Osteopathic Manipulative Medicine/Treatment Models
Chapter 2: Treatment ModelsEdit
- Identify the major treatment techniques utilized in osteopathic manipulative treatment
- Describe the mechanism of the major treatment techniques
- Discuss the absolute and relative contraindications of each treatment model
- Understand the physiology of facilitated segments, somatic dysfunction, and neuromusculoskeletal receptors.
Osteopathic Treatment Techniques:Edit
Osteopathic manipulative treatment (OMT), historically also known as Osteopathy, is a manual treatment modality that serves as an adjunctive therapy to medical management. The goals of using OMT are to relieve or reduce pain, increase range of motion, improve physiologic functioning, increase circulation (of blood, venous and lymphatic flow), and to restore homeostatic balance of autonomic neural transmission.
Osteopathic treatment techniques can be classified as active/passive and as direct/indirect:
- Direct technique: movement into the restrictive barrier
- Indirect technique: movement into the ease of motion
- Active technique: patient is actively involved in the treatment
- Passive technique: physician performs treatment without patient input
The classes of techniques which we will consider from the 2017 Glossary of Osteopathic Terminology from the Educational Council on Osteopathic Principles (ECOP) :
- Soft tissue (ST)
- Myofascial release (often used interchangeably with soft tissue; MFR)
- Counterstrain (CS)
- Muscle energy (ME)
- High-velocity low-amplitude (HVLA)
- Lymphatic techniques
- Osteopathic cranial manipulative medicine (OCMM)
- Balanced ligamentous tension (Ligamentous articular strain) (BLT/LAS)
- Facilitated positional release (FPR)
- Still technique
|Technique||Direct or indirect||Active or passive||Mechanism of action||Absolute contraindications||Relative contraindications|
|Myofascial release (MFR)||Passive||
|Muscle energy (ME)||Active||
|High-velocity low-amplitude (HVLA)||Passive||
|Lymphatic (an extension of MFR)||Passive||
|Osteopathic cranial manipulative medicine (OCMM)||Passive||
|Balanced Ligamentous Tension (BLT) &Ligamentous Articular Strain (LAS)||Passive||
|Facilitated Positional Release (FPR)||Passive||
Physiology & Mechanism of Action:
There are three joint capsule receptors that are affected by OMT:
- Proprioceptors are receptors which sense motion and position of the body
- Mechanoreceptors are receptors excited by mechanical pressures or distortions such as those responding to touch and muscular contractions
- Nociceptors are peripheral nerve organs or mechanisms for the appreciation and transmission of painful or injurious stimuli
These neurologic receptors have dysfunctional physiology when affected by pathologic disease states and somatic dysfunction. This altered neurologic functioning within a specific region or vertebral segment is known as "facilitation" or a "facilitated segment".
Facilitated segments exist in a state whereby the maintenance of a pool of neurons is at full or partial sub-threshold excitation. Facilitation occurs when a segment of the nervous system has been subject to injury via trauma or chronic disease, causing the segment to become hyperactive and hypersensitive. Strain on facilitated segments are often compensated for by the body until mechanical failure and/or injury occurs. This may manifest as various somatic dysfunctions throughout the body and spine. Single vertebral dysfunctions often form initially, with group spinal dysfunctions occurring as a result of compensation and adaptation of the soma. Nociceptive input, also known as pain, can lead to increased muscle tension and chronic irritation as well as gradual compensatory structural changes (i.e. facilitated segments). This is usually in response to physical tissue damage or toxic stimuli and can be induced either mechanically or chemically.
Two mechanisms of muscular physiology that are affected by OMT include muscle spindle fibers and Golgi tendon organs:
|Muscle spindle fibers are stretch receptors are very sensitive to changes in length. The three subclasses of muscle spindle fibers are dynamic nuclear bag fibers (bag 1), static nuclear bag fibers (bag 2), and nuclear chain fibers. When stretched sufficiently, they will induce reflex contraction of the muscle, as a protective mechanism to prevent further tissue injury. Muscle spindle fibers monitor stretch and rates of change. In somatic dysfunction, the muscle spindle fibers are facilitated and functioning with imbalanced physiology, thus causing TART (Tenderness, asymmetry, restricted range of motion, abnormal tissue texture changes) findings that become evident upon osteopathic examination.|
|Golgi tendon organs is a proprioceptive sensory receptor that senses changes in muscle tension. It lies near the origin and insertion of all muscle tissue. They are safeguards of anatomic integrity and joint structure; they serve as a “relief reflex” which produces marked reduction of muscular activity when there is a severe stretch. Sufficient impulses from Golgi tendon organs will result in inhibition of the muscle it occupies and its muscular synergists (and facilitate antagonists).|
1. A patient presents with significantly hypertonic paraspinal muscles. Which treatment technique is the most appropriate initial treatment on this patient?
B. Muscle energy
D. Myofascial release/Soft tissue
E. Lymphatic techniques
Questions 2-5: Match the following descriptions with the listed treatment technique.
2. Myofascial release/Soft tissue
4. Muscle energy
A. Passive, direct
B. Passive, indirect
C. Active, direct
D. Active, indirect
E. Can be either direct or indirect
Questions 6-10: Match the mechanism with the treatment technique.
6. Post-isometric muscle energy
9. Reciprocal inhibition muscle energy
10. Myofascial release/Soft tissue
A. Deep pressure, kneading, stretching, inhibition and/or traction of the skin, fascia, and muscle tissues with separation of muscle origins and insertion while monitoring tissue response and motion changes by palpation
B. Positioning of a tenderpoint to a position of significantly decreased or eliminated pain (typically for 90 seconds)
C. Increased stretch is sensed by the Golgi tendon organ proprioceptors within the muscle tendon leading to reflex inhibition and subsequent muscle lengthening
D. Utilization of agonist/antagonist muscle relationships of inverse relaxation with contraction used primarily in the treatment of acute somatic dysfunctions
E. Quick thrust with very minimal distance through a restrictive barrier, which may generate a "pop" or "click"
11. Which of the following correctly describes a direct and active technique?
A. A technique in which the patient is taken to the barrier of the somatic dysfunction and the patient performs an action, against resistance, as directed by the physician.
B. A technique in which the patient is taken into the ease of motion and the patient performs an action, against resistance, as directed by the physician.
C. A technique in which the patient is taken into the barrier of the somatic dysfunction and the physician performs all of the action without assistance from the patient.
D. A technique in which the patient is taken into the ease of motion and the physician performs all of the action without assistance from the patient.
Answers to Review QuestionsEdit