OMM18-LumbarDiagnosis

8/13/2019 OMM18-LumbarDiagnosis

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OMM-2, #18

Submitted for approval February 13, 2003, 11am

Corrections to be posted Sharon Gustos!i, "O

e$in Stanco$en %or acy &ee$es

'() 1 o% *

Segmental Motion Testing & Diagnosis of Somatic Dysfunction

+he obecti$e o% this '+& session is to %ocus o% dia(nosin( somatic dys%unction in the

umbar re(ion) .e spent o$er ha% the cass practicin( somatic dys%unction dia(nosis o%

%eo cassmates)

/) +) Sti

ou as Osteopathic machinists can (o no %arther than to adust the abnorma condition,

in hich you %ind the a%%icted) ature i do the rest)

Philosophy of Osteopathy

4 5umbar Spine

o /natomica6 51-57

o Functiona6 +11-57

o 5umbar spine has ordotic cur$e

o +he cur$e is a ei(ht-bearin( desi(n

o Fer(usons /n(e

+he an(e beteen the sacrum and 57

.e can measure this on 9-ray :shoud be about 37;<

.e dont ha$e to orry about this an(e ri(ht no

4 Osteoo(y

o Sa(itta pane orientation o% the %acets

o Superior articuar %acet %aces posteromediay

o =n%erior articuar %acet %aces anteroateray

o Orientation o% %acets aos (ood F> ? >>

o Orientation discoura(es rotation ? S>

4 Spina mechanics

o &otation occurs around a $ertica a@is

=n a horiAonta pane

o Sidebendin( occurs around /B' a@is

=n a corona paceo F> ? >> occurs around a horiAonta a@is

=n a sa(itta pane

o eutra position

/natomica position

orma cer$ica ? umber ordosis

orma thoracic !yphosis



.hen in neutra position $ertebra ei(ht bearin( is on the

$ertebra bodies4 Somatic "ys%unction :S"<

o "e%inition6 =mpaired or atered %unction o% reated components o% somatic

system

S!eeta, arthrodia, ? myo%acia structures &eated $ascuar, ymphatic, ? neura eements

o S" is named %or the ay a esioned se(ments i mo$e

D@)6 a se(ment is restricted in sidebendin( to the e%t, rotation to

the ri(ht, and bac!ard bendin(

• S" is :F>< S& & 5

• S" is opposite o% restriction

4 Spina Mechanics

+horacic ? 5umbar Spine

• >oth %oo Fryettes 'rincipes

•

+ype 1 hen motion is introduced into the spine inneutra position, sidebending precedes rotation, & rotation

occurs to the side opposite of sidebending

• D@)6 S9&

>e%ore dia(nosis, it is usuay a (ood idea to per%orm a %e so%t-tissue procedures to ease tension in the umbar re(ion

• .e ent o$er so%t tissue on +uesday mornin(

o Mutipe pane +ype 1 mechanics dia(nosis

&otation testin(

"octor on side o% dominant hand

+humbs paced o$er trans$erse processes

• /bout a ha%-inch atera to spinous processes

/o thumbs to sin! throu(h sub-cutaneous tissue

Contact trans$erse processes ? increase pressure o$er one o% the

trans$erse processes

Ese other thumb to monitor motion

+est %or ease o% motion

Sitch and increase pressure o$er other +' and test %or ease o%

motion

Sidebendin( testin(

Side thumbs mediay to base o% spinous process, near

inter$ertebra space /ppy motion testin( in a media direction

ame sidebendin( %or the ay it ants to (o

• Conca$e side indicates direction o% S>

o +ype 1 mechanics

Common dia(nostic %indin(s

S5& & :e@ampe<



S> e%t presents ith6

• /ppro@imation o% e%t +' to se(ment beo

• Separation o% ri(ht +' %rom se(ment beo

• 5e%t motion %reedom

• &i(ht motion restriction

&otation ri(ht presents ith6

• &i(ht +' posterior

• 5e%t +' anterior

• &i(ht rotation %reedom

• 5e%t rotation restriction

o +ype 2 mechanics

.hen sidebendin( is introduced into a re(ion o% the spine in a non-

neutra position, rotation of at least one segment must precede sidebeding

&otation and sidebedin( occur to the same side

D@)6 & 9S9

o on-neutra position

Mo$ement o% the spine out o% anatomica position so that thenorma cur$es strai(hten out and the spine becomes more i!e a

ri(id rod

• +his occurs hen su%%icient F> or >> is introduced

o 'hysica %indin(s6 :F>< & 5S5

F> component presents ith6

• S' appro@imates se(ment abo$e

• S' ?Bor supraspinous i(ament is tender

• S' process shi%ted si(hty to ri(ht• Motion is restricted in >> mo$es si(hty in %orard

bendin(

&otation component presents ith6

• 5e%t +' reati$ey posterior

• &i(ht +' reati$ey anterior

• Motion is restricted toard ri(ht rotation mo$es si(ht in

e%t rotation

• +' ?Bor articuar capsue o%ten $ery tender

Sidebendin( component presents ith6

•'ossibe si(ht appro@imation o% e%t +' ith se(ment beo

• 'ossibe si(ht separation o% ri(ht +' %rom se(ment beo

• Motion is di%%icut to detect due to musce spasm ? nature

o% esion, but shoud be si(ht to the e%t and restricted insidebendin(

o Fryettes 3rd 'rincipe



Motion occurrin( in any one pane ithin a re(ion i reduce

motion in other panes4 Sa(itta pane dia(nosis

'atient in atera recumbent position

'ads o% %in(ers o% interspinous spaces

'apate and compare separation beteen spaces Crade patients e( %or motion testin(

Forard bendin( testin(

• Grasp patients e(s ith caudad hand

• eeps %in(ers o$er spaces beteen spinous processes

• Mo$e e(s into %e@ion unti motion is %et at %in(er pads

• "id cosey appro@imated processes open up

F> Common %indin(s

• Si(ht separation %rom S' o% se(ment beo

• Si(ht appro@imation to S' o% se(ment abo$e

• +enderness o% supraspinous i(ament• >iatera restriction o% rotation

• &estriction o% S>

• >> restriction F> ease

>ac!ard bendin( testin(6

• Grasp patients e(s ith caudad hand

• Mo$e e(s into e@tension unti motion is %et at %in(er pads

• "id open spinous processes appro@imate

>> common %indin(s

• Si(ht appro@imation o% S' to se(ment beo

• Si(ht separation o% S' %rom se(ment abo$e

• +enderness o% supraspinous i(ament

• >iatera restriction o% rotation

• Sidebendin( may be restricted

• F> restriced >> ease

4 ey 'oint

The key to effective treatment is accurate diagnosis

4 For test, !no6

Mechanics o% umbar spine

• /@is o% motion

• Fryettes principes "ia(nostic %indin(s

no ho to dia(nose

4 =ndications %or OM+

+o mo$e body %uids

+o modi%y somato-somatic, somato-$iscera, $iscero-somatic, or

$iscero-$iscera re%e@es



+o pro$ide a tonic ?Bor circuatory e%%ect

+o pro$ide maintenance treatment in irre$ersibe situations

"r) Gustos!i ent uic!y thou(h the poer points, since e ha$e pretty much aready per%ormed most o% the dia(nostic techniues, so that e had ampe time to practice

dia(nosin( somatic dys%unctions o% more than 1 person)

Documents

OMM18-LumbarDiagnosis