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OMM BlockII
Y2S1B2
| Question | Answer |
|---|---|
| MAN Concept | mechanical, anatomical, and neurally related factors are interdependent and 3-dimensionally related |
| Tethering Effects | common in areas of asymptomatic tightness; loosening is a/w indirect barriers suggesting joint/soft tissue laxity w/ or w/o neural inhibition & may have pain |
| The Tightness-Looseness Concept | they both occur generally and locally throughout body; myofacial tightening is response to underlying joint looseness and vice versa |
| Loose facet joints have: | tight overlying myofascial tissues |
| Tight facet joints have: | loose overlying myofascial tissues |
| Myofascial Balance, Barrier, Release Concept (BBR) | 3-D related direct and indirect barriers are sequentially stretched, twisted, and compressed to mechanically strain related areas of tightness and looseness |
| Balance, Barrier, Release Concept: Goal #1 | to create mechanical deformation (strain) and decrease high gain neurological inputs (primarily to the tight area); *recall that most proprioceptors are w/in fascia |
| Balance, Barrier, Release Concept: Goal #2 | to create more appropriate mechanical, proprioceptive and neurophysiologic relationships |
| Myofascial approaches | tight muscles weaken their agonists |
| In chronic cases of muscle tightness, | direct myofascial stretch is often necessary |
| Stretch and inhibition of a tight muscle can lead to | spontaneous facilitation of an inhibited muscle, leading to its inclusion in the movement chain and therefore improvement in key motion patterns |
| Apply tight or loose mechanics and then load into one or the other; then wait for | deeper inherent movement to become apparent and either follow directly or indirectly until the superficial and deepest fascial compartments become more integrated and symmetrical in motion/quality |
| Loading into the tissues mechanically induces: | reflex controlled inherent tissue motion |
| With loading, | 3D tightness and looseness become apparent |
| By using combos of distraction and compression while monitoring inherent tissue movements | changes in tissue quality emerge |
| Integrated Neuromusculoskeletal Release (INR) | patient driven movement patterns to release myofascial imbalance from central neural mechanisms; cerebellar processing = >99% sensorimotor activities; pioneered by Robert Ward, DO, FAAO |
| Forearm, Elbow, and Wrist Release (direct transverse approach): Goal | release the forearm, elbow and wrist by transversely straining direct myofascial barriers along the F, E, & W in a stepwise fashion (the first direct MFR 1976 w/scleroderma pt) |
| Forearm, Elbow, and Wrist Release | pt in any position; transversely displace skin across forearm; induce deformation against direct barrier by twisting in opp directions; hold at barrier until it gives way, release the force when inherent motion is better synchronized |
| Wrist, Forearm, Elbow Release (direct long axis approach): Goal | to release the forearm flexors and extensors in relation to distal wrist and hand mechanics and the proximal lateral and medial elbow to shoulder mechanics |
| Wrist, Forearm, Elbow Release (direct long axis approach): Approach | pt in any position; grasp thenar eminence w/finger tips at transverse carpal lig; other hand grasps elbow; turn wrist to barrier/hold/wait for mechanical release; retest (unwinding also works) |
| Median Nerve: Cutaneous sensory distribution | palmar surfaces of thumb, index/middle/lateral 1/2 of ring finger |
| Pathophysiology of Carpal Tunnel Syndrome | freq a/w repeat/sustained overuse (typing, tools, etc); inflam leads to compressive effect in carpal tunnel; cyclic, self-amplifying impairment of nutrition to the nerve |
| First Effect of Carpal Tunnel Syndrome | obstruction of venous return from the nerve; leads to increased capillary distension and further increases intratunnel pressur |
