OMM BOARD REVIEW
THE BASICS
THE OSTEOPATHIC PRINCIPLES
 The body is a unit.
 Structure and function are reciprocally related.
 The body possesses self-regulatory mechanisms
 The body has the inherent capacity to defend
itself and repair itself.
 When normal adaptability is disrupted, or when
environmental changes overcome the body’s
capacity for self maintenance, disease may
ensue.
THE OSTEOPATHIC PRINCIPLES
 Rational treatment is based on the previous
principles
Movement of the body fluids is essential to the
maintenance of health.
The nervous system plays a crucial part in
controlling the body.
There are somatic components to disease that are
not only manifestations of disease but also are
factors that contribute to maintenance of the
diseased state.
SOMATIC DYSFUNCTION
An impairment or altered function of related
components of the somatic (body framework)
system: Skeletal, Arthroidial, and Myofascial
structures and related vascular, lymphatic, and
neural elements.
Somatic Dysfunction is a Restriction in joints
muscles, or fascia that may affects blood supply,
lymph flow, and nervous function.
SOMATIC DYSFUNCTION
Diagnostic Criteria:
Tenderness
Asymmetry
Restriction
Tissue Texture Changes
SOMATIC DYSFUNCTION
Tenderness
May be produced during palpation of tissues where
it should not occur if there was no somatic
dysfunction.
SOMATIC DYSFUNCTION
Asymmetry
Bones, muscles, or joints may feel asymmetric to
corresponding structures.
SOMATIC DYSFUNCTION
Restriction
In somatic dysfunction, a joint will have a restrictive
(pathologic) barrier. A restrictive barrier lies
before the physiologic barrier.
Barriers to Motion
Physiologic Barrier:
A point at which a pt can
actively move a given joint.
Anatomic Barrier:
A point at a physician can
passively move a given
joint.
Motion beyond the anatomical barrier will
cause skeletal injury.
Acute VS Chronic Somatic Dysfunction
Findings
Acute
Chronic
Tenderness
Severe, Sharp
Dull, Achy, Burning
Asymmetry
Present
Present with
compensation in other
areas
Restriction
Present, painful ROM
Present, dec. or no pain
w/ROM
Tissue Texture Changes Edema, erythema,
boggy, Inc. tone, Inc.
moisture
Decreased or no edema
or erythema. Cool dry
skin, flaccid tone, fibrotic
Fryette’s Principle’s
 Principle I
If the spine is in neutral position (no flexion or
extension) and if sidebending is introduced,
rotation would then occur to the opposite side.
Principle I
In the Neutral position:
Sidebending precedes
rotation. Sidebeding and
rotation occur in opposite
directions.
e.g.:
NSLRR
Typical of a group dysfunction
Principle II
If the spine is in a non neutral
position (flexed or extended) and
rotation is introduced, sidebending
would then occur to the same side.
Type II Somatic Dysfunction
In a non neutral position:
Rotation precedes sidebending,
sidebending and rotation
occur to the same side.
e.g.:
FRRSR
Principle II is typical of a single
vertebral dysfunction
Principles I and II do not apply to
cervical vertebral motion.
Principle III
 Initiating motion of any vertebral segment in any
one plane of motion will influence the mobility of
that segment in the other two planes of motion.
 Eg: Forward bending will decrease the ability to
sidebend and rotate.
Naming Somatic Dysfunction
Somatic Dysfunctions are always named for their
FREEDOM OF MOTION.
When referring to segmental motion, it is traditional
to refer to motion of the segment above in a
functional vertebral unit.
e.g.: If L2 is restricted in the motions of flexion,
sidebending to the right and rotation to the right,
then L2 is said to be extended, rotated and
sidebent to the left on L3……L2 is ERLSL.
Evaluating Somatic Dysfunction
 Thoracic and Lumbar Spine
Assess rotation by placing the thumbs over the
transverse processes of each segment
(posterior thumb).
Then check the rotation of the segment.
– Flexion
– Extension
– Neutral
Somatic dysfunction is named for freedom of motion
Evaluating Somatic Dysfunction
 Motion Testing of
the Cervical Spine
Translation– Best for evaluation of the OA. Right
translation will induce left sidebending.
Rotation– Best for evaluation of the AA. Remember
to flex the neck 45* to lock out C2-C7.
C2-C7—Typically evaluated with translatory force
directed at the articular pillars
Facet Orientation
REGION
Facet Orientation
Cervical
Backward, upward,
medial
(C2-C7)
Thoracic
Backward, upward,
lateral
Lumbar
Backward, medial
Main Motion
OA-flexion/extension
AA-rotation
C2-C7—rotation/SB
Rotation
Flexion/Extension
Physiologic Motion
Motion
Axis
Plane
FLx’n/Ext’n
Transverse
Sagittal
Rotation
Vertical
Transverse
Sidebending
A/P
Coronal
Osteopathic Treatment
GOAL: To eliminate restrictive barriers and restore
equilibrium and symmetry within the body.
Treatment techniques are aimed at improving
quality and range of impaired movements,
softening fibrotic areas, relieving muscle spasm,
and mobilization of joints.
Direct VS Indirect

Direct Treatment: the
practitioner engages the
restrictive barrier
eg; T3 FRRSR: TX:
extension, left rotation
and sidebending.

