OMM Exam 1 LGT

Be Wary
Dont overthink the questions.
It is ok to move during your exam!
Read EVERY answer choice VERY CAREFULLY
There are lots of words that look the same
Words like not and only can completely
change answers
History
Focus on Dates
When was 1st school to opened
Year when all states accepted DOs
Also know last state to accept DOs

Focus on Places
First DO school name
Person who helped set up school
Where was the first school located
Research
What technique produces the greatest
increase in lymphatic flow?
What were the topics covered by research
presented in class
Otitis Media
Lymph flow (canines)
pregnancy (pain, outcome times, and
meconium staining)
Carpal Tunnel
Post CABG
Four Osteopathic
Principles:
I. The person is a unit of body, mind, and
spirit
II. The body is capable of self-regulation,
self-healing, and health maintenance
III. Structure and function are reciprocally
interrelated
IV. Rational treatment is based upon an
understanding of these prinicples
Structure & Function
Viscero-somatic
Reflexes
Visceral dysfunction
can cause reflex
sympathetic activity in
the paravertebral
musculature of
associated spinal level
Somato-visceral
reflexes
Somatic Dysfunction
impaired or altered function of related
components of the somatic (body framework)
system: skeletal arthrodial, and myofascial
structures and related vascular, lymphatic,
and neural elements.
A 29 y/o female comes to your office
complaining of fatigue, lack of hunger, and
lack of desire to do the things she used to
love. What is the first thing you should do?
A. Get an osteopathic diagnosis involving the
cervical spine.
B. Be a good osteopath and use your exam to
identify problems effecting the mind, body,
and spirit of the patient.
C. Giver her some antidepressants.
D. Perform a list of psychological evaluations.
E. Perform a physical exam
Which landmark is NOT intersected by
the posture line of the sagittal plane?
A. Body of L3
B. Glenohumeral Joint
C. External Auditory Meatus
D. Greater Trochanter
E. Lateral Maleolus
The vertebral prominence is associated
with which vertebral segment?
A. L2
B. T4
C. C6
D. T1
E. C7
15 Key Points:

Suboccipital Shelf
Medial Border of Scapula
Distal Radius
Distal Ulna
Costal Margin
Superclavicular Fossa (Sibsons Fascia)
Thoracic Spinous Process
Thoracic Transverse Processes
Iliac Crest
Anterior Superior Iliac Spine (ASIS)
Sacral Base (Lumbosacral Junction)
Inferior Lateral Angle of Sacrum (ILA)
Patella Tendon
Fibular Head
Medial Malleolus
Landmarks/ Vertebral
Segment
Sternal Notch = T2
Angle of Louis = T4
Xyphoid Process = T9
Umbilicus = L3 L4 (intervetebral disc
between segments)
Iliac Crest = L4
Inferior angle of scapula = T7- T8
Spine of scapula = T3-T4
Palpation
the application of variable manual pressure to the surface of
the body for the purpose of determining the shape, size
consistency, position, inherent motility and health of the
tissues beneath (osteopathic glossary).

Propioception/Touch
First 2 digits
Thumb

Temperature
Dorsum of the hand
TART
T Tissue Texture Changes
A Asymmetry
R Reduced Motion/Restriction of motion
Not just asymmetry of joint motion also
depends on how the motion feels
T Tenderness
Tenderness is associated with palpation
Pain is felt with or without palpation
Palpation and TART
Acute can be caused from bradykinin and
vasodilators released from local tissue injury
Red (erythema)
Boggy/swollen - edema
Warm
moist
Recent injury or dysfunction
More Tender than chronic changes
Palpation and TART
Chronic
Excessive blanching during red reflex
Caused by excessive sympathetic tone that causes
vasoconstriction
ropey fibrotic tissue
Long lasting dysfunction
Cool and pale skin
Dull, uncomfortable, burning
End Feel
Associated with Elastic Barrier
springy resiliency indicates the endpoint of motion
as you approach the anatomic barrier. (fights you as
you approach the anatomic barrier)
Motion
Active Motion
Movement produced voluntarily by the patient
Passive Motion
Motion induced by the physician while the
patient remains relaxed
Inherent Motion
Spontaneous motion of every cell, organ,
system, component of the body
Respiration, blood flow, etc.
Barriers
Anatomic barrier: the limit of motion imposed by
anatomic structure; the limit of passive motion
Elastic barrier: the range between the physiologic
and anatomic barriers of motion in which passive
ligamentous stretching occurs before tissue disruption
Pathologic barrier: permanent restriction of joint
motion associated with pathological change of tissue
( e.g. contracture, osteophytes)
Physiologic barrier: the limit of active motion
Restrictive barrier: a functional limit within the
anatomic range of motion, which abnormally
diminishes the normal physiologic range
 PASSIVE
(involuntary)
MOTION

