Opp

OPP By Dark Horse

Chapman Reflex Points • Viscerosomatic reflex points on the surface of the body, to be used for diagnosis and treatment of disease. The reflex points correspond to an organ/system as a result of dysfunction or pathology in an organ. • Discretely palpable or multiple grouped in irregular patches called gangliform • Current thinking: Lymphatic involvement linked with sympathetic nervous system dysfunction • Chapman stressed that the pelvis should always be treated prior to treating reflex points • Move tip of finger in a circular fashion to flatten the mass • Continue moving pressure for 10-30 seconds or until mass disappears

Myofascial Component • 1. Superficial fascia – encircles the neck, contains fat, encloses voluntary muscles • 2. Prevertebral fascia – encloses vertebral column and associated muscles forming a vertebral compartment • 3. Carotid sheaths – fascia surrounding great vessels and Vagus nerve

OMT in Pharyngitis • Osteopathic manipulation to increase lymphatic flow and reduce inflammation maybe beneficial. Consider The Galbreath technique , to increase mandibular drainage • Myofascial trigger points seen in throat pain: – Medial Pterygoid Muscle – Digastric Muscle

Innominates and Pubes • Hamstring Test: Patient supine, place cephalad hand over the patient’s contralateral ASIS. With your other hand placed under the ipsilateral ankle, raise patient’s leg until you feel slight motion at the opposite ASIS and note the angle • Innominate Flares: Occurs when the ASIS on one side is more medial or lateral to the opposite side. One side is then rotated on the other side along the vertical axis • Posterior Innominate: Superior ASIS and Inferior PSIS on same side. Relatively short leg on same side • Superior Innominate Shear: Superior ispilateral ASIS and PSIS. Relatively short leg on same side • Anterior Innominate: ASIS lower and PSIS higher on same side. Relatively short leg on opposite side • Inferior Innominate Shear: Ipsilateral inferior PSIS

Muscle Energy • An active, direct treatment involving voluntary and precise patient movement against a isometric resistance away from a pathological barrier engaged by the physician. The treatment results in reflexive relaxation of the agonist muscle fibers. The isometric resistance resets the golgitendon organ. A gentle contraction initiated in an agonist muscle will give a reflex relaxation in the antagonistic muscle group • Example: In restricted elbow extension, isometric contraction of biceps is followed by relaxation so that biceps can be stretched to a new resting length.

TYPES OF MUSCLE CONTRACTION • Isometric: Contraction(exerts tension) without motion between origin or insertion. • Concentric Isotonic: A shortening contraction. • Eccentric Isotonic: A lengthening contraction. • “Isolytic”: Contraction of a muscle by the patient that is overcome by

Pathophysiology of Somatic Dysfunction

•

Research

– Korr and Patterson—1950s helped define the SD – Denslow—1970s biopsied SD to identify inflammation and edema

•

Spinal facilitation – Chemical mediators elaborated by tissues send messages to local nociceptive nerve endings that then signal the spinal cord

•

• • •

Terminal of PAN releases Substance P Substance P triggers release of: histamines bradykinins prostaglandin White cells migrate to area and release cytokines which cause edema and trigger increased activity in PAN FEED FORWARD PAN receptors activate release of: SP CGRP somatostatin

Pathophysiology of Somatic Dysfunction • Extravasation of intravascular and lymphatic fluid into tissue—edema • This causes tissue texture changes • The humoral response to tissue event increases PAN activation— inflammation • This results in hyperalgesia • These structural and functional alterations require the excessive synaptic drive from the PANs

Fascia & Lymphatics • Thoracic Duct: Longest lymph vessel in body(3645cm) • Lies against vertebral column • Passes through diaphragm • Drains everything except right side head/neck/arm and chest(including heart, portions lung) • All lymphatic fluid must pass through fasciae of thoracic inlet • All lymph below diaphragm drains into cisterna chyli • Only the lower extremities &

Lymph Nodes •

Superficial nodes drain into 3 main groups • • •

•

Cervical Axillary Inguinal

Factors that influence flow: – Interstitial fluid pressure – Lymphatic pump – External pressure on lymph channels

•

Edema causes – Compression of lymphatic channels & nearby vascular/neurologic structures – Diminished function

•

Edema effects bioavailability of drugs & hormones – Hampers medical management & effect of pharmacologic treatment

• Interstitial fluid accumulates “upstream” from fascial restrictions when they impair lymph channels • Lymphatic congestion may be within