| Opponen's Roll for Carpal Tunnel Release | grab thenar and hypothenar eminence w/palm facing up; contact pisiform/scaphoid bones, extend wrist, abduct and laterally rotate 1st/5th fingers and stretch transverse carpal lig for 3-5min; perform at each office visit/have pt do it at home daily |
| Squeeze with Rapid Circumduction | squeeze carpal bones btw heel of both hands; circumduct in figure-8 fashion; maintain capsular tension throughout articulatory sweep; perform at each office visit |
| The Functional Ankle: Tibiotalar joint (ankle mortise) | dorsiflexion with posterior glide; plantar flexion with anterior glide |
| The Functional Ankle: Talocalcaneal Joint (shock-absorber) | posterolateral glide with foot inversion; anteromedial glide with foot eversion |
| Lower Extremity Dysfunctions: what is the effect on the entire system from inversion ankle sprains? | eversion of calcaneous, postlat talus glide, post fib head, ER w/antmed tibia glide, IR of femur; post ipsil innominate; neutral ipsil sacral oblique axis |
| Ankle-Foot Release: indications | lateral ankle weakness/looseness a/w tightness in medial foot around the deltoid ligament |
| Ankle-Foot Release: technique | seated/supine; hands over forefoot/distal tibia; deform directly by twisting in opp directions; hold at barrier until they give way to better synchrony |
| Lower Limb (knee) Direct Release: technique | leg extended/heels on table; minimal stress on head/spine/pelvis; check leg length/hip mechanics (prone&supine); grab distal femur and distal patellar/prox tibial attachments |
| Lower Limb (knee) Direct Release: technique cont'd | passivley test 3D tightness/looseness in knee (lat hamstring/iliotibial band/proximal fibular head and med hamstring attachments; twist knee in opp directions w/axial twist from areas of tightness |
| biceps femoris is attached to the sacrum via: | the attachments at the sacrotuberous ligament and fibular head |
| Lower Extremity Release (direct long lever/unwinding) approach: Goal | release the whole lower limb from the foot to the ankle to the lumbar spine and pelvis |
| Lower Extremity Release (direct long lever/unwinding) approach: Technique | rapid and slow-moving releases may occur during Tx; apply combos of traction, compression, twisting, and bending sequentially; may reach "still point" where no movement is perceived (once subsided more unwinding may resume) |
| Superficial Fascia | under skin, has irregular cells, dense, flluid filled |
| Deep Fascia | sheaths separating muscles; pericardium; pleura of lung |
| We can palpate differences between: | superficial and deep fascia |
| Functions of Fasca: Packaging | divides body into compartments |
| Functions of Fasca: Protection | establishes limits by stabilizing joints, bony tissues, and body areas |
| Functions of Fasca: Posture | sensing of body movemnets |
| Functions of Fasca: Passageways | from passageways for somatic and autonomic nerves and arterial, venous and lymphatic vessels |
| Overal Function of Fasca | Homeostasis |
| The master of myofascial though | AT Still |
| Properties of Fascia: Elasticity | ability of CT to return to its original resting shape when the forces of distention are removed |
| Properties of Fascia: Plasticity | the capability of a substance or tissue to be formed or molded |
| Properties of Fascia: Viscosity | a tissues ability to resist elongation |
| Properties of Fascia: Viscoelastic material | any material that deforms in relation to the rate of loading and deformation |
| Properties of Fascia: Stiffness | ability of tissues to resist elongation; ratio of load to deformation |
| Properties of Fascia: Relaxation | progressive decrease in internal stress over time as a result of lengthening to a constant strain |
| Properties of Fascia: Creep | elongation of tissues that results from constant loading over time (typically take tight structures and make them loose; can be inc by inc temp) |
| Properties of Fascia: Hysteresis | energy lost in the CT dt its viscoelastic behavior (can be felt as heat/kinetic energy) |
| Properties of Fascia: Stress | force normalized over the area on which it acts; normal stress is perpendicular to the x-section and sheer stress is parallel to it |
