Ppc-omm Outline 9.1.09

7/29/2019 Ppc-omm Outline 9.1.09

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PPC/OMM Outline 9.1.09Spinal Curves Kyphosis- Spinal curve with the convexity looking posterior and the concavity looking anterior

Primary kyphotic curve Thoracic

Lordosis- Spinal curve with the convexity looking anterior and the concavity looking posterior

Secondary lordotic curves Cervical Thoracic

Homeostatic response to gravity begins as soon as upright posture begins. Secondary lordotic curves in Cervical and lumbar areas form to counterbalance primary curve present

from birth Normal Postural Curves Optimal - perfect distribution of the body mass around the center of gravity. Compressive forces are

balanced by tensile forces with minimal muscular energy expenditure. Compensated - result of patients homeostatic mechanisms working through the entire body unit to

maintain function and all postural lines maximally. Homeostatic mechanisms working through the entire body to maximize function Occurs in all three planes of body motion Keeps the body balanced and the eyes level Static and dynamic postures are influenced by and influence soft tissue functions

Decompensated- despite continuous homeostatic attempts, function and/or postural lines notmaintained

Group Curves Spinal curve that involves several segments Compensatory changes often named according to group curve

Sagittal plane-kyphotic or lordotic Lateral curves-scoliosis

Mechanics of Group Curves Unilateral muscle contraction creates concavity (short-term, resolves with relaxation) Long-term anatomic adaptation associated with positional change (tissue change over time)Transitional Zones- corrections made at transition zones (referred to as transitional areas or junctions)

Craniocervical

Cervicothoracic Thoracolumbar Lumbosacral

Accommodative

ZONE JUNCTIONS TRANSVERSE DIAPHRAGMS

OA Occipital-Atlantal Craniocervical Tentorium Cerebelli

CT Cervico-Thoracic Cervico-Thoracic Thoracic Inlet/Simpsons Fascia

TL Thoraco-Lumbar Thoraco-Lumbar Abdominal diaphragm

LS Lumbo-Sacral Lumbosacral Pelvic diaphragmTransitional Zones

Occipitocervical- OA,AA,C2 region Cervicothoracic- C7-T1 Thoracolumbar- T10-L1 Lumbosacral- L5-S1 Areas of the axial skeleton where structural changes significantly lead to functional

changes Occipitocervical


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Cervicothoracic Thoracolumbar Lumbosacral

occipito-atlantal junction Transitional area

Craniocervical junction Occipital-Atlantal Tent cerebelli

thoracic inlet Transitional area

Cervicothoracic Thoracic inlet/Simpsons fascia

thoracolumbar junction

Transitional area Thoracolumbar

Abdominal DiaphragmAdversely affectedDisturbs the normal physiological functionRespiratoryCirculatory

Lumbosacral Junction The lowest transitional area The keystone of the musculoskeletal stress pattern Foundation upon which the spine is balanced and is dependent upon

Stability Equilibrium Function of the thoracic cage.

Planes of movementRange of Motion

Sagittal (Median) Flexion / Extension

Horizontal (transverse) Rotation

Coronal (frontal)SidebendingFlexion/Extension

Flexion forward or anterior bending of any segment or region of the spine

Extension posterior or backward bending of any segment or region of the spine

Right Sidebending Motion in a coronal (frontal) plane Defined as right or left depending on which direction the moving part bends in the coronal plane Right sidebending

Right concavityLeft convexity

Rotation The turning of the superior part around a longitudinal axis, describing the motion of the ventral

surface of the body of the vertebra. Left rotation of a vertebra

Ventral/Anterior surface rotates left Spinous process moves to right Transverse process posterior on left

Rosetta Stone for Osteopathic Nomenclature

Positional diagnosis for a joint (since were describing presence or absence of motion)


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Always named forposi t ion of the anterior aspect of superior / cephalad bone in relation toinferior / caudad bone

E.g., relationship of L4 to L5 Usually described in the three cardinal planes

Flex/Ext. Sidebending L/R Rotation L/R

The Rosetta Stone was carved in 196 B.C. and was found in 1799 by French soldiers who wererebuilding a fort in Egypt in a small village in the Delta called Rosetta (Rashid). The Rosetta Stone is astone with writing on it in two languages (Egyptian and Greek), using three scripts (hieroglyphic, demoticand Greek).Nomenclature

