Lecture (3)
Dr. Al shimaa
Mokhtar
DO , PT , PHD
Osteopathic Manipulative
Treatment (OMT)
Osteopathic diagnosis :
Changes in the musculoskeletal system can affect other organs
( somatovisceral reflex ) or allow visceral pathology
To manifest as aberrations in musculoskeletal tissue texture
and articular motion ( viscerosomatic reflex).
These musculoskeletal changes are known as Somatic
dysfunction
Somatic dysfunction is palpable on structural examination
and can be treated with manual medicine including
osteopathic manipulations.
Somatic dysfunction is impaired or altered
functioning of related components of the somatic
system: skeletal (frame work) affect on vascular,
lymphatic , neural and visceral elements.
Types:
-Acute somatic dysfunction.
-Chronic somatic dysfunction.
*Primary somatic dysfunction: SD that cause the
total pattern of dysfunction.
*Secondary somatic dysfunction: mechanical
response subsequent to other etiology.
How do you get somatic dysfunction ?
• Local acute injury
• Local repetitive injury
• Compensatory changes
to acute injury
• Long term strain
• Compensatory changes
to long term strain
• Segmental facilitation
Types of lesions
reflexes
1-Somato-Visceral Reflexes
• Dysfunction of somatic structures causing
pain and/or dysfunction in a visceral
structure.
• Examples:
*Dysfunction of T4 causing segmental
facilitation, which reflexively results in
increased sympathetic nervous stimulation
to the heart (chest pain) .
*Recurrent urinary tract infection due to
pelvic torsion or pubic shift.
2- Viscero - Somatic Reflexes
• Dysfunction of visceral structures causing
pain and/or dysfunction in another somatic
structure.
• Examples: * Back pain due to colon
dysfunction ( constipation).
* Neck pain due to restriction of diaphragm .
3- Somato-Somatic Reflexes
• Dysfunction of somatic structures
causing pain and/or dysfunction in
another somatic structure.
• Example:
Neck pain due to thoracic dysfunction
The thoracic is the base of neck from
mechanical element .
4- Viscero – Visceral Reflexes
• Dysfunction of visceral structures causing
pain and/or dysfunction in another somatic
structure
• Example: Restriction of diaphragm affect on
abdominal organs' circulation & functions .
Autonomic nervous system:
Sympathetic and
parasympathetic of visceral
organs
Parasympathetic nervous system of viscera :
Diagnosing Somatic Dysfunction
• T - Tenderness
• A - Asymmetry
• R - Restricted Range of Motion
• T - Tissue Texture Changes
Tender points vs. Trigger points
• Tender points –small discrete hypersensitive
areas within myofascial structures that result in
localized pain.
• Trigger point – small discrete hypersensitive
areas within myofascial structures – palpation
causes referred pain away from site.
Asymmetry
Look : Visually analyze for
asymmetry - Gait, Standing, Sitting,
Lying Down
Reference points e.g. : standing
mastoid, shoulders, inferior angles of
scapula, iliac crest ,PSIS , ASIS and
greater trochanter of femur Pelvic
shift, lat. curves, AP. Curves .
Palpate : Palpate for bony asymmetry
.
R - Restricted Range of Motion
Barriers to Range of Motion
• Physiological Barrier
- Limit of normal motion
- Tested actively
• Anatomical Barrier
- End range of motion
- Tested passively
• Elastic Barrier
- Range of motion between physiological and anatomical
barriers
• Restrictive Barrier
- Abnormally diminishes physiological range of motion
- This is the barrier we work with in OMT
Tissue Texture Changes
-Temperature
-Texture
Acute: Increased Temperature ,Tissue may be
edematous, tender, and/or red.
Chronic: Decreased (or slight increase) Temperature,
Tissue may be rigid, and/or atrophic.
Somatic dysfunctions arise when alterations occur either
to the bones acting as compression elements or the soft parts acting as
tension elements or if the balance between both is altered.
Somatic dysfunction
give me information
of which segment
affected thus which
organs supply with
the same segment .
Autonomic Nervous System
If the affected
segment in group
lesion its sign of
the lesion is
visceral origin or
scoliosis
oscillation test :
to detect the level of lesion (somatic dysfunction).
For cervical & upper For Mid & lower thoracic
thoracic region and lumber region
Look for Area of Greatest Restriction by:
Palpate Facet motion**Assess Rt then Lt side**
For Assess the cervical region
Flex neck slightly
Introduce side bending or rotation to the same side of assessment.
For Assess the upper thoracic T 1 - T 4
Introduce motion from head .
For Assess the mid and lower thoracic & lumber region
Introduce motion through the shoulder.
Erythema Friction Rub
The purpose of this test is to identify central
spinal areas of automatic change related to
segmental dysfunction.
Spring Test :
Apply a downward “springing” force through the spinous
process of each vertebrae to assess anterior posterior motion.
Positive Finding:
Increases or decreases
in motion at one
vertebrae compared to
another (hypermobility
or hypomobility).
Thank You
