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CORE OMM Curriculum Board Review

CORE OMM Curriculum Board Review. Developed for OUCOM CORE By: Janet Burns, D.O. Edited by: James Preston, D.O., Clay Walsh, D.O., and the CORE Osteopathic Principles and Practices Committee Series A, B, & C - Session #5. Overview.

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CORE OMM Curriculum Board Review

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  1. CORE OMM Curriculum Board Review Developed for OUCOM CORE By: Janet Burns, D.O. Edited by: James Preston, D.O., Clay Walsh, D.O., and the CORE Osteopathic Principles and Practices Committee Series A, B, & C - Session #5

  2. Overview • It is not the intention of this review to be comprehensive or exhaustive; that is best left to the several OMM board review books available. • The best use of your limited time is on high yield subject areas. • Current CORE residents provided the following recommendations for areas to focus on:

  3. 1. Memorize Chapman’s Reflexes 2. Dx and Tx of Sacral Dysfunctions via Muscle Energy model 3. Know the difference between Direct and Indirect techniques 4. Know contraindications to certain techniques SuggestedAreas of Study

  4. 5. Memorize Viscerosomatic reflex levels 6. Memorize steps to Spencer Technique 7. Diagnosis and treatment of somatic dysfunction in: cervical, thoracic, lumbar spine, sacrum, pelvis, ribs, and extremities; utilizing Direct and Indirect approaches Suggested Areas of Study - continued…

  5. OMM Board Review, John D. Capobianco, D.O., F.A.A.O. http://www.md-do.org/NewOMMBoard%20Review02-REV.htm - A free 32 page outline format review. Excellent for last minute studying; includes mnemonics for recall, clinical correlations, functionally relevant anatomy. Highly recommended. 60 multiple choice questions with key http://www.mommd.com/comlexsample.shtml - Free, good questions, but are not labeled as to whether they are Level I, II, or III Board Review Web Sites

  6. OMT Review 3rd edition - A Comprehensive Review in Osteopathic Medicine; Robert G. Savarese, D.O., 2003 - $36 Suitable for Levels I - III, has updated COMLEX-style questions, includes a lot more relevant anatomy than previousedition. There are a few errors, if you own this book go to: http://www.omtreview.com/errata.htm Board Review Resources

  7. Major Resource for appropriate terminology: OMM Terminology Found in the back of Foundations for Osteopathic Medicine, 2nd Ed.

  8. Sympathetic Innervations

  9. Physiologic – limit of active motion Anatomic – limit of passive motion Elastic – range between physiologic and anatomic motion Restrictive – limit within anatomic range which decreases Physiologic range Pathologic – permanent restrictive barrier associated with pathologic change in tissue Barriers

  10. Foundations for Osteopathic Medicine, 2nd Ed., pp. 575-576

  11. Definition – impaired of altered function of related components of the somatic system: skeletal, arthrodial and myofascial structures and related vascular, lymphatic and neural elements. Somatic Dysfunction

  12. All somatic dysfunctions are named according to the POSITION of the dysfunctional structural element. The POSITION of the structural element EQUALS the EASE OF MOTION of that structural element. Therefore RESTRICTION OF MOTION of the structural element is OPPOSITE the POSTION diagnosis Naming/Diagnosing Somatic Dysfunction

  13. (T) A. R. T. T – Tissue Texture changes A – Asymmetry R – Range of Motion (ROM) (T) – Tenderness CARDINAL INDICATOR – R.O.M. Somatic Dysfunction: Physical Findings

  14. AcuteChronic Temperature increased cool Texture boggy, rough doughy, thin Moisture increased decreased Tension increased sl. increased Tenderness Increased less tender Edema yes no Erythema yes, stays fades quick Somatic Dysfunction: Acute

  15. Concentric – shortening of muscle during contraction Eccentric – lengthening of muscle during contraction Isolytic – contraction while forcing to lengthening; operator>patient Isometric – inc. tension, length constant; operator= patient Isotonic – approximation without change in tension: operator<patient Contraction

