfunction
freyettes principles type 2 dysfunction
FRYETTE’S SECOND PRINCIPLE (TYPE 2 MECHANICS)

When sidebending is introduced into a region of the spine in a non-neutral position, rotation of one segment must preceed sidebending. Rotation and sidebending occur to the same side.

Type II dysfunction
Occur as a result of trauma/abrupt twisting
Should be treated before Type I somatic
dysfunctions
Found at apex or extremes of Type I curves at
transitional areas or by themselves .
Apex is the mid point of the curve.
Often traumatic in origin.
Non-neutral spine : active or passive flexion
or extension will change the position of the
vertebra.

Example: T 4 E RXSX
T 4 E Rr Sr

muscles involved in a type 2
rotatores brevis and longus

intertransversarii
interspinalis
short rotator

freyettes 3rd principle
THIRD PRINCIPLE
When motion occurs in any one plane within a joint or region, motion in all other planes of that joint will be influenced.
Example: If a vertebral unit was flexed, its range of sidebending and rotation would be reduced.
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