NEUTRAL

ACTIVE (VOLUNTARY) MOTION

PHYSIOLOGICAL BARRIERS

ANATOMICAL BARRIERS
 NORMAL MOTION
Anatomic/ Elastic
D.
Pathologic
A Physiologic C.
NEUTRAL Barrier
Barrier
. B
Barrier POINT
.

PASSIVE PASSIVE
MOTION ACTIVE MOTION MOTION

Physiologic
E. ROM

Anatomic
F. ROM
 NORMAL MOTION
Anatomic/ Elastic
Pathologic Physiologic NEUTRAL Barrier
Barrier Barrier POINT

PASSIVE PASSIVE
MOTION ACTIVE MOTION MOTION

Physiologic ROM

Anatomic ROM
When performing muscle energy on the AA joint
which barrier do you approach and pass through?
A. Restrictive Barrier
B. Physiologic Barrier
C. Anatomical Barrier
D. Elastic Barrier
E. Osteopathic Barrier
Where does the neutral point move to
with somatic dysfunction?
A. it rotates left
B. It does not move
C. Away from the restrictive barrier
D. Towards the anatomical barrier on the side
of dysfunction
Some basic components of a
vertebrae
Spinous process
Lamina
Pedicles
Body
Vertebral Unit
1. Two adjacent vertebrae, their joints, and the
intervertebral discs between them.
2. The vertebral unit is given the name of the
superior member of the unit.
Ex: motion or somatic dysfunction of C2 means the motion
of C2 on C3.
Ex: motion or somatic dysfunction of L3 means the motion
of L3 on L4.
Generalities:
Cervicals: C2-7: flexion, extension,
sidebending and rotation. (varies thru
region)
Thoracics: rotation > flexion/extension>SB
Lumbars: flexion/extension>SB>rotation
Fryettes Principles of Physiologic
Motion
1st Principle
When sidebending is attempted from neutral
(anatomical) position, rotation of vertebral
bodies follows to the opposite direction.
2nd Principle
When sidebending is attempted from non-neutral
(hyperflexed or hyperextended) position, rotation
must precede sidebending to the same side.
3rd Principle
Motion introduced in one plane limits and
modifies motion in the other planes.
Fryettes Principles
Type I mechanics usually occur with groups of segments
Greatest motion often occurs towards the middle
segments
Neutral mechanics: sidebending PRECEEDS rotation

When Writing it follows the same principle

Ex: L3 in neutral position(resting lordosis), sidebent left

and rotated right on L4:
L3 NSLRR
ype I Mechanics - Thoracic and Lumbar
What is the correct way to write a diagnosis of
T7 on T8 is rotated right and side bent left.
A. T8 N SLRR
B. T7 N SLRR
C. T7 N RR SL
D. T8 N RR SL
E. T7 N SR RL
Your patient comes in complaining of back
pain. You find that L2 follows Fryettes 1st
principle and has restricted rotation to the
left. What is the Correct Diagnosis?
A. L2 N SRRL
B. L2 N RL SR
C. L2 N RR SL
D. L2 N SLRR
E. L2 F RR SR
Non-neutral (Fryette Type II)
Motion occurring when the spine is in a position
where facet structures determine the motion
characteristics.

