Submitted for approval
Corrections to be posted
OMM-2, #18
February 13, 2003, 11am
Sharon Gustowski, DO
Kevin Stancoven for Kacy Reeves
Pg. 1 of 4
Segmental Motion Testing & Diagnosis of Somatic Dysfunction
The objective of this PTR session is to focus of diagnosing somatic dysfunction in the
lumbar region. We spent over half the class practicing somatic dysfunction diagnosis of
fellow classmates.
A. T. Still
“You as Osteopathic machinists can go no farther than to adjust the abnormal condition,
in which you find the afflicted. Nature will do the rest.”
 Philosophy of Osteopathy
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Lumbar Spine
o Anatomical: L1-L5
o Functional: T11-L5
o Lumbar spine has lordotic curve
o The curve is a weight-bearing design
o Ferguson’s Angle
 The angle between the sacrum and L5
 We can measure this on X-ray (should be about 35º)
 We don’t have to worry about this angle right now
Osteology
o Sagittal plane orientation of the facets
o Superior articular facet faces posteromedially
o Inferior articular facet faces anterolaterally
o Orientation of facets allows good FB & BB
o Orientation discourages rotation & SB
Spinal mechanics
o Rotation occurs around a vertical axis
 In a horizontal plane
o Sidebending occurs around A/P axis
 In a coronal place
o FB & BB occurs around a horizontal axis
 In a sagittal plane
o Neutral position
 Anatomical position
 Normal cervical & lumber lordosis
 Normal thoracic kyphosis
 When in neutral position – vertebral weight bearing is on the
vertebral bodies
Somatic Dysfunction (SD)
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o Definition: Impaired or altered function of related components of somatic
system
 Skeletal, arthrodial, & myofacial structures
 Related vascular, lymphatic, & neural elements
o SD is named for the way a lesioned segments will move
 Ex.: a segment is restricted in sidebending to the left, rotation to
the right, and backward bending
 SD is N (FB) SRRL
 SD is opposite of restriction
Spinal Mechanics
 Thoracic & Lumbar Spine
 Both follow Fryette’s Principles
 Type 1 – when motion is introduced into the spine in
neutral position, sidebending precedes rotation, & rotation
occurs to the side opposite of sidebending
 Ex.: SXRY
 Before diagnosis, it is usually a good idea to perform a few softtissue procedures to ease tension in the lumbar region
 We went over soft tissue on Tuesday morning
o Multiple plane – Type 1 mechanics – diagnosis
 Rotation testing
 Doctor on side of dominant hand
 Thumbs placed over transverse processes
 About a half-inch lateral to spinous processes
 Allow thumbs to sink through sub-cutaneous tissue
 Contact transverse processes & increase pressure over one of the
transverse processes
 Use other thumb to monitor motion
 Test for ease of motion
 Switch and increase pressure over other TP and test for ease of
motion
 Sidebending testing
 Slide thumbs medially to base of spinous process, near
intervertebral space
 Apply motion testing in a medial direction
 Name sidebending for the way it wants to go
 Concave side indicates direction of SB
o Type 1 mechanics
 Common diagnostic findings
 SLRR (example)
 SB left presents with:
 Approximation of left TP to segment below
 Separation of right TP from segment below
 Left motion freedom
 Right motion restriction
 Rotation right presents with:
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 Right TP posterior
 Left TP anterior
 Right rotation freedom
 Left rotation restriction
o Type 2 mechanics
 When sidebending is introduced into a region of the spine in a nonneutral position, rotation of at least one segment must precede
sidebeding
 Rotation and sidebeding occur to the same side
 Ex.: RXSX
o Non-neutral position
 Movement of the spine out of anatomical position so that the
normal curves straighten out and the spine becomes more like a
rigid rod
 This occurs when sufficient FB or BB is introduced
o Physical findings: NN (FB) RLSL
 FB component presents with:
 SP approximates segment above
 SP &/or supraspinous ligament is tender
 SP process shifted slightly to right
 Motion is restricted in BB – moves slightly in forward
bending
 Rotation component presents with:
 Left TP relatively posterior
 Right TP relatively anterior
 Motion is restricted toward right rotation – moves slight in
left rotation
 TP &/or articular capsule often very tender
 Sidebending component presents with:
 Possible slight approximation of left TP with segment
below
 Possible slight separation of right TP from segment below
 Motion is difficult to detect due to muscle spasm & nature
of lesion, but should be slight to the left and restricted in
sidebending
o Fryette’s 3rd Principle
 Motion occurring in any one plane within a region will reduce
motion in other planes
Sagittal plane diagnosis
 Patient in lateral recumbent position
 Pads of fingers of interspinous spaces
 Palpate and compare separation between spaces
 Cradle patients leg for motion testing
 Forward bending testing
 Grasp patients legs with caudad hand
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 Keeps fingers over spaces between spinous processes
 Move legs into flexion until motion is felt at finger pads
 Did closely approximated processes open up?
FB Common findings
 Slight separation from SP of segment below
 Slight approximation to SP of segment above
 Tenderness of supraspinous ligament
 Bilateral restriction of rotation
 Restriction of SB
 BB restriction – FB ease
Backward bending testing:
 Grasp patients legs with caudad hand
 Move legs into extension until motion is felt at finger pads
 Did open spinous processes approximate?
BB common findings
 Slight approximation of SP to segment below
 Slight separation of SP from segment above
 Tenderness of supraspinous ligament
 Bilateral restriction of rotation
 Sidebending may be restricted
 FB restriced – BB ease
Key Point
 The key to effective treatment is accurate diagnosis
For test, know:
 Mechanics of lumbar spine
 Axis of motion
 Fryette’s principles
 Diagnostic findings
 Know how to diagnose
Indications for OMT
 To move body fluids
 To modify somato-somatic, somato-visceral, viscero-somatic, or
viscero-visceral reflexes
 To provide a tonic &/or circulatory effect
 To provide maintenance treatment in irreversible situations
Dr. Gustowski went quickly though the power points, since we have pretty much already
performed most of the diagnostic techniques, so that we had ample time to practice
diagnosing somatic dysfunctions of more than 1 person.