| Properties of Fascia: Piezoelectric Phenomenon | mechanical stress is transformed to electric potentials and vice-versa; all CT has this capacity |
| Typical stress vs. strain curve for CT | toe region (little stress is required to lengthen the tissue; straightening of wavy collagen fibers); Elastic region (tissue returns to original length when stress is removed); Plastic region (resultant permanent elongation when stress is removed) |
| Wolf's Law | bones tend to deform along the lines of force placed on them; this is also true for soft tissues |
| Hooke's Law | any strain placed on an elastic body is in proportion to the stress placed on it |
| Newton's 3rd Law | for every action there is an equal and opposite reaction |
| Piezoelectric Phenomenon explored: | the concave side of a bone or side under compression becomes electronegative; electronegativity signals osteoblasts to lie down bone on the concave side |
| Fascial Mechanoreceptors: Golgi tendon organs | myotendinous jxn; aponeurosis attatchment; ligs of periph joints; joint capsules; Responds to muscular contraction/strong stretch; Results in tonus decrease in related muscles |
| Fascial Mechanoreceptors: Pacini corpuscles | myotendinous jxn, deep capsular layer, spinal ligs, investing muscular tissue; Responds to change in pressure/vibration; Results in proprioceptive feedback for movement control |
| Fascial Mechanoreceptors: Ruffini Endings | ligs of periph joints, Dura Mater, outer capsular layers; Responds to sustained pressure, tangential forces; Results in inhibition of SNS |
| Fascial Mechanoreceptors: Interstitial (free nerve endings) | most abundent; periosteum; Responds to rapid/sustained pressure, light touch nociception; Results in changes in vasodilation |
| Fascial Release approach to somatic dysfunction | system of diagnosis/Tx which engages continual palpatory feedback to achieve release of myofascial tissues |
| Subcategories of Fascial Release | balanced ligamentous tension (BLT)/ligamentous articular strain (LAS); Integrated neuromuscular release |
| Direct MFR | a restrictive barrier is engaged for myofascial tissues; the tissue is loaded w/constant force until tissue release occurs |
| Indirect MFR | dysfunctional tissues are guided along the path of least resistance until free movement is achieved |
| Normal physiologic barrier | limit of active motion |
| Anatomical barrier | limit of passive motion |
| Activating Forces: intrinsic or extrinsic | force which is used to correct somatic dysfunction |
| Indirect method uses inherent patient forces | rhythmic activity present in all living tissues; neural/circulatory mediated mechanisms (counterstrain, MFR, functional, cranial) |
| Direct method uses physician or pt induced forces (intentional) | thrust (HVLA), springing (LVLA), articulatory (still, FPR); pt muscle contraction (muscle energy), respiratory cooperation/force |
| Respiratory cooperation | a physician directed inhalation and/or exhalation by the pt to assist the manipulative process |
| Respiratory force | the force brough to bear when pt is instructed to hold breath in either inhalation or exhalation beyond their usual limits so that a force will exert itself on the lesioned structure |
| Respiration and the soma: Inhalation | external rotation, spinal curves tend to flatten |
| Respiration and the soma: Exhalation | internal rotation, spinal curves tend to increase |
| Evaluation of the fascia | evidence of trauma/degeneration; contraction/contracture; tendon/ligament integrity and fxn; muscle layers (fascicles/fibers); pain w/palpation otherwise not present |
| Layer Palpation | superficial fascia, muscles, tendons/ligaments, deep fascia, bone |
| Motions of fascial layers | motion of breath, motion of cranial respiratory mechanisms, segmental motion, tightness/looseness |
| Tightness suggests: | a direct barrier; tethering (acute muscle spasm), bind, restriction of motion |
| Looseness suggests: | an indirect barrier; neural inhibition (weak muscles), pain, hypermobility |
