PPC/OMM Outline

9.1.09

Spinal 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 not maintained 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 OA CT TL LS Occipital-Atlantal Cervico-Thoracic Thoraco-Lumbar Lumbo-Sacral JUNCTIONS Craniocervical Cervico-Thoracic Thoraco-Lumbar Lumbosacral TRANSVERSE DIAPHRAGMS Tentorium Cerebelli Thoracic Inlet/Simpsons Fascia Abdominal diaphragm Pelvic diaphragm

Transitional 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

 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 Diaphragm Adversely affected Disturbs the normal physiological function Respiratory Circulatory 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 movement Range of Motion Sagittal (Median) Flexion / Extension Horizontal (transverse) Rotation Coronal (frontal) Sidebending Flexion/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 concavity Left 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)

Always named for position of the anterior aspect of superior / cephalad bone in relation to inferior / 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 were rebuilding a fort in Egypt in a small village in the Delta called Rosetta (Rashid). The Rosetta Stone is a stone with writing on it in two languages (Egyptian and Greek), using three scripts (hieroglyphic, demotic and Greek). Nomenclature Segmental palpation and motion diagnosis is always named for the movement of a superior vertebrae on the vertebrae underneath Motion preference of vertebrae is named based on the direction of the superior anterior most point 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 inferior Nomenclature 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 L4FRRSR Somatic Dysfunction Impaired 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 palpation HH 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 Lesion Fryettes 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

When thoracic and lumbar spine is in a neutral position(easy normal),the coupled motions of sidebending and rotation for a group of vertebrae are such that side-bending and rotation occur in opposite 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 joints Fryettes 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 joints Type II Somatic Dysfunction Rotation and sidebending have equal importance Type II dysfunctions are maintained by the short restrictor 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 motion Fryettes First Law (Type I Mechanics) Usually applies to Thoracic & Lumbar group 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 or Tx-Ty N SLRR Memory Tool for Type I Mechanics Opposite - rotation and sidebending Neutral no flexion or extension involved Expansive 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 joints Fryettes 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 DYSFUNCTION Opposite - rotation and sidebending Towards- rotation is towards sidebending Neutral no flexion or extension involved Worse pain - Pain is worse with dysfunction and Expansive more than one segment involved this is an extreme position One- involves single segment