  16. Transverse: Shoulder to shoulder Anterior-Posterior: Front to back Longitudinal: (Vertical) Head to toe Axes

  17. Transverse: Separates top from bottom Sagittal: Separates left from right Coronal: Separates front from back Planes

  18. Def. – ends of arc approximate Sacral – base anterior Craniosacral –sacrum counter nutates (base posterior); sphenobasilar ascends Regional – cervical, thoracic, lumbar Flexion

  19. Sacral Flexion Foundations for Osteopathic Medicine, 1st Ed., pp. 1130

  20. Def. – ends of arc move apart Sacral – base posterior Craniosacral – sacrum nutates (base forward) sphenobasilar descends Regional – cervical, thoracic, lumbar Extension

  21. Sacral Extension Foundations for Osteopathic Medicine, 1st Ed., pp. 1130

  22. Rules apply to thoracic and lumbar spine only Fryette’s I – with spine in neutral side – bending and rotation are opposite Fryette’s II – with spine hyperflexed or hyperextended sidebending and rotation are to the same side. Fryette’s III – motion in any plane of motion modifies motion in all other planes of motion. Fryette’s Principles

  23. Non-neutral Mechanics Type II Rotation Before SB Non-neutral Mechanics Type II Rotation Before SB Thoracic Mechanics Kimberly Manual, millennium edition, pp. 11-12

  24. Definition – area of impairment or restriction that develops a lower threshold for irritation and dysfunction when other areas are stimulated. Reflex hyper-excitability Hyper-irritable Hyper-responsive Facilitation

  25. OA – Type I only with flexion/extension AA – Rotation only C2 – C7 – Type II only Thoracic – Type I and Type II Lumbar – Type I and Type II Spinal Motion

  26. External auditory meatus Lateral head of humerus Third lumbar vertebrae (center) Greater trochanter Lateral condyle of knee Lateral malleolus Gravitational Line

  27. Gravitational Line Foundations for Osteopathic Medicine, 1st Ed., pp. 1131

  28. Movement of ilium on sacrum Standing Flexion test Landmarks: ASIS, PSIS Anterior rotation – ASIS down, PSIS up Posterior rotation – ASIS up, PSIS down Inflare – ASIS in Outflare – ASIS out Inferior shear – ASIS down, PSIS down Superior shear – ASIS up, PSIS up Iliosacral Somatic Dysfunctions

  29. DiGiovanna, 3rd Ed, p. 289

  30. DiGiovanna, 3rd Ed, p. 288

  31. DiGiovanna, 3rd Ed, p. 291

  32. Extension – unilateral and bilateral Flexion – unilateral and bilateral Forward Torsions – L on L, R on R (rotation on an axis) Backward Torsions – L on R, R on L Sacral Shear Anterior Sacrum (translated) Posterior Sacrum (translated) Sacral Somatic Dysfunctions

  33. Sacral Torsions Seated Flexion Test Axis (Oblique) Superficial Sulcus Right Superficial Sulcus Left ------------------------ ------------------------ ------------------------ ------------------------ Positive Right Left Right on Left Left on Left (L5) L5 Left Rotation L5 Right Rotation (Sacral bending) Backward Forward ------------------------ ------------------------ ------------------------ ------------------------ Positive Left Right Right on Right Left on Right (L5) L5 Left Rotation L5 Right Rotation (Sacral bending) Forward Backward

  34. Motion of pubic symphysis Landmarks: pubic bone Dysfunctions – superior, inferior Pubic Somatic Dysfunction

  35. DiGiovanna, 3rd Ed, p. 291

  36. Seated flexion test Sphinx test (lumbar extension) Spring test 2 Landmarks – Sacral Sulcus – ILA (inferior lateral angle) Sacral Somatic Dysfunctions

  37. Glossary of Osteopathic Terminology

  38. 7 axes of motion Vertical – rotation A/P – sidebending 2 Obliques (diagonals) R and L – torsions 3 Transverse axes – flexion and extension Superior transverse - respiratory axis Middle transverse - postural axis Inferior Transverse – Innominate rotation axis Sacral Motion