| How does MFR work? | Dr must contact pt's fascia w/their own and listen to perceive changes in living tissue |
| Dr chooses (based on pt's needs) to use intrinsic or extrinsic activating forces | complex homeostatic mechanisms begin to work (creep, hysteresis, piezoelectric phenomenon); activation and inhibition of nerve endings; interaction of PNS with CNS in the Dr's and pt's body |
| Myofascial Release: Pt/Dr Interactions - Terminal nerve fibers | light touch, temp changes, nociception; Dr: uses to identify temp and tissue changes; Pt: uses to identify nociceptive signals |
| Myofascial Release: Pt/Dr Interactions - Pacinian corpuscles | acceleration receptors; Dr uses to ID end range of motion/restrictive barrier/end feel of joints; Pt uses to ID acceleration/deceleration forces involved in mechanisms of injury |
| Myofascial Release: Pt/Dr Interactions - Pacinian corpuscles cont'd | the sensation of accleration/deceleration causes the pt to adjust the tension of muscles in response to differing forces being applied |
| Myofascial Release: Pt/Dr Interactions - Ruffini's endings | dermal stretch receptors; Dr uses to determine skin drag; Pt uses to determine physiologic barrier and end range of motion |
| Myofascial Release: Pt/Dr Interactions - Merkel's discs | Dr uses for identification of deep fascial strain |
| Choice of Treatment Method is determined by 2 factors | ability of physician to execute the technique and the ability of the patient to respond to the treatment |
| Indications for Indirect Methods of MFR | acute painful situations (trauma: sprains/strains/fractures); Hospitalized patients; Diseased states (arthritis, osteoporosis) |
| Contraindications for Indirect Methods of MFR | physician inability to perform technique, inability to position patient appropriately; Inability of patient to respond to the treatment (severe illness) |
| What do you see on the lateral weight-bearing view of a patient? | overactive shoulder elevators; increased activity from the assessory muscles of respiratory effort; flattened diaphragm; overactive quadratus lumborum; relatively enhanced exhalation orientation |
| Supine Evaluation Advantages | reflects a better picture of baseline structural influence on the body in a position requiring reduced anti-gravitational effort from pt; allows for subtle clues to possible abnormalities in normal respiratory and circulatory suport |
| What is the level of respiratory effort in relation to the throacoabdominal cylinder? (supine position) | the proximity of breathing motion to the pubic rami (limited to costal region? above umbilicus? below umbilicus? all the way to pubic rami?) |
| What is the rate, rhythm, and quality of repsiratory effort in supine position? | in addition to the rate of breathing, what is the inhalation-to-exhalation ratio; what is the orientation of the body core? is there excess use of neck/upper chest muscles, nasal flaring, lumbar arching, leg length discrepency? |
| Functional Fluid Movement Pumps | hear is force pump; throacic cage is suction pump; brain is CSF pump; GI is extraction pump; **abdominal diaphragm is extrinsic respiratory/venous/lymphatic pump;** |
| muscle contraction efforts augment fluid return to the body core; | the venous and lymphatic reservoir is a low-pressure system dependent on pressure differentials in the body generated by all the "pumps" working together properly |
| Innominate leg lengthening | inferior shear, anterior rotation |
| Innominate leg shortening | superior shear, posterior rotation |
| Hip leg lengthening | external rotation, extension |
| Hip leg shortening | internal rotation, flexion |
| Knee leg lengthening | extension |
| Knee leg shortening | flexion |
| Foot leg lengthening | supination |
| Foot leg shortening | pronation |
| Discrepencies with the thoracoabdominal movement patterns may demonstrate: | abnormalities with the respiratory and circulatory activities of the patient |
| Leg length discrepency may demonstrate: | abnormalities withing the lumbopelvic and lower extremity regions and may augment discrepencies throughout the body |