Applies only to T and L spine!

Spine usually straightened(rigid rod)
Type II Fryette Mechanics-apply only to the T & L
spine!
Usually occur as single segment dysfunctions
Non -Neutral mechanics: rotation PRECEEDS
sidebending

Osteopathic Notation follows the sequence of

events:
EXAMPLE:
from a FLEXED (OR EXTENDED) position
First rotation left occurs
After rotation left occurs, then sidebending left can occur
Therefore: F RLSL (or E RLSL)
Divisions of the Cervical Spine
Superior Division
Occiput
PROVIDES 45 degrees of BB and FB in OA joint
Atlas no body and rotates around dens
PROVIDES 45 degrees of rotation in each direction in
AA joint
Axis body forms odontoid process (Dens)

Inferior Division
C2 C7
Cervicals
OA joint = Occiput and Atlas (1/2 of FF and BB)
- sidebending and rotation are always opposite
AA joint = Atlas and Axis ( of rotation

ALL MOTION IS SAME DIRECTION IN LOWER

CERVICALS Sidebending and rotation is same sided

By convention we name them as Rotation First: Then

Rotated (like Type II non neutrals)
Cervical Spine
Soft Tissue
1. Effleurage
2. Inhibition
3. Kneading force at 90 degree angle to muscle
4. Stretching force parallel to muscle fibers
5. Tapotement
6. Traction

Be aware of what position person is in for each treatment

Supine, prone, lateral recumbant, etc.
Know which direction the force is being directed and hand
position
4. In which of the following situations is it NOT appropriate to use soft
tissue treatment to treat the problem described?

a. A patient reports she twisted her ankle 1 week ago and it is still
sore. She
was evaluated in the emergency department at the time of the
injury and
no fracture or tissue tears were found.
b. A patient reports back pain across the top part of his back. It
came on
gradually after he sat at his computer for about 5 hours.
c. A patient reports that she has been in a fight with her mother-in-
law this
morning. Her mother-in-law punched her and now she has facial
pain and
puffy eyes.
d. A patient reports that she slept wrong and now her neck is
sore. She
can move her head, but cant turn as far to the right as she can to
the left.
e. A patient reports that the scar from the cholecystectomy that she
Where is the force directed in
suboccipital traction?
A. Anterior
B. Anterior and slightly superior
C. Inferior and slightly anterior
D. Directly lateral of the suboccipital shelf
E. Cannot be determined because it depends
on your diagnosis of the OA join.
During supine transverse cervical kneading
where is the caudad hand placed?
A. On the forehead
B. On the ipsilateral paravertebral muscles of
the cervical spine
C. On the contralateral paravertebral muscles
of the cervical spine
D. On the spinous processes of th ecervical
spine
E. On the body of the cervical vertebrae
Red Flags
Significant trauma
Severe pain
Paralysis (or increased
tone)
Loss of sensation
(anesthesia)
Loss of bowel or bladder
 Yellow Flags
Fever
Unexplained weight loss or night
sweats
Osteoporosis or unexplained
fractures
Lack of response to appropriate
treatment
Think twice before proceeding. Must rule out
Somatic Dysfunction
Impaired or altered function in
related components of the
somatic system including
muscular, fascial, and
arthrodial structures and their
related neural, vascular, and
lymphatic elements.
Treatment
Indirect
Jones Strain Counter Strain

Direct
Muscle Energy
General Concepts to help with OMM
Testing
For techniques, know:
a. when it would or would not be appropriate to use
this technique
b. how does the technique work
c. where do your hands go
d. how is force applied
e. why do this technique
f. is this a direct or indirect technique
Indirect Method
A manipulative technique where the
restrictive barrier is disengaged
The dysfunctional body part is moved away
from the restrictive barrier until tissue tension
is equal in one or all planes and directions

