Study Guide for Written Final Spring OMM 512
Know the 4 basic tenets of osteopathic philosophy
1. Body is a unit and the person is a unit of body, mind, and spirit.
2. The body is capable of self-regulation, self-healing, and health maintenance.
3. Structure and function are reciprocally interrelated.
4. Rational treatment is based upon an understanding of the basic principles of body unity, self-
regulation, and the interrelationship of structure and function.
Be able to define and use following definitions:
o Somatic Dysfunction: impaired or altered function of the somatic (body framework)
system: skeletal, arthrodial, and myofascial structures; and related vascular, lymphatic,
and neural elements.
o ART triad:
A: asymmetry, discerned by observation and palpation
R: range of motion restriction, particular decreased range, discerned by active and
passive motion testing combined w/observation
T: tissue texture abnormality, alterations in the palpatory characteristics of the
soft tissues.
o TTA: tissue texture abnormality
Understand the general treatment principles of the following techniques:
o Muscle Energy Treatment (MET)
Direct, active technique with an intrinsic activating force
Voluntary contraction of patient muscle, in a precisely controlled direction, against
a counterforce applied by operator
Localize barrier, apply force, patient counterforces
o High Velocity Low Amplitude (HLVA)
Direct, passive technique using high velocity (quick), low amplitude (short) forces
to remove motion restriction
Rapid force engages restrictive barrier in one or more planes of motion release
of restriction
o Counterstrain (CS)
Indirect, Passive technique, tissue being treated positioned at point of balance
REQURIES DIAGNOSIS OF TENDER POINT
Reduction and arrest of inappropriate muscle activity shorten muscle that
contains malfunctioning muscle spindle by applying strain to its antagonist
Find tender point, treatment, reduce pain by at least 70%, hold for 90% seconds
o Soft Tissue (ST)
Direct, passive, technique using lateral and linear stretching, deep pressure, and
separation of muscle origin and insertion
Combined diagnostic and therapeutic technique, prepare tissues for more
definitive manual medicine procedures
Use finger pads, thenar eminence, and palmar aspect of thumb. Pressure exerted
AWAY from spinous processes
o Myofascial Release (MFR)
Direct MFR: restrictive barrier engaged, tissue loaded with constant force until
release occurs
Indirect MFR: dysfunctional tissues guided along path of least resistance, until free
movement achieved
Stack either direct or indirect add enhancers to SPEED release wait for
release
Be able to document appropriately an OMM encounter in SOAP note format
Understand the anatomy and biomechanics of:
o Rib motion
Including pump handle, bucket handle, caliper motion
Pump handle
All ribs, primarily ribs 1-5
Scalenes, pecs
Motion at anterior aspect of rib due to more medial-lateral orientation of
the upper thoracic transverse processes
Bucket handle
All ribs, primarily ribs 6-10
Serratus anterior
Motion at lateral aspect of the rib due to the more anterior-posterior
orientation of the lower thoracic transverse processes
Caliper motion
Ribs 11 and 12
Quadratus lumborum
Possible because no anterior articulation
Motion is posterolateral during inhalation, anteromedial during exhalation
o Lumbar spine motion
Primary motion of lumbar spine is flexion and extension (small amount of side
bending and rotation).
Vertebral segments should follow thee segment below through forward and
backward bending
At the lumbosacral junction, L5 and sacral base motion are coupled in opposite
directions
Including Type 1 and type 2 mechanics
Type 1 (Neutral): Facets not loaded, rotation and side bending will occur to
opposite sides, 3 or more segments, semi-rigid rod
Type 2 (Non-neutral): Facets loaded and drive motion at segment, rotation
and side bending occur on same side, ONE single segment
o Pelvis and sacrum motion
Sacral motion: group of 5 vertebrae Type 1 motion
Side bending and rotation couples to opposite sides (sacrum)
Lumbar flexion sacral counternutation
Lumbar extension sacral nutation
Lumbar rotated left sacrum rotated right
Including Gait cycle
Oblique axes- “instantaneous axes” that are engaged in the walking cycle
allowing the necessary anterior torsional motion
o Only active in sacral rotations
o The sacrum rotates left or right around an oblique axis
Anterior torsions- physiologic in the walking cycle – can be
dysfunctional
Posterior torsions- occur with bending and twisting
motions – always dysfunctional
o Middle transverse- runs through the anterior aspect of S2. The axis
for postural motion of the sacrum, nutation, and counternutation.