| If the pelvis is your key restriction | thoracoabdominal movement and leg length discrepencies may be reduced or removed with treatment of pelvis |
| Supine Sacroiliac Release: Goal | establish symmetrical nutation and counternutation movement of the sacroiliac region |
| Supine Sacroiliac Release: technique | supine w/caudal hand under sacrum; SIJ in contact w/index&ring fingers; apex at MCPs; cephalad hand over ASISs; both hands apply distraction/compression/twisting as necessary to follow direct/indirect barriers to motion; end point = symmetric motion |
| Supine Sacroiliac Release: motion felt at sacrum/innominate | sacrum (nutation, counternutation, sidebending, axial motion); innominate (anterior/posterior; in-flare, out-flare) |
| Sacrotuberous Ligament Release: Goal | to balance the 3D sacrotuberous and sacrospinous ligament factors affecting lumbopelvic, lower limb, and pelvic diaprhagm mechanics |
| Sacrotuberous Ligament Release: technique | pt prone w/feet off end of table; thumbs btw sacral apex and each ischial tuberosity; press superior/anterior towards pubic symphysis (works thru pelvic diaphragm); ID tightness/looseness |
| Ischial tuberosity height | gives valuable info about pelvic orientation and helps in the differential of short leg syndrome |
| Ischial tuberosity release may allow: | global releases in lumbopelvic region |
| Ischial tuberosity lateral release: Goal | global pelvic release with augmented muscle energy (Rennie's variation) |
| Ischial tuberosity lateral release: technique | pt prone w/legs bent against dr's arms; thumbs on medial side of ischial tuberosities; press laterally on bone (NOT sacrotuberous lig); pt squeezes against Dr's arms isometrically |
| Ischial tuberosity lateral release: fulcrum of leverage | is through Dr's thumbs to reset the innominate orientation back toward symmetry; pt may be instructed to contract and release up to 3-4x until adequately treated |
| Rib Motions: Pump handle | ribs 1-4 (they also have some bucket handle) |
| Rib motions: bucket handle | ribs 8-10 |
| Rib motions: caliper | ribs 11, 12 |
| Ribs 5-7 | have mixed bucket and pump handle motion |
| Inhalation somatic dysfunction | rib held in inhalation (anterior is superior; posterior part is inferior); rib is restricted in exhalation (dec motion in exhalation/doesn't return to exhalation position/ceases movement 1st during exhalation); "key rib" at bottom of group |
| Exhalation somatic dysfunction | rib held in exhalation (anterior is inferior; posterior part is superior); rib is restricted in inhalation (dec motion in inhalation/doesn't return to inhalation position/ceases movement 1st during inhalation); "key rib" at top of group |
| MFR Rib Treatment Principles | pick a direct or indirect approach (indirect - move ribs towards direction of somatic dysfunction/away from restriction) |
| If INHALATION somatic dysfunction | treat the most caudad rib (bottom of grp) |
| if EXHALATION somatic dysfunction | treat the most cephalad rib (top of grp) |
| Indirect MFR - Pump Handle Inhalation SD | pt supine/dr sits on side of dysfxn; cephalad hand cradling rib angle (to rotate vertebrae away from affected rib); caudad hand anteriorly along shaft of rib; hold rib in inhaltion (anterior sup/posterior inf); add compression; pt breaths&holds 3rd breath |
| Indirect MFR - Bucket handle inhalation SD | pt supine; dr sits on dysfxnl side; during inhalation, inc superior motion of rib at lateral part and on 3rd breath pt holds as long as possible to release rib bf pt breaths again |
| 12th Rib | connected to quadratus lumborum and diaphragm; often is restricted in its inhalation position (caliper motion) |
| Direct MFR of 12th Rib | works well for both inhalation and exhalation positions |
| Direct MFR of the 12th rib | pt supine; sit on side of dysfxn; both hands under rib (caud under ceph); pull rib anterior/lateral/inferior (toward restriction); use respiratory cooperation; hold until released; Tx other rib if necessary (can be done w/another person on other side) |