float the restricted region being treated

Uses Inherent force

Definition of Tender Point
Specific discrete areas of local tenderness,
the size of a fingertip
May be found in muscle belly, tendon and
ligaments
No radiation of pain
Usually unilateral, but can be bilateral
Area of patients pain may not be where
the physician finds the tenderpoint
JSCS
Alpha Motor Unit
Innervates extrafusal muscle fibers
Move muscles
Gamma Motor Units
Innervate intrafusal muscle fibers
Maintain tension of muscle fiber containing
muscle spindle
Alpha-Gamma coactivation
Activation of alpha and gama muscles
maintains muscle tension so that muscle
spindle can remain responsive
JSCS
Find it, Fold it, Hold it
Find tender point
Label the pain as 10
Fold the muscle so that pain is reduced to <3
Hold for 90 seconds
Return to neutral WITHOUT patients help
Reassess
 Treatment Position
The patient lies supine on the treatment table.
The physician sits beside the patient at the level of the
shoulder girdle.
The physician may palpate the tender point with either
hand's fingertip pad or control the patient's ipsilateral arm
with the other
The patient's arm is flexed to approximately 45 degrees,
abducted approximately 45 degrees.
The physician externally rotates until the tender point
dissipates
The physician fine-tunes through small arcs of motion
(flexion and extension, abduction and adduction, external
rotation).
Proposed Effects of JSCS
normalize muscle hypertonicity
reduce GAMMA gain
normalize facial tension
reduce joint restriction by decreasing
muscle tone
increase blood circulation due to reduction
of spasm
decrease pain- normalize thresholds
increase strength- no joint spasm to work
against
Absolute
contraindications
Strained sprained tissues that preclude pt.
ability to get into appropriate position
Severe illness with positional restrictions
Instability of the area: neuro or vascular risk
Basilar insufficiency, neuroforaminal
compromise when the treatment position may
exacerbate the condition
Severe degen. spondylosis with local fusion
and lack of motion in area to be positioned
Relative contraindications

Pt cannot relax
Patients that cannot evaluate their level of
pain or pain change
Pts with connective tissue dz, or severe
arthritis for whom positioning of one body part
exacerbates tissue in another region
Direct Method
Any osteopathic treatment strategy by which
the restrictive barrier is engaged and a final
activating force is applied to correct somatic
dysfunction GLOSSARY

Engage the restrictive barrier in each

plane of motion normal to the
articulation so that the activating
(corrective) force selected may carry the
lesioned component through the barrier.
Direct Methods
Stretching
Inhibition
Range of Motion (ROM)
Soft Tissue (ST)
Springing
Muscle Energy (ME)
Thrust (HVLA)
 Steps to Muscle Energy:
Gently position patient just up against restrictive
barrier.
Have patient gently apply muscle force for 3-5 seconds
to move away from barrier.
Apply a counterforce exactly equal to patients applied
force so that their contraction is isometric and there is
no movement away from barrier.
Have patient discontinue their muscle force as you
match their drop in force and hold their position stable
(not approaching or retreating from your original
positioning).
Allow 3-5 seconds for patient to fully relax.
Gently reposition patient against new restrictive barrier.
Repeat as necessary.
REASSESS/REDIAGNOSE
ME technique: Mechanisms
Post Isometric Relaxation: the affected
muscle (the agonist) is placed in a position and
an isometric contraction generated by the pt.
Tension in a mm causes Golgi Tendon Organ GTO
activation, causing a reflex inhibition and then
increase in muscle length
Immediately after an isometric contraction, the
neuromuscular apparatus is in a refractory state
during which passive stretching may be
performed without encountering strong
myotactic reflex opposition. FOM p 882.
Reciprocal inhibition: when the agonist contracts the
antagonist should relax. Light contraction. Acute
indications.
Muscle Energy: glenohumeral (shoulder)
flexion and extension
Example: AA rotated left
Contraindications
RELATIVE:
Moderate to severe mm strain
Severe osteoporosis with high risk of tendon
avulsion
Severe illness, post-op, ICU
ABSOLUTE CONTRAINDICATIONS:
Fracture, dislocation, moderate to severe joint
instability
Lack of patient cooperation, lack of
understanding by the patient (could be
language)