Indirect Treatment: the
practitioner moves
tissues and joints away
from the restrictive
barrier.
eg; T3 FRRSR : TX:
flexion right rotation
and sidebending
Active VS Passive

Active Treatment: the pt
will assist in the
treatment, usually in the
form of isometric or
isotonic contraction

Passive Treatment: the
pt relaxes and allows the
practitioner to to move
the body tissues.
Myofascial Release
 Can be either direct or indirect, passive or active
Palpate restriction
Apply compression (indirect) or traction (direct)
Add twisting or transverse forces
Use enhancers---respiration, eye movement, muscle
contraction.
Await release



Indications: acutely ill, elderly who cannot tolerate much movement. CHF,
Asthma, COPD
Contraindications: Cancer, Sepsis, osseous fracture, traumatic disruption of
viscera.
E.g. Diaphragm Release
Counterstrain
Passive, indirect technique.
 Extremely gentle technique where “tenderpoints” are
treated at a point of balance, or ease.
 Positioning is aimed at shortening the muscles around
the tenderpoint and held for 90 seconds.*
 Body part is then returned to resting position, passively.

Treat the most tender area first.
Know specific tenderpoints!
Facilitated Positional Release
 Passive, indirect technique
The component region of the body is placed into a
neutral position, diminishing tissue and joint tension
in all planes.
A facilitating force, either compression or torsion, is
then added to place a joint or muscle into it’s ease of
motion.
Used to treat superficial muscles, and deep
intervertebral muscles to influence spinal motion.
Muscle Energy
 An Active, direct technique.**
Involved joint’s restrictive barrier is engaged.
The pt is directed to gently push in the direction of
freedom for about 3-5 sec and then relax the
contracted muscle(s)
Physician engages new barrier.
Process is repeated for a total of 3 times.
Don’t forget the passive stretch.
** postisometric relaxation
High Velocity Low Amplitude
A passive and direct technique
 The force is applied very quickly and the distance
moved is very small.
 The physician directs a quick controlled force through
the joint to move it.
 Absolute Contraindications:

Sever RA
Osteoporosis
Fractures
Osteomyelitis
Bone metastases
Most common overall complication: Vertebral artery injury.
Methods of Treatment
Treatment
Direct or Indirect
Active or Passive
Myofascial Release
Both
Both
Counterstrain
Indirect
Passive
FPR
Indirect
Passive
Muscle Energy
Direct (rarely indirect)
Active
HVLA
Direct
Passive
Choice of Treatment
 Elderly pts and hospitalized patients typically
respond better with indirect techniques.
 The use of HVLA in a pt with advanced
osteoporosis my lead to pathologic fractures.
 Acute neck strain/sprains are often treated with
indirect techniques to prevent further strain.
 Pts with advanced stages of cancer should not
be treated with lymphatic techniques due to
increased risk of lymphogenous spread
Dose and Frequency
 The sicker the pt, the less the dose.
 Allow time for the patient to respond to treatment
 Chronic disease requires chronic treatment
 Pediatric pts can be treated more frequently;
geriatric pts need longer interval to respond to
treatment.
 Acute cases should have a shorter interval
between treatments; as they respond, the
interval is increased.
Sequence of Treatment
 For low back pain with psoas involvement, treat the
lumbar spine first.
 Treat the upper thoracic spine and ribs before treating the
cervical spine.
 Treat the T-spine before treating specific rib dysfunctions.
 For very acute SD, treat secondary areas to allow access
to the acute area.
 For extremity problems, treat the axial skeleton
components first (spine, sacrum, ribs).
Question 1
Which one of the following is not a diagnostic
characteristic of somatic dysfunction?
A. Edema
B. Temperature change
C. Tenderness
D. Full range of motion
E. Asymmetry
Question 1
Which one of the following is not a diagnostic
characteristic of somatic dysfunction?
A. Edema
B. Temperature change
C. Tenderness
D. Full range of motion
E. Asymmetry
Question 2
While evaluating a pts upper back you notice T2 is rotated
right. Flexing causes T2 to further rotate right.
Extending the pts back cause T2 to return to neutral
position. Which best describes this dysfunction?
A. ERRSR
B. FRRSR
C. ERRSL
D. FRRSL
Question 2
While evaluating a pts upper back you notice T2 is rotated
right. Flexing causes T2 to further rotate right.
Extending the pts head cause T2 to return to neutral
position. Which best describes this dysfunction.
A. ERRSR
B. FRRSR
C. ERRSL
D. FRRSL
Question 3
Which cervical segment is best evaluated by flexing the
neck 45* and rotating the head?
A.
B.
C.
D.
E.
OA
C1
C2
C3
C4
Question 3
Which cervical segment is best evaluated by flexing the
neck 45* and rotating the head?
A.
B.
C.
D.
E.
OA
C1
C2
C3
C4