| Treatment of exhalation dysfunctions | hold rib in exhalation phase; when pt exhales follow rib in that direction; have pt hold breath out as last respiratory effort; for pump handle: motion is inf on ant surface and sup on post angle of rib; Bucket: use caudal motion on lateral part of rib |
| On real patients always attempt to treat this first | the area of greatest restriction |
| How many breaths are sufficient for a patient to achieve 50% or better change in motion/tissue tension? | 3 (keep picture of 3D anatomy in head to assess change) |
| If you aren't achieving appropriate results, | make sure treatment position is correct; re-examine pt and consider an alternate technique |
| Ansa cervicalis | C1, 2, 3; supplies anterior muscles of neck |
| Phrenic nerve | C3, 4, 5; "keeps you alive;" only motor nerve to diaphragm |
| Brachial plexus | C5-8, T1; supplies motor to arm and prevertebral neck muscles |
| Parasympathetics | supplied through the vagus nerve |
| Sympathetics | carried with the carotid artery to the skull/face |
| Ligamentum Nuchae Regional Technique | for balancing >2 segments or addressing general CT (post neck); cradle occiput; thenar eminence on opp side of fingers on articular pillars; F/E, SB, R motion test; place in pos of ease; follow activ force to tension; release; return to neutral; retest |
| Ligamentum Nuchae Regional Technique: activating forces | respiratory cooperation, releasing enhancing maneuvers, slight compression/traction/torque |
| Suboccipital Release | sit at head of pt; finger pads under inf occiput at atlas; allow weight of pt's head to create the release; enhance w/traction/compression/or initiating micro-motion & following the progressive tissue relaxation as it occurs; retest for TART |
| C3-7 Segmental Technique | sit at head; Dx key dysfxn; contact articular pillars; induce F/E then SB (translation), R; go indirect; use activating forces; continue until release; retest TART |
| MFR: OA and AA | can use indirect (OA, AA) or direct (AA) technique; take joint toward, rather than away from, the barrier and use activation forces |
| What is MFR? | progressive relaxation of abnormal tensions in muscle and CT |
| Principles of MRF Dx and Tx: | diagnose restriction by ease and bind; treat directly (load and hold) or indirectly (unload and follow) |
| Other possiblilities for MFR of cervicals | release of myofascial tissues in anterior neck; connections from head to rib or sternum; connections from hyoid to head/sternum/scapula; follow the same principles with special awareness of vulnerable structures (carotids, etc) |
| Sacral Rock: Goal | relaxation of the muscles at the lumbosacral junction |
| Sacral Rock: technique | prone pt; cephalic hand on sacral base (fingers towards coccyx) w/caudal hand on top; follow sacrum into nutation/counternutation; help move sacrum in direction of restriction w/respiratory motion |
| Sacral Inhibition: Goal | inhibit sacral motion to alter parasympathetic nervous system |
| Sacral Inhibition: Technique | prone pt; cup sacrum (ceph +caud hands); direct a deep pressure anteriorly toward table and maintain w/o augmenting sacral rocking motion for 30s-2min; use to stabilize CV4 craniosacral Tx |
| Supine Lumbosacral Release: Goal | relaxation of the sacrum, iliosacral and lower lumbar myofascial tissues |
| Supine Lumbosacral Release: Technique | caudal hand under sacrum; cephalic hand under lower lumbar SPs (L3-5); fulcrum applied thru elbows pressing on table; enhance lumbosacral movement via distraction or compression of sacral base w/lumbars and via respiratory assistance |
| Prone lumbosacral release: Goal | to establish symmetric sacral nutation and counternutation movements in relation to the innominate, lumbar spine and lower limbs |
| Prone lumbosacral release: treatment | stand next to pt w/one hand over thoracolumbar jxn SPs and other over sacral base w/index&ring fingers at ILAs; evaluate tight/looseness w/distraction/compression/twisting in opp directions; follow direct or indirect to release/symmetry/smooth motion |