Segmental palpation and motion diagnosis is always named for the movement of a superiorvertebrae on the vertebrae underneath

Motion preference of vertebrae is named based on the direction of the superior anterior mostpoint on the vertebral body

Diagnosis is based on the direction of ease (not restriction)Cardinal Spinal Segmental Motions

Flexion Extension Side-bending (lateral flexion) Rotation

Flexion and Extension

These motions describe the superior vertebrae in relation to the inferiorNomenclature

Always named for superior / cephalad bone in relation to inferior / caudad bone E.g., relationship of C4 to C5

Usually described in the three cardinal planes Flex/Ext/or Neutral in Thoracic and Lumbar Rotation L/R Sidebending L/R

Description: Level of dysfunction

Neutral or Flex/Ext Type I Sidebending first, then rotation Type II Rotation first, then sidebending

Eg, L4NSRRL or L4FRRSRSomatic DysfunctionImpaired or altered function of related components of the somatic (body framework) system: skeletal,arthroidal, and myofascial structures, and related vascular, lymphatic and neural elements.

The diagnosis of Somatic Dysfunction is supported by visual and palpable findings of TART:-Tissue texture changes-Asymmetry of structure-Restriction of motion-Tenderness to palpationHH Fryette,DO,MD

1870-1960 Expanded on the work of Dr.RobertA Lovett Physiologic Movements of The Spine 1918 Expanded Dr. A.D. Beckers concept of the Total structural lesion to the Total Osteopathic LesionFryettes First Principle: Sidebending and Rotation occur in opposite directions Applies to Thoracic & Lumbar Group curves Physiological type of motion of spine Applies to Neutral range When dysfunction occurs - has to do with large group of muscles Side-bending occurs before rotation


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When thoracic and lumbar spine is in a neutral position(easy normal),the coupled motions of side-bending and rotation for a group of vertebrae are such that side-bending and rotation occur inopposite directions( with rotation occurring toward the convexity)

Type I Somatic Dysfunction Group motion restriction is maintained by long restrictor muscles

maintain the sidebending position Long restrictors span more than one joint, and are superficial to the involved jointsFryettes Second Principle: Sidebending and Rotation occur in the same direction Applies to Single Thoracic & Lumbar segment dysfunctions Restriction type of motion of small region of spine Definite dysfunction occurs - has to do with small shunt & spurtmuscles Involves restriction of motion of the jointsType II Somatic Dysfunction Rotation and sidebending have equal importance Type II dysfunctions are maintained by the shortrestrictor muscles

These span only one joint, and are intimately related In hyperflexion or hyperextension, rotation and sidebending will be to the same side Rotation is in the direction of the concavity The facet joint capsules are under tension from small muscles and have to rotate and sidebend in the

same direction

*** Type 1 and type 2 are cervical and thoracic(Fryettes) Third Principle Initiating motion of a vertebral segment in any plane of motion will modify the movement of that

segment in other planes of motionFryettes First Law (Type I Mechanics) Usually applies to Thoracic & Lumbargroup curves Sidebending and Rotation occur in opposite directions Physiological type of motion of spine Applies to neutral range Large group of muscles involved Named as Tx-Ty N SRRL orTx-Ty N SLRRMemory Tool for Type I Mechanics

Opposite - rotation and sidebending

Neutral no flexion or extension involvedExpansive more than one segment involved

Fryettes Second Law (Type II Mechanics) Applies to single thoracic & lumbar segment dysfunctions Sidebending and rotation occur in the same direction Restriction type of motion of small region of spine Definite dysfunction occurs - has to do with small shunt & spurt muscles Involves restriction of motion of the jointsFryettes Principles of Motion Motion in one plane affects motion in all other planes at a joint.

- Fryettes Third Law of Motion E.g., misalignment in the frontal plane reduces amount of flexion, extension, translation, and rotation. Fryettes Third Law

Motion in one direction modifies motion in the other two as well Allows for rotoscoliosis testing to be effective If there is a dysfunction where flexion or extension exists, then the motion will show a preference for

the sidebending and rotation components Type I vs Type II- SOMATIC DYSFUNCTIONOpposite - rotation and sidebendingNeutral no flexion or extension involvedExpansive more than one segment involved

Towards- rotation is towards sidebendingWorse pain - Pain is worse with dysfunction and

this is an extreme positionOne- involves single segment

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Ppc-omm Outline 9.1.09