OPP

By
Dark Horse
 Chapman Reflex Points
• Viscerosomatic reflex points on the surface
of the body, to be used for diagnosis and
treatment of disease. The reflex points
correspond to an organ/system as a result of
dysfunction or pathology in an organ.
• Discretely palpable or multiple grouped in
irregular patches called gangliform
• Current thinking: Lymphatic involvement linked
with sympathetic nervous system dysfunction
• Chapman stressed that the pelvis should always
be treated prior to treating reflex points
• Move tip of finger in a circular fashion to
flatten the mass
• Continue moving pressure for 10-30
seconds or until mass disappears
 Myofascial Component
• 1. Superficial fascia – encircles the
neck, contains fat, encloses
voluntary muscles
• 2. Prevertebral fascia – encloses
vertebral column and associated
muscles forming a vertebral
compartment
• 3. Carotid sheaths – fascia
surrounding great vessels and Vagus
nerve
 OMT in Pharyngitis
• Osteopathic manipulation to
increase lymphatic flow and reduce
inflammation maybe beneficial.
Consider The Galbreath technique
, to increase mandibular drainage
• Myofascial trigger points seen in
throat pain:
– Medial Pterygoid Muscle
– Digastric Muscle
 Innominates and Pubes
• Hamstring Test: Patient supine, place cephalad
hand over the patient’s contralateral ASIS. With your
other hand placed under the ipsilateral ankle, raise
patient’s leg until you feel slight motion at the
opposite ASIS and note the angle
• Innominate Flares: Occurs when the ASIS on one
side is more medial or lateral to the opposite side.
One side is then rotated on the other side along the
vertical axis
• Posterior Innominate: Superior ASIS and Inferior
PSIS on same side. Relatively short leg on same
side
• Superior Innominate Shear: Superior ispilateral
ASIS and PSIS. Relatively short leg on same side
• Anterior Innominate: ASIS lower and PSIS higher
on same side. Relatively short leg on opposite side
• Inferior Innominate Shear: Ipsilateral inferior PSIS
Muscle Energy
• An active, direct treatment
involving voluntary and
precise patient movement
against a isometric resistance
away from a pathological
barrier engaged by the
physician. The treatment
results in reflexive relaxation
of the agonist muscle fibers.
The isometric resistance
resets the golgitendon organ.
A gentle contraction initiated
in an agonist muscle will
give a reflex relaxation in the
antagonistic muscle group
• Example: In restricted elbow
extension, isometric
contraction of biceps is
followed by relaxation so that
biceps can be stretched to a
new resting length.
 TYPES OF MUSCLE
CONTRACTION
• Isometric: Contraction(exerts
tension) without motion between
origin or insertion.
• Concentric Isotonic: A shortening
contraction.
• Eccentric Isotonic: A lengthening
contraction.
• “Isolytic”: Contraction of a muscle by
the patient that is overcome by
 Pathophysiology of Somatic
Dysfunction
• Research
– Korr and Patterson—1950s helped define the SD
– Denslow—1970s biopsied SD to identify inflammation and edema
• Spinal facilitation
– Chemical mediators elaborated by tissues send messages to local nociceptive
nerve endings that then signal the spinal cord
• Terminal of PAN releases Substance P
Substance P triggers release of:
histamines
bradykinins
prostaglandin
• White cells migrate to area and release cytokines which cause edema
and trigger increased activity in PAN
• FEED FORWARD
• PAN receptors activate release of:
SP
CGRP
somatostatin
 Pathophysiology of Somatic
Dysfunction
• Extravasation of intravascular and
lymphatic fluid into tissue—edema
• This causes tissue texture changes
• The humoral response to tissue
event increases PAN activation—
inflammation
• This results in hyperalgesia
• These structural and functional
alterations require the excessive
synaptic drive from the PANs
 Fascia & Lymphatics
• Thoracic Duct: Longest
lymph vessel in body(36-
45cm)
• Lies against vertebral
column
• Passes through
diaphragm
• Drains everything except
right side head/neck/arm
and chest(including heart,
portions lung)
• All lymphatic fluid must pass
through fasciae of thoracic
inlet
• All lymph below diaphragm
drains into cisterna chyli
• Only the lower extremities &
 Lymph Nodes
• Superficial nodes drain into 3 main
groups
• Cervical
• Axillary
• Inguinal
• Factors that influence flow:
– Interstitial fluid pressure
– Lymphatic pump
– External pressure on lymph channels
• Edema causes
– Compression of lymphatic channels & nearby
vascular/neurologic structures
– Diminished function
• Edema effects bioavailability of drugs &
hormones
– Hampers medical management & effect of
pharmacologic treatment
• Interstitial fluid accumulates
“upstream” from fascial restrictions
when they impair lymph channels
• Lymphatic congestion may be within