| Prone Thoracolumbar MFR | prone; feet off end of table; head/arms to side of comfort; place spread hands cephally at TL jxn covering inf ribs/diaphragm; ID superficial & deep tight/looseness 3D (sup/inf, L/R, clockwise/counter) and ID restrictions in each/both hands; stack barrier |
| Prone Thoracolumbar MFR, cont'd | indirect or direct; add compression/traction, use respiratory cooperation; follow tissues until >50% change; reassess in all 3 planes |
| Supine Upper Thorax MFR | may rest pt's head on pillow; sit at head; one hand/arm along upper thoracic SPs w/fingers sprea to contact ribs and opp hand on sternum; use elbows as fulcrum; ID superficial/deep tight/looseness 3D; restrictions separately/as unit; stack/release/reasses |
| Alternate thoacic cage/diaphragm/lower costal cage technique | treat thoracic spine w/both hands under supine pt (not on test) |
| Bregma | jxn of coronal and sagittal sutures (articulation of parietal and frontal bones); remnant of anterior fontanelle in fetal skull; area of depression on ant 1/3 of top of head |
| Saggital suture | posterior to bregma along midline of skull; articulation btw parietal bones; serrated |
| Lambda | jxn of sagittal and lambdoidal sutures (parietal and occipital bones); sutures often asymmetric; remnant of posterior fontanelle |
| Lambdoidal sutures | lateral from lambda; articulation btw parietal and occipital bones |
| Asterion | articulation btw parietal bone, mastoid process of temporal bone, and occipital bone; you can feel a slight depressin |
| Occipitomastoid sutures | articulation btw occipital and temporal bones; often affected in TMJ disorder and headaches |
| Coronal sutures | bilaterally descend laterally from bregma; articulation of frontal and parietal bones |
| Pterion | inferior end of coronal sutures; articulation btw frontal, parietal, sphenoid (greater wing) and temporal (squamous) bones; they interlock in that order (frontal bone is the outermost layer) |
| Nasion | jxn of internasal and frontonasal sutures (2 nasal bones and frontal bone); the depression at the base of the nose and btw each orbit |
| Metopic suture | superior from the glabella along midline; remnant is a depression or ridge in 10% of skulls |
| Bones of the calvarium (8) | sphenoid, occiput, temporals (2), parietals (2), ethmoid, frontal |
| Bones of the facial skeleton (14) | zygomas, palatines, maxillae, vomer, lacrimals, nasals, inferior conchae, mandible |
| Midline bones | sphenoid, occiput, vomer, ethmoid |
| Motions of midline bones | flexion, extension |
| Paired bones | parietals, frontals, temporals, zygomae, maxillae, nasals, lacrimals, palatines |
| Motions of paired bones | external rotation, internal rotation |
| Principles of Cranial Motion: Flexion "Ernie-like" | SBS rises, Paired bones ER, Palate widens/flattens, Sacrum counternutates (moves posteriorly), cranial vault widens, AP diameter shortens, superior/inferior diameter shortens |
| Principles of Cranial Motion: Extension "Bert-like" | SBS falls, Paired bones IR, Palate narrows/heightens, Sacrum nutates (base moves anteriorly), Cranial vault narrows, AP diameter lengthens, Superior-Inferior diameter lengthens |
| 2 Parallel Transverse Axes: flexion and extension - SBS and Sacral Movement | sphenobasilar synchondrosis |
| Ethmoid: development | endochondral ossification; birth: small lateral masses; 2yo: perpendicular plate joins lateral masses; 5-6yo: ossification; no muscular attachments to bone |
| Ethmoid: articulations | frontals, sphenoid, vomer, septal cartilage, palatines, nasal maxillae, inferior conchae, lacrimal |
| Ethmoid: Parts | horizontal (cribiform plate w/crista galli); Perpendicular plate; Lateral masses (orbital plate, superior & middle conchae) |
| Ethmoid: Motion | perpendicular plate flexes/extends around a transverse axis thru its center |
| Vomer: development | membranous ossification, 2 ctrs (lamellae) on each side of sagittal plane; 2 lamellae separated & united after puberty; no muscular attachments to bone |
| Vomer: articulations | sphenoid, ethmoid, septal cartilage, palatines, maxillae |
| Vomer: motion | flexion, extension around horizontal axis; depresses the hard palate (flexion = wide/flat; extension = narrow/vaulted) |
