1. OMM BOARD REVIEW
THE BASICS

2. 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.

3. 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.

4. 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.

5. SOMATIC DYSFUNCTION Tenderness Asymmetry Restriction
Diagnostic Criteria:
Tenderness
Asymmetry
Restriction
Tissue Texture Changes

6. SOMATIC DYSFUNCTION Tenderness
May be produced during palpation of tissues where it should not occur if there was no somatic dysfunction.

7. SOMATIC DYSFUNCTION Asymmetry
Bones, muscles, or joints may feel asymmetric to corresponding structures.

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

9. Barriers 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.

10. 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

11. Fryette’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.

12. Principle I In the Neutral position:
Sidebending precedes rotation. Sidebeding and rotation occur in opposite directions.
e.g.: NSLRR
Typical of a group dysfunction

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

14. 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.

15. Principle 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.

16. 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.

17. Evaluating 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
Neutral
Somatic dysfunction is named for freedom of motion

18. 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

19. Facet Orientation REGION Facet Orientation Main Motion Cervical
Backward, upward, medial
(C2-C7)
OA-flexion/extension
AA-rotation
C2-C7—rotation/SB
Thoracic
Backward, upward, lateral
Rotation
Lumbar
Backward, medial
Flexion/Extension

20. Physiologic Motion Motion Axis Plane FLx’n/Ext’n Transverse Sagittal
Rotation
Vertical
Sidebending
A/P
Coronal

21. 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.

22. Direct 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

23. Active 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.

24. Myofascial Release Can be either direct or indirect, passive or active
Palpate restriction
Apply compression (indirect) or traction (direct)
Add twisting or transverse forces
Use 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

25. Counterstrain 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!

26. Facilitated Positional Release
Passive, indirect technique
The 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.

27. Muscle 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

28. 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 RA
Osteoporosis
Fractures
Osteomyelitis
Bone metastases
Most common overall complication: Vertebral artery injury.

29. Methods of Treatment Treatment Direct or Indirect Active or Passive
Myofascial Release
Both
Counterstrain
Indirect
Passive
FPR
Muscle Energy
Direct (rarely indirect)
Active
HVLA
Direct

30. Choice 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

31. 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.

32. 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).

33. Question 1
Which one of the following is not a diagnostic characteristic of somatic dysfunction?
Edema
Temperature change
Tenderness
Full range of motion
Asymmetry

34. Question 1
Which one of the following is not a diagnostic characteristic of somatic dysfunction?
Edema
Temperature change
Tenderness
Full range of motion
Asymmetry

35. Question 2
While 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?
ERRSR
FRRSR
ERRSL
FRRSL

36. Question 2
While 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.
ERRSR
FRRSR
ERRSL
FRRSL

37. Question 3
Which cervical segment is best evaluated by flexing the neck 45* and rotating the head? OA C1 C2 C3 C4

38. Question 3
Which cervical segment is best evaluated by flexing the neck 45* and rotating the head? OA C1 C2 C3 C4