CORE OMM Curriculum Board Review

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

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 Suggested Areas of Study

4. 5. Memorize Viscerosomatic reflex levels 6. Memorize steps to Spencer Technique 7. Diagnosing and treating somatic dysfunction in: cervical, thoracic, lumbar 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 previous edition. 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. Anatomic – limit of passive motion Elastic – range between physiologic and anatomic motion Physiologic – limit of active 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) – Tenderness A – Asymmetry R – Range of Motion (ROM) T – Tissue Texture changes CARDINAL INDICATOR – R.O.M. Somatic Dysfunction: Physical Findings

14. AcuteChronic Temperature increase cool Texture boggy, rough smooth, thin Moisture increase decrease Tension increase sl. increase Tenderness greatest less tender Edema yes no Erythema yes, stays fades quick Somatic Dysfunction: Acute

15. Concentric – approximate attachments 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. 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. 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. Def – 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. Foundations for Osteopathic Medicine, 1st Ed., pp. 1131

28. Movement of ilium on sacrum Standing Fexion 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 axis of motion Vertical – rotation A/P – sidebending 2 Obliques (diagonals) R and L – torsions 3 Transverse axis – flexion and extension Superior transverse – respiratory axis Middles transverse – postural axis (motion during flexion/extension of spine) Sacral Motion

39. Foundations for Osteopathic Medicine, 1st Ed., pp. 1136

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

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

42. 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 ( unilat. or bilat 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) mech. ME Sacral Diagnosis -Tips

43. 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 R, Posterior /Inferior ILA is on L ME Sacral Diagnosis -Tips

44. 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 Lig. taut on L Mitchell, The Muscle Energy Manual, Volume III, p. 62

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

46. 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 Lig. taut on R DS Mitchell, The Muscle Energy Manual, Volume III, p. 62

47. 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

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

49. 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

50. Mitchell, The Muscle Energy Manual, Volume III, p. 61