| Frontal bone: development | membranous ossification; originates as paired bone (fusion btw 2yo-12yo; metopic suture); forms roof of orbit |
| Frontal bone: Parts | glabella, ethmoid notch, orbital plate, lateral angle, nasal spine, zygomatic process |
| Frontal bone: articulations | sphenoid, ethmoid, parietals, nasals, maxillae zygomae, lacrimal |
| Frontal bone: motion | roughly from center of each orbital plate through frontal eminence; internal/external rotation |
| Pairetal bones: development | membranous ossification |
| Parietal bones: articulation | occipital, frontal, sphenoid, opposite parietal, temporal |
| Parietal bones: motion | 2 which converge anteriorly; from a point lateral to the bregma on the coronal border in a posterolateral direction through the parietal eminence; Internal/External Rotation |
| Temporal bones: development | membranous ossification (squamo-zygomatic, tympanic plate); Endochondral ossification (petromastoid portion, styloid process from branchial arch III) |
| Temporal bones: dural attachment | tentorium cerebelli attaches along petrous ridge |
| Temporal bones: parts | squamous; mastoid (doesn't develop until 1yr); Petrous (medial projection in base of skull and exit of eustachian tube) |
| Temporal bones: articulations | Occiput (occipitomastoid, petrobasilar); Parietals (parieto-squamous, parieto-mastoid); Sphenoid (spheno-squamous, petro-sphenoid); Zygomae (temporal-zygomatic); Mandible (temporomandibular TMJ) |
| Temporal bones: openings | carotid canal (internal carotid artery); Jugular foramen (btw temporal bone and occiput: CN IX, X, XI, sigmoid sinus, inferior petrosal sinus, posterior meningeal artery) |
| Temporal bones: motion | influenced by occiput; axis is through the petrous ridge and converges medially; Mastoid process moves medial/posterior with External Rotation and lateral/anterior with Internal Rotation |
| Sympathetic Tone and Sinusitis | increased vasoconstriction, thick secretions w/lots of goblet cells; decreased drainage |
| Parasympathetic Tone and Sinusitis | thin secretions, improves drainage |
| Lymphatics and Sinusitis | removes congestion |
| Sympathetic treatments | rib raising, T1-T4, Cervical ganglia, Chapman's reflexes, T-L junction |
| Parasympathetic treatments | cranial, trigeminal |
| Lymphatic treatments | thoracic inlet, cervical fascia, diaphragm, effleurage |
| Chapman's Reflexes: Treatment | circular motion over neurolymphatic reflex points for 30sec; have pelvis balanced; palpable when present as small, soft pea-sized swellings |
| ENT Treatment Sequence | 1. thoracic outlet, 2. anterior cervical chain, 3. anterior cervical arches, 4. galbraith technique, 5. auricular chain, 6. frontonasal distraction, 7. trigeminal stimulation (you can also add facial lymphatics and chapman's reflexes) |
| Anterior Cervical Arches: Treatment | for any ENT dysfxn or lymphatic congestion; stabilize forehead and use thumb/index fingers to massage the anterior arches side to side (hyoid bone, laryngeal cartilages and upper trachial rings); 30sec-2min |
| Cervical chain drainage technique | for ENT dysfxn or lymphatic congestion; cradle head w/one hand and grasp border of SCM and massage muscle in a rolling motion to mobilize the anterior and posterior lymphatic chains |
| Auricular drainage | ear (otitis media/externa) dysfxn or lyphatic congestion; cradle head and split fingers around ear btw ring and middle; make circular motions for 30sec-2min moving skin/fascia over skull |
| Mandibular drainage (Galbreath) | problems in submandibular region; cradle head and turn it away from Tx side; massage under TMJ drawing it towards midline for 30sec-2min |
| Trigeminal Stimulation | ENT congestion; Goal is autonomic system normailzation; sit at head of table and massage each of the 3 foramina for 30sec-2min |
| Alternating nasal pressure | exert pressure on a diagonal into the jxn of frontal and nasal bones, first in one direction then the other |
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bscaryp