Nutation: forward nodding of the sacrum
o Associated w/lumbar extension
o Sacrum rotates anteriorly on the middle transverse axis and
translates inferiorly, forward and down
Counternutation: backward nodding of the sacrum
o Associated w/lumbar flexion
o Sacrum rotates posteriorly on the middle transverse axis and
translates superiorly, back and up
Gait Cycle
o Weight bearing R leg sacrum moves into R rotation around R
oblique axis and L sacral base nutates. This produces an
instantaneous right on right sacral torsion.
Lumbar spine moves opposite the sacrum and rotates left,
side bends right.
Know the anterior and posterior locations of tenderpoints AND their common CS treatment
positions for the following regions:
o Rib
ALL RIBS HOLD FOR 120 SECONDS
Anterior ribs
o AR1: inferior to medial clavicle near sternoclavicular joint
o AR2: superior second rib at the midclavicular line
o AR307: along anterior axillary line corresponding to each rib
o Treatment: F StRt
Posterior ribs
o Correspond to inhaled or elevated ribs, located along the superior rib
angles
o PR1: E SaRt
o PR 2-12: F SaRa
o Lumbar
AL1: medial to ASIS
AL2: medial to AIIS
AL3: lateral to AIIS
AL4: inferior to AIIS
AL5: anterior pubic rami
Anterior lumbar treatment
AL 1: F StRA
AL 2-4: F SaRT (stand on opposite side)
AL5: F SaRa
Posterior lumbar treatment (points on spinous or transverse processes)
ESARA
o Pelvis/Sacrum
Upper Pole L5 (superior aspect of PSIS)
E ADD IR/ER
HIFO (High Ilium Flare Out), located at coccyx or ILA
E ADD (extension and adduction of the leg)’
HI High Ilium (2-3cm lateral to PSIS)
E AB ER (extension and abduction of the leg, external rotation of the leg)
PL3 (Glut Medius), 2/3 lateral between PSIS and TFL
E AB ER (extension and abduction and external rotation of leg to fine tune)
PLR (Glut Medius), lateral edge of glut medius near TFL
E AB ER (extension and abduction and external rotation of leg to fine tune)
Lower Pole L5, below PSIS
F IR ADD (flexion, internal rotation, and adduction of the leg)
Piriformis (middle of muscle, ILA-greater trochanter)
F AB ER (flexion, abduction, and external rotation of leg)
PS1 Bilateral, medial to PSIS at S1 level
Pressure post to anterior on opposite ILA
PS5 Bilateral, medial and superior to ILA
Pressure posterior to anterior on opposite base
Psoas, 2/3 distance from ASIS to midline
F ST
Iliacus, 1/3 distance from ASIS to midline
F ER (hips), abduct the knees
Low ilium , superior surface of lateral rums of pubic bone
F
Inguinal, lateral aspect of pubic tubercle
F, ADD, IR
Know how to diagnose and treat Type 1 and Type 2 somatic dysfunction of lumbar spine using MET
and HVLA
Know how to diagnose and treat respiratory and structural rib somatic dysfunction using MET
o Inhaled ribs/inhalation dysfunction/exhalation restriction (key rib)
o Exhaled ribs/ exhalation dysfunction/inhalation restriction (key rib)
o Anterior, Posterior, Superior rib subluxation
o External, Internal rib torsions
Know how to diagnose and treat pelvic somatic dysfunction using MET
o Pubic shears
o Innominate shear
o Innominate Rotations
Know how to diagnose and treat sacral somatic dysfunction using MET, including landmarks and
special test
o Unilaterals
o Torsions