  39. Sacral Axes 1 Longitudinal axis 1 Anterior-posterior axis 2 Oblique axes • Right and Left 3 Transverse axes • Superior, Middle, and Inferior DiGiovanna, 3rd Ed, p. 287

  40. Sacral Axes • 3 Transverse Axes • Superior: Respiratory axis • Motion relative to the pull of the dura occurs around this axis • Middle: Postural axis • Bilateral Flexion & Extension occur around this axis (motion during flexion/extension of spine) • Inferior: Innominate rotation axis DiGiovanna, 3rd Ed, p. 287

  41. Similar to algebra, you will be expected to solve the equation for the unknown, you need to know the “rules” and algorhythms: (+) Spring or Sphinx (prone backward bending) tests reflect an extended sacral base (unilateral or bilateral extensions or backward torsions) Sacral torsion “rules” of L5 on S1 Sacrum rotates opposite L5 When L5 is sidebent, it forms an oblique axis on that side The (+) seated flexion test is found on the side opposite the oblique axis Forward Torsions occur in Neutral (Type 1) mechanics Backward torsions occur in Non-neutral (Type 2) mechanics ME Sacral Diagnosis -Tips

  42. Using these rules, if you are given L5 FrSr: There will be a (+) flexion test on L, sacrum rotated L on R oblique axis You then extrapolate that this is a backward torsion (because forward torsions are named same on same, i.e. L on L, Backward torsions are vice versa) Therefore the Spring or Sphinx tests would be (+) reflecting the extended (posterior) sacral base on the L Deep Sulcus (DS) is therefore on the R, Posterior /Inferior ILA is on the L ME Sacral Diagnosis -Tips

  43. Forward Torsions - Review • Findings for Left on Left: • (+) Standing flexion test on R • Deep sacral sulcus (DS) on R • Posterior/Inferior ILA on L • (-) Spring / Sphinx Test • Sacrotuberous Ligament taut on the L Mitchell, The Muscle Energy Manual, Volume III, p. 62

  44. Forward Torsions Occurs when lumbar spine is in neutral mechanics Exaggerated ambulation mechanics Sacrotuberous Ligament is taut on side of Posterior/Inferior ILA Forward Torsions: Causes

  45. Backward Torsions - Review • Findings for Right on Left: • (+) Standing flexion test on R • Deep sacral sulcus (DS) on L • Posterior/Inferior ILA on R • (+) Spring / Sphinx Test • Sacrotuberous Ligament taut on the R Mitchell, The Muscle Energy Manual, Volume III, p. 62

  46. Backward Torsions How do these occur? Physiologically during Non-Neutral Lumbar Mechanics Is backward torsional motion always dysfunctional? No, only if it can’t return to neutral Backward Torsions: Causes

  47. Backward Torsion: • possible mechanism • Mitchell, The Muscle Energy Manual, Volume III, p. 64

  48. L. Unilateral Sacral Flexion • L half of Sacrum has moved forward & down relative to R • (-) Sphinx test • (+) Seated flexion test on L • Sacrotuberous lig. taut on L Mitchell, The Muscle Energy Manual, Volume III, p. 60

  49. Compare Mitchell, The Muscle Energy Manual, Volume III, p. 61

  50. Deep Sulcus and Posterior/ Inferior ILA on Same side (i.e. both on L, could be L Flex or R Ext) What separates a L sacral Flexion from a R sacral Extension is: the Sphinx test: (-) in flex (+) in ext or the Seated flexion test (+) R on R Ext, (+) L on L Flex Some find it easier to think of it as a shear or combination of Sidebending and Rotational strains: Sidebending and Rotation occur to opposite sides Caused by unbalanced sacral base loading during trunk sidebending- same mech. that can cause innominate upslip, but trunk is sidebent, not upright Unilateral Sacral Flexions / Extensions

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