Missed OMT Qs

1. The cecum through the proximal colon refers to the right IT band in a proximal-to-distal manner.
1. Following the prostate and sigmoid through the distal transverse colon refer proximal to distal down the left IT band.
2. There is only a Chapman’s point for the rectum on the lesser trochanter located on the medial thigh.
2. OMM for URIs should be directed at the sphenopalatine ganglion.
3. The pedal pump can be a valuable tool for augmenting thoracoabdominal pressure gradients but is contraindicated in patients with DVT, fractures to the lower extremities, or those who have recently undergone surgery to the abdomen.
4. Patients suffering from complex regional pain syndrome of the lower extremities should receive treatment directed toward the T11-L2 cord levels.
5. Inhaled steroids are the first choice agents for persistent asthma that is not well-controlled by a rescue inhaler alone.
6. These four rules are critical for memorization and must be followed when diagnosing sacral torsions:

1) Sidebending of L5 and the sacral oblique axis must be engaged on the same side.

2) The sacrum rotates in the opposite direction of L5.

3) The seated flexion test must be positive for the diagnosis of sacral torsion.

4) The seated flexion test will be positive on the side opposite of the oblique axis.

7. The CV4 technique can increase the CRI
8. Rule of 3's (Spinous processes and Transverse processes):
1. T1-3, the spinous process is at the level of the corresponding vertebral body.
2. T4-6, the spinous process is half a level below the vertebral body.
3. T7-9, the spinous process is one level below the vertebral body.
4. T10, same as T7-9.
5. T11, same as T4-7.
6. T12, same as T1-3.
9. Cranial Dysfxn:
1. A) Compression occurs when the sphenoid and occipital bones are forced towards one another at the sphenobasilar synchondrosis (SBS) articulation. This commonly occurs when there is an impact to the back of the head, such as during a high speed motor vehicle accident. The associated clinical finding is a severely decreased (sometimes absent) CRI.
2. B) A flexion/extension straining pattern occurs when the cranium is restricted in either flexion or extension (named for the direction of ease). This is diagnosed by observing asymmetry while palpating the CRI.
3. C) Lateral strain occurs when the sphenoid deviates laterally in relation to the occiput. The cranium will feel like a parallelogram during palpation.
4. D) Torsion occurs when the sphenoid rotates about an anterior-posterior axis relative to the occiput at the SBS. The torsion is named by the side of the more superior greater wing of the sphenoid. Torsion can be a physiological variant if it does not interfere with the CRI.
5. E) Vertical strain occurs when the sphenoid deviates superior or inferior relative to the occiput. There will not be asymmetry between the greater wings of the sphenoid.
10. Posterior fibular head dysfunctions occur when the fibular head is stuck posteriorly and resists anterior spring.
1. Posterior fibular head dysfunctions lead to internal rotation of the talus causing foot inversion and plantarflexion.
2. Tx: Patient prone, dorsiflex and evert the foot to barrier and instruct patient to plantarflex against isometric resistance
3. The common peroneal nerve runs posteriorly in close proximity to the proximal fibular head and is subject to injury with fracture of the fibula or with posterior dysfunction of the fibula.
11. Flexion at the SBS causes the dura to be pulled in the cephalad direction. Recall the coordination of cranial motion. Craniosacral Flexion: midline bones flex, sacrum counternutates, paired bones externally rotate and the AP diameter decreases. Extension: midline bones extend, sacrum nutates, paired bones internally rotate, and the AP diameter increases
12. L5 and the sacrum always rotate in opposite directions. Sidebending of L5 engages the ipsilateral sacral oblique axis.
13. The uterus and cervix are innervated autonomically at the level of T10-L2
14. L4 nerve root entrapment giving rise to impairment of the tibialis anterior.
15. A forward sacral torsion on a left oblique axis is the correct diagnosis for patients with
1. a right deep sacral sulcus and
2. a left posterior ILA in the presence of
3. a negative lumbosacral spring test.
1. The lumbosacral spring test is an important test used to distinguish forward and backward sacral torsions.
1. In forward torsions, L5 has good spring and the lumbosacral spring test is negative.
2. In backward torsions, L5 does not have good spring and the lumbosacral spring test is positive.
16. During pronation the radial head moves posteriorly.
1. if the patient can pronate well, the radial head's position of ease is in the posterior position
2. Restricted passive range of motion implies that there is something impeding supination of the forearm, not simply pain preventing supination.
17. The anterior Chapman’s point for the myocardium is located at the 2nd intercostal space, near the sternum.
1. Chapman’s points for the upper and lower lungs are located at the 3rd and 4th intercostal spaces, near the sternum
2. The Chapman’s points for the stomach, liver and gallbladder are located at the 5th/6th intercostal space in the midclavicular line.
18. For direct muscle energy to the ribs, the patient holds their breath against the restriction barrier and the physician will push to counteract this force.
19. Rib Attachments
1. Rib 1: Anterior and middle scalenes
2. Rib 2: Posterior scalene
3. Ribs 3-5: Pectoralis minor
4. Ribs 6-9: Serratus anterior
5. Ribs 10-11: Latissimus dorsi
6. Rib 12: